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Food Control 27 (2012) 206e213

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Knowledge, attitudes and practices in food safety and the presence of coagulase-
positive staphylococci on hands of food handlers in the schools of Camaçari, Brazil
Lilian S. Soares, Rogeria C.C. Almeida*, Ellayne S. Cerqueira, Joelza S. Carvalho, Itaciara L. Nunes
Escola de Nutrição, Universidade Federal da Bahia, Av. Araújo Pinho, n 32, Canela, Salvador-Bahia, Cep: 40.110-160, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: The aim of this study was to evaluate the level of knowledge, attitudes and practices in food safety and
Received 30 August 2011 the presence of coagulase-positive staphylococci species on the hands of food handlers in the municipal
Received in revised form schools of Camaçari, Bahia in northeast Brazil. This study was conducted in two stages. In the first stage,
9 March 2012
166 food handlers were interviewed via a questionnaire to assess their food safety knowledge, attitudes
Accepted 17 March 2012
and practices. In the second phase, the presence of coagulase-positive staphylococci species on the hands
of food handlers was determined. The results indicated that most of the handlers had been trained
(92.2%), but the level of knowledge was insufficient; the average proficiency score was <70% accuracy.
Food handlers
Food safety knowledge
Attitude received the highest scores, and no handler had a score below 50.0%. Logistic regression analysis
Coagulase-positive staphylococci showed that the level of education and specific subject expertise of the handlers were associated with
general knowledge about food safety. Food handler overall had positive attitudes on food safety with all
scores above 50.0%. Despite a high prevalence of training and positive attitudes about food safety, 53.3%
of the hand samples showed the presence of coagulase-positive staphylococci. No associations were
found between the knowledge attitudes and practices of food handlers and the presence of the pathogen
on their hands. The results showed inadequate sanitary practices of food handlers, highlighting the need
to review the current model for training food handlers and to improve accessibility to sinks and supplies
to ensure proper hygiene.
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction various stages of food preparation (Santana, Almeida, Ferreira, &
Almeida, 2009).
Food-borne diseases have been increasing in recent years, with In Brazil, the National School Feeding Program (NFP) was
a greater impact on the health and economy of developing coun- responsible in 2010 for the 45.6 million meals distributed in public
tries than developed countries (WHO, 2007). According to the schools to students. Currently this program provides the food
World Health Organization, in 2005 alone, 1.8 million people died supply for students (from day care institutions, elementary and
from diarrheal diseases, and most of these cases were attributed to high schools, and general education for youth and adults) enrolled
the ingestion of contaminated food and drinking water. in public and philanthropic schools (FNDE, 2009). For many
Meals prepared and distributed in schools should receive special students, these meals are the primary meal, and often the only meal
attention because the foods are intended for young children, consumed by students in a day (Brasil, 2009).
a population with an increased risk for several diseases due to Good personal hygiene and sanitary handling practices at work
microbial pathogens in foods. To ensure high quality meals for are an essential part of any prevention program for food safety.
students, catering services need to follow the regulations set forth Although the majority of food handlers have the skills and
by the Health Surveillance Committee. Despite the existence of knowledge to handle food safely, human handling errors have been
specific regulations, the safety measures taken during school meal implicated in most outbreaks of food poisoning (Ehiri & Morris,
preparation are still inadequate, as most schools do not take into 1996; Greig, Todd, Bartleson, & Michaels, 2007; Howes, Mcewen,
consideration the specific sanitary requirements needed for the Griffiths, & Harris, 1996). The inappropriate handling of foods by
the food service industry has been implicated in 97% of food
poisoning cases (Greig et al., 2007; Howes et al., 1996). There is no
indication that food-borne illnesses are diminishing.
* Corresponding author. Tel.: þ55 71 3283 8937; fax: þ55 71 3283 7705. Worldwide, numerous food-borne disease outbreaks in schools
E-mail address: (R.C.C. Almeida). have been reported (Hutin et al., 1999; Nicholas et al., 2002), but the

0956-7135/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved.

