Effects of health educational and participatory consumer group interventions in improving food handling practices in regional director of health services area Kalutara, Sri Lanka: non-randomized controlled community trial.

INTRODUCTION: Safe and nutritious food is the key to sustaining life and promoting good health. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly, and the sick. METHODS: The study consisted of two phases, a descriptive cross-sectional study, and an intervention study. Both studies were conducted in the Regional Director of Health Services area, Kalutara, Sri Lanka. The descriptive cross-sectional study [food handlers (n = 904), food establishments (n = 421)] was conducted with the objective of determining factors associated with food handling practices among food handlers and in food establishments. The interventional study was a three-arm non-randomized controlled community trial (n = 50 per arm) with interventions of a participatory consumer group, educational package group, and control group. RESULTS: The food establishments assessment tool (FEAT) contained 11 domains including 75 items with more than a hundred assessment points with a guide to conduct an assessment of food handling. The descriptive cross-sectional study found that food handlers' knowledge of food handling practices of storing milk, fish, and meat and fast-food items containing fish and meat was very poor (96.6%). Visibility of the last place of processing inside the food establishments to consumers was inadequate (19.2%) and the absence of the above-mentioned factor was significantly associated with an unsatisfactory level of food handling score in food establishments (p = 0.03). The unsatisfactory level of food handling was significantly higher among food establishments with non-personal ownership (p = 0.005), a low number of notices issued by legal authorities (p = 0.02), dereliction of duty by owners/managers on supervising (p < 0.001) and lack of medical certification to food handlers (p < 0.0001). Participatory consumer group intervention and educational package interventions were effective in improving food handling practices in food establishments and among food handlers (p < 0.0001). Two independent sample analysis using the Mann-Whitney U test showed, the best improvement in food handling practices was by participatory consumer group intervention (p < 0.0001) and the second was educational package intervention (p < 0.0001). CONCLUSIONS: Knowledge and practices of food handling among participants were poor. A participatory consumer group is more effective than an educational package on improving food handling practices both among food handlers and in food establishments.

Methicillin-Resistant Staphylococcus aureus and Coagulase-Negative Staphylococcus from School Dining Rooms in Argentina.

Methicillin-resistant Staphylococcus aureus (MRSA) constitutes an important cause for concern in the field of public health, and the role of the food chain in the transmission of this pathogen and in antimicrobial resistance (AMR) has not yet been defined. The objectives of this work were to isolate and characterize coagulase-positive Staphylococcus (CoPS) and coagulase-negative Staphylococcus (CoNS), particularly S. aureus, from school dining rooms located in Argentina. From 95 samples that were obtained from handlers, inert surfaces, food, and air in 10 establishments, 30 Staphylococcus strains were isolated. Four isolates were S. aureus, and the remaining ones (N = 26) belonged to 11 coagulase-negative species (CoNS). The isolates were tested for susceptibility to nine antibiotics. The presence of genes encoding toxins (luk-PV, sea, seb, sec, sed, and see), adhesins (icaA, icaD), and genes that confer resistance to methicillin (mecA) and vancomycin (vanA) was investigated. The resistance rates measured for penicillin, cefoxitin, gentamicin, vancomycin, erythromycin, clindamycin, levofloxacin, trimethoprim-sulfamethoxazole, and tetracycline were 73%, 30%, 13%, 3%, 33%, 17%, 13%, 7%, and 7% of the isolates, respectively. Seventeen AMR profiles were detected, and 11 isolates were multidrug resistant (MDR). Seven methicillin-resistant Staphylococcus isolates were detected in the hands of handlers from four establishments, two of them were MRSA. Two S. aureus isolates presented icaA and icaD, another one, only icaD. The gene vanA was found in two isolates. In relation to S. aureus, resistance to vancomycin but not to gentamicin was detected. School feeding plays a key role in the nutrition of children, and the consumption of food contaminated with MRSA and vancomycin-resistant S. aureus (VRSA) can be a serious threat to health. In particular, it was detected that the handlers were the source of MRSA, VRSA, MR-CoNS (methicillin-resistant coagulase-negative Staphylococcus), and MDR isolates. The results obtained indicate that the vigilance of this pathogen in school dining rooms should be extreme.

Factors associated with recent iodine intake level among household food handlers in Southwest Ethiopia: a cross-sectional study.

