Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study
Abstract
:1. Introduction
2. Methods and Materials
2.1. Study Settings
2.2. Study Design, Subjects and Sampling
2.3. Sample Size Calculation
2.4. Interviews and Data Collection
2.5. Study Variables and Measures
2.5.1. Explanatory Variables
2.5.2. Outcome Measures
2.6. Validity and Reliability of the Questionnaire
2.7. Statistical Analyses
3. Results
3.1. Sociodemographic and Employment-Related Characteristics of Study Participants (N = 191)
3.2. Food Safety Knowledge and Its Associated Factors among Food Handlers in Bangladeshi Hospitals
3.3. Food Safety Attitudes and Associated Factors among Food Handlers in Bangladeshi Hospitals
3.4. Food Safety Practices and Associated Factors among Food Handlers in Hospitals
3.5. Association of Food Safety Knowledge, Attitudes and Practice Scores
4. Discussion
4.1. Strength and Limitations
4.2. Implication for Practice
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Frequency | Percentage |
---|---|---|
Gender | ||
Male | 173 | 90.6 |
Female | 18 | 9.4 |
Age (in year) | ||
18–25 | 94 | 49.2 |
26–35 | 70 | 36.6 |
≥36 | 27 | 14.2 |
Marital status | ||
Single | 107 | 56.0 |
Married | 84 | 44.0 |
Education status | ||
No formal education | 36 | 18.8 |
Primary | 88 | 46.1 |
Secondary | 47 | 24.6 |
Higher Secondary | 13 | 6.8 |
Honors or above | 7 | 3.7 |
Monthly income (in BDT) | ||
<10,000 | 48 | 25.1 |
10,001–15,000 | 58 | 30.4 |
15,001–20,000 | 59 | 30.9 |
20,001–25,000 | 14 | 7.3 |
>25,000 | 12 | 6.3 |
Work experience (in years) | ||
<5 | 79 | 41.4 |
5–10 | 77 | 40.3 |
>10 | 35 | 18.3 |
Employment type | ||
Full time | 156 | 81.7 |
Part time | 21 | 11.0 |
Temporal | 14 | 7.3 |
Current employment position | ||
Food service supervisor | 9 | 4.7 |
Chef | 71 | 37.2 |
Support staff | 111 | 58.1 |
Food safety training | ||
Yes | 108 | 56.5 |
No | 83 | 43.5 |
Idea about HACCP system | ||
Yes | 45 | 23.6 |
No | 146 | 76.4 |
Employed hospital type | ||
Government | 28 | 14.7 |
Private | 163 | 85.3 |
Number of beds in the hospital | ||
<250 | 94 | 49.2 |
≥250 | 97 | 50.8 |
Working sectors | ||
Patient meals | 78 | 40.8 |
Cafeteria for staff and visitors | 113 | 59.2 |
In charge of food service operation in the hospital | ||
Hospital administrator | 125 | 65.4 |
Nutritionist | 8 | 4.2 |
Food service supervisor | 34 | 17.8 |
Dietitian | 24 | 12.6 |
Statements | Responses, n (%) | ||
---|---|---|---|
True | False | Don’t Know | |
Preparation of food in advance could contribute to food poisoning. | 167 (87.4) | 14 (7.3) | 10 (5.2) |
Reheating food is likely to contribute to food contamination. | 128 (67) | 43 (22.5) | 20 (10.5) |
The correct temperature for storing perishable foods is 5 °C. | 99 (51.8) | 23 (12) | 69 (36.1) |
Incorrect application of cleaning/sanitization procedures on equipment (refrigerator, slicing machine) can increase the risk of foodborne disease to consumers. | 181 (94.8) | 6 (3.1) | 4 (2.1) |
Hand washing before handling food, using only water reduce the risk of contamination. | 32 (16.8) | 150 (78.5) | 9 (4.7) |