2010). Practices reported as sporadic (seldom. 2005). & “good” knowledge. & d’Azevedo. 2010).. & Raspor. hygiene. 2006) because most handlers interviewed had in various parts of the world (Ansari-Lari et al. Because of this. however. and contaminated with S. of coagulase-positive staphylococci species on hands of food Handlers that answered 11 or fewer questions correctly were handlers in the municipal schools of Camaçari in northeast Brazil. more “insufficient” knowledge and those that had scores equal to or knowledge of food safety practices does not always lead to positive greater than 18 points (70% accuracy) were considered to have changes in food handling behaviors (Ansari-Lari. S. Ninety-four handlers were from schools in the metropolitan regarded as “good” practices. area (response rate of 96. Handlers that had practice (Sharif & Al-Malki. relationship between enough to warrant hospitalization (Argudín.. and 72 handlers were from schools on the waterfront (response rate of 100%). Hlebec. osteomielites. “often”. 2008. 2010. Pearson’s chi-square (X2) and Fisher’s tests. part 4: attitudes on food safety. Greco. Material and methods considered to have “good” understanding. The knowledge section (part 3) included 25 close-ended ques- ulation is so high that it is likely impossible to completely eliminate tions with three possible answers. Meally. attitudes and one (1) point was awarded. & Otero. SEG to SEI. and “always”. The work load. indicating “strongly disagree” and five (5) indicating “totally agree”.2%). / Food Control 27 (2012) 206e213 207 extent of these outbreaks has not been systematically described.. Ersun. The questionnaire was analysis of association between variables and for logistic regression . 70% or more correct answers (n  14 points) were 98. Data analysis ously approved by the Ethics Committee of the School of Nutrition of the Federal University of Bahia. we used the same criterion as that used for the other Camaçari. “true”. 2005). Soares et al. considered to have “insufficient” understanding. satisfaction with profession. A total of 52. The term attitudes was indicate that the continuous education is needed to assure used according to Princeton University definition: “a complex constantly a good hygienic quality of food. and Cowan (2008) and Ansari-Lari et al. although staphylococci can also be found on hands. previ. The questions that addressed knowledge.9%).. microor- Three factors are playing major role in the occurrence of food ganisms. fulfill the norms and rules. sometimes or often). However. Results We assessed the knowledge. to SEE. Blair. aureus by improper handling and subsequent part 5: food hygiene practices. with or without diarrhea.e. 2. SER to SET). Soodbakhsh. Hogg.6% of the docu. schools were responsible for 11. Interviews We used multiple logistic regression analyses and two tests of association. “some- on the waterfront (ocean area). 4 and 5) were adapted from the work of Angelillo. length of employment and participation in training). Bonamigo. diseases carried by food. For evaluation. part 3: a main cause of food poisoning that occurs after ingestion of foods knowledge about food safety. students and work team) were adapted from Jevsnik et al. these 90 schools in 2010. (2008). attitudes and prac- ganism is responsible for enormous variety of infections. “false”. L. attitudes and practices of food handlers have been conducted 2001. Capunzo et al. These questions focused on issues regarding personal most important ways to prevent the spread of food-borne diseases. The cut-off point for the analysis of the results Lakzadeh. We assessed the knowledge. hand washing has been identified as one of the know”. For each correct practice reported. were not scored. several studies on the knowl.. 2. Kivanç. edge. endocarditic and bacteremia (Gelatti. SEA of education. The microor. attitudes and practices in food safety and the presence (Sharif & Al-Malki. pneumonias. Bas et al. and Rito (2001). Informed consent. between June and November 2010. There are two major aggravations to its presence: the toxins The questionnaire was organized into the following five distinct production and antimicrobial resistance. Becker. Bolton. storage at elevated temperatures. 2005. Bahia in northeast Brazil. “disagree”.226 students attended times”. level stable enterotoxins with demonstrated emetic activity (SEs. Forty-nine schools hygiene and related food handling procedures. “never”. mental state involving beliefs and feelings and values and dispo- The objectives of the present study were to evaluate the level of sitions to act in certain ways” (http://wordnet. (2010). The attitudes section of the questionnaire (part 4) aimed to Martins. 2012. In section 5. “seldom”. 2010). Jevsnik. Bas. with one (1) The main reservoir of staphylococci in humans is the nostrils. 2010). aureus produces heat. age. Symptoms are of rapid onset and The questions regarding employees’ work satisfaction (part 2: include nausea and violent vomiting. the good hygienic practices of food handlers were We performed a descriptive. attitude and we used a scale ranging between 0 and 25 points. temperature control and hygiene practices. version 13. According to the authors SEs are part 2: information about the employees’ work satisfaction. & already received some form of training. subcutaneous and skin infections. cross-sectional study of 90 public evaluated and were assessed through self-reporting on personal schools in Camaçari. cross contamination. and answers were graded on five levels of intensity. Seaman & Eves. The data collection period occurred cause of food-borne diseases in the world (Normanno et al. even though correct. poisoning with regard to food handlers: knowledge.1. and “do not know”. such as tices (parts 3. The prevalence of the bacteria in the pop. For A total of 169 handlers were registered in the schools of classification. attitudes and practices of food with a p-value < 0. These works determine the understanding of the handler about food safety and reinforce the importance of conducting a preliminary assessment of contained 16 questions that required three levels of answers. 2010). was higher than that reported in other studies (Angelillo et al. The data obtained from the questionnaires were tabulated and analyzed statistically using SPSS software for Windows. i. parts: part 1: demographic information (such as gender.S.05 were considered statistically significant. a nearby town before the final version was distributed to food mented food-borne diseases outbreaks noticed (Brasil. The questionnaire was read and completed by an inter- Staphylococcus aureus is considered the third most important viewer in individual interviews. training needs and evaluating the effectiveness of training and “agree”. where as the handlers that answered 12 or more questions correctly were 2. For handlers using a structured questionnaire. & Rodicio.princeton. Training programs are important a score equal to or less than 17 points were regarded to have for improving the knowledge of food handlers. In peer-reviewed and underwent a pilot study in 40 schools in Brazil in 2005. and 166 participated in interviews (a response rate of parts. Mcdowell. 2006.. practices of food handlers using a structured questionnaire.2. illness is usually self-limiting and only occasionally it is severe conditions to guaranteeing safety of the food. Viggiani. handlers. There were 20 were located in the metropolitan area and 41 schools were located questions with five levels of answers. was provided by each participant. and “do not them. abscesses. Mendoza. 2009).edu/) knowledge.