BACKGROUND: Iodine deficiency is a global public health threat, affecting an estimated two billion people. The median urinary iodine concentration is more reliable in determining recent iodine intakes and the risks of iodine deficiency. Therefore, this study was aimed to identify the factors associated with recent iodine intake level using median urinary iodine concentration as an indicator among household food handlers in southwest Ethiopia. METHODS: A community-based survey was conducted with selected households using a pretested interviewer-administered questionnaire in southwest Ethiopia. A 20-gram sample of table salt and a 5 ml causal urine samples were also collected and analyzed using rapid test kit and a Sandell-Kolthoff reaction, respectively. A salt iodine concentration above 15 ppm was classified as adequately iodized and a median urinary iodine concentration between 100 and 200µgl- 1 was considered as adequate iodine intake. A bivariable and multivariable logistic regression model was fitted. Crude and adjusted odds ratios with their 95% confidence levels were reported. Associations with a p-value ≤ 0.05 were used to declare statistical significance. RESULTS: A total of 478 women were included, with a mean age of 33.2 (± 8.4 years). Only 268 (56.1%) of the households had adequately iodized salt (> 15 ppm). The median urinary iodine concentration (interquartile range) was 87.5 µg l- 1 (45.6-107.6). In a fitted multivariable logistic regression model (p-value = 0.911), illiterate women (AOR = 4.61; 95% CI: 2.17, 9.81), poorly iodized salt in the household (AOR = 25.0; 95% CI: 13-48), salt purchased from open market (AOR = 1.93; 95% CI: 1.0, 3.73) and women who do not read the label during purchasing the salt (AOR = 3.07; 95% CI: 1.31, 7.17) were important predictors of the risk of Iodine deficiency. CONCLUSION: Despite public health efforts to improve iodine intake, its deficiency is still a major public health problem among southwest Ethiopian women.

Food hygiene knowledge and behaviour among domestic food handlers during COVID 19 pandemic in Bangladesh.

The COVID-19 pandemic reshaped every aspect of life, including food safety. Understanding food safety behaviour at home is necessary for developing effective strategies to mitigate foodborne disease during and after this pandemic. This study administered a cross-sectional survey among 503 domestic food handlers to examine the food handlers' food safety concerns during the pandemic and pandemic-related knowledge and hygiene behaviour (PRKHB) in Bangladesh. The results found that only 35.8% of respondents in this study were more concerned about food safety because of the COVID-19 pandemic. Although the results found a good PRKHB among 95.8% of urban food handlers, overall, 62% showed a poor level of PRKHB. Only 38.8% reported washing their hands after returning home or preparing meals every time. The regression model found that food safety concerns positively related to the PRKHB, and participants who lived in rural areas had a negative association with the PRKHB. The study also explored sociodemographic variations and significant differences observed between urban and rural areas. Meticulous educational campaigns and targeted messages to the food handlers on food safety risks, food handling practices and hand hygiene are necessary to minimise the foodborne disease burden in this region.

Quality of indoor air environment and hygienic practices are potential vehicles for bacterial contamination in University cafeteria: case study from Haramaya University, Ethiopia.

The aim of this study was to investigate the microbial quality of indoor air environment and hygienic practices of food handlers in Haramaya University cafeteria, Ethiopia. A total of 36 air samples were collected from the cafeteria using passive air sampling technique. Furthermore, 42 swab samples were taken from the hands and clothes of food handlers for microbial analysis. The results showed that air quality in the cafeteria is below satisfactory. Total coliform counts from all the swab samples were also above the acceptable microbial target value. Significantly higher microbial load was recorded in food handlers involved in serving food than these deployed in baking and sauce making roles. This study generally showed the importance of indoor air quality, and hands and clothes of food handlers as potential sources of bacterial contamination in the University's cafeteria. Therefore, improved housing condition, regular training, and close supervision are recommended.

Intestinal parasites among food handlers in Iran: A systematic review and meta-analysis.

