INTRODUCTION TO SAFE FOOD HANDLING AND PRACTICES
RISK FACTORS LEADING TO UNSAFE FOOD HANDLING PRACTICES
Food from Unsafe Sources
Poor Personal Hygiene
Improper Holding/Time and Temperature
Contaminated Equipment/Protection from Contamination
SAFE FOOD HANDLING GAPS WITHIN FOODSERVICE ESTABLISHMENTS
Restaurant Foodservice Establishments
Institutional Foodservice Establishments
Retail Foodservice Establishments
1. INTRODUCTION TO SAFE FOOD HANDLING AND PRACTICES
The National Restaurant Association (NRA) defines food safety as the scientific discipline describing the handling, preparation, and storage of food in ways that prevent foodborne illness. Respectively, a foodborne illness is a disease carried or transmitted to people by food constituted by gaps within safe handling practices (NRA 2010). According to the World Health Organisation (WHO), illness resulting from foodborne diseases have become one of the most widespread public-health problems in the world today (WHO 2012). Scharff (2012) reveals that the economic impact of foodborne illness is estimated at 77.7 billion dollars. Despite numerous efforts to reduce the epidemic, foodborne illnesses remains a significant problem globally where the Centers for Disease Control and Prevention (CDC) estimates 48 million illnesses, 128 000 hospitalizations, and 3000 deaths annually (CDC 2010).
The entire food chain is susceptible to unsafe food handling practices however; studies reveal that over 60% of illnesses occur as a result of improper food handling and preparation practices in food service establishments (Redmond & Griffith 2003; Lynch et al. 2003; and Batz et al. 2011). The United States Food and Drug Administration (FDA) defines a foodservice establishment as an operation that stores, prepares, packages, serves, vends, or otherwise provides food for human consumption which, in a general scope, include restaurants such as full service and fast food restaurants; institutional foodservices specifically hospitals and schools; and retail food outlets from seafood, produce, meat and poultry, and deli departments (FDA 2009). The CDC identified five of the most significant contributing factors to foodborne illness as a result of unsafe food handling practices. These foodborne illness risk factors include food from unsafe sources, inadequate cooking, improper holding times and temperatures, poor personal hygiene, and contaminated equipment/prevention of contamination (CDC 2000).
Early acknowledgment of the foodborne illness epidemic propelled the FDA to initiate a ten-year study in 1998 to measure trends towards the occurrence of foodborne illness risk factors. More specifically, the study analyses preparation practices and employee behaviours most commonly reported to the CDC as contributing factors to foodborne illness outbreaks at the retail level. The study further included data collection inspections of the restaurant, institutional, and retail foodservice establishments in order to observe and document trends in the occurrence of foodborne illness risk factors (FDA 2014). The latest report was published in 2009 which includes the last phase of the 10-year study (FDA 2009). These foodborne risk factors are ultimately the specific gaps within food handling practices which forms the basis of this review in contrast to the respective foodservice establishments.
According to Fardiaz and Bhat (2011), in order to effectively reduce the occurrence of foodborne illness risk factors, operators of retail and food service establishments must focus their efforts on achieving Active Managerial Control (AMC). AMC is a purposeful incorporation of specific actions or procedures into the operation to attain control over foodborne illness risk factors (FDA 2013). Thus, under the guidance of the FDA surveillance report, the review aims to discuss the risk factors leading to unsafe food handling practices within various food service establishments. AMC should thus be augmented on these conclusions derived to assist foodservice establishments bridge the gap in safe food handling behaviours which may occur.
2. RISK FACTORS LEADING TO UNSAFE FOOD PRACTICES
The Centers for Disease Control and Prevention (CDC) Surveillance Report for 1993-1997 titled, “Surveillance for foodborne disease outbreaks” identified the most significant contributing factors to foodborne illness. Five of these broad categories of contributing factors directly relate to food safety concerns within retail and food service establishments and are collectively termed by the FDA as “foodborne risk factors”. These five broad categories include food from unsafe sources, inadequate cooking, improper holding times and temperatures, poor personal hygiene, and contaminated equipment/prevention of contamination (CDC 2000). This section briefly discusses the these various foodborne risk factors to gain a general understanding towards its contributing role related to food safety concerns within food service establishments.
2.1 FOOD FROM UNSAFE SOURCES
The majority of biological and toxic agents that cause foodborne illnesses originate from early sources in the food handling chain, such as farming. Regulations must be in place to govern farm land use, animal feed, agrochemical use, sanitary practices and other aspects of food safety (Becker 2009). According to Knechtges (2011), trust is implicit from retail and consumer levels that agricultural producers and food processors comply with the food safety regulations. Foods from unregulated sources pose the greatest risk of contamination with biological, chemical and physical agents. The latest FDA Food Code report reveals that a factor of compliance regarding food from unsafe sources for food handling establishments include that shellstock tags to be retained for 90 days (FDA 2013). It is clear that if food from unsafe sources are not properly regulated and managed, a serious gap within safe food handling practices will inevitably prevail.
2.2 CONTAMINATED EQUIPMENT/PREVENTION OF CONTAMINATION
Food can become contaminated by biological and toxic agents during the food preparation process itself and the importance of cleaning equipment and the prevention of contamination is significant (Lelieveld et al. 2014). According to Knechtges (2011) all utensils and equipment should be properly cleaned and sanitized at least once every 4 hours or more frequently as needed to prevent the spread of pathogens. The FDA Food Code report reveals that factors of compliance regarding contaminated equipment/prevention of contamination for food handling establishments include that surfaces and utensils be cleaned and sanitized; raw and ready-to-eat foods to be separated from each other and protected from environmental contamination; raw animal foods to be separated completely from other food items; and food that has been served should not be re-served (FDA 2013).
