evaluation of the effect of person-in-charge (pic)...
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Accepted Manuscript
Evaluation of the effect of person-in-charge (PIC) program on knowledge and practicechange of food handlers in Dubai
Aisha M. Abushelaibi, Baboucarr Jobe, Hanan S. Afifi, Bahaa-Elden Mostafa, Asia A.Murad, Abdulwahed Q. Mohammed
PII: S0956-7135(14)00519-2
DOI: 10.1016/j.foodcont.2014.09.013
Reference: JFCO 4062
To appear in: Food Control
Received Date: 12 May 2014
Revised Date: 8 September 2014
Accepted Date: 13 September 2014
Please cite this article as: Abushelaibi A.M., Jobe B., Afifi H.S., Mostafa B.-E., Murad A.A. & MohammedA.Q., Evaluation of the effect of person-in-charge (PIC) program on knowledge and practice change offood handlers in Dubai, Food Control (2014), doi: 10.1016/j.foodcont.2014.09.013.
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Highlights
� Three of the four groups showed an increase in knowledge after the training
� There was no significant difference in practice between pre and post PIC
intervention
� Work experience has significant effect on food safety knowledge of PIC
individuals but only before the training intervention
� Education and professional training on food safety have significant effect on
knowledge and practice
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Running Title: Effect of PIC program on knowledge and practice of food handlers 1
2
Evaluation of the effect of Person- in-charge (PIC) program on knowledge and practice 3
change of food handlers in Dubai 4
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To be submitted to Food Control 6
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Aisha, M. Abushelaibi a Baboucarr Jobe a,*, Hanan S. Afifi a, Bahaa-Elden Mostafa b, Asia A. 8
Murad b, Abdulwahed Q. Mohammed b. 9
a Department of Food Science, College of Food and Agriculture, United Arab Emirates 10
University. P.O. Box 15551 Al Ain, United Arab Emirates 11
b Dubai Municipality. P. O. Box 67, Dubai, United Arab Emirates 12
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Corresponding author’s Address: Department of Food Science, Faculty of Food and Agriculture, 18
United Arab Emirates University. P.O. Box 15551 Al Ain, United Arab Emirates. Email: 19
[email protected] Tel: 00971 50 7300298. Fax 0097137675336 20
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Evaluation of the effect of person in charge (PIC) program on knowledge and practice 23
change of food handlers in Dubai 24
Abstract 25
The effect of Person in Charge (PIC) intervention on knowledge and practice of food handlers in 26
Dubai was evaluated. Data were collected from 48 food establishments located in 4 zones in the 27
city. Each establishment was visited twice in the assessment. In each visit, the same set of 12-28
knowledge questionnaire was asked and 20 observable practices evaluated. Hand and cutting 29
board swabbing were also conducted to evaluate the personal hygiene of foodhandlers. Results 30
showed that all the groups gained additional knowledge on food safety during training except 31
group 4. Irrespective of knowledge gained, some of the trained PICs were unable to change food 32
safety and handling practices at place of work. In group 1, the performance got worsen by 12%. 33
Group 2 and 3 showed 4.3% and 10.3% improvement in food safety practices respectively. 34
While, group 4 remained almost same as before the PIC intervention. With regards to cutting 35
board swabbing, results showed that group 1 dropped by 16.6% while the remaining groups 36
improved by 41.6%. In the case of hand swabing all establishments in group 1 showed 37
satisfactory results after training. Group 2, group 3 and group 4 showed 41.7% improvement. 38
Statistics revealed that there was a significant improvement in the performance of food handlers 39
in hand swabbing after the intervention with mean values of 60.4 % and 85.5% before and after 40
respectively. In the case of cutting board swabbing, there was a considerable improvement but 41
not statistically significant at (P˂0.05) with mean values of 41.6% and 62.5% before and after 42
respectively. 43
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Key words: Training; Knowledge; Food handling practice, Food safety. 44
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1. Introduction 46
Food and Agricultural Organization of the United Nations (FAO) and the World Health 47
Organization (WHO) (2002) have jointly reported that millions of people get sick or die because 48
of consuming unsafe food. Therefore, having a reliable and safe food supply chain remains one 49
of the major preoccupations of many countries (McIntyre, Vallaster, Wicott, Henderson & 50
Kosatsky 2013; Da Cunha, Stedefeldt & De Rosso, 2014). Literature reviewed has shown that, in 51
the past, many foodborne outbreaks were associated with foods from animal sources. For 52
example, Pires Vieira, Perez, Wong, and Hald (2012) conducted study on human foodborne 53
illnesses and attributed sources in Latin America and Caribbean from (1993-2010) and reported 54
that the most important sources of outbreaks varied substantially in the two decades. In 1990s, 55
the researchers found that meat and dairy products were the most important sources of disease 56
each contributing around 15% and 14.3% respectively. The researchers further mentioned that in 57
this decade, the most frequently reported pathogens were S. aureus, Salmonella, E. coli and C. 58
perfringens. In the 2000s, seafood and eggs appeared to be among the most important vehicle of 59
reported illnesses and Salmonella, V. Parahemolyticus, and Shigella spp, were the most reported 60
agents. The majority of the Salmonella outbreaks were reported in Cuba by Pires et at. (2012). 61
Wallace, Guzewich, cambrdge, Alterkruse and Morse (1999) also gave a detailed review of 62
seafood-associated outbreaks in New York from (1980-1994). 63
In recent years, it has been observed that the shift in the consumption patterns towards eating 64
minimally processed food have changed the picture Abadias, Usall, Anguera, Solsona, & Viñas, 65
(2008). The driving force behind the increased consumption of fresh produce is the desire of 66
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consumers to lead a healthy lifestyle. This desire perhaps was made stronger by the joint 67
recommendation of FAO and WHO for people to have at least five servings of fruits and 68
vegetable daily FAO and WHO (2006). Studies conducted recently showed that a number of 69
disease outbreaks in countries like United States and within the European Union are associated 70
with fresh produce and sprout seeds (Soon & Baines, 2012). The reported outbreak of haemolytic 71
uremic syndrome (HUS) and bloody diarrhea in which the Shiga toxin-producing Escherichia 72
coli 0104:H4 was implicated in Germany in May and June 2011 was a good example (Jansen & 73
Kielstein, 2011). Another outbreak in south-west of France in June of the same year in which the 74
causative strain was genetically related to the one identified in Germany supports the implication 75
of fresh produce in many food borne outbreaks (Gault, Weill, Mariani-Kurkdijan, Jourdan-da 76
Silva. King & Aldabe, 2011). In both outbreaks, the subsequent investigations concluded that 77
both were associated to one lot of imported fenugreek seed and the consumers were accordingly 78
advised not to use sprout or sprouted seeds without proper cooking (EFSA, 2011). 79