1e30 Ratio of students to food handlers 2.2). civil servant.4 (9) 80.1 14e922 using swabs moistened with 2 ml of 0.3 (80) did you share it with your colleagues? 3 When you have personal trouble.MO. Soares et al. knowledge and attitudes about 36e55 120.3 (SD ¼ 2.208 L. in general. complete or not High school or higher 9.0 44.3.9 44.0 (25) 48. education level.0 25.0 (20) 76. model 2. Characteristics n % Mean  SD Range Four models for logistic regression analysis were developed to Sex identify the variables that impacted the results of interest. / Food Control 27 (2012) 206e213 models. Half of the handlers said that not all of the the food? 10 The meals served in the school did not 13.8 43. and transported to the laboratory in an insulated cold box strated a rate of 16.2. the school? faction (part 2) showed that 65. aureus Statements Respostas % (n) positive control (ATCC 25923) and one uninoculated negative Disagree No matter Agree control were used for each set of analyzed samples. which conco Corporation.4 (9) 65. Germany) for 30 s.3 temperature control.4  6. correct).0 (83) offered something better to you in mately half (45.9  8.5 presence of soap. understood knowledge Age (years) about food-borne disease.9 personal hygiene. Braun answers. model corresponded to 80.6% of the food model 36210 class BII.0 (88) 44. 10e30 42. In the attitude containing trypticase soy broth in a class II biosafety cabinet (Lab. The colonies were Table 2 identified macro.2% you share it with your principal? were female.05 were Middle school 81. certified ISO 9002.4 (67) 6.0 1.5 239  148. the equivalent of 65.4 (4) 9. 36. streaked onto mannitol salt agar plates and incubated at 37  C for 24 h. and model 4. 53.8 (SD ¼ 1.0 (25) 40. Brazil) and incubated for 24 h at 37  C. considering that most participants had Biotech International.2 employee hygiene practice and food handler practices. and ages ranged between 26 and 65 years.0 63.6% were civil servants (Table 1).9 chosen randomly to be sampled. Brazil (part 1).2% correct filled with ice.6 employment and training. The mean age of participants was 44 (Standard 4 Did you always fulfill the norms and 2. 98.4 Yes 74. evaluation (part 4).6% of the handlers affirmed that 9 The work place provides all the necessary 50.0 44. These swabs were rubbed onto the hands of food handlers during food preparation. were 121e350 106. p-values less than 0. 1 If you could choose the profession. and the dependent variable was the complete or not general knowledge about food safety.3 7.0 (83) 10.6 (147) Deviation ¼ 8.0 72. USA) Labconco (50% correct answers).6 (109) would choose the same one? 3. Civil servants are workers that 7 The team of the kitchen is respected 12.0% determined that the conditions to guaranteeing safety of work load was adequate.8 (18) 39. All models incorporated predictive Education Illiterate 2. Assessment of work place practice and the presence of or not Civil servant coagulase-positive staphylococci on hands No 92. .4 2665 hygiene in relation to practice. each from a different school.8 Female 163.8 considered statistically significant. and 6 The work load is adequate? 40.4 (19) 50.2 variables. These results indicated that 56.0).0 48. did 44. These Male 3. transferred to tubes already undergone previous food safety training.0 36210-04.7 Forty-five food handlers. Sampling and laboratory procedures 10e120 31. knowledge and attitudes of food 56e65 18.0% correct answers.7 (61) 15.8%) of the food handlers did not have a middle another place? school education (less than 8 years of education or illiterate).4 (19) 77. Kansas City.2 (65) they would choose the same profession.6).0 10. have greater by the students? 8 The team of the kitchen is respected 10.1.0 0. by the teachers and other workers of Results obtained in evaluation of the employees’ work satis.4 (67) Of the 166 food handlers who participated in this study. Responses of “do not know/do not remember” were considered incorrect. Approxi. and the lowest rate was 8. the swabs were vortexed (B.2 models included the following: model 1.0 98.8 (18) 11. 5 Did you would leave this work.0 17. knowledge and attitudes of 25e35 28. 2009). Results 2 When you have personal trouble.0 (20) 12.8 (129) employment stability.0 26.0 16.9 80. Samples were aseptically collected 351e950 29. Total Exhaust.8 (23) 5.4).3. length of Elementary school 74. 29. The pres- Length of employment ence and position of washbasins with tap water were assessed with (years) attention given to production flow and service.0 1.6 (74) 15. if they 38. including age.0 (126) the government has pre-approved and. This rate was low. attitudes and practices (KAP) were Table 1 categorized as “good” (70% correct) or “insufficient” (<70% Demographic characteristics of food handlers employed in the schools of Camaçari.0 (15) 88.6 (64) 11.7 (134) necessary conditions were provided in the work place for guaran.6 (11) 53. A loop of liquid was removed from the cultures. Labconco Purifier Class IIb. Additionally.8 Sim 153.0 7.0 48. both before and immediately after the distribution of The survey of the food handlers’ knowledge (part 3) demon- meals.4 education complete 2. One S.0 (48) 5.85% saline solution. catalase and coagulase tests (Souza & Santos.2 evaluated.0 55. the 0e4. the average rate was 12.and microscopically (Gram staining) and by Assessment of employees’ work satisfaction (part 2).S.0 5. scrubbing-brush hands. teeing the safety of the food (Table 2). the levels of knowledge.4 years (SD ¼ 6. and paper towels was 5e9.3.0 18. In the laboratory.0 92. represent health risk to the students. model 3. The rules of the principal? mean length of employment was 7. Assessment of work place practice Training course Visual observations were performed in the kitchens to verify Não 13.6 2.