Regarding preparing and serving foods, food handlers have an influential role in the spreading of foodborne infections. Due to the great potential to cause foodborne infections, intestinal parasites (IPs) are considered a significant public health problem in today's societies. In Iran, despite several regional reports, national data on IPs prevalence in food handlers are lacking. The aim of the present study, therefore, is to estimate the pooled prevalence of IPs infections and associated pooled odds ratio of educational level among food handlers in Iran. PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and SID and Magiran databases (national) were systematically searched for studies that reporting the prevalence of IPs in food handlers in Iran, published between 2000 and 2020. Pooled prevalence was estimated using a random-effects model with a 95% confidence interval (CI) and depicted as a forest plot, while heterogeneity was evaluated using Cochran's Q-test. The overall pooled prevalence estimate for IPs was 19.3% (95% CI = 14.9-23.7%). Prevalence of the protozoan parasites (20%, 95% CI = 13.7-26.3%) was significantly higher than that of the helminthic parasites (1.6%, 95% CI = 1.1-2.0%). Giardia lamblia (5.2%), Entamoeba coli (5.0%), and Blastocystis spp. (4.4%), as protozoan parasites, and Ascaris lumbricoides (1.4%), Enterobius vermicularis (0.9%), and Hymenolepis nana (0.5%), as helminthic parasites, were the most commonly reported species. Food handlers with low educational levels were 20% more exposed to IPs infection, compared to those with high educational levels (OR = 1.21, 95% CI = 0.88 to 1.65). The prevalence of IPs infections among food handlers in Iran is significant. Besides taking into account this epidemiologic information, a holistic approach, including periodic stool screening, health education, and treatment of infected food handlers, will help in the control of these infections in Iran.

Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Dayi District, Ghana.

BACKGROUND: Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana. METHODS: This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization's Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. RESULTS: The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p=0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p=0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p=0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p<0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p<0.001]. CONCLUSIONS: Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.

Norovirus infections and knowledge, attitudes and practices in food safety among food handlers in an informal urban settlement, Kenya 2017.

INTRODUCTION: A leading cause of acute gastroenteritis, norovirus can be transmitted by infected food handlers but norovirus outbreaks are not routinely investigated in Kenya. We estimated norovirus prevalence and associated factors among food handlers in an informal urban settlement in Nairobi, Kenya. METHODS: We conducted a cross-sectional survey among food handlers using pretested questionnaires and collected stool specimens from food handlers which were analyzed for norovirus by conventional PCR. We observed practices that allow norovirus transmission and surveyed respondents on knowledge, attitudes, and practices in food safety. We calculated odd ratios (OR) with 95% confidence intervals (CI) to identify factors associated with norovirus infection. Variables with p < 0.05 were included in multivariate logistic regression analysis to calculate adjusted OR and 95% CI. RESULTS: Of samples from 283 respondents, 43 (15.2%) tested positive for norovirus. Factors associated with norovirus detection were: reporting diarrhea and vomiting within the previous month (AOR = 5.7, 95% CI = 1.2-27.4), not knowing aerosols from infected persons can contaminate food (AOR = 6.5, 95% CI = 1.1-37.5), not knowing that a dirty chopping board can contaminate food (AOR = 26.1, 95% CI = 1.6-416.7), observing respondents touching food bare-handed (AOR = 3.7, 95% CI = 1.5-11.1), and working in premises without hand washing services (AOR = 20, 95% CI = 3.4-100.0). CONCLUSION: The norovirus infection was prevalent amongst food handlers and factors associated with infection were based on knowledge and practices of food hygiene. We recommend increased hygiene training and introduce more routine inclusion of norovirus testing in outbreaks in Kenya.

Intestinal parasites among food handlers of food service establishments in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Intestinal parasites remain considerable public health problems in low-income countries where poor food hygiene practice is common. Food handlers, people involved in preparing and serving food, working with poor personal hygiene could pose a potential threat of spreading intestinal parasites to the public in a community. The aim of this systematic review and meta-analysis was, therefore, to synthesize the pooled prevalence estimate of intestinal parasites and associated pooled odds ratio of hygienic predictors among food handlers of food service establishments in Ethiopia that could aid to further bringing down the burden of intestinal parasites and it can also be used as a springboard for future studies. METHODS: We searched exhaustively for studies Published before 20 April 2019 using eight Databases; PubMed, Science Direct, Web of Science, Scopus, Embase, Google Scholar, ProQuest, and Ovid MEDLINE® complemented by the gray literature search. In the final synthesis, we included twenty study reports. We used the Cochrane Q test and I2 test to assess heterogeneity of studies, while we employed a funnel plot followed by Egger's regression asymmetry test and Begg rank correlation methods to evaluate publication bias. We also performed a point estimates and 95% confidence interval for each study using STATA version 14 statistical software. RESULTS: The overall pooled prevalence estimate of intestinal parasites among food handlers of food service establishments in Ethiopia was 33.6% (95%CI: 27.6-39.6%). Among ten intestinal parasites identified from food handlers, Entamoeba histolytica/ dispar (11, 95%CI: 7.9-14.1%) and Ascaris lumbricoides (8.8, 95%CI: 6.4-11.2%) were the most predominant intestinal parasites. Food handlers who washed hands after toilet use had 54% (OR, 0.46, 95% CI: 0.23-0.94) protection from intestinal parasites compared to those who did not. CONCLUSIONS: This study revealed that intestinal parasitic infections are notable among food handlers of food service establishments in Ethiopia, which may be a risk for transmitting intestinal parasites to food and drinks consumers through the food chain. Thus, periodic stool checkup, training on intestinal parasitic infections and personal hygiene should be applied to reduce public health and socio-economic impacts of parasitic infections.