In addition to the accusation leveled against fresh produce, there are also several reports 80
published in recent years that have shown poor handling to be an important cause of food borne 81
illness (GonÇalves, 1998; Greig Todd, Bartleson, & Michaels, 2007; Silva, German, & 82
Germano, 2003). The European Food Safety Authority (EFSA, 2010) reported that in year 2010 83
alone, about 48.7 % of foodborne diseases were associated with catering establishments. Greig 84
et al., (2007) have documented more than 233 outbreaks involving 16028 cases of food 85
poisoning between 2000 and early 2006 and the majority of these cases happened in restaurants 86
and catering establishments. Griffith (2000) also found that many food illnesses in USA, UK, 87
Netherlands and, Korea were associated with food catering services. The principal causes of the 88
reported outbreaks were associated with poor food handling practices, such as cross 89
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contamination of raw and processed foods, slow cooling and inadequate refrigeration of foods 90
(Da Cunha et at., 2014). Because of the strong association between foodborne illness and 91
catering industry, numerous food safety trainings have been designed to address the problem in 92
these establishments (Capunzo, Cavallo, Boccia, Brunetti, Buonoma & Mazza, 2005; Coleman & 93
Roberts, 2005; Costello, Gaddis, Tamplin, & Morris, 1997; Medeiros, Cavalli, Salay, & Proença, 94
2011). Since food handlers have been blamed for many cases in outbreaks, it has been suggested 95
by many producers and government agencies that this category of people in the food chain need 96
to be educated on food safety and good food handling practices. For example, in British 97
Columbia (BC) Canada, food safety training has become a legislated standard since July 2000 98
(McIntyre et al., 2013). According to the BC regulations, the operator and at least one worker in 99
every food service establishment must have a certificate demonstrating successful completion of 100
FOODSAFE level 1 training or equivalent food safety training course (McIntyre et al., 2013). In 101
Brazil, Health Ministry resolution no 216 (Brazil – Health Ministry, 2004) established technical 102
legislation that requires all food handlers to be trained periodically in food handling (Da Cunha 103
et al., 2014). In Romania too, training food handlers in food hygiene is binding and a certificate 104
valid for two years after which training must be conducted again is required as an evidence to 105
support acquisition of basic hygiene knowledge (Jianu & Goleț, 2014). 106
In Dubai, food safety is considered as a critical part of operating any food business (Food 107
Control Department, 2012). Consequently, people in the food service business need to be trained 108
on the risk and suffering that unsafe food can bring to the society. However, although training of 109
food handlers was made mandatory since 2005, obtaining the desired outcomes in food safety 110
remained to be a big challenge (Food Control Department, 2012). One of the explanations given 111
is that most of the trained food handler’s work under managers who do not necessarily have the 112
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skills and knowledge to appreciate the importance of food safety and facilitate activities geared 113
towards its attainment. The lack of understanding between food handlers and management 114
creates a weak point in the food supply change that is difficult to correct when there is no 115
designated person or point of contact. In order to solve this problem and harmonize the working 116
relationship between food control authorities and those in the catering service the concept of 117
having a person in charge (PIC) in every food establishment was created (Food Control 118
Department,2012). 119
Literature reviewed has shown that considerable studies on food safety knowledge and 120
practices have been conducted elsewhere (Sani & Siow 2014). However, studies related to the 121
evaluation of food safety knowledge and personal hygiene of food handlers in Dubai is scarce at 122
the time of conducting this evaluation. Therefore, the objectives of this study were to evaluate 123
the effectiveness of the PIC intervention in providing food safety knowledge and to assess the 124
extent of utilization of knowledge gained in the PIC program to improve food safety practices 125
among handlers in selected food service establishments in Dubai. 126
2. Materials and methods 127
2.1. The PIC concept 128
In order to consolidate the gains registered in many sectors, it was deemed necessary for 129
the Dubai Government, to have a vibrant food catering business that will continue to provide 130
excellent service to inhabitants and visitors alike (Food Control Department, 2012). The concept 131
consisted of sets of sections. The first section defined mandatory requirements that all operating 132
food establishments have to meet. 133
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One of the first obligations that any food establishment operating in Dubai must comply 134
with is the employment of at least one full time, on-site PIC certified in Food safety. The PIC 135
must receive adequate training in food safety depending on the role, responsibility and the risk 136
category his food establishment is presenting. 137
Upon completion of the designed training modules, the PIC will be awarded a certificate 138
that must be retained in the establishment and should be reachable when required for inspection. 139
In the event that the PIC is terminated, the PIC requirements asked the food establishment to 140
employ a new PIC within (30) days and the new PIC must enroll in a training program within 14 141
days. Table 1 represents a portion of the list of requirements for a person in charge based on 142
business type and level of training required. 143
2.2. Key competency requirements of a certified PIC 144
In order to qualify for the job of a person in charge in food safety, certain criteria, which 145
the individual must fulfill, have been set. The first among these criteria is to meet the 146
requirements of ISO IEC 17024 standards in addition to the requirements set by the Food 147
Control Department. The requirement of the Food Control Department includes (i) completing 148
the approved Food Safety Certification Course for the identified food business activity and (ii) 149
successfully passing the approved Food Safety Certification written examination administered 150
jointly by the Department of Food Control and the Awarding Body. 151
2.3. Rules and requirements pertaining to the Awarding Bodies, Training companies and 152
trainers 153
The second section of the PIC concept as outlined in Guidance Document of the Food 154
Control Department of Dubai Municipality, Revised Edition, January (2012) focuses on the 155
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roles and responsibilities of the awarding bodies, training companies and the trainers who offer 156
the accredited qualifications for person in charge of food establishments in Dubai. The section 157
identifies sets of roles and responsibilities for each stakeholder in the PIC concept. The first 158
stakeholder in the PIC framework is the Food Control Department of Dubai Municipality, 159
followed by the Awarding Bodies, the training companies and the trainers. The primary role of 160
the Food Control Department among other things include (i) developing appropriate training 161