0 (0) 4 Eating and drinking in the work place increase the risk of food contamination. 76.5 (137) 1. Table 5).9 (121) 2. compare presence/absence of coagulase-positive staphylococci in questions 2.1% correct answers. ready-to-eat food should be kept at a temperature of 65  C. 86.935).4 (9) 6. 93. odor or taste. and between the data obtained. 75. L.4 (155) 6.2 (2) 8 Children.9 (28) 3.0 times more possibilities to have a good level of food handlers from schools located in the metropolitan area of knowledge on food safety when compared with food handler with Camaçari (37.3%) failed to select the correct civil servants the analysis indicated a statistic difference.8) (70. Although.5 (49) 47.2% correct answers) and civil servants (Fig. question number levels of answers. For example. 7. 1). although the questionnaire had been evaluated 15. 10 and 16). respectively). 80.6 (1) 7 Washing utensils with detergent leaves them free of contamination.4 (19) 44.0 (5) 21 The correct temperature for storing perishable foods is 5  C.0% staphylococci on their hands. statistically significant (p ¼ 0. 80. 44.0 (CI95.3% correct answers) on the results obtained.0 (0) 2 Using gloves while handling food reduces the risk of food contamination. healthy adults. 17 Microbes are in the skin. which 81. 98.4%.2 and 20.1 (40) 38.0 (20%) and 18. The models the risk of food contamination. / Food Control 27 (2012) 206e213 209 Table 3 Assessment of food safety knowledge of food handlers in the schools of Camaçari.6 (74) 11. Soares et al.8 (3) 4.6 (79) 22. 53. 63. tested demonstrated significant differences (p < 0. 68.1% knew that microbes can be found in the skin. 97. demonstrating a good level of knowledge participated in the second stage of the study had attended food and attitude about food safety (Table 4). 20 Freezing kills all the bacteria that may cause food-borne illness.1 (45) 4.3 (27) 82.7 (41) 72. aureus is a pathogenic microorganism This analysis presents some limitation due to the use of three that is responsible for food-borne disease (part 3.4 (9) 19 Cross contamination is when microorganisms from a contaminated food are 94. 62.3 (57) 4.4 (37) 1. 16. although in the case of the knowledge of (Table 3). mouth and nose Analyzing the association between other variables.3% (n ¼ 24) had coagulase-positive reported practices.2 (2) handlers did not know that S. we observed a greater percentage of for food-borne diseases had an adjusted OR of 11. 6 and preparation and distribution of meals (Table 7). These statistics differences were observed the presence or absence of coagulase-positive staphylococci on the only when we used the explanatory variable education level.3 (22) 28. employees’ work satisfaction and (97.2 (2) 16.7 (114) 27. 97.3 (47) 23 Contaminated foods always have some change in color. the average value was 14 (SD ¼ 2.9 (13) 6. respectively) were observed.2 (163) 0.0 ganism was observed in the samples collected during food (90%).6 (1) 3 Proper cleaning and sanitization of utensils increase the risk of food contamination. showed significant differences (p < 0.6 (64) 15 Staphylococcus is among the food-borne pathogens. 61.4 (9) 51. . Table 3).6 (84) 14.1 (103) 32.1 (143) 7.094). 90. such as hand washing knowledge about food safety. using gloves (89. question number 25.9 (58) 22 Hot. samples that were negative for the microorganism on the hands of that means 11. this indicates that the presence of infected food handler can raise Logistic regression results are shown in Table 6.05) with the The statistical analysis of the activity of the food handlers and exception of model 2.2 (7) 25 During infectious disease of the skin.9 (58) 14 Hepatitis A virus is among the food-borne pathogens. Most of the participants (75.5 (24) 34. 88.4 (4) 0. to work out the comparison infectious skin disease (part 3. 63. Table 3).9 (38) 13 Salmonella is among the food-borne pathogens.4 (97) 13.9 (136) 1. handlers that presented good level of knowledge about risk groups With regard to the work place. knowledge about food-borne diseases and general sanitary practices in the work place.0 (73) 54. 44. the food handlers achieved scores equal hands.1 (133) 16. Table 3).0%. 98.9 (28) causes botulism.2% of the food handlers recog.3 (105) 33.6 (1) 1.8% of the samples). Brazil (part 3). 58. 50.2 (7) transferred by the food handler’s hands or kitchen utensils to another food.2 (17) 0.0 (156) 1. due to the relatively small number of food handler used to In the questions about hand hygiene and personal health (part 4. (2001). 37. 43. distribution is the last stage in the process of food preparation.3 (105) 1. On the other hand.8% (n ¼ 44) of the food handlers that to or higher than 96.3 (62) 24. safety training programs. In the evaluation of hand hygiene (part 5. nose and mouth of healthy handlers.0 (5) 18 Clean is the same as sanitized. question number 17.S.2 (2) 24 Raw vegetables are at higher risk of contamination than undercooked beef. in a pilot study. answer for the question about high-risk groups for food poisoning In the second stage of the study there are some limitations (Table 3). Age does not have a statistic significant effect proper cleaning of the instruments (75.2 (2) 6 Reheating cooked foods can contribute to food contamination.2 (7) 5 Food prepared in advance reduces the risk of food contamination. high scores (89. preparation and distribution (22. 9 Typhoid fever can be transmitted by food. it is necessary to take leave from work.2 (85) 16 Swollen cans may contain the microorganism. P ¼ 0.4 (4) for food poisoning. 29.6% correct answers).5 (54) 5.4 and 89.4 (127) 22.3 (125) 24.000).7 (56) 3.05) for civil servants and the Almost all of the food workers were aware of the critical role of knowledge level. and values ranged between 4. but this association was not insufficient level of knowledge for this variable.0 (10) 11 Bloody diarrhea can be transmitted by food. The hands (Table 7) showed that although the presence of the micro- models demonstrated that the food handler with higher specific organism was observed in the samples collected during both knowledge had a better knowledge about food safety. pregnant women and older individuals are at equal risk 24. 89.6 (162) 2.6 (11) 12 Abortion in pregnant women can be induced by food-borne disease. Considering that 7.0 (73) 10 AIDS can be transmitted by food. a prevalence of the microor- correct answers). In the evaluation of self. questions 2.4 (72) 5. Clostridium botulinum.8 (3) 34. Statements Responses % (n) Right Wrong Do not know/remember 1 Washing hands before work reduces the risk of food contamination.0 (10) 0.0 (146) 5. The model for questionnaire adopted was adapted nized that it is necessary to take leave from work during cases of from the work of Angelillo et al. there in the analysis of model 1 the results indicates that the food was no significant difference between these variables (p ¼ 0.2 (148) 10.4 (102) 34.1. the results of healthy food handlers (part 3.8 (91) 1.7 (41) 0.

