[Instrument for assessment of best practices in school food and nutrition units: from design to validation]

Assessment tools in food safety and adherence to the sanitary protocol for coping with COVID-19 in food services

Food services, which must meet the sanitary standards for food production, needed to adapt to COVID-19 protocols in times of pandemic. In this context, the study of food safety assessment tools and sanitary protocols can contribute to the systematization of sanitary control actions and to the understanding how services have adapted to the new requirements. Thus, the present study aims to evaluate the relationships among the results of the assessment tools for food safety and adherence to the sanitary protocol for coping with COVID-19 in food services. Sanitary inspections were performed in 40 food services located in the center of the city of São Paulo - Brazil. Data were collected through the application of four checklists to evaluate the following: i. risk for FBD; ii. Good Handling Practices; iii. the structural requirements; and iv. The implementation of the COVID-19 sanitary protocol. The risk assessment tool was interpreted using a risk score, with each item weighted according to the risk for FBD. The results of the other tools were evaluated using the overall percentage of violated items. The results showed the predominance of high risk of GHP in the food services evaluated and a high percentage of violation of Good Handling Practices and structural requirements. The percentage of violation of the COVID-19 health protocol was moderate in most establishments. The degree of risk showed a high positive correlation with Good Handling Practices violations (Spearman ρ = 0.73; p < 0.001) and structural requirements (Spearman ρ = 0.63; p < 0.001). Regarding the tool for assessing adherence to the COVID-19 sanitary protocol, a moderate correlation was found with the violations of Good Handling Practices (Spearman ρ = 0.65; p < 0.001), with an emphasis on the thematic block relevant to food handlers. This discussion of the relationships among the results of the evaluation tools and their measurements may therefore be useful for improving the application of these tools by professionals involved in inspection activities, allowing the greater systematization of sanitary control actions and contributing to reduced risk of FBD.

Checklist to assess food safety when handling home enteral nutrition

BACKGROUND

Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN).

METHODS

This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases.

RESULTS

The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended.

CONCLUSION

The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.

Factors interfering with the adoption of good hygiene practices in public school food services in Bahia, Brazil

This cross-sectional study aimed to identify factors that interfere with the adoption of good hygiene practices in public school food services (SFS) in Bahia, Brazil. The search was conducted in public schools in Bahia/Brazil. Data collection included (i) evaluation of the adoption of Good Practices in school food services through visual observation and registration in the checklist in Good Hygienic Practices in School Food Services; (ii) Identification of schools' foodservice physical areas and environmental comfort measures; (iii) identification of sociodemographic and occupational characteristics and assessment of attitudes and level of knowledge in food hygiene. The minimum sample of 158 schools (confidence level of 95% and an error of 5%) was stratified considering the total number of districts (areas) and the schools' number per area. The data were analyzed using the Statistical Package for Science-SPSS® in version 26.0. The categorical variables were described as frequencies and percentages, and the quantitative variables as mean and standard deviation. Chi-square, Kruskal-Wallis with Tukey's post-hoc tests were used to examine qualitative variables. Independent Student t-test and ANOVA with Tukey's post-hoc tests were used to examine quantitative variables. Categorical variables were evaluated by Pearson Chi-squared tests. The Pearson test was used to analyze the correlation between Attitude and knowledge. The classification of the sanitary status was of moderate risk in 74.8% (n = 119) of the SFS (51-75% of compliance) and 25.2% (n = 40) at high risk (26-50% compliance). The average percentage of compliance for the 159 SFS in the municipality was 50.23%, obtaining a high-risk classification (26-50% compliance). In the SFS, the absence of dry goods' storage, meat preparation area, and storage of residues in more than 98% of schools was observed. Accessing attitudes, 1.4% (n = 2) of the food handlers were classified as unsatisfactory (0 to 49% of correct answers), 8.5% (n = 12) as satisfactory with restriction (50-69% of correct answers) and 90.1% (n = 128) as satisfactory. There was no correlation between Attitude and Knowledge level (p = 0.394). Considering the knowledge level, the item with the highest and lowest number of hits were: "To avoid food contamination, I wash and disinfect my hands before preparing food" and "Contaminated food will always have some change in color, smell, or taste". There was a significant difference in the level of knowledge considering mean wage (p = 0.000), time working in school food service (p = 0.001), weekly workday (p = 0.000), and participation in food hygiene training (p = 0.000). Therefore, factors that interfered in adopting good practices in the SFS were: inadequate physical structure, absence of areas in the SFS, and absence/low number of equipment to control the production process in the cold and hot chain. Food handlers showed satisfactory attitudes and level of knowledge. However, the physical structure of the SFS compromises the adoption of good practices. It risks the safety of the food served to students at the evaluated public schools.