programs and qualifications jointly with the Awarding bodies; (ii) monitoring implementation of 162
the agreed activities; and taking necessary action against partners short in fulfilling their 163
obligations etc. With regard to the awarding bodies, the key requirements include acquiring 164
approval of the Food Control Department and obtaining accreditation of Dubai Accreditation 165
Department, which is based on ISO 17024 standards. Their responsibilities include (i) 166
Developing relevant and up to date training programs and materials written in appropriate 167
languages including Arabic and English; (ii) The materials and programs must be approved by 168
the Food Control Department before they are offered to the industry. 169
2.4. Selection of PIC graduate and food handlers 170
Forty eight food establishments visited were selected randomly from four zones in Dubai. 171
Briefly, Dubai city was divided into four zones. In each zone, four types of food establishments 172
were identified and three food establishments were selected from each type. The types of 173
establishments that are similar in function were put together to form a group consisting of 12 174
food establishments. Group 1 represents 4 and 5 star hotels, group 2 consists of (chain 175
restaurants with big number of meals and limited variety), group 3 represents (normal 176
restaurants with limited meals and big variety) while group 4 represents small cafeterias. 177
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178
2.5. Duties of the PIC 179
PIC is a person entrusted with supervisory responsibilities during all operating hours of 180
the business and must be trained in the prevention of foodborne illness and injury. His primary 181
duties include: (i) developing and implementing policies and procedures to prevent foodborne 182
illness; (ii) ensuring that all employees are fully trained before they start to work; (iii) 183
monitoring employee hygiene such as proper hand washing, cleaning and sanitizing of 184
equipment and utensils. 185
2.6. Survey design 186
The survey approach consists of three parts. The first part deals with assessment of food 187
safety knowledge among PIC graduates and the second part handles the application of food 188
safety practices at selected food services establishments while the third part evaluates personal 189
hygiene and sanitary condition adopted by food handlers under the supervision of the PICs. The 190
knowledge assessment consisted of 12 knowledge questions and the food safety practice part 191
consisted of 20 observable practices. Both of the knowledge and practice issues were generated 192
from the training modules (available upon request) covered during the food safety training 193
sessions conducted by the awarding bodies. The rationale of selecting these questions and 194
observable action was to have a general idea about the effectiveness of the PIC concept and the 195
food safety trainings that are being offered to impart knowledge and induce attitudinal change 196
towards better food handling practices among food handlers. 197
In the knowledge-based questions, which were completed by the PIC individuals, the 198
respondent is given score of two if the answer is correct and score of one if the answer is 199
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unsatisfactory. This made the maximum possible score of 24 points and 12 points to be 200
unsatisfactory. The second part consisted of twenty observable food safety practices that were 201
evaluated by an evaluating team before and three months after the training. The evaluation scale 202
ranged from excellent (4 points), acceptable (3 points), good (2 points) and bad (1 point). 203
The third part represents hand and cutting board hygiene. In this part, cutting board and hand 204
swabbing were conducted to enumerate total plate count and coliform bacteria and to detect the 205
presence of E. coli within the coliform group found in hands and cutting boards that were 206
utilized by food handlers. The maximum acceptable limit for total plate count was set at 1000 207
CFU/���, while the limit of coliform and E. Coli was set at 0/100���. If the swabbing results 208
were satisfactory, a score of 2 was given. If not a score of 1 is recorded. The swabbing was done 209
following the method outlined in Yousef and Carlstrom (2003). Serial dilutions from each 210
peptone sample were made by serial transfer of 1 ml from the previous test tube into a new 9 ml 211
of sterile peptone saline. 1 ml from each dilution was inoculated into appropriate plate using pour 212
plate technique. Plates were aerobically incubated at 37 oC for 18-24h for evidence of microbial 213
growth. Total number of colony forming units (CFU) was determined from countable plates 214
containing 20 to 200 CFU. The total number of colonies CFU / ��� was calculated using the 215
equation given in Yousef and Carlstrom (2003). For the material applied (HiMedia Laboratories 216
limited, Mumbai India) supplied all the Plate Count Agar (PCA), Violet Red Bile Agar (VRB 217
agar), Brilliant Green Lactose Bile Broth (BGLB) and Eosin Methylene Blue Agar (EMB agar). 218
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2.7. Statistical analysis 220
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The statistical analysis of the data obtained from processing the results of the study was done 221
using IBM SPSS (version 20) SPSS Inc.233S Wacker Drive, Chicago IL, USA. Analysis of 222
Variance (ANOVA) was used to compare between means of the four groups before and after 223
intervention. A regression model was used to determine if work experience, education level and 224
type of food safety training received previously have any effect on reported food safety 225
knowledge and practice of food handlers. T-test was used to determine if there was any 226
significant difference between food safety knowledge and practice before and after intervention. 227
3. Results and discussion 228
3.1. Description and characteristic of the PIC respondents. 229
230
The education level, work experience and food safety training level of the PICs are 231
shown in Table 2. The PICs vary in terms of level of education, years of experience and level 232
of professional training. In terms of education, 11 (22.9%) of them received basic education, 233
11 (22.9%) hold diploma in management and 13 (27%) obtained bachelor’s degree in arts and 234
the remaining 13 (27%) missed the train of education. In the case of working experience, 15 235
(31.2%) of them have experience ranging between 1 to 5 years, 9 (18.7%) between 5 to 10 236
years of experience, 14 (29.1%) fall in the 10 to 15 year range while 8 (16.7%) were in the job 237
for more than 15 years. Two (4%) were fresh and 1 (2%) has only 5 months of experience at 238
the time of the first visit. 239
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3.2. Overall effect of PIC intervention on Food safety knowledge 241
Forty eight food establishments were visited twice in this assessment. The first visit was 242
before the training intervention and the second visit was three months after. In each visit, the 243
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same set of 12-knowledge questionnaire was asked and 20 food safety practice observations 244
were assessed. The questionnaire aimed at testing the level of food safety knowledge of the PIC 245
graduates before and after the training while, the food safety practices were geared towards 246