7 (21) 86.3 (125) 24.e.6 (1) jars of food that are also closed. Statements Responses % (n) Right Wrong 1 Do you use gloves during the distribution of unpacked foods? If you never use gloves.8 (164) 0.. Brazil.8 (164) 0.3 (120) 27.5 (44) 69. Discussion contaminated by coagulase-positive staphylococci.6 (1) 0.1% of the food handlers who did not washing has been shown to reduce the risk of diarrhea disease in have contaminated hands were civil servants. practiced by almost all the food handler are very encouraging. / Food Control 27 (2012) 206e213 Table 4 Assessment of food safety attitudes of food handlers in Camaçari schools. the use of gloves with proper hand washing can reduce the risk of dents claimed that they washed their hands before using gloves cross contamination (Montville.6 (1) 8 The best way to thaw a chicken is in a bowl of cold water.2 (95) 20 Do you use the sanitizer when washing fruits? 48.0% of the staphylococci-positive and answered correctly that washing hands before work reduces samples were from food handlers with insufficient knowledge of the risk of food contamination.6 (152) 7. eliminated the risk of cross contamination.4 (4) 0. 96.9 (18) 3 Do you wear an apron while working? 66. 72.5 (117) 29. 12 The ideal place to store raw meat in the refrigerator is on the 12.6 (1) bottom shelf. 98. was not statistically significant (Table 7).0 (98) 14 Do you check the shelf life of foods at the time of delivery? 82. It was observed that 57.2 (136) 17.6 (6) 0.6 (6) 14 Dish towels can be a source of food contamination. Table 5 Assessment of food hygienic practices of food handlers in the schools of Camaçari.5 (137) 0.2 (7) 9 Wearing masks is an important practice to reduce the risk of food 91.4 (4) 1. 16 Food handlers who have abrasions or cuts on their hands should 97.9 (28) 82.e.0 (161) 3. Oporto.0 (18) 16 Do you check the internal temperature of meat with a thermometer? 0.7 (109) 9 Do you wear nail polish when handling food? 86.8 (13) 5 Do you wear a mask when you distribute unwrapped foods? 1.9 (141) 14.9 (33) 12 Do you use cutting boards of different colors or do you sanitize a cutting board between 79. Despite the reported hand washing.7 (56) 4 Do you wear a cap while working? 92.6 (1) 0.7 (46) 11 Do you prepare a meal in advance (i.9 (18) 8 Do you eat or drink in your work place? 34. this association was not statistically signifi..1 (131) 20. but this association child care institutions (Xavier.1 (148) 10.210 L.2 (166) 6 Do you wash your hands properly before touching raw foods? 90.7 (144) 13.2 (153) 7.0 (0) 100 (166) 17 Do you use leftover food? 86.3 (22) 18 Do you properly clean the food storage area before storing new products? 75. 11 Wearing caps is an important practice to reduce the risk of food 98.7 (41) 19 Do you use the sanitizer when washing service utensils (plates.9 (23) 10 Do you taste the food with your hand cupped? 72.6 (1) 2 Proper hand hygiene can prevent food-borne diseases.3 (120) 23.0 (156) 5. Chen.7 (144) 0. however.5 (39) 4. 70. 5 It is necessary to check the temperature of refrigerators/freezers 95.4 (9) 0.9 (116) 3.6 (1) of food contamination. 13 Eggs must be washed immediately after delivery.8 (3) 98.0 (0) 15 Knives and cutting boards should be properly sanitized to prevent 98.0 (0) contamination.6 (1) contamination. These important hygiene measures food safety.6 (162) 2. Table 8 demonstrates that 75.1 (143) 13.0 (68) 59. they can be stored with cans and 84.4 (4) 0. mugs and spoons)? 42. & Abrantes.6 (164) 0.5 (24) 0.3 (110) 33.8 (86) . & Schaffner.6 (16) 7 Do you wash your hands properly after touching raw foods? 89.1 (148) 10. 10 Wearing gloves is an important practice to reduce the risk of food 97.1 (133) 19. 94.8 (30) 15 Do you check the packing integrity of foods at the time of delivery? 89.0 (148) 11.6 (162) 2. 4 Raw and cooked foods should be stored separately to reduce the risk 98. 2001). Silva. Statements Responses % (n) Right Wrong Do not know/remember 1 Well-cooked foods are free of contamination.0 (0) contamination. attitudes. These results are important considering that staphylococcal infections and This investigation provides valuable information about the level related diseases are increasing (Stepanovic et al. 2007) and could certainly do the same in the schools.8 (159) 2.0 (0) not touch foods without gloves.9 (35) preparation of raw foods and cooked foods? 13 Do you thaw food outside the refrigerator (i. the use of gloves nor even the practice of hand washing completely ence of coagulase-positive staphylococci on hands of food handlers. 16. However. 97. 2005) and neither of knowledge.. Soares et al.8 (13) 0. 6 Defrosted foods can be refrozen.6 (1) cross contamination.6 (1) 0. from one shift to another)? 80.5 (49) go to question 3.3 (57) 65. room temperature)? 41. however many employees’ had their hands 4.0 (0) 3 When cleaning products are closed. Silveira.8 (3) 0. 2 Do you wash your hands properly before using gloves? 89. combining An important result from this study was that almost all respon.0 (5) 0. and practices in food safety and the pres.6 (1) 7 The health status of workers should be evaluated before employment.2 (80) 51. Hand cant.8 (3) periodically to reduce the risk of food contamination.8 (71) 57.S.4 (160) 3.4 (150) 9.2 (163) 1. 26.