Work Conditions, Social Incorporations, and Foodborne Diseases Risk: Reflections About the (Non)Compliance of Food Safety Practices.

The number of foodborne diseases has increased in all continents, and efforts must be made to control this urgent and expressive public health problem. This article aims to present and discuss situations related to the compliance and noncompliance of food safety practices (FSPs) in light of Bourdieu's social theory. This qualitative study was conducted in commercial restaurants in two cities in São Paulo, Brazil. Participant observation was used in the restaurants, and notes referring to the kitchen workers and their bosses' work processes were registered in field journals. Thematic type content analysis was used to determine the meaning cores of field journals. It was found that aspects inherent to convenience and haste at work, deficient infrastructure, lack of employees, negative boss examples, exposure to noise, and body pain experienced by workers can contribute to noncompliance of FSPs and consolidate in the habitus and practical sense some dispositions that can increase the risk of foodborne diseases. This study highlights the necessity of creating environments that address food safety, which means being able to perform a service properly.

High prevalence of methicillin resistant and enterotoxin gene-positive Staphylococcus aureus among nasally colonized food handlers in central Iran.

This study defined the prevalence of enterotoxin gene-positive Staphylococcus aureus strains among food handlers and non-food processing healthy nasal S. aureus carriers in central Iran. Meticillin-resistant S. aureus (MRSA) strains were diagnosed by cefoxitin disk diffusion. PCR was used to detect the mecA, Sa442, and enterotoxin genes. Out of the 1113 food handlers, 224 (20.1%) were nasal carriers of S. aureus and 157 (70.1%) of these isolates were positive for one or more enterotoxin genes. The most prevalent enterotoxin gene was sei (40.2%), followed by seg (35.3%), sea (23.5%), seb (15.2%), sec (5.5%), and seh (2.7%). See and sed genes were not found. Sixty seven (42.7%) of enterotoxin gene-positive isolates possessed a single enterotoxin gene, and 64 (40.8%), 23 (14.7%), and 3 (1.9%) contained two, three, or four enterotoxin genes, respectively. The most frequently detected gene combination was sei/seg (n = 35, 22.3%). Thirty seven (16.5%) isolates were diagnosed as MRSA, and 27 (73%) of these strains were positive for at least one enterotoxin gene. Out of 546 healthy controls, 100 individuals were identified as S. aureus nasal carriers; among the strains, 39 (39%) were positive for at least one enterotoxin gene. Only one (1%) CA-MRSA was identified among the strains from the volunteers. A high prevalence of meticillin resistant and enterotoxin-positive S. aureus were documented in food handlers. We suggest that this may be due to the frequent handling of contaminated foodstuffs and that this is possibly related to the elevated frequencies of acquired staphylococcal food poisoning in this population.

UK trends of allergic occupational skin disease attributed to fragrances 1996-2015.

BACKGROUND: Fragrances are well known to cause allergic contact dermatitis (ACD). Occupationally related cases occur, with certain groups being at higher risk. OBJECTIVE: To investigate the incidence of occupationally related cases of cutaneous fragrance allergy and to evaluate trends. METHOD: Data on incident cases of occupational ACD caused by fragrances between 1996 and 2015 (inclusive) reported to the EPIDERM surveillance scheme were analysed. RESULTS: Of the cases reported to EPIDERM during the study period, 5.2% had ACD attributed to fragrances. The highest annual incidence rates were observed in women. Hairdressers, beauticians and people working in related occupations had a 47-fold higher incidence rate ratio than the reference category (the average of all other occupations combined). Trends analysis suggested a non-significant increase in fragrance allergy over the study period among all occupations, and beauty and food workers, and a slight decrease in healthcare workers. CONCLUSIONS: Fragrance allergy is a significant problem in an occupational setting. Although there was no significant change in the incidence of fragrance-related allergic occupational contact dermatitis (OCD) during the 20-year study period, this does not mirror the trend in OCD, which is falling. Fragrance allergy continues to be a major contributor to OCD, and contributes to a greater proportion of cases.

Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana.

BACKGROUND: In large scale cooking, food is handled by many individuals, thereby increasing the chances of food contamination due to improper handling. Deliberate or accidental contamination of food during large scale production might endanger the health of consumers, and have very expensive repercussions on a country. The purpose of this study was to evaluate the food safety knowledge, attitudes, and practices among institutional food- handlers in Ghana. METHODS: The study was conducted using a descriptive, cross-sectional survey of 29 institutions by conducting face to face interview and administration of questionnaire to two hundred and thirty-five (235) institutional food-handlers. The questionnaire was peer-reviewed and pilot tested in three institutions in the Upper East Region of Ghana, before the final version was distributed to food-handlers. The questionnaire was structured into five distinctive parts to collect information on (i) demographic characteristics, (ii) employees' work satisfaction, (iii) knowledge on food safety, (iv) attitudes towards food safety and (v) food hygiene practices. RESULTS: Majority of the food-handlers were between 41-50 years (39.1%). Female respondents were (76.6%). In our study, the food-handlers were knowledgeable about hygienic practices, cleaning and sanitation procedures. Almost all of the food-handlers were aware of the critical role of general sanitary practices in the work place, such as hand washing (98.7% correct answers), using gloves (77.9%), proper cleaning of the instruments/utensils (86.4%) and detergent use (72.8%). On disease transmission, the results indicates that 76.2% of the food- handlers did not know that Salmonella is a food borne pathogens and 70.6% did not know that hepatitis A is a food borne pathogen. However, 81.7% handlers agreed that typhoid fever is transmitted by food and 87.7% agreed that bloody diarrhea is transmitted by food. Logistic regression analysis testing four models showed statistically significant differences (p < 0.05), for models in which the explanatory variable was the level of education. CONCLUSIONS: In generally, the institutional food-handlers have satisfactory knowledge in food safety but this does not translate into strict hygienic practices during processing and handling food products.

Prevalence and factors associated with intestinal parasites among food handlers of food and drinking establishments in Aksum Town, Northern Ethiopia.

BACKGROUND: Various epidemiological studies indicate that the prevalence of intestinal parasites is high in developing countries and those parasites are major public health importance in Sub-Saharan Africa. Their distribution is mainly associated with poor personal hygiene, environmental sanitation and lack of access to clean water. This study was conducted to estimate the prevalence of intestinal parasitic infection and identify factors associated with intestinal parasitic infection among food handlers in the Aksum Town of Tigray Regional State, North Ethiopia. METHODS: A cross-sectional study design was used among 400 randomly selected food handlers who were selected as respondents. Data were collected by face to face interviewer administered questionnaire supplemented with observational checklist. Fresh stool samples were collected from respondents and were examined microscopically for the presence of any of intestinal parasites using standard laboratory methods. Multivariable logistic regression model using Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) was fitted to analyze the independent predictors of intestinal parasitic infections. RESULT: The mean age of the food handlers included in this study was 26.0 years. Of the total respondents, 72.5% were females, 63% have completed at least secondary school educational level. Five species of Intestinal Parasites (IPs) were identified. The overall prevalence of being infected with at least one intestinal parasite was 14.5%, 95% CI (11.3, 18.0). The odds of being positive for at least one intestinal parasitic infection was 12.3 times higher among food handlers who practice medical checkup every 9 months compared to those who have a medical checkup every 3 months. The odds of being positive for intestinal parasitic infection was 3 times higher among food handlers with no formal education compared to those who have a level of education secondary school and above. Food handlers who received food hygiene and safety training were 66% less likely to be positive for at least one intestinal parasitic infection as compared to those who did not receive training. CONCLUSION: Prevalence of parasitic infection among food handlers observed in the current study is relatively low but is still a public health importance. Number of medical checkup, training in food hygiene and safety, feedback from customers and level of education were significantly associated with reduced odds of being infected with parasitic infection. Hence, these factors should be focused by policy makers and implementers to further bring the prevalence below the level of public health importance.