assessing change in food safety practices. 247
Figure 1 represents the overall picture of the effect of training on the food safety 248
knowledge of the PIC graduates before and after training. The figure shows that all groups 249
gained additional knowledge about food safety issues raised during the training exercise except 250
group 4. Group 4 did not achieve much from the training in terms of food safety knowledge. The 251
low performance could be related to the fact that this group has the least trained PIC members 252
prior to the intervention. Only 3 out of 12 PIC in the group (25%) received basic training in food 253
safety and handling. The remaining 9 (75%) did not received any kind of food safety training 254
before. In addition to this, the education matrix Table 2 (a) has shown that 7 PIC individuals in 255
this group representing (58 %) did not complete high school level. For the three PIC who have 256
obtained bachelor’s degree, they got it in hotel management and tourism. The low level of 257
education in addition to the fact that 75% of PICs in this group did not receive any form of food 258
safety training prior to the PIC intervention may explain why this group has low scores in the 259
food safety knowledge test. 260
In terms of variation of food safety knowledge between groups before the intervention, 261
the ANOVA results (p˂0.05) showed that group 1 was significantly different from other groups. 262
The average score for group 1 was 88.2 % while group 2, group 3 and group 4 have the mean 263
value of 67.3 %, 69.4% and 60.4% respectively. This trend of dominance in food safety 264
knowledge continued to surface even after the PIC intervention where group 1 registered the 265
highest score (93%) followed by group 2 and 3 with the mean value of 72% and 77% 266
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respectively. Group 4 maintained the lowest score of 61%. Based on the statistical values, one 267
can reasonably conclude that group 1 has more ability to receive information from trainers when 268
compared with other groups. However, there was no significant difference between group 2 and 269
group 3 (p˂ 0.05). The finding of the study showed that observed scores in knowledge on food 270
safety among PIC interviewed were higher than what has been reported by (Jianu & Goleț 2014). 271
In a quantitate evaluation of knowledge and practice of meat handlers in Romania these 272
researchers found that the average score of respondents was 10.34 (in a scale ranged from 0 to 273
16) representing (64.6%) when their knowledge on food poisoning, cross contamination, 274
temperature and time control and personal hygiene was tested. Although these meat handlers 275
were working in the industry for a considerable period, 71.43% of them could not recognize 276
animal waste, minced meat and meat carcasses as a potential source of contamination with E. 277
coli, while only 56.54 % of them were able to realize that microbiological contamination of meat 278
carcasses cannot be evaluated visually (Jianu & Goleț 2014). 279
3.2.1. Effect of work experience on food safety knowledge and observed practice 280
For the evaluation of the effect of work experience on the food safety knowledge of the 281
PIC individuals and hygienic practice of food handlers, a regression analysis was conducted. 282
Results showed that work experience has significant effect on food safety knowledge of PIC 283
individuals but only before the training intervention (p˂ 0.05). This can be understood because 284
after the training, all of them have equal exposure to the educational modules covered. With 285
respect to practice, number of years of experience of PICs did not show any significant effect on 286
the hygienic practice of food handlers working in the food establishments neither before nor after 287
PIC intervention (p˂0.05)6). This seems logical because the actual persons doing the work at the 288
establishment level are the food handlers and not the trained PIC individuals. However, this 289
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finding suggests that a communication gap may exist between PIC individuals with supervisory 290
role and food handlers at the field level. 291
To compare the overall performance of the PIC intervention before and after, a T-test was 292
conducted on the data collected. Statistics showed that there was a significant improvement in 293
terms of food safety knowledge of PIC individuals after the intervention. The mean values 294
obtained before and after intervention were 71.3% and 76.1% respectively at (p˂0.05). 295
In terms of food safety handling practice among the food handlers, results showed that 296
there was no significant difference in performance between pre and post intervention with mean 297
values of 70.4% and 69.8% respectively. 298
299
3.2.2. Effect of education and previous trainings on food safety knowledge 300
For the effect of educational level and professional training on food safety knowledge and 301
practice, statistics showed that educational level has positive effect on the ability of the PIC to 302
demonstrate knowledge. Analysis of results showed that PIC with tertiary education registered 303
higher score in knowledge before and after the intervention with average score of 75% and 80.7 304
% respectively. For those who have completed secondary school the average scores were 63.3% 305
and 70% before and after the intervention. The candidates who did not complete secondary 306
school recorded lowest scores 58% and 58.3% before and after intervention. With respect to the 307
effect of previous training in food safety knowledge, results showed that the least trained PIC 308
recorded the lowest scores in food safety knowledge with the average mean value of 60% and 309
63.9% before and after training respectively. The PIC who completed basic training achieved 310
70.2% and 76% before and after intervention while PIC with intermediate level showed higher 311
scores with average values of 89 and 94.5 before and after. Beyond intermediate (advance) level 312
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the average scores decrease to 87.5% and 89%. The decrease happened because there was an 313
outlier in the data. The observations made in this study are similar to what Jianu and Goleț 314
(2014) have reported. The researchers found that educational level and professional training have 315
significant effect on food safety knowledge and practice. 316
3.3. Effect of PIC intervention on Food safety knowledge within groups 317
For better understanding of the performance of individual food service establishments in 318
knowledge retention in each group Figure 2 was presented. Fig. 2 (a), showed that seven out of 319
the twelve PIC contacted in group 1, have benefited from the food safety knowledge provided 320
during the training. Three of them remained the same as before while 2 of them dropped. In 321
group 2 and group 3, Fig. 2 (b & c), similar observations have been made. Group 4, Fig. 2 (d) 322
represented special scenario in the sense that most of the members did not received any form of 323
food safety training before and have lower level of education. As a result, only two of them 324
registered gain in food safety knowledge after the training. Nine of them remained the same and 325
one of them dropped. 326
327
Although the general picture looks unsatisfactory, the value are comparable to what have 328