003 Level of education 3.9e12.3 0.002 Knowledge about refrigeration temperatures 3. 2007. Reinforcing the need to adopt multidimensional approach.8e7. practices and other variables (Pearson’s chi-square).3 1.1 0..5 1. 1. correct practices for hand hygiene do not necessarily results in the mensional. These results corroborate with ensure adequate hygienic practices of food handlers since failures recent work of Ansari-Lari et al.2 0. Todd.8 1. especially since its one of the biggest concerns of a washbasin in the processing area is of primary importance to in the attendance to this clientele. show that the question about AIDS was answered correctly by 86.001 Model 3 Knowledge about freezing versus microorganisms 4.4 1. 2009).5e7.8e9.002 Knowledge about Clostridium versus swollen cans 10. supervisors and colleagues and also provision of the the isolation of methicillin-resistant S.7e6.4 0.1e1. Soares et al. (2010).020 Level of education 3. L.S.0 0. demonstrating that the propagation of the may negatively impact food safety.004 Knowledge about hepatitis virus as a food-borne pathogen 3.0 3. infected food handlers may contaminate foods Unlike the knowledge about food-borne diseases. such as absence of disposable AIDS health campaigns reached the population in general. The soap and towels and also the lack of exclusive wash areas for hand unfamiliarity about the groups of food-borne diseases risks also hygiene (only two schools had an exclusive lavatory).2 0.9 0.1 0. and borne disease outbreaks (Greig et al.0 0.3e13. including visual acknowledgments of awareness by the appliance of these methods because of the work place barriers Fig.2e1.05). attitudes.019 Knowledge about Staphylococcus as a food-borne pathogen 4.1% In the present study important practices were observed that of the food handlers.143 Level of education 4. hepatitis A and the B viruses. Michaels. Staphylococcus caused food-borne disease. One of the main reasons for this concern is the fact that recently handlers.4 0.144 Practice about eat and drink in the work place 0.003 Level of education 3.1 1. aureus (MRSA) strains from necessary resources. 2010).6 1.3 0.2e8.001 that may indicate contamination Knowledge of the shelf life 4.7e11. dents did not know if Salmonella.5 2. the knowledge of proper hand hygiene is not the only studies have demonstrated that the extensive knowledge of the procedure to be applied in training.3 1.1 0. and behaviors of the food handlers. where half of the respon- in hygienic procedures have been associated as the cause of food.7 0..2 1.000 Knowledge about HIV as a food-borne disease 13.6e14. Furthermore.9 0. some Although.7 2.1 1.0 1. Smith.013 Knowledge about microorganisms versus the health of food handlers 17.6 0.5 0.0 0. The presence must be mentioned.9 0.3e75. The training must be multidi.8e8.130 Attitude about masks use 0. These approaches will reinforce the beliefs several food producing animals has been reported.5e34.5 0.001 Model 2a Knowledge about gloves use 2. Variable OR adjusted Confidence interval (95%) p-value Model 1 Knowledge about risk groups for food-borne diseases 11.185 Knowledge about eat and drink in the work place 2.7e12.1 1. Greig. .8e5.000 a Model 2 did not show significant differences (p > 0. after processing.6e62.6e117.9 0.000 Model 4 Knowledge about food contamination versus attributes of foods 5. / Food Control 27 (2012) 206e213 211 Table 6 Results from the logistic regression analyses.4 0.4 0. Bivaried analysis between knowledge. our findings with MRSA during further preparation (Boer et al. & Bartleson.