Wearing gloves while handling food reduces the risk of transmitting infection to consumers. | 169 (88.5) | 7 (3.7) | 15 (7.9) |
Wearing gloves while handling food reduces the risk of transmitting infection to food-services staff. | 165 (86.4) | 13 (6.8) | 13 (6.8) |
Eating and drinking in the work place increases the risk of food contamination. | 114 (59.7) | 54 (28.3) | 23 (12) |
During infectious disease of skin and eye, it is necessary to take leave from work. | 167 (87.4) | 13 (6.8) | 11 (5.8) |
Cross-contamination is when microorganisms from a contaminated food are transferred by the food handler’s hands or utensils to another. | 167 (87.4) | 8 (4.2) | 16 (8.4) |
All persons, including children, adults, pregnant women and old-ages are at equal risk for food poisoning. | 146 (76.4) | 27 (14.1) | 18 (9.4) |
Typhoid can be transmitted by food. | 72 (37.7) | 32 (16.8) | 87 (45.5) |
Diarrhea can be transmitted by food. | 173 (90.6) | 11 (5.8) | 7 (3.7) |
Hepatitis A can be transmitted by food. | 53 (27.7) | 43 (22.5) | 95 (49.7) |
E. coli is a food borne pathogen. | 32 (16.8) | 3 (1.6) | 156 (81.7) |
Salmonella is among the foodborne pathogens. | 27 (14.1) | 2 (1) | 162 (84.8) |
Staphylococcus is among the foodborne pathogens. | 21 (11) | 1 (0.5) | 169 (88.5) |
Clostridium botulinum is among the foodborne pathogens. | 22 (11.5) | 1 (0.5) | 168 (88) |
Statements | Responses, n (%) | ||
---|---|---|---|
Agree | Disagree | No Idea | |
One of the most important responsibilities of the food handlers is to maintain food safety measures. | 183 (95.8) | 6 (3.1) | 2 (1) |
Raw and cooked foods should be stored separately to reduce risk of food contamination. | 177 (92.7) | 9 (4.7) | 5 (2.6) |
Food hygiene training for workers is an important issue in reducing risk of food contamination. | 172 (90.1) | 9 (4.7) | 10 (5.2) |
It is necessary to check the temperature of the refrigerator periodically to reduce risk of food contamination. | 154 (80.6) | 12 (6.3) | 25 (13.1) |
Health status of the workers should be evaluated before employment. | 116 (60.7) | 40 (20.9) | 35 (18.3) |
Foodborne illnesses can have deleterious health and economic effects on the society. | 143 (74.9) | 19 (9.9) | 29 (15.2) |
Safe food handling to avoid contamination and diseases is part of food-service staff’s job responsibilities. | 166 (86.9) | 16 (8.4) | 9 (4.7) |
After serving food, any leftovers should be kept in refrigerator. | 111 (58.1) | 63 (33) | 17 (8.9) |
I think it is unsafe to leave cooked food out of the refrigerator for more than two hours. | 75 (39.3) | 44 (23) | 72 (37.7) |
Using watches, earrings and rings will increase the risk of food contamination. | 118 (61.8) | 51 (26.7) | 22 (11.5) |
Food handlers who have abrasions or cuts on hands should not touch foods without gloves. | 174 (91.1) | 13 (6.8) | 4 (2.1) |
Food Safety Practices | Responses, n (%) | ||||
---|---|---|---|---|---|
Never | Rarely | Sometimes | Often | Always | |
Do you wash your hands before touching unwrapped raw food? | 9 (4.7) | 14 (7.3) | 26 (13.6) | 8 (4.2) | 134 (70.2) |