been reported in other studies conducted at other places. Bas, Ersun, and Kivanç (2006) 329
performed study in Turkey and reported limited knowledge of food handlers, with only 43% 330
providing correct answers. Da Cunha et al. (2014) carried out study in Brazil and documented 331
36% of foods handlers being unable to give correct answers on the knowledge questionnaire. The 332
most problematic question that many of them failed to answer correctly was related to hand 333
hygiene. A high proportion of food handlers believe that hand washing with mild detergent was 334
adequate to prevent microbial contamination, which contradicts the recommended practice of 335
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applying antiseptic soap or 70% alcohol. Another disturbing question that exposed low level of 336
food safety knowledge among food handlers related to their inability to recognize that unsafe 337
food does not have to always present altered sensory characteristics (Da Cunha et al., 2014). 338
In order to have better understanding of the ability of PIC to answer satisfactorily the 339
basic food safety questions, eight questions were selected from the twelve and results presented 340
in Table 3. The eight questions were selected because the remaining four were not related 341
directly to food safety. For example one of them was asking whether a list of supplier is being 342
maintained or not while another one was talking about whether the PIC can remember the last 343
grade scored in the food inspection visit. 344
According to table 3, it was obvious that about 98 % of the PIC were aware of the fact 345
that, raw meat and cooked food should not be kept in the same chiller without separation even 346
before the training. This suggests that many of the PIC candidates do have reasonable knowledge 347
about cross-contamination as a potential vehicle to food poisoning unlike to what have been 348
reported by Jianu and Goleț (2014). With respect to how fast, a food should be cooled after 349
cooking to avoid microbial proliferation in the danger zone; results have shown that 60% of the 350
PIC’s interviewed were not able to give correct answers to the question presented. Unfortunately, 351
the picture got worse after the training. This value is lower than what has been reported by Jianu 352
and Goleț (2014) who found that 62.5% of respondents are aware of the fact that bacterial 353
proliferation is faster at 37 oC. The inability of PIC to maintain their position in relation to the 354
basic food safety knowledge suggests that some of the answers given were based on guess rather 355
than convincing knowledge. 356
For the availability of thermometers in kitchen as a measuring device, 65% of the PIC 357
reported that they were keeping it before the training and the number increased to 70% after the 358
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training. In addition to that, (63% of the PIC visited know that food should be kept bellow 5 oC 359
in refrigerator and this knowledge was consolidated after the training by 14 % increase on the 360
originally reported value. When asked about the right temperature to keep hot food hot, 33% of 361
the PIC interviewed did not know that food meant to be served hot should be kept above 60 oC 362
on the counter. Fortunately, this piece of information was well received during the training and 363
by the end of the intervention only (18%) of them was not certain about the message Table 3. 364
When it comes to application of sanitizers, Table 3 shows that, (44%) of the PIC visited were not 365
able to differentiate between sanitizing and cleaning and their opinion did not changed much 366
even after training. For hand washing and drying, 97.7% of PIC reported that hands should be 367
washed thoroughly after visiting toilet or when exposed to contaminated surface and they know 368
the appropriate way of drying them. This revelation is similar to what Giritlioglu, Batman and 369
Tetik, N. (2011) and Tan, Bakar, Karim, Lee and Mahyudin (2013) have reported (98.8% and 370
95.3%) respectively for a similar question. 371
372
3.3.1 Effect of education and work experience on observed practice within groups. 373
The group performance in hygiene practice is shown in Figure 3. For group 1 Fig. 3 (a), it 374
can be noticed that although this group had more educated and highly experience managers, the 375
majority of the trained PIC were unable to improve food safety handling practice in the place of 376
work. Infact the performance of the group has worsen by 12% indicating that although the ability 377
to learn is there, there could be some problems that is preventing them to translate what they 378
have learned into real action. For group 2 and 3, Fig. 3 (b and c) there was a slight improvement 379
in performance. Group 2 improved by 4.3% while group 3 registered about 10.3 % enhancement 380
in food safety practices. Group 4 Fig. 3 (d) remained almost the same before and after the PIC 381
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intervention. The decrease in the score for group 1 and the inability of group 4 to benefit from 382
the PIC intervention is not easy to explain and it may infolve more than one factor. One of the 383
possible reasons is that the PIC individuals who received the training are different from the food 384
handlers who are at the kitchen doing the work. The other possible reason could be that some of 385
the PICs trained were not clear with the food safety messages and as a result, it may be very 386
difficult for them to transfer the required knowledge to the food handlers. The third possibility 387
may relate to the designing gap in the PIC concept. For example in all the PIC documents 388
reviewed, there was no mention made of any form of motivation for the food handlers who are 389
doing good job or what are the consequences if they did not perform well. Whatever the case 390
might be, the picture is not that much different from what have been reported by other 391
researchers (Tan et al., 2013; Nieto-Montenegro, Brown & LaBorde, 2008; Choudhury, 392
Mahanta, Goswami, & Mazumder, 2011; Ehiri, Morris & McEwen, 1997; Rennie, 1994). In a 393
study of hand hygiene knowledge, attitudes and practices among food handlers in Malaysia. Tan 394
et al., (2013) found that in the self-reported hand hygiene practices 89.4% of the food handlers 395
reported that they always use proper hand-washing procedures. However, in realty none of them 396
was doing it correctly. To avoid this kind of disappointment, Nieto-Montenegro et al, (2008) 397
suggested that a training session to increase awareness of the possibility of accumulation of E. 398
coli bacteria for example under fingernails must be accompanied with correct demonstration of 399
proper hand washing procedures followed by adequate practice until the learner masters the 400
procedure. In another study conducted by Choudhury et al. (2011), in India, it was found that 401
although 24%-66% increase was observed in knowledge score of food handlers, only 13% of 402
increase was realized in the overall performance. This kind of observation perhaps lead 403
Clayton, Griffith, Price, & Peter, (2002); Ehiri et al, (1997) to reported that improvement in food 404
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safety knowledge does not necessarily lead to adoption of good practice. Rennie (1994) reported 405
that there is no evidence that food-handling practices improve when only information based 406
training programs are offered. 407
