2439

Journal of Food Protection, Vol. 68, No. 11, 2005, Pages 2439–2442
Copyright Q, International Association for Food Protection

A Training Course on Food Hygiene for Butchers: Measuring Its

Effectiveness through Microbiological Analysis and the Use of
an Inspection Checklist
MARIA LUIZA SANTOMAURO VAZ,1 NEIL FERREIRA NOVO,2 DIRCE MARIA SIGULEM,1 AND
TANIA BENINGA MORAIS1*

1Food Quality Control Laboratory and 2Department of Preventive Medicine, Federal University of São Paulo, Rua Napoleão de Barros,
889 CEP 04024, 002 São Paulo, SP, Brazil

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MS 05-106: Received 16 March 2005/Accepted 21 June 2005

ABSTRACT
The effectiveness of food hygiene training for a group of retail butchers was evaluated with the aim of verifying whether
the butchers modified their behavior in the light of knowledge gained and whether their acquired knowledge or behavior
change was sustained over a period of time. Microbiological analysis (enumeration of mesophilic and coliform bacteria and
Escherichia coli) of a raw semiprocessed product (stuffed rolled beef) was conducted, and an inspection checklist was issued
before the training course (T0). Initial results were later compared with results obtained 1 month (T1) and 6 months (T6) after
the training. The checklist comprised 89 items classified into five categories: A, approved suppliers and product reception; B,
storage conditions and temperature control; C, flow process, food handling procedures, and conditions of the window display
unit; D, facility design and proper cleaning and sanitizing of equipment, utensils, and work surfaces; and E, pest control
system, water supply control, and garbage disposal. The inspection results were recorded as ‘‘yes’’ or ‘‘no’’ for each item.
Compliance with food safety procedures was recorded as the percentage of ‘‘yes’’ answers. The bacterial counts were signif-
icantly higher at T0. At T6, there was no significant increase in bacterial counts. There was a significant improvement in food
safety practices at T1 and T6 compared with T0 for all categories. When comparing T0 and T1, the largest increases in the
compliance scores were seen within categories C and D. No significant decrease in scores for compliance with food safety
practices was observed at T6. Supervision and refresher activities may be necessary to maintain behavioral changes for a
longer period of time.