food workers have been implicated in spread of foodborne disease.1) 19.jsp/ Good (12 right answers) 75. Variable Coagulase-positive staphylococci Total % p-value Argudín.. & Raspor. Todd.. S. M.0) 18/40..0 (6/13) 38.9 (9/20) 22/49 0.9 0. British Food Journal.. W. Radke. P. G. A. et al. No 54. C. M. I.1(12/27) 23/51 using notational analysis. Boletim Ele- Insufficient 58. . (2007). C. taken root are addressed. A. Alimentação Escolar –Histórico. Morris. Food Control. b % represents the frequency of positive or negative samples related to number of samples collected (45).2) 19. Factors related to food worker hand hygiene practices. J.. Becker. 595e602. 69. & Botterill.. Available at http://www. Cramer..016. M. Staphylococcus aureus resistentes à meticilina: disseminação emergente na comunidade. Evaluation of a food hygiene training course in Scotland. from the work staff. et (13 right answers) arquivos/pdf/ [acess in November 2009]. R. Buonomo.. Brasília.7 (10/22. 260e263. Observation of food safety practices in catering Good (7e9 right answers) 45.. 1e7. V. 317e322. Outbreaks where Rennie... (1999). Journal of Food improper food handling practices are not always a result of a low Protection.0 The authors thank CAPES for scholarship support. courses should be planned for food handlers. (2004). (1996). Weth. 1752e1761.foodcont. attitudes.03. 1107e1118. A. Therefore. Supplementary material metropolitan area Schools near the sea 41.7 (10/22. International Journal of Food Microbiology. Food Protection. 243e251.9 (13/29) 23/51 Capunzo. L. R..0 0. D.. B. Insufficient 75. structural factors.1 (8/18) 22/49 0. including inhibitory attitudes of supervisors Gelatti. S. Mason.0) 42. Radke. Insufficient 54. I.9) 14/31. L. Personal hygiene Food hygiene on merchant ships: the importance of food handlers’ training. P. J. & Morris.. S. Bolton.8 (5/11. Blair.. M. Fundo Nacional de Desenvolvimento da Educação.. Hygiene or cleanliness 20.. Griffiths. 1995).. / Food Control 27 (2012) 206e213 Table 7 factors need to be investigated in order for a change in behavior to Bivaried analysis between presence of coagulase-positive staphylococci on hands of take place (Green et al.. Food poisoning and a a (n) Staphylococcus aureus enterotoxins. 661e666. foodborne outbreak of hepatitis A.1 (12/26. F.5 (19/42) 37/82 arquivo¼alimentação_escolar. W. HACCP and food hygiene in hospital: knowledge. Positive % Negative % Bas. 16. R.1016/j.fnde.8) 31/68. 501e516. J. we agree with many researchers A multistate. New England Journal Medicine. Ministério da Saúde. does it work? Ecology of Food and Nutrition.saude. G.9) 9/20. J. Reimann.0 (18/40) 61. Bushnell. C. 2000. environmental and organizational factors.. Nainam. A. social and work Jevsnik.9 (13/29) 31/69 0.. & d’Azevedo. Mendoza. R. Cavallo.1 Activity of food handler Acknowledgments Distribution of meals 37.9 0. D.. Selman. et al. References d Fisher’s test. 2007).. and with Green.2 (13/29) 42.1) 81. P. M. D. 70. Neeling.5 (9/20. Huijsdens.2012.. S. Insufficient 25. 21.3 (14/31. E. Good (14 right answers) 41.9) 42. (2008). It is n/% therefore necessary to evaluate the impact of the knowledge Positive %a Negative %a (n/%b) (n/%b) acquired in food safety training to develop methodologies to Civil servant properly train food handlers.. (2010). V. A. C. and specialists that argue that a chain of personal. W.3 (14/31) 38.324c Food Control.. A. Food safety (18 right answers) knowledge of head chefs and catering managers in Ireland. 1997.. Iran. Practices Brasil. A. Fundo Nacional do Desenvolvimento da Educação. 19. (2009)..4) 8/18 0. C..0 (4/8. M.0 (18/40) 90. The courses should Variable Coagulase-positive staphylococci Total p-value include an evaluation process to ensure the effectiveness. Food safety knowledge and practices place factors influences the practices of the food handler. Journal of Food Protection. (2008). 22. J. Journal of (Coleman.0) 22/48.. G. Alimentação (11 right answers) escolar. E. P. Ehiri. L. 2417e2423. International b Journal of Hospitality Management. P. improper handling may simply be reflective of by home study: measuring changes in knowledge and behavior. such as facilities and accessibility to supplies. C. 106. necessarily occur if the circumstances under which the practice has Hutin.0 (6/13) 9. Toxins. Soares et al. (1997). FNDE.php/ae-historico [acess in (Clayton & Griffith... 8. Hygiene training and education of food handlers: c Fisher’s test. 19. (2006). (6 right answers) Clayton. 2004. C. Greig. L. M.. Bartleson. practices of workers on food hygienic practices in meat processing plants in Fars. C... 737e744.7 (10/22) 61. Knowledge.. Anais and colleagues.. Food worker hand washing practices: an observation study. & Mcewen. (2000).1 Supplementary data related to this article can be found online at a % represents the frequency of the variable.1 (8/17. Mack. & Lakzadeh. E. 19. methods. and certain unsafe practices might not Environmental Sanitation. Green et al. 16.S. 2. 