3.4. An overview of overall performance of food handlers at work 408
The performance of food handlers at work place is presented in Table 4. Review of the 409
tabled showed that, the availability of holding facility to keep food in safe condition increased 410
from 81.3 % to 83.4 % after the training. The percentage of those who were keeping cooked food 411
in chiller remained at 73%. The proportion of those with the ability to recognize the importance 412
of cooling food rapidly before storage improved from 41.3% to 54.1%, those who keep food 413
below 5 oC in refrigerator increased from 54.2% to 64.4% while those denouncing holding food 414
with bare hands slide back from 75% to 73%. With respect to cleaning food contact surface, a 415
potential source of cross contamination, results showed that the scores obtained by the food 416
handlers were not good enough (62.5%) and (52.1%) before and after respectively. In the case of 417
separating ready to eat food from raw meat, the results have improved from 66.7% to 70.8%. 418
This finding showed that scores reported in this study are much lower than what have been given 419
by Walker, Pritchard, and Forsythe (2003). These researchers found that, 97% of food handlers 420
in small businesses within the East Midlands region in United Kingdom know that raw food and 421
cooked food should be separated to prevent microbial transfer. Raw food contains harmful 422
bacteria that can spread easily to any surface that it touches. Therefore, inadequate cleaning can 423
lead to cross contamination which is a main factor contributing to the generation of food borne 424
illness. In order to reduce it Sneed, Strohbehn, Gilmore and Mendonca, (2004) suggested 425
application of correct hand washing steps, training and ongoing supervision of food handlers 426
including periodically checked standard cleaning procedures. 427
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For proper application of these recommendations to inculcate the culture of good practice, 428
one must address what Rennie (1995) described as five systems that are influential to behavior 429
change. The first system is the knowledge system. Food handlers must be adequately trained in 430
the job so that they know what to do. The second system is the normative system, which consists 431
of worksite norms and rules. The third system is motivational system, which defines the 432
remuneration of a person if a good job is done. The other two systems are the belief system that 433
consists of values and beliefs of target audience and worksite environmental system, which 434
addresses worksite physical conditions (Nieto-Motenegro, Brown & LaBorde, 2006). To a 435
different extent, these systems have influence on each other. For example, the motivational 436
system tends to be very influential on behavioral intent as shown in some nutritional education 437
interventions (Gribble, Falciglia, Davis, & Couch, 2003; Miller, Edwards, Kissling, & Sanville, 438
2002). Motivation is an important process that can trigger and guide behavioral change. The food 439
handler is more likely to wash his hand if the supervisor asked him to do that especially when a 440
reward is attached to full compliance. 441
The score for keeping a supplier list was enhanced from 79.1% to 85% and the habit of 442
sending sick person home increased from 56.3% to 64%. It can also be observed that a good 443
number of food handlers are making effort to keep sickness report, which improved from 48% to 444
54.2%. Hand washing done by food handler when needed remained relatively high 79.2%. Other 445
areas where reasonable improvements have been observed at acceptable level include pest 446
control in the surrounding of food service establishments, which improved from 77.1% to 81.2%. 447
3.5. An overview of performance of food handlers within groups 448
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For better understanding of the performance of individual establishments in each group, 449
Figure 4 was presented. Fig.4 (a) displays the performance of 4 and 5 five star hotels in group 1. 450
According to the figure, 7 hotels out of the 12 surveyed representing 58% have dropped in 451
performance. Four of them remained the same and only one hotel has managed to change 452
practice after the training. This suggests that there is an existing gap in translating knowledge 453
into action in this category and the reasons for this decrease in performance need to be 454
investigated. 455
The performance of establishments in group 2 is shown in Fig. 4 (b). Careful observation 456
can show that 33.3% of the group dropped in performance. 16.6 % of them remained unchanged 457
while 6 out of the 12 representing 50% remarkably improved their practice. Similar to group 2, 458
the performance of group 3 is shown in Fig.4 (c). Here also four establishments did not do well. 459
However, the remaining eight benefited from the training and their practices were changed 460
accordingly. In group 4 business more or less remained in the same way Fig.4 (d). This 461
revelation is expected since this group consisted of small cafeteria with one or two people who 462
may not take the training very seriously. 463
In order to increase the chance of success and smooth running of food safety 464
interventions, Arvanitoyannis and Kassaveti, (2009) reported that many trainers of food safety 465
programs focus heavily on the provision of knowledge hoping that increasing knowledge will be 466
eventually translated into concrete steps that will enhance performance of the food service 467
industry. In reality, studies have shown that increasing knowledge does not necessarily lead to 468
behavior change (Clayton et al., 2002; Ehiri et al., 1997; Rennie, 1994). In a study conducted by 469
Byrd-Bredbenner et al., (2007), they have realized that although 97% of the participants 470
considered their food safety knowledge high, only 40% of them did practice proper hand 471
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washing with soap and water after touching raw poultry. The argument put forward by Griffith 472
(2000) is that behavioral change and adoption of required hygiene practices are not easy to 473
obtain and that consideration must be given to other factors such as motivation, constraints, 474
barriers, facilities and cultural aspects. 475
The important lesson that can be learned from Fig. 4 and the Table 3 is that successful 476
training program requires careful planning and that the needs of the trainees must be highly 477
considered in the design of the training. Rennie, (1994); Nieto-Montenegro et al. (2008) 478
reported that training programs which are more closely associated with the work site are 479
potentially more effective especially if supported by practical reinforcement of the message. 480
Consequently, to make the training program more effective, one must understand the food 481
handler’s behavior and how it interacts with beliefs and levels of knowledge. 482
3.6. Personal hygiene and sanitary conditions 483
For the evaluation of the level of hygiene maintained in each establishment, swab 484
analyses were conducted on hands and cutting board of each food handler who were working 485
under the supervision of PIC personnel. Detailed results of the cutting board swab for each group 486
are given in Figure 5. For a general view of the overall picture, results indicated that 27.1% were 487
able to maintain their position of good performance while 29.2% registered improvement. The 488