Data on the occurrence of foodborne diseases have in-
dicated that most outbreaks result from faulty food handling
practices. Consequently, the training of food handlers is a
key factor in improving food safety and preventing food-
borne illnesses. Countries have imposed mandatory food
hygiene training before a license is granted to retail butch-
ers who sell raw meat (8, 12). However, knowledge does
not always result in a positive change in food handling
behavior (9). Thus, in addition to bringing about changes
in knowledge, a training course should reflect behavioral
changes and improve professional performance (3, 5).
There are many possible reasons for the lack of impact of
training initiatives, including recruitment from lower socio-
economic classes with fewer educational opportunities, rap-
id staff turnover, high number of seasonal staff, literacy and
language problems, and poor motivation due to low pay
and low job status (16). In one study, managers of food
businesses considered some food safety measures difficult,
burdensome, and unnecessary (13).
The effectiveness of training has been a concern in a
number of studies (4, 6, 7–9, 11, 12) in which the effec-
tiveness of food hygiene training was evaluated by using
scores on inspection checklists, microbiological analyses,
* Author for correspondence. Tel: 55-11-5571-1160; Fax: 55-11-5571-
1160; E-mail: tania.pnut@epm.br.
and questionnaires. In very few studies have the long-term
effects of a training course been evaluated (7, 8).
In the present study, both visual inspection and micro-
biological sampling were used with a longitudinal design
to assess the effectiveness of food hygiene training for a
group of retail butchers. The aim was to determine whether
the butchers modified their behavior in the light of knowl-
edge gained and whether the knowledge and/or behavioral
changes were sustained over a period of time.
MATERIALS AND METHODS
Unlike other countries such as the United Kingdom, where
butchers may prepare and sell both raw and cooked ready-to-eat
meat products (12), in the state of São Paulo, Brazil, the regula-
tions allow butchers to handle only semiprocessed raw meats. A
retail butcher license is mandatory for premises that produce semi-
processed raw meats, and staff training must be carried out before
a license can be obtained. To comply with the regulation, the retail
butcher’s association hired a nonprofit educational organization to
provide a course on food hygiene training for employees. The
course was given by M. L. S. Vaz. Twenty-two employees from
four butcher shops attended the course. The shop owners paid
them for the time they attended the training sessions. The attend-
ees voluntarily agreed to take part in the study, which was ap-
proved by the Committee of Ethics of the Federal University of
São Paulo. Because the researchers had no legal right of entry
onto the premises, cooperation of the owners was essential. Data
2440 VAZ ET AL.
on education and length of service in the business revealed that
most employees (19 of 22) had only primary schooling and on
average around 9 years of service.
The butchery product chosen as the indicator for both mi-
crobiological quality and training effectiveness was semiprocessed
raw braciola (stuffed rolled beef) because its preparation provided
many opportunities for food contamination via hand and surface
contact. To prepare this product, a large piece of meat is sliced
into thin steaks, which are wrapped around a seasoned filler made
of chopped carrot, bacon, garlic, celery, and parsley. The ingre-
dients are spread over the steak, which is roll tightly and tied with
string. The finished products are kept in refrigerated display units
and cooked by the consumer at home.
Microbiological analyses were conducted and an inspection
checklist was filled out before the training course was initiated.
Initial results were later compared with those obtained after the
training course to assess effectiveness. Samples of raw braciola
for microbiological analyses were collected at three different pe-
riods at the point of sale: before the training (T0) and 1 month
(T1) and 6 months (T6) after the training. Each time, 10 samples
were collected from each butcher shop, for a total of 120 samples.
To avoid any interference from the researcher in the butchers’
behavior (which might interfere with the microbiological results),
three samples were collected each week for three consecutive
weeks before direct observations were recorded and the checklist
was filled out again.
Direct observation and checklist. Information on the each
butcher shop was recorded on a standard checklist form based on
general principles of food hygiene (15, 17) and on the Brazilian
regulations for the inspection of food service establishments. A
direct observation was carried out by M. L. S. Vaz during three
visits to each shop: at T0, T1, and T6. The checklist comprised
89 items classified into five categories:
1. Category A (13 items): approved suppliers and product recep-
tion (proper temperature, appearance, odor, color, and pack-
aging condition).
2. Category B (11 items): storage conditions and temperature
control.
3. Category C (34 items): flow process, food handling procedures,
and conditions of the window display unit.
4. Category D (19 items): premises (facility design and proper
cleaning and sanitization of equipment, utensils, and work sur-
faces).
5. Category E (16 items): pest control system, water supply con-
trol, and garbage disposal.
The inspection results were recorded as ‘‘yes’’ or ‘‘no’’ for
each item. Compliance with food safety procedures was recorded
as a percentage of the ‘‘yes’’ answers.
Microbiological analyses. Samples of raw braciola (n 5
120) for microbiological analyses were collected at the selling
point and maintained at a temperature below 108C until they
reached the Food Quality Control Laboratory of the Federal Uni-
versity of São Paulo, where they were processed within 2 h after
sampling. Samples were analyzed for the presence and concentra-
tion of indicator microorganisms, i.e., mesophilic and coliform
bacteria and Escherichia coli, which have long been used as in-
dicators of bacterial quality. Twenty-five-gram samples were
weighed into sterile stomacher bags, blended with 225 ml of ster-
ile 0.1% peptone water (Merck, Darmstadt, Germany), and ho-
mogenized in the stomacher for 2 min. Tenfold dilutions of the
homogenate were made with peptone water (1). Aerobic plate
counts for mesophilic bacteria were conducted on plate count agar
J. Food Prot., Vol. 68, No. 11
(Merck) after incubation at 358C for 48 h (1). Chromocult coli-
form agar (Merck) was used for coliform and E. coli counts after
incubation at 358C for 24 h (14).
Training course. The food hygiene course objectives were
improvement of butcher awareness of roles and responsibilities,
explanation of the regulatory and public health rationales, and
explanation of the importance of complying with the regulations
of the licensing process. The main topics discussed during the
course were legislation and consumer demand, basic food micro-
biology, foodborne disease agents in meat, rationale for storing
foods at proper temperatures, need for and methods used to protect
food from cross-contamination, personal hygiene principles and
practices, importance of proper utensil storage and equipment san-
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itization, rationale and techniques for correct sanitization, proper
storage of hazardous materials, and proper housekeeping practic-
es. The course was 20 h long (4 h/day for 5 days).
The Tones’ health action model applied to food hygiene ed-
ucation (10) was used in the development of the training course.
The teaching strategies encouraged active learner participation.
Discussions provided the participants with the opportunity to con-
sider common problems or concerns and make use of prior knowl-
edge and practical experience, which was built upon. The students
benefited from being taught how to use information rather than
simply being taught facts. An operational flow chart of the food
process was built with the significant food safety concerns for
each step highlighted in the colors of the traffic lights: red for
presence of a hazard, yellow for an action by the food handler
that minimizes or eliminates a significant food safety hazard, and
green for a safe food ready to be sold. At the end of the training
course, the participants received a booklet designed to be con-
sulted during daily activities. A hands-on approach was used dur-
ing the teaching of sanitization techniques and personnel hygiene
practices. Prepared plates of meat samples collected previously
from the shops were used to make the contamination concept
more ‘‘real.’’
Statistical analyses. Because the data failed the normality
test, the Friedman repeated measures analysis of variance on ranks
was used to compare the bacteria counts at T0, T1, and T6. When
differences were significant, a multiple comparison procedure
(Dunn’s method) was used to isolate the group or groups that
differed from the others. The results were recorded as medians
and the 25th and 75th percentiles (P25 and P75). For compliance
with food safety procedures, the scores of the four butcher shops
at T0, T1, and T6 were compared using Cochran’s Q test. Signif-
icance was defined at P # 0.05.
RESULTS
Table 1 lists the medians and 25th and 75th percentiles
for the mesophilic and coliform bacteria and E. coli counts
at T0, T1, and T6. The bacterial counts were significantly
higher before the training course. At T6 there was a non-
significant increase in counts. In Figure 1, the scores for
compliance with food safety procedures according to the
five categories are shown for T0, T1, and T6. In all cate-
gories, there was a significant improvement in the food
safety practices in T1 and T6 when compared with T0. A
slight decrease was observed in T6, although it was not
significant. When T0 and T1 were compared, the largest
increase in compliance scores occurred for category C.
However, when comparing T1 and T6 in the same category,
the largest decrease was observed. The highest compliance
J. Food Prot., Vol. 68, No. 11 EFFECTIVENESS OF FOOD HYGIENE TRAINING 2441