Food safety knowledge, attitude and practices of meat handler in abattoir and retail meat shops of Jigjiga Town, Ethiopia.

A cross-sectional survey was carried out among 91 meat handlers by using structured questionnaire to determine the food safety knowledge, attitude and practices in abattoir and retail meat shops of Jigjiga Town. The result shows that majority of the meat handlers were illiterate (30.8%) and primary school leaver (52.7%), and no one went through any food safety training except one meat inspector. The food-handlers' knowledge and safety practices were below acceptable level with the mean score of 13.12 ± 2.33 and 7.7 ± 2.1 respectively. Only few respondents knew about Staphylococcus aureus (3.3% correct answer), hepatitis A virus (19.8% correct answer), and E. coli (5.5% correct answer) as food borne pathogens. About 64% of meat handlers have good attitude about safety of food with mean of total score 14.4 ± 2. All respondents answer correctly questions about proper meat handling and hand washing but they did not translate into strict food hygiene practices. Chi2 analysis testing for the association between knowledge, attitude and practices did not show any significant association. It may be due to meat handlers' below acceptable level safety practices regardless of sociodemographic characteristics, knowledge and attitude. However, there was strong association between level of education and knowledge, and knowledge and hand washing (p < 0.05). There was also association between age and knowledge though it was not statistically significant. Thus, continuous education and hands on training for meat handlers that can enhance good safety practices through better understanding and positive attitude.

Effectiveness of an intervention package on knowledge, attitude, and practices of food handlers in a tertiary care hospital of north India: A before and after comparison study.

BACKGROUND: Food-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions. METHODS: The study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled 'Gravy Extra', and a documentary titled 'Food Safety from farm to Fork'. Chi square test, paired t test, and Wilcoxon sign rank test were used. RESULTS: The mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p < 0.05). Their attitude toward food safety changed in a positive direction (p < 0.05). CONCLUSION: The intervention package was useful in improving the knowledge, creating a positive attitude and enhancing the food safety practices of food handlers working inside a tertiary care hospital.

Prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella and Salmonella among food handlers in Arba Minch University, South Ethiopia.

BACKGROUND: The availability of safe food improves health of the people that contributes to productivity and provides an effective platform for development and poverty alleviation. On the other hand, unsafe food handling and processing can serve as a vehicle for the transmission of a variety of disease causing agents. The risk of food getting contaminated depends largely on the health status of the food handlers, their personal hygiene, knowledge and practice of food hygiene. Food borne diseases are therefore a public health problem in developed and developing countries which is also true for Ethiopia. Hence, the aim of this study was to determine prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella and Salmonella among food handlers in Arba Minch University, South Ethiopia. METHODS: A cross sectional study was conducted among food handlers in Arba Minch University students' cafeteria from April- June, 2015. Structured questionnaire was used to collect socio demographic data and associated risk factors. Stool sample was collected and examined for pathogens following standard procedures. Biochemical tests were done to identify the species of pathogens and sensitivity test was done using Kirby- Baur disk diffusion technique. RESULTS: A total of 376 food handlers were enrolled in the study with the response rate of 100% for data collected by questionnaire. About 7.4% were aged less than 20 years with majority (63.3%) lay in the working age group of 21-35 years. However, a total of 345 food handlers participated for stool examination of whom, stool cultures revealed 6.9% of Salmonella and 3% Shigella isolates. Finger nail status (AOR=0.033), hand washing practice after toilet (AOR= 0.006) and touching food with bare hands (AOR= p < 0.001) were independent predictors of infectious enteric diseases among the food handlers. All isolated pathogens were resistant to amoxicillin (100%), followed by clarithromycin (41%) and amoxicillin-clavulanic acid (35%). CONCLUSION: The present study showed high prevalence of enteropathogens among the study participants. The study also revealed poor personal hygiene like poor practice of hand washing. Therefore, pre placement, in service training on personal and food hygiene should be provided to all food handlers with regular sanitary inspection to improve adherence of food handlers to personal hygiene and food safety practices.

Sources of Calicivirus contamination in foodborne outbreaks in Denmark, 2005-2011--the role of the asymptomatic food handler.