Do you wash your hands after touching unwrapped raw food? | 5 (2.6) | 9 (4.7) | 25 (13.1) | 4 (2.1) | 148 (77.5) |
Do you wash your hands before touching unwrapped cooked food? | 1 (0.5) | 2 (1) | 21 (11) | 7 (3.7) | 160 (83.8) |
Do you wash your hands after touching unwrapped cooked food? | 1 (0.5) | 2 (1) | 12 (6.3) | 5 (2.6) | 171 (89.5) |
Do you wear apron during work? | 12 (6.3) | 7 (3.7) | 24 (12.6) | 13 (6.8) | 135 (70.7) |
Do you use hair cover during work? | 18 (9.4) | 3 (1.6) | 20 (10.5) | 12 (6.3) | 138 (72.3) |
Do you use mask when you prepare or distribute foods? | 6 (3.1) | 5 (2.6) | 16 (8.4) | 16 (8.4) | 148 (77.5) |
Do you use separate kitchen utensils to prepare raw and cooked food? | 16 (8.4) | 4 (2.1) | 14 (7.3) | 7 (3.7) | 150 (78.5) |
If you have lesions on your hands, you treat yourself and complete your work? | 118 (61.8) | 9 (4.7) | 14 (7.3) | 36 (18.8) | 14 (7.3) |
Do you allow your finger nails to grow as wearing gloves protects the transmission of germs? | 169 (88.5) | 2 (1) | 14 (7.3) | 2 (1) | 4 (2.1) |
Do you thaw food at room temperature? | 26 (13.6) | 14 (7.3) | 55 (28.8) | 41 (21.5) | 55 (28.8) |
Do you ask for cleaning food contact surfaces before and after preparing food? | 4 (2.1) | 2 (1) | 25 (13.1) | 7 (3.7) | 153 (80.1) |
Do you check shelf life of food products while using them? | 6 (3.1) | 5 (2.6) | 25 (13.1) | 9 (4.7) | 146 (76.4) |
Do you check integrity of food packages while buying food products? | 17 (8.9) | 5 (2.6) | 30 (15.7) | 15 (7.9) | 124 (64.9) |
Do you smoke inside food processing areas? | 172 (90.1) | 2 (1) | 14 (7.3) | 2 (1) | 1 (0.5) |
Characteristics | Knowledge Score | Attitude Score | Practice Score | |||
---|---|---|---|---|---|---|
Mean ± SD | p Value † | Mean ± SD | p Value †† | Mean ± SD | p Value †† | |
Gender | 0.003 | 0.092 | 0.159 | |||
Male | 10.96 ± 3.03 | 8.40 ± 1.94 | 50.16 ± 9.83 | |||
Female | 8.72 ± 2.82 | 7.56 ± 2.04 | 49.44 ± 6.91 | |||
Age (in year) | 0.576 | 0.579 | 0.533 | |||
18–25 | 10.57 ± 2.43 | 8.50 ± 1.80 | 51.66 ± 8.68 | |||
26–35 | 11.06 ± 3.37 | 8.13 ± 2.01 | 49.21 ± 9.97 | |||
36–45 | 10.56 ± 4.19 | 8.19 ± 2.35 | 46.89 ± 10.73 | |||
Marital status | 0.188 | 0.476 | 0.378 | |||
Single | 10.48 ± 2.52 | 8.26 ± 1.90 | 50.02 ± 9.79 | |||
Married | 11.10 ± 3.66 | 8.39 ± 2.04 | 50.18 ± 9.36 | |||
Education status | <0.001 | 0.062 | 0.006 | |||
No formal education | 10.06 ± 2.76 | 8.56 ± 2.01 | 52.17 ± 7.57 | |||
Primary | 10.33 ± 2.53 | 8.07 ± 1.90 | 49.62 ± 9.81 | |||
Secondary | 10.66 ± 3.05 | 8.21 ± 2.19 | 47.49 ± 10.73 | |||
Higher Secondary | 12.62 ± 4.21 | 8.92 ± 1.32 | 53.31 ± 8.26 | |||
Honors or above | 16.71 ± 1.11 | 9.86 ± 0.69 | 56.71 ± 0.76 | |||
Monthly income (in BDT) | <0.001 | 0.051 | <0.001 | |||
<10,000 | 9.90 ± 2.68 | 7.94 ± 2.16 | 48.35 ± 9.09 | |||
10,001–15,000 | 10.26 ± 2.75 | 8.34 ± 2.05 | 51.53 ± 9.10 | |||
15,001–20,000 | 11.08 ± 2.57 | 8.41 ± 1.74 | 50.69 ± 9.51 | |||
20,001–25,000 | 9.71 ± 3.85 | 7.93 ± 2.06 | 41.93 ± 11.93 | |||