percentage of those who were not able to change their unsatisfactory position was 29.1%, while 489
the remaining 14.5% slide back to unsatisfactory level. The T-test conducted on the mean values 490
showed that although there was a considerable enhancement in performance, the difference was 491
not statistically significant between the food handlers performance before and after the PIC 492
intervention (p˂ 0.05) with the mean values of 41.6 % and 62.5% respectively. 493
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It is well known that foods can be contaminated during preparation, processing or storage 494
In many foodservice establishments, factors such as unsafe sources, inadequate cooking, cross-495
contamination and poor personal hygiene are the leading cause of most of foodborne illnesses 496
(Egan et al., 2007). Consequently, good personal hygiene such as proper hand washing before 497
and after handling food together with correct food handling practices can greatly reduce chances 498
of transferring disease causing organisms from food handlers to consumers (Evans, Madden, 499
Doudlas, Adak, Obrien & Djuretic, 1998). In this regards, food handlers play very crucial role in 500
the final stages of preventing food borne illnesses and must be prepared to take significant steps 501
to minimize the number of pathogenic microorganisms in to the minimum level in food 502
(Medeiros, Hillers, Chen, Bergmann, Kendall & Schoreder, 2004). 503
In considering the pivotal role that food handlers play in any foodservice establishment, 504
the PIC concept from the very beginning put significant emphasis in imparting knowledge and 505
skills needed to handle food in safe manner (Food Control Department, 2012). However, in spite 506
of all the trainings conducted to provide skills and knowledge to handle food safely, human 507
handling mistakes can still exist to cause food poisoning as reported by (Ehiri & Morris, 1996; 508
Greig et al., 2007). 509
For the evaluation of hand washing, the results of the hand swabbing are shown in 510
Figure 6. According to Fig., 6 (a), 4 and 5 star hotels in this group were practicing proper hand 511
washing even before the training, with the exception of only one hotel. After the training, all 512
food handlers in the group showed satisfactory results in hand swabbing. The high standard of 513
personal hygiene that is being practiced in these hotels could be associated to the wealth of 514
experience accumulated in many years and higher educational attainment of the PICs when 515
compared with other counterparts. In the group, (11 PIC out of the 12) representing (91.6%) got 516
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more than 5 years of experience. With respect to academic qualification, (9 out of 12) 517
representing (75%) hold a diploma in management or bachelors in arts. Similarly, in terms of 518
professional training, (8 out of 12), (66.6%) received intermediate level or HACCP and basic 519
hygiene training. 520
For chain restaurants with big number of meals and limited variety Fig. 6 (b), and the 521
normal restaurants with limited number of meals with big variety Fig.6 (c), there performance in 522
hand swabbing are quite similar. In both groups, remarkable improvement in hand washing 523
practices have been realized after the PIC intervention. The scenario for group 4 representing 524
small cafeterias is shown in Figure 6 (d). This group although consisted the least educated and 525
most untrained members, the performance in the swabbing exercise was impressive (6 out of 12) 526
(50%) maintained their satisfactory position while (5 out of 12) 41.6% were able to improve 527
hand washing practice after the training. Only one cafeteria did not perform satisfactorily. In 528
general, the global view of the results showed that 52.1% of the food handlers managed to keep 529
their rightful position, while 33.3% were able to change incorrect hand washing practices. The 530
percentage of those who failed to change incorrect hand washing practices was 6.2% and the 531
remaining 8.3% slide back to wrong hand washing habits. The T-test conducted (P˂0.05) on the 532
mean values showed significant difference between the food handlers performance before and 533
after the PIC intervention (p˂0.05) with the mean value of 60.4% and 85.5% respectively. 534
4. Conclusion 535
This study was carried out to evaluate the overall effect of PIC intervention adopted by 536
Dubai Municipality as a new strategy to enhance knowledge and practices of food handlers in 537
order to maintain high standard of food safety measures in the City. Data were collected and 538
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analyzed from 48 food establishments located in different parts of Dubai. The food 539
establishments were categorized in four groups. Group 1 represents 12 four and five star hotels. 540
Group 2 consisted of 12-chain restaurant with big number of meals and limited variety. Group 3 541
represents normal restaurants while group 4 was composed of 12 small cafeterias with two to 542
three employees. Results obtained showed all the groups gained additional knowledge about the 543
food safety issues raised during the training exercise except group 4. Group 4 did not achieve 544
much from the training in terms of knowledge. 545
From a practical point of view, many of food handlers were able to effect changes in food 546
handling habits however, a considerable number of them were unable to do so. In group 1 the 547
ability to maintain proper food safety measures dropped by 12% indicating that althoug the 548
ability to learn is there, there could be still some other problems that are preventing from 549
translating knowledge and skill into real action. For group 2 and 3, there was slight 550
improvement in the performance. Group 2 improved 4.3% while group 4 registered about 10.3% 551
enhancement in food safety practice. Group 4 remained almost the same before and after the PIC 552
intervention. For the swabbibg exercise, there was a significant improvement in hand cleanliness 553
but the cuttung board cleaning requres additional efforts. Looking into the overall picture of the 554
evaluation it can be suggested that, the PIC intervention needs to acommodates a motivating 555
system in order to encourage food handlers to make extra effort in implemnting the recommeded 556
practices. 557
4. Acknowledgement 558
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The authors acknowledge the support of Emirates Foundation for funding the study and 559
promoting social and scientific research in the United Arab Emirates in order to promote the 560
culture of excellence in any undertaking. 561
562
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Figure legends 682
Fig. 1 Comparison of knowledge between PIC groups before and after training. 683
Fig. 2 Comparison of knowledge within PIC groups before and after training. 684
Fig. 3 Comparison of change in observed practice between PIC groups before and after 685
training 686
Fig. 4 Comparison of change in observed practice within PIC groups before and after 687
training. 688
Fig. 5 Comparison of cutting board-swabbing satisfaction within PIC groups before and 689
after training 690
Fig. 6 Comparison of hand swabbing satisfaction within PIC groups before and after 691
training 692
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Table 1: Selected examples of the PIC requirements for each business type.