BACKGROUND: Norovirus (NoV) is the predominant cause of foodborne disease outbreaks. Virus contamination may occur during all steps of food processing, from production to preparation and serving. The relative importance of these different routes of contamination is unknown. METHODS: The purpose of this study was to estimate the proportions of outbreaks caused by asymptomatic and symptomatic food handlers (FHs). Reports of foodborne NoV and sapovirus outbreaks (n=191) that occurred over a 7-year period were extracted, reviewed, and categorized according to the available evidence for source of contamination. RESULTS: In 64 (34%) of the outbreaks, contamination from FHs took place during preparation or serving of food. In the majority of these outbreaks (n=41; 64%), the FHs were asymptomatic during food handling. Some had been in contact with ill household members before handling the food and remained asymptomatic; others developed symptoms shortly after or were post-symptomatic. In 51 (27%) of the outbreaks, contamination occurred during production of the food, and in 55 (29%) of the outbreaks, contamination had supposedly occurred after serving a guest at a self-serve buffet. CONCLUSIONS: Guidelines regarding exclusion of FHs where household members suffer from gastroenteritis could limit the number of outbreaks.

Bacterial contamination of the hands of food handlers as indicator of hand washing efficacy in some convenient food industries in South Africa.

BACKGROUND AND OBJECTIVES: Hands of ready-to-eat food service employees have been shown to be vectors in the spread of foodborne disease, mainly because of poor personal hygiene and accounting for approximately 97% of food borne illnesses in food service establishments and homes. Our objective was to evaluate the efficacy of hand washing practices and sanitation before commencing work among food handlers in the convenient food industry in Gauteng, South Africa. METHODS: A total of 230 samples were collected, involving 100% of the food handlers, in 8 selected convenient food outlets with their main focus on preparing ready-to-eat foods. The workers' cleaned and disinfected dominant hands were sampled for Total Plate Count (TPC), Staphylococcus aureus and Escherichia coli. Bacteria were isolated and counted using standard methods. RESULTS: The highest bacterial count from the hand samples was 7.4 x 10(3) cfu.cm(-2) and the lowest showed no detectable growth. Although hands with a count of 0 cfu.cm(-2) were found in all of the plants, the results indicated that all the plants exceeded the legal limit for food surfaces or hands of < 100 cfu.cm(-2) when the average bacterial counts on hands were compared. Sixty percent of the TPC analysed exceeded the legal limit and only 18% of the food handlers had no bacteria detectable on their hands. One sample tested positive for E. coli and S. aureus could not be detected on the hands of any of the food handlers. CONCLUSION: The study revealed that hand hygiene is unsatisfactory and may have serious implications for public health due to contamination of food from food handlers' hands. This therefore underlined the importance of further training to improve food handlers' knowledge of good hand washing practices.

Determinants of food safety knowledge and practices among food handlers in Bangladesh: An institution-based cross-sectional study.

The engagement of a large number of people in big-scale cooking raises the danger of food contamination due to incorrect handling, whether deliberate or unintentional. Contamination during large-scale production poses a serious hazard to consumer health and has significant financial implications for a nation. This study aimed to investigate the food safety knowledge and practices of institutional food handlers in Bangladesh, considering the growing concern surrounding this issue and the lack of available information on foodborne illnesses related to institutions. In addition, the study aimed to determine the factors influencing both knowledge and practices. A cross-sectional study was conducted from June to September 2022, involving 408 institutional food handlers. The sample size was determined using Cochran's formula, and data was collected through purposive sampling. The participants were interviewed in person and completed a pilot-tested questionnaire. A multiple linear regression analysis was conducted to determine the factors related to food safety knowledge and practices. The majority of participants were female (71.3%) and aged between 26 and 35 (mean age 34.53 ± 9.06 years). They were most knowledgeable about hand hygiene and food separation but lacked knowledge about foodborne pathogens and food storage. Thawing food at room temperature was the most inappropriate practice (86%). The mean scores for knowledge and practice were found to be 16.11 ± 2.76 on a 26-point scale (61%), and 9.59 ± 2.07 on a 15-point scale (64%), respectively. Rural food handlers, those with higher education, working more than 10 h per day, and being familiar with HACCP, had higher knowledge. Food handlers aged 18 to 25, with higher income, working in private institutions, having food safety authority knowledge, actively engaging in food safety training, working more than 10 h per day, and having a positive health perception, had better food safety practices.The results of this study reinforce the notion that institutional food handlers would benefit from enhanced exposure to food safety interventions, active participation in training sessions, and strict adherence to food hygiene regulations in their food handling knowledge and practices.