>25,000 | 16.08 ± 1.93 | 9.75 ± 0.62 | 56.58 ± 0.90 | |||
Work experience (in years) | <0.001 | 0.031 | 0.003 | |||
<5 | 9.78 ± 2.54 | 7.87 ± 2.05 | 47.94 ± 10.02 | |||
5–10 | 11.30 ± 3.12 | 8.62 ± 1.75 | 52.18 ± 8.21 | |||
>10 | 11.71 ± 3.56 | 8.66 ± 2.04 | 50.34 ± 10.53 | |||
Employment type | 0.011 | 0.045 | 0.054 | |||
Full time | 11.00 ± 3.06 | 8.45 ± 1.85 | 50.67 ± 9.38 | |||
Part time | 8.86 ± 2.29 | 7.10 ± 2.47 | 44.29 ± 10.76 | |||
Temporal | 10.79 ± 3.45 | 8.71 ± 1.68 | 52.36 ± 7.09 | |||
Employment position | <0.001 | 0.023 | 0.042 | |||
Food service supervisor | 15.33 ± 3.54 | 9.56 ± 1.42 | 54.78 ± 5.22 | |||
Chef | 10.13 ± 2.89 | 7.94 ± 2.01 | 47.34 ± 10.93 | |||
Support staff | 10.77 ± 2.85 | 8.46 ± 1.91 | 51.47 ± 8.47 | |||
Food safety training | <0.001 | <0.001 | <0.001 | |||
Yes | 12.13 ± 2.78 | 9.15 ± 1.34 | 54.81 ± 4.82 | |||
No | 8.95 ± 2.46 | 7.24 ± 2.11 | 43.94 ± 10.70 | |||
Idea about HACCP system | <0.001 | 0.006 | <0.001 | |||
Yes | 12.82 ± 3.39 | 9.09 ± 1.28 | 53.58 ± 6.97 | |||
No | 10.11 ± 2.68 | 8.08 ± 2.07 | 49.01 ± 10.02 | |||
Employed hospital type | <0.001 | <0.001 | <0.001 | |||
Government | 7.86 ± 1.96 | 6.07 ± 1.27 | 35.50 ± 6.36 | |||
Private | 11.25 ± 2.96 | 8.71 ± 1.79 | 52.60 ± 7.60 | |||
Number of beds in the hospital | 0.019 | 0.194 | 0.132 | |||
<250 | 11.28 ± 3.16 | 8.47 ± 1.99 | 50.90 ± 9.24 | |||
>250 | 10.24 ± 2.92 | 8.18 ± 1.92 | 49.30 ± 9.88 | |||
Working sectors | <0.001 | <0.001 | <0.001 | |||
Patient meals | 9.46 ± 3.31 | 7.10 ± 2.04 | 42.64 ± 10.92 | |||
Cafeteria for staff and visitors | 11.64 ± 2.58 | 9.16 ± 1.38 | 55.23 ± 2.89 | |||
In charge of food service operation in the hospital | <0.001 | <0.001 | <0.001 | |||
Hospital administrator | 11.18 ± 2.86 | 8.86 ± 1.70 | 53.36 ± 6.54 | |||
Nutritionist | 7.88 ± 2.53 | 5.63 ± 0.92 | 37.50 ± 7.11 | |||
Food service supervisor Dietitian | 11.71 ± 3.29 8.08 ± 1.98 | 8.53 ± 1.90 6.13 ± 1.23 | 50.91 ± 10.22 36.08 ± 6.53 |
Variables | Model 1: Food Safety Knowledge | Model 2: Food Safety Attitudes | Model 3: Food Safety Practices | |||
---|---|---|---|---|---|---|
β | 95% CI | β | 95% CI | β | 95% CI | |
Gender | ||||||
Male | 1.82 * | 0.53, 3.10 | 0.49 | −0.36, 1.35 | −0.66 | −3.43, 2.11 |
Female | RC | RC | RC | |||
Age (in year) | ||||||
18–25 | RC | RC | RC | |||
26–35 | 0.37 | −0.63, 1.37 | −0.02 | −0.68, 0.63 | −0.30 | −2.40, 1.80 |
36–45 | −0.52 | −2.22, 1.08 | 0.60 | −0.44, 1.64 | 1.03 | −2.33, 4.39 |
Marital status | ||||||
Single | RC | RC | RC | |||
Married | 0.23 | −0.80, 1.26 | −0.04 | −0.71, 0.63 | 0.14 | −2.01, 2.29 |
Education status | ||||||
No formal education | RC | RC | RC | |||
Primary | 0.19 | −0.70, 1.07 | −0.39 | −0.97, 0.18 | −0.63 | −2.48, 1.23 |
Secondary | 0.37 | −0.68, 1.42 | −0.00 | −0.68, 0.68 | −1.42 | −3.62, 0.78 |
Higher Secondary | 0.70 | −0.86, 2.27 | −0.27 | −1.29, 0.75 | 0.69 | −2.60, 3.97 |
Honors or above | 2.25 | −0.59, 5.10 | −0.54 | −2.40, 1.32 | 0.86 | −5.14, 6.87 |
Monthly Income (BDT) | ||||||
<10,000 | RC | RC | RC | |||
