Importance of food safety knowledge and other determinants of positive attitudes and safe practices among food handlers in the EMRO region

1. The importance of food safety
knowledge, attitudes and Practices
(KAP) among food handlers in the
region
WHO/EMRO regional meeting
5-7 April in Amman
Dima Faour-Klingbeil, MSc., MIFST
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food safety auditor, DFK for Safe Food Environment

2. FOOD SAFETY : A
GROWING GLOBAL
CONCERN
Foodborne disease outbreaks continue
to occur worldwide, often intensified by
globalized trade that substantially
impact costs to individuals, the food
industry and the economy.
Dima Faour-Klingbeil, MSc.,MIFST
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

3.  The 2011 outbreak in Germany:Shiga toxin-
producing E. coli O104
 E. coli serotype O157:H7 outbreaks
(Lettuce)
 In 2012, a multistate Outbreak of Shiga
Toxin-producing Escherichia coli O145
Infections
 Multistate Outbreak of Shiga toxin-
producing Escherichia coli O157:H7
Infections Linked to Ready-to-Eat Salads
 2014, Multistate Outbreak of Listeriosis
Linked to Commercially Produced,
Prepackaged Caramel Apples Made from
Bidart Bros. Apples

4. 2014: Lebanon's health minister closes restaurant over 40 food
poisoning cases
March 2015
Over 100 Egyptian, Tunisian, Sudanese and Omani pilgrims Sunday
night suffered from food poisoning after dinner
April 2013:
Egypt: Al-Azhar's Food Poisoning cases rises to 479.
Jordan 2014:Mother dies of food poisoning”
RECENT CASES IN THE REGION
Dima Faour-Klingbeil, MSc.,MIFST
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment
May 2014 : More than 150 food poisoning cases in Saudi Arabia/month
associated with eating out at popular restaurants (Salads)

5. Up to 70% of the food borne
illnesses in the USA, the UK and
Netherlands were associated with
catering or food service
establishments
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment
Improper food handling
may be implicated in
majority of all foodborne
illness associated with
catering outlets

6. Unhygienic handling of food
Cross contamination
Time/Temperature control

7. “27 % of food exports from Egypt, Jordan,
Lebanon, and Syria to the United States were
rejected by the U.S. Food and Drug
Administration due to non-compliance with the
U.S. safety measures”
Food Safety Around the World, Center for Science in the Public Interest (CSPR), June 2005
January - June 2001:
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

8. Input
supply
Agri.
Production Handling Processing Wholesalers/
Distributions
Retailers Consumers
FOOD
SAFETY
• Microbiological
hazards
• Physical hazards• Chemicals hazards

9. FOOD SAFETY CHALLENGES
 Global trade
 Food production
 Consumption pattern and lifestyle
 Emergence of new pathogens
 Overlapping role of authorities
 Up-to-date legislation
 Risk-based system
 Cultural diversity
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

12.  It is a mandatory for any person
directly involved in food handling to
possess a valid training
 Certificate before being engaged as
food workers
Under the Food Hygiene
Regulations 2009 (Act 281)
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

13. Pre-employment checks on the health of
food handlers and other workers in food
businesses are not required by law, but
they have been common in the food
industry for many years.
Snapshot of someone’s current health
Reveal health information
BUT no anticipation of the health status
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

14. WHAT FOOD HANDLERS
NEED TO KNOW?
To keep
food
safe
General
Hygiene
practices
Organization
commitment
and
regulations
Specific Safe
handling

15. Knowledge
Practices
Attitude
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

16. ASSESSMENT OF KAP

18. Muhammad et al (2010) Consumers’ Attitudes and Perceptions of Food
Safety in the United Arab Emirates
Sharif et al (2010) Knowledge, attitude and practice of Taif University
students on food poisoning
Ansari-Lari et al. (2010) Knowledge, attitudes and practices of workers
on food hygienic practices in meat processing
plants in Fars, Iran
Sharif et al. (2013) Food Hygiene Knowledge, Attitudes and Practices
of the Food Handlers in the Military Hospitals in
Jordan
Osaili et al (2013) Food safety knowledge among food workers in
restaurants in Jordan
Faour-Klingbeil et al.(2015) Investigating a link of two different types of food
business management to the food safety
knowledge, attitudes and practices of food
handlers in Beirut, Lebanon
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