A Study on Perception and Exposure to Occupational Risks at Public School Food Services in Bahia, Brazil

Food service work is hazardous due to the intense rhythm of food production, and the working conditions can cause discomfort, fatigue, and occupational accidents and illnesses. For the perception of exposure to occupational hazards, workers must participate in continuing education programs. This study aimed to verify the perception and exposure to occupational risks at school food services (SFS) in Bahia, Brazil. This cross-sectional study was conducted in SFS from public schools in Bahia/Brazil. Researchers identified sociodemographic variables, occupational characteristics, and the Perception of Exposure to Occupational Risks by SFS food handlers. Also, anthropometric assessment (weight, height, and waist circumference), the presence of comorbidities, and the identification of exposure to occupational risks and measures of environmental comfort were evaluated. Most workers were female (98.6%; n = 140), mean age of 46.85 y/o, working as SFS food handlers between 1 and 5 years (50.7%; n = 72) but with no training on occupational risks (52.8%; n = 75). This lack of training is not associated with demographic or other occupational variables. The majority of the food handlers present a fair or good perception of exposure to occupational risk. These food handlers are also mostly overweight, and higher BMI was associated with hypertension and edema. The SFS were classified as of high occupational risk (mean of 31.24% of adequacy) environments. Ergonomic Risks had the lowest percentage of adequacy (7.69%, very high risk) regarding occupational risks, followed by chemical risks (31.5% of adequacy, high risk), accident risk (32.19%, high risk), and physical risk (36.89%, high risk). The excess of activities associated with precarious physical structure, insufficient number of equipment and utensils (in inadequate conservation) favors the exposure to occupational risk in SFS.

Occupational Risk Assessment in School Food Services: Instruments’ Construction and Internal Validation

Occupational risk assessment in school food services (SFS) should include factors related to occupational hygiene, physical–functional planning, worker health, and good meal production practices. This study aimed to develop an instrument to assess occupational risk in school food services and perform content validation and semantic evaluation. The research included three steps: (i) instrument’s development; (ii) content validation (Delphi); and (iii) semantic evaluation (focus group). After an extensive literature review, four instruments were developed. The Delphi was validated by the Content Validity Coefficient (CVC), with an agreement greater than 90%. The semantic analysis was performed through four meetings using a focus group. After the content and semantic evaluation, there were four final instruments: Identification of Socioeconomic and Demographic Conditions of Food Handlers and Geographical Mapping of SFS (30 items); Knowledge and Attitudes in Food Hygiene Assessment (33 items); Perception of Occupational Risks (16 items); and Mapping of Occupational Risks in SFS (97 items). Instrument’s content validation and semantic evaluation contributed to constructing and validating forms for analyzing occupational risks and adjusting respondents’ language and sociocultural components.

Desenvolvimento de um instrumento quantitativo para inspeção sanitária em serviços de alimentação e nutrição, Brasil

Resumo O estudo visou desenvolver um Instrumento Quantitativo para Inspeção Sanitária (IQIS) em serviços de alimentação e nutrição de grande porte no Brasil. Utilizou-se a tecnologia de inspeção, no Modelo de Avaliação do Risco Potencial (MARP) e legislação sanitária brasileira. Estruturaram-se 12 dimensões, 41 módulos, 57 indicadores de controle de riscos (críticos/não críticos), numa escala de 0-5, totalizando 1.512 índices com codificação de respostas fechadas. O IQIS foi validado com o Coeficiente de Kappa, com excelente concordância para atributos de clareza e relevância (k = 0,82 e k = 0,92) e boa concordância para o atributo aplicabilidade (k = 0,78). O teste de Kruskal-Wallis mostrou inexistir diferença significativa entre as avaliações (p = 0,423), o Coeficiente de Correlação Intraclasse foi satisfatório (CCI = 0,53), o Alpha de Cronbach (α = 0,71) aceitável. O resultado final possibilitou classificar o serviço como tendo risco sanitário inaceitável. Considera-se o IQIS com conteúdo validado, tendo confiabilidade e reprodutibilidade para avaliação higiênico-sanitária, sendo uma inovação tecnológica para serviços de alimentação e nutrição e vigilância sanitária, possibilitando inspeção detalhada e rigorosa.