TABLE 1. Counts of mesophilic and coliform bacteria and Esch-

erichia coli for stuffed rolled beef at times T0, T1, and T6a
Bacteria T0 T1 T6 Statistical analyses

n 40 40 40
Mesophilic
Median 5.2 3.6 4.0 P , 0.001
P25–P75 4.8–5.4 3.3–4.2 3.1–4.2 T1, T6 , T0
Coliform
Median 4.2 2.9 3.0 P , 0.001
P25–P75 3.8–4.8 2.6–3.1 2.9–3.3 T1, T6 , T0
E. coli
P , 0.001

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Median 2.5 1.3 1.8
P25–P75 2.3–3.0 0.0–2.0 1.2–2.1 T1, T6 , T0 FIGURE 1. Scores for compliance checklist (% of ‘‘yes’’ answers)
according to the five categories at times T0, T1, and T6. * P ,
a Values are log CFU per gram. P25 and P75 are the 25th and 0.05 when compared with T0.
75th percentiles, respectively.

scores were observed in category E, and the lowest were
in category A.
DISCUSSION
In most studies of food hygiene training effectiveness,
evaluations have been directed toward owners and man-
agers, whose levels of educational have been assumed to
be higher than those of the operative food handlers (7–11).
In this study, the training was targeted toward practicing
butchers, whose educational level was low; most had only
primary schooling. Taking this situation into account, an
initial direct observation was planned to provide informa-
tion useful in planning the content and methodology of the
training program. The methodology adopted for the devel-
opment of the practical and theoretical lessons seemed ap-
propriate for meeting the main objective, which was to in-
volve the participants in the learning process. The peda-
gogical model took into account the reality of the estab-
lishments and included a hands-on approach. The
educational level and the professional experience of the par-
ticipants were respected. At the end of the training course,
the participants received a booklet designed for consultation
during their daily activities. The content was written in sim-
ple and specific language suitable for this type of establish-
ment, which contributed to a better assimilation of the train-
ing material. More emphasis was placed on the crucial areas
of basic cleanliness, temperature control, and avoidance of
cross-contamination either from the food handlers them-
selves or from surfaces and equipment (2).
The results of both the microbiological analyses and
the checklist indicated that immediately after the training
course there were significant differences compared with the
initial results. This finding supported the idea that the train-
ing had been effective in improving overall food safety.
However, after 6 months the bacterial counts and demerit
scores had increased (although not significantly), suggest-
ing that the training may have a short-term effect. Thus, it
may be necessary to periodically advise managers and pro-
vide refresher training activities in addition to the initial
training course. Further studies for longer periods of time
would determine the optimum time interval between train-
ing sessions.
Knowledge does not always result in a positive chang-
es in food handling behavior (3). Thus, in addition to bring-
ing about changes in knowledge, training should promote
behavioral changes and improved professional performance
(3, 5). According to the checklist used in this study, the
compliance scores were significantly improved in catego-
ries C (food handling) and D (cleanliness of premises),
which reflected basic changes in butcher behavior. The
checklist was specially adapted for this kind of shop, and
more importance was given to observing changes in be-
havior. Owners and managers also invested the necessary
resources in providing appropriate facilities.
A training course can be an effective tool in improving
overall food safety as long as the training methods are re-
alistic and respectful in the social and environmental con-
text of the target participants, which can be achieved
through careful design, implementation, and evaluation. Su-
pervision, strong management controls, regular training,
and refresher activities also should be implemented, be-
cause the improvements obtained through the training
course appeared to be relatively short lived.
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