35. % represents the frequency of positive or negative samples related to number of samples collected. These barriers come november 2011].. time pressures and/or lack of staff. & Mazza. Food handler certification level of education. V.. doi:10. Mcdowell. D.8 (11/24.168c Brasil.9 (9/20. L. & Botterill. Pool.. A. Prevalence of methicillin-resistant Staphylococcus Good 25.. Dairy Food a dominant practice.html#consultas [acess in 20 out 2009]. C. Ersun.9 (9/20. R.8) 18/40. J.. Available at http://portal.. S. Zwartkruis-Nahuis. G. Ehiri. & Mcewen... D. 17. H.. covering social. (2005). et al. & Harris.4) 57.. (17 right answers) Bosch.5 (2/4.. T. 183e188. Secretaria de Vigilância Sanitária. 52e56. C. & Rodicio. FNDE. J.fnde.1 (8/18) 14/31 aureus in meat. Wit.. D.. Williams. D.148d Yes 45. Food Control. E. Green.. the findings about educational level demonstrated that Description of the problem.. R. C. attitudes and handlers and the presence of coagulase-positive staphylococci on hands. P. Boccia.. Soodbakhsh. 70. J. O. M. Morris.0 Work place Schools of the 58. Food Control.. and these among food handlers in Slovenia. J. Y. R. (2009). Finally. M. Viggiani.145c trônico Epidemiológico. & Michaels.8 (11/24) 57. Infection Control Hospital Epidemiology. Griffith. as well as Brasileiros de Dermatologia.. T. c Pearson’s X2 test. Mcewen. Ripley. Food Knowledge Control. J. Hlebec.094d Appendix A. 2006).212 L.0 (4/ 211e227. B. 134. 1751e1773. and practices of food handler’s in food businesses in Turkey. Bivaried analysis between data from knowledge. the training of food handlers should be carried out (2007). of attitudes towards safe food handling in the hospitality industry. A. & Griffith. (2010). Angelillo. V.0 (17/37.. E. Coleman.935c Preparation of meals 41. (1996).. Reimann. M. T. M. Mack. and agents involved. 340. Meally. I. J. Greco. M. (2001). 145e157. Howes. & Kivanç 84..2 (13/ Boer.. D. & Cowan. and practices of food services staff in Table 8 Calabri. P. attitudes and practices of food Ansari-Lari. Griffith. G. N.7) 23/51. Ehiri. Italy. It seems that more specific training food handlers and other variables. A. R. greater focus on risk perception that may lead to unsafe practices (2006). (n/%b) (n/%b) attitudes. Ano 5 n 6. (2009). Food Control. part 1.2) 38. (2005). A. Brunetti. Attitudes 291e300. D. L. X. & Rito.. 137e147. Thus. Welsh caterers: an exploratory study a % represents the frequency of the variable. Bonamigo. L. The evaluation of food hygiene knowledge. J. Available at http://www. V. (2009).br/home/index.

(2009). O. I. H. M.. R. M. P. A. M. Mackinnon. D. Microbiological sheet No. 73e79. M. D. 21. Chen. Nicholas. 623e628. (2009). Dakic. P. L.. 55e60. A. The of the Staphylococcus sciuri group. Michaels.. & Schaffner. Food Control.. 23. Revista Brasileira de Análises Clínicas. contamination between hands to food. students on food poisoning. R. 21. B. 39. Je zek. (2007). 165e168.. Journal contamination. 98. & Abrantes. D. (2012). I. & Al-Malki.. Hauschild. handlers in elementary schools from Brazil.. S. of Royal Society Health. 64. (2010). P. G. Morrison. Firinu. Food handlers’ knowledge on food Sharif. A. P.. 43. D. 73. P. Journal of Food Safety. & Bartleson. T. P. F. 956e958. & Santos. Health education models and food hygiene education. . 845e849. Coagulase-positive staphylococci and Staphylococcus aureus in food products Outbreaks where food workers have been implicated in the spread of food- marketed in Italy. 424e429. Microbiological risk factors associated with food Montville.. Oporto. Smith. quality and safety of meals served to children and adoption of good manufacturing (Reviewed March). & Eves. Food Control. World Health Organization. creches municipais da cidade do Natal-RN. & Almeida. 20. 75e79. A. Hogg. M. Food Control. Food safety and food-borne illness. S. Journal of Food Protection... T. Virgilio. Stepanovic.. Journal of Clinical Microbiology. Available at http://wwwwho. P. Bean. R. et al... C. Food Control.. Souza. Pediatric Infectious Disease Journal. D. S. M. Almeida. P. C. / Food Control 27 (2012) 206e213 213 Martins.. 29. Rowe. F. 255e261. Journal of Food Protection. A.. D. 23. Washing and drying of hands to reduce microbial Rennie.. A. T. G. J. (1995). International Journal of Food Microbiology. 115. L. N. Fact Santana.. & Otero. Xavier. attitude and practice of Taif University hygiene: the case of a catering company in Portugal. Seaman. 184e190. (2001). practices in public school catering in Brazil. L. Identification and characterization of clinical isolates of members Mead. Silva. Perceptions of hygiene training amongst food Prevalência de Staphylococcus aureus em manipuladores de alimentos das handlers. managers and training providers e a qualitative study. Normanno. (2005).... Knowledge. 1937e1955. (2002).. Dambrosio. D. Mula. Griffin... Gloves barriers to bacterial cross. Ferreira. Foodborne disease outbreaks in United States schools.. Greig. 1037e1041. G. D. & (2005). (2010). G. M. A. R. borne disease.. C. 21. S. et al. D. C. Y..S. N. S. (2007). J... (2010).. E. Petrâs. B.. S. C. Todd. Soares et al. A. J. A... Poggiu. C. Silveira.. Part 9.