2.3 IMPROPER COOKING TEMPERATURES OF FOODS
As part of the food preparation process, cooking institutes temperatures which effectively destroy most pathogens and vegetative forms of toxigenic microorganisms (Knechtges 2011). The temperature range in which foodborne pathogens can grow is known as the danger zone. Food safety agencies, such as the United States' Food Safety and Inspection Service (FSIS), define the danger zone as roughly 4–5 to 60 °C (FSIS 2015). The FDA Food Code report reveals that factors of compliance regarding improper cooking temperatures of food for food handling establishments include that poultry, stuffed fish, meat, and pasta to be cooked to 74°C for 15 seconds and potentially hazardous food to be rapidly reheated to 74°C/15 seconds for hot holding (FDA 2013).
2.4 IMPROPER HOLDING/TIME AND TEMPERATURES
The purpose of holding potentially hazardous foods at proper temperatures is to minimize the growth of any pathogenic bacteria that may be present in the food. The number of bacteria that a person ingests with their food has a direct impact on a possible illness (Lelieveld et al. 2014). The FDA Food Code reveals that factors of compliance regarding improper holding/time and temperatures of food include that potentially hazardous food to be cooled to 21°C in 2 hours or 5°C in total of 6 hours, held cold at 5°C or below, held hot at 57°C or higher; including commercially-processed and ready-to-eat food to be date marked after 24 hours, and including ready-to-eat food to be discarded after 4 days/7°C or 7 days/5°C; and when time only is used as a public health control, food is cooked and served within 4 hours (FDA 2013). From a general food safety perspective, improper holding/time and temperature’s practical importance in terms of safe food handling remains eminent.
2.5 POOR PERSONAL HYGIENE
Food workers are frequently the primary and secondary sources of pathogenic or toxigenic microorganisms which contaminate food. Good personal hygiene reduces the likelihood of food contamination and should apply to every food handler by understanding the proper procedures and compliances for personal cleanliness, handwashing and protective clothing usage (Knechtges 2011). The FDA Food Code reveal that factors of compliance regarding poor personal hygiene for food handling establishments include that proper and adequate handwashing protocols be in place; handwashing facilities must be convenient and accessible; good hygiene practices must be active; prevention of contamination from hands must be ensured; and handwashing facilities which includes cleanser and drying devices must be in place (FDA 2013).
The Food and Agriculture Organisation of the United States (FAO) reaffirmed that food safety and quality are basic human rights and therefore efforts have to be made in each foodservice establishment to implement appropriate food safety and quality control systems (FAO 1996). Thus, the respective foodborne illness risk factors must be in compliance for food handling establishments to protect the health of consumers by preventing both acute and chronic foodborne illness. Understanding where each foodborne illness risk factor is most susceptible at within the different foodservice establishments, will deem impelling to investigate towards further understanding of the specific gaps which needs to bridged more effectively. For this purpose, the following section highlights various foodservice establishments where relative gaps in food safety practices are prominent.
3. SAFE FOOD HANDLING GAPS WITHIN FOODSERVICE ESTABLISHMENTS
The foodservice industry today is a complex and fast-changing industry which has expanded rapidly in the last 50 years. Estimation reveals that 47% of meals consumed are planned, prepared, and served outside the home in a variety of establishments (Mitchell et al. 2007). In correspondence to the FDA Occurrence of foodborne illness in foodservice establishments report, nine foodservice facility types are analysed within restaurants; institutional foodservices; and retail foodservice segments (FDA 2009). The selected foodservice establishments represent a high proportion and diverse types of operations globally. A direct focus on these industry segments will allow the provision to track unsafe food handling practices that serve both the general and highly susceptible populations.
Eating establishments are the source of a large number of foodborne outbreaks (Panchal et al. 2012). In 2007, of the 1097 outbreaks reported to the CDC, 41% were associated with restaurants (Debess et al. 2009). Restaurants are therefore important venues to consider in the prevention of foodborne illnesses and outbreaks by addressing certain safe food handling gaps. Full service and fast food restaurants are the two main types of restaurant foodservice facilities (FDA 2009). According to Payne-Palacio and Theis (2009), a full service restaurant offers fine dining with a wide selection of foods and beverages, and table service. Concurrently, fast food restaurants is characterised by its fast food cuisine, limited menu and by minimal table service. Table 1 presents a summary of the foodborne risk factors which contribute to the gaps within food handling practices within both full service and fast food restaurants. The summary is transcribed from the data results established within the FDA occurrence of foodborne illness in foodservice establishments report.
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Table 1: Summary of risk factors primarily leading to unsafe food handling within full service and fast food restaurants.
Source: FDA (2009)
- Risk factors pertaining to both fast food and full service restaurants
- Risk factors pertaining to fast food restaurants
- Risk factors pertaining to full service restaurants
In summary, for both full service and fast food restaurants, there is a clear correlation towards the gap in safe food handling practices relating to improper holding time and temperature, poor personal hygiene, and contaminated equipment/prevention of contamination respectively. More specifically, safe food handling gaps that require the most attention within both restaurant foodservice segments include the hot and cold holding of potentially hazardous food; date marking; proper and/or adequate handwashing; prevention of contamination from hands; poor hygiene practices; cleaning and sanitizing of food contact areas; protection from environmental contamination; and lastly, the separation of raw animal products from other food types. For fast food restaurants, it is essential that time is used as a public health control which should be routinely monitored before an unsafe product reaches the consumer. Contrary, for full service restaurants, it will be essential that potentially hazardous food be cooled adequately; ready-to-eat food and potentially hazardous food be discarded after 4 days; separating raw animal food products from each other; potentially hazardous food be rapidly reheated to 74°C for 15 seconds for hot holding and lastly, shellstock tags retained for 90 days needs further attention (FDA 2009).