Food Trucks: Assessment of an Evaluation Instrument Designed for the Prevention of Foodborne Diseases

This study aimed to validate an evaluation instrument for food trucks (FTs) regarding its internal consistency and to establish a score classification according to the food contamination probability assessment. The instrument was applied in 44 food trucks (convenience sample), along with microbial analysis, in the Federal District, Brazil. After its application, sample collection and statistical analysis, the evaluation instrument was reduced to a 22-item final version. FTs were divided into three groups according to their ready-to-eat foods. Food trucks from Group A (hot and cold sandwiches) presented the highest percentage of contamination. The lowest percentage of contamination was observed in food trucks from Group C (regional and international cuisine). The application of the validated evaluation instrument to the 44 food trucks revealed that none achieved 100% adequacy. The reproducibility analysis exhibited an Intraclass Correlation Coefficient (ICC) value of 0.780 (CI 95%: 0.597; 0.880), indicating good reproducibility of the instrument. The reliability assessment presented a Kuder⁻Richardson Formula 20 (KR-20) value of 0.627 and a Cronbach's alpha coefficient of 0.634, indicating good internal consistency. The proposed classification score was obtained by assigning 1 point for each item with an inadequate response, and the final score may vary between 0 and 20 points. Food trucks with up to 11 points exhibit low probability of contamination and low risk of foodborne diseases, while food trucks scoring 12 or more points exhibit a high probability of contamination and high risk of foodborne diseases. The evaluation instrument will allow effective assessment of the hygienic⁻sanitary practices and conditions of food trucks and potentially ensure consumers' access to safe food.

Importance of training in ensuring the hygiene-sanitary quality of lettuce salads served in nursery schools

Abstract The food provided in nursery schools should meet the sanitary and nutritional requirements needed to promote a child's intellectual and physical health. Therefore, training of the School Nutrition Technicians (SNT) in good food handling practices is essential to ensure the safety of the foods prepared. This study was aimed at evaluating the microbiological quality of lettuce salads consumed by children in public nursery schools in the municipality of Cuiabá, Mato Grosso, Brazil. The lettuce salad samples were collected in two distinct phases: before and after training of the SNTs in good food handling practices by the nutritionists of the school meals program of the municipality of Cuiabá, according to the school calendar routine. Thirty fresh (in natura) lettuce samples that had not been sanitized (representing samples obtained from the supplier) were collected for the detection of Salmonella spp. and 240 prepared lettuce salad samples (salads ready for consumption), for the detection of Salmonella spp. and the heat-tolerant coliform count. The genus Salmonella was not detected in either of the phases of the study. However, prior to training, 54% of the lettuce salad batches were contaminated with heat-tolerant coliforms, but after training 100% of the batches were considered to be in satisfactory sanitary conditions. In conclusion, offering training courses on good food handling practices to food handlers in school meals units was capable of reducing contamination.