Business Type Risk level PIC requirement Recommended qualification
Bakery/Confectionary
Category 1, Meat,
egg/cream/ milk based
products.
High Risk. One per shift present
in the production
area.
At least with one PIC level3
training and others with level
2 training.
Bakery/Confectionary
Category 1, Bread
chocolate, sweets, sugar.
confectionary
Low risk. One per
establishment.
At least one PIC with level 2
training
Central Kitchens of
restaurant or catering
services
High risk One per shift per
kitchen (depends on
the size
One PIC per kitchen with
level 3 training
Hospital Kitchen High
Risk
High Risk One per shift present
in the production area
One PIC per kitchen with
level 3 training
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Table 2. Education level, work experience and food safety training of PIC respondents (n = 12
in each group).
Experience matrix of PIC (a)
1-5 years 5-10 years 10-15 yeas above15
years
Group 1 1 2 5 4
Group2 6 3 3 0
Group3 4 1 5 2
group 4 4 3 1 2
Education level of PIC (b)
Basic education
Diploma in management
Bachelors in arts
Group 1
7 2
Group2
4 5
Group3 4
3
group 4 7
3
Training matrix of PIC ©
Basic Intermediate
HACCP &
Basic
Intermediate
& HACCP
HACCP &
basic & ISO
2200
Untrained
Group 1 4 3 2 1 2
Group2 11
1
Group3 8
2
2
Group 4 3
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Table 3. Comparison of correct and incorrect answers by PIC in basic food safety knowledge
before and after training.
Sr Question Answers % Before Answers % After
correct incorrect correct
incorrect
1 Raw meat and cooked food can be stored together in the chiller without any separation
(47)97.9 (1) 0.1
(47) 97.9 (1) 0.1
2 Once rice or meat is cooked, it should be kept at room temperature for two hours to cool and then placed in the refrigerator
(19)39.6 (29)60.4
(17) 35.4 (31) 64.6
3 Do you have thermometer in your kitchen? (31)64.5 (17)35.5
(34) 70.8 (14) 29.2
4 Cold food should be store at which temperature
(30)62.5 (18)37.5
(37) 77.1 (11) 22.9
5 The temperature of the food held in the hot counter in a buffet should be at?
(32 66.6 (16)33.4
(39) 81.2 (9) 18.8
6 Can you differentiate between disinfectant and cleaning
(27)56.2 (21)43.8
(29) 60.4 (19) 39.6
7 What is the best way to dry our hands (46)95.8 (2) 4.2
(45) 93.7 (3) 6.3
8 When do food handlers wash their hands (48) 100 (0) 0.00
(47) 97.9 (1) 0.1
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Table 4. Comparison of observable practices among food handlers before and after the PIC
intervention.
% of
excellent % of
acceptable % of good % of bad Item before after before after before after before after 1 Is there a holding facility to keep food hot at 60 oC 56.3 41.7 25.0 41.7 8.3 12.5 10.4 4.2 2 Are there cooked foods in chiller? 31.3 27.1 41.7 45.8 16.7 22.9 10.4 4.2 3 Does the manager know that cooked food should
be cooled rapidly from 60 oC to 5 oC or less within 6 hours before storing in the chiller? 33.3 20.8 8.3 33.3 14.6 18.8 43.8 27.1
4 Are foods in the refrigerator at the right temperature less than 5 oC 22.9 14.6 31.3 45.8 22.9 29.2 22.9 10.4
5 Is ready to eat food being handle with bare hands 16.7 12.5 58.3 60.4 18.8 18.8 6.3 8.3 6 Are ready to eat food clearly separated from raw
food? 22.9 25.0 43.8 45.8 25.0 25.0 8.3 4.2 7 Is there a list of supplier 20.8 35.4 58.3 50.0 14.6 14.6 6.3 0.0 8 Are raw vegetable properly washed and sanitized
prior to serving 22.9 12.5 25.0 37.5 27.1 25.0 25.0 25.0 9 Is food protected from potential source of
contamination during storage, preparation, transportation, display or serving 18.8 14.6 37.5 50.0 35.4 27.1 8.3 8.3
10 Is there a sickness reporting system? 18.8 14.6 29.2 39.6 16.7 27.1 35.4 18.8 11 Do food handlers wash hands thoroughly when
needed 22.9 14.6 56.3 64.6 16.7 16.7 4.2 4.2 12 Are there food items that are spoiled, adulterated or
contaminated 27.1 16.7 56.3 52.1 16.7 25.0 0.0 6.3 13 Are there evidence of pest activity inside or outside
of the kitchen 29.2 20.8 47.9 60.4 16.7 16.7 6.3 2.1 14 Is there a cleaning schedule 22.9 14.6 39.6 47.9 16.7 18.8 20.8 18.8 15 Are there facilities available to wash, rinse and
sanitize utensils and equipment? 29.2 10.4 41.7 52.1 25.0 31.3 4.2 6.3 16 Are food contact surface properly washed and
disinfected after each use? 25.0 16.7 37.5 35.4 33.3 41.7 4.2 6.3 17 Is hand washing facilities provided in or near food
preparation area and toilet room? 22.9 14.6 50.0 56.3 16.7 20.8 10.4 8.3 18 Is there A/C inside the kitchen 25.0 25.0 52.1 56.3 16.7 14.6 6.3 4.2 19 Condition of the sewage system 22.9 16.7 43.8 58.3 27.1 18.8 6.3 6.3 20 How is the personal hygiene of staff 29.2 16.7 47.9 56.3 22.9 25.0 0.0 2.1
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