19. IMPACT OF TRAINING ON
KNOWLEDGE
 Poor knowledge on temperature control and cross
contamination
 Trained food demonstrated higher knowledge in
food safety
 Restaurant Association's SERVSAFE®
program led to significant improvements in
all areas.
 FOODSAFE trained food handlers'
reported significantly better hand washing
practices and attitudes.
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

20. IMPACT OF FOOD
SAFETY KNOWLEDGE
 Theoretical training programs as well as practical
activities were important tool in which food handlers
 Food safety information sheet on practices within the
foodservice environment impacted food handler behaviors.
 Food safety training influenced the reduction of overall
microbiological parameters
 Knowledge fostered better practices and positive attitude
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

21. Jordan:
Trained food workers scored higher in knowledge test
than untrained group,
 Poor knowledge regarding foodborne pathogens
and safe storage, thawing, cooking and reheating
of the foods
Iran:
Respondents had acceptable level of knowledge,
excellent attitudes,
 and poor practices toward food hygiene measures
Lebanon:
Trained food handlers scored higher in knowledge and in
self -reported practices.
 Limited knowledge in critical food safety areas

22.  Positive attitude to food safety was not correlated with
self-reported practices
 Discrepancy between self-reported behavior
and observed or actual behavior
(e.g. Faour-Klingbeil, et al.2015, Angellilo, Viggiani, Rizzio, &Bianco, 2000).
IMPACT OF KNOWLEDGE,
ATTITUDES AND PRACTICES
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

23. Training
Improvement in post-training inspection scores
After six months
Inspection scores
reduced
A reduction in post-
training performance
After only eight
weeks

24. Food safety performance
FSP
Structural &
hygienic
conditions
Processes
Behavior
Knowledge

25. INADEQUATE FOOD SAFETY
PRACTICES
Lack of Knowledge
Lack of motivation
Ineffective system
Lack of skills
Lack of time and resources
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

26. Managerial support
the availability of equipment and tools
Training and pre-training motivation
Influence of cultural background, legislation,
environmental
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

27. 0
10
20
30
40
50
60
Why?
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
On the
uppermost rack
In the lowest
rack
In the middle It doesn’t matter I don't know Depends on the
ventilator
Keep it out
covered
Where in the fridge frozen meats are thawed?

28. Contrasting results on practices when paralleled to
attitudes of food handlers towards food safety
Practices related to temperature control are not
diffused :
“we make sure foods are transported in cooled vehicles”
• The food temperature during cooling and reheating
as well as during cooking
• Coolers/freezers and display counter
• Temperature of incoming cold or frozen items
“by experience, visually”
“There are external gauges”

29. PROVISION OF KNOWLEDGE TO
IMPROVE FOOD HANDLING
PRACTICES
 Barriers
 Quality of training and intervals
 Workplace, allowing for practical
reinforcement
 Job specific to influence operational
practices.
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

30. General food safety principles
Monitor and evaluate compliance
Food legislation requirements
Information, training, communication
Knowledge of formal enforcement
SAFE PRACTICES
Food service/
Manufacturing industry

31. FOR BETTER FOOD SAFETY
PERFORMANCE
“Only knowledgeable, motivated and skilled
employee who are trained to follow procedures
together with management that effectively
monitors employee's performances can ensure
food safety”(Cohen, 2001)
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment

32. STATUTORY ROLE
LAW ENFORCEMENT AUTHORITIES
GUIDANCE AND
ADVISORY
FOOD SERVICE/
MANUFACTURING
INDUSTRY

33. EAT SAFE, STAY WELL !
Dima Faour-Klingbeil, MIFST,
PhD candidate, School of biological sciences, Plymouth university
Certified trainer and food auditor, DFK for Safe Food Environment;..