QUALIDADE MICROBIOLÓGICA DE PRODUTOS DE ORIGEM ANIMAL ENCAMINHADOS PARA ALIMENTAÇÃO ESCOLAR

Resumo Doenças Transmitidas por Alimentos (DTA) estão associadas ao consumo de alimentos e água contaminados por microrganismos patogênicos, sendo alguns desses grupos utilizados como indicadores dos cuidados higiênico-sanitários e empregados nos produtos de origem animal (POA). O objetivo foi avaliar a qualidade higiênico-sanitária dos POA encaminhados para alimentação escolar no município de Pelotas, Rio Grande do Sul, Brasil. As coletas foram realizadas no posto de distribuição da Secretaria de Educação. Foram coletadas cinco amostras de todos os lotes de leite UHT, bebida láctea e filés de frango que deram entrada no período de onze meses, totalizando cinquenta e cinco amostras. Os produtos foram avaliados quanto aos padrões microbiológicos da Agência Nacional de Vigilância Sanitária (ANVISA). Além dessas análises foram realizadas pesquisa da presença de Campylobacter e de Salmonella nos produtos de frango. Foi aplicada uma lista de verificação das boas práticas de armazenamento. Todas as amostras estavam dentro dos padrões microbiológicos admitidos pela ANVISA, entretanto Salmonella foi detectada em quatro amostras de filés de frango. Campylobacter não foi isolado de nenhuma amostra. As condições de armazenamento foram consideradas ruins, apresentando 72,4% de não conformidades, especialmente nos quesitos temperatura e condições de armazenamento. A presença de Salmonella pode oferecer risco à saúde das crianças que venham a consumir filé de frango.

[Best Practices in School Food and Nutrition Units of a municipality in the state of Rio de Janeiro - Brazil]

The scope of this study was to analyze the hygienic-sanitary conditions in nine School Food and Nutrition Units (UANE) of a municipality in the state of Rio de Janeiro (Brazil). A Best Practices in School Food Checklist proposed and validated by Stedefeldt et al., containing items scored and grouped into six thematic blocks (BT) was applied. The total score (P) results per BT and the final score (PF) were obtained using the Best Practices in School Food software®. The P results in UANE were compared with the classification of Collegiate Board Resolution No. 275 of 2002 of the National Health Surveillance Agency2 and PF results were used for UANE classification. All the UANE results were partially suitable for BT building. For BT handlers, processes/procedures, environmental hygiene and equipment for controlled temperature, most had partially adequate and inadequate results. Most UANE were adequate for BT reception. The PF results classified most UANE (66.7%) as standard health risks, indicating the need for corrective measures for Best Practices in UANE and the supply of safe and healthy meals to schoolchildren.

Best practices in school food and nutrition units of public schools of Bayeux, PB, Brazil

The occurrence of foodborne illness outbreaks is increasing in schools, and due to the number of children who consume school meals as the only daily meal, this factor becomes even more worrisome. In this sense, the aim of this study was to evaluate the hygienic-health aspects of Food and Nutrition Units (SFNU) of public schools of Bayeux / PB in relation to the adoption of best practices in school food and nutrition. Data were collected through SFNU checklist during visits to units in 29 schools. The health risk of units evaluated was from regular to very high regarding structure and facilities, hygiene of food handlers, environment and food preparation. It was found that 10.3% of handlers used clean and adequate uniforms, and environment and equipment showed poor conservation status in 75.9% and 89.7% of Units, respectively; control of urban pests and vectors was not effective and cleaning of fresh produce was incorrectly conducted in 51.7% of SFNU of schools evaluated. It could be concluded that the production of meals in SFNU of schools evaluated does not meet the requirements established by the best practices in school food and nutrition.

Should Weights and Risk Categories Be Used for Inspection Scores To Evaluate Food Safety in Restaurants?

The objective of this study was to verify the characteristics of food safety inspections, considering risk categories and binary scores. A cross-sectional study was performed with 439 restaurants in 43 Brazilian cities. A food safety checklist with 177 items was applied to the food service establishments. These items were classified into four groups (R1 to R4) according to the main factors that can cause outbreaks involving food: R1, time and temperature aspects; R2, direct contamination; R3, water conditions and raw material; and R4, indirect contamination (i.e., structures and buildings). A score adjusted for 100 was calculated for the overall violation score and the violation score for each risk category. The average violation score (standard deviation) was 18.9% (16.0), with an amplitude of 0.0 to 76.7%. Restaurants with a low overall violation score (approximately 20%) presented a high number of violations from the R1 and R2 groups, representing the most risky violations. Practical solutions to minimize this evaluation bias were discussed. Food safety evaluation should use weighted scores and be risk-based. However, some precautions must be taken by researchers, health inspectors, and health surveillance departments to develop an adequate and reliable instrument.