10,001–15,000 | −0.03 | −0.96, 0.90 | 0.20 | −0.40, 0.80 | 2.82 * | 0.87, 4.77 |
15,001–20,000 | 0.84 | −0.39, 2.06 | 0.68 | −0.13, 1.48 | 5.07 * | 2.47, 7.67 |
20,001–25,000 | 1.19 | −0.64, 3.02 | 1.39 * | 0.20, 2.59 | 1.22 | −2.69, 5.13 |
>25,000 | 3.19 * | 0.84, 5.55 | 0.13 | −1.44, 1.69 | 2.43 | −2.61, 7.48 |
Work experience | ||||||
<5 years | RC | RC | RC | |||
5–10 years | 0.43 | −0.38, 2.05 | 0.13 | −0.40, 0.66 | 0.91 | −0.79, 2.62 |
>10 years | 0.45 | −0.77, 1.66 | 0.09 | −0.70, 0.88 | −0.59 | −3.14, 1.95 |
Employment type | ||||||
Full time | RC | RC | RC | |||
Part time | 0.39 | −0.72, 1.50 | 0.09 | −0.63, 0.82 | 1.80 | −0.53, 4.12 |
temporal | 0.19 | −1.03, 1.41 | 0.09 | −0.71, 0.87 | 0.05 | −2.51, 2.62 |
Employment position | ||||||
Food service supervisor | RC | RC | RC | |||
Chef | −0.51 | −2.90, 1.88 | −0.34 | −1.90, 1.22 | 0.77 | −4.24, 5.79 |
Support staff | 0.14 | −2.25, 2.54 | −0.16 | −1.72, 1.40 | 1.01 | −4.01, 6.03 |
Food safety training | ||||||
Yes | 0.75 | −0.18, 1.68 | 0.12 | −0.49, 0.73 | 1.61 | −0.36, 3.57 |
No | RC | RC | RC | |||
Idea about HACCP system | ||||||
Yes | RC | RC | RC | |||
No | −0.26 | −1.18, 0.65 | 0.27 | −0.33, 0.87 | 0.69 | −1.24, 2.62 |
Employed hospital type | ||||||
Government | RC | RC | RC 15.93 * | 10.15, 21.71 | ||
Private | 4.00 * | 1.37, 6.64 | 2.29 * | 0.52, 4.05 | ||
Number of beds in the hospital | ||||||
<250 | RC | RC | RC | |||
≥ 250 | −0.26 | −1.16, 0.64 | 0.14 | −0.44, 0.73 | 0.94 | −0.95, 2.82 |
Working sectors | ||||||
Patient meals | RC | RC | RC | |||
Cafeteria | 4.69 * | 2.99, 6.39 | 2.84 * | 1.63, 4.04 | 13.72 | 9.60, 17.84 |
In charge of food service operation in the hospital | ||||||
Hospital administrator | RC | RC | RC | |||
Nutritionist | 1.83 | −0.42, 4.08 | 0.33 | −1.14, 1.81 | 5.15 * | 0.39, 9.90 |
Food service supervisor | 4.36 * | 2.63, 6.08 | 2.11 * | 0.91, 3.32 | 11.44 * | 7.42, 15.47 |
Dietitian | 5.82 * | 2.71, 8.93 | 2.37 * | 0.26, 4.47 | 13.01 * | 6.12, 19.89 |
Food safety knowledge score | NI | 0.18 * | 0.09, 0.29 | 0.31 | −0.03, 0.64 | |
Food safety attitudes score | NI | NI | 0.87 * | 0.37, 1.37 | ||
Food safety practices score | NI | NI | NI |
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Al Banna, M.H.; Khan, M.S.I.; Rezyona, H.; Seidu, A.-A.; Abid, M.T.; Ara, T.; Kundu, S.; Ahinkorah, B.O.; Hagan, Jr., J.E.; Tareq, M.A.; et al. Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study. Nutrients 2022, 14, 2540. https://doi.org/10.3390/nu14122540
Al Banna MH, Khan MSI, Rezyona H, Seidu A-A, Abid MT, Ara T, Kundu S, Ahinkorah BO, Hagan, Jr. JE, Tareq MA, et al. Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study. Nutrients. 2022; 14(12):2540. https://doi.org/10.3390/nu14122540
Chicago/Turabian StyleAl Banna, Md. Hasan, Md Shafiqul Islam Khan, Humayra Rezyona, Abdul-Aziz Seidu, Mohammad Tazrian Abid, Tasnu Ara, Satyajit Kundu, Bright Opoku Ahinkorah, John Elvis Hagan, Jr., Md. Abu Tareq, and et al. 2022. "Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study" Nutrients 14, no. 12: 2540. https://doi.org/10.3390/nu14122540