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

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 affecting effectiveness of food control inspections in food production establishments in Finland

Inspections are an important tool for food control. However, there is a lack of knowledge about how inspection history, interval between inspections, and pre-announcement of the inspection affect compliance with food safety legislation in food production establishments. We used register-based meat, fish, and dairy establishment food control inspection data (5550 inspections from 757 establishments) from Finland in 2016–2019 to study compliance in relation to these factors. Hypothesis was that there is an association between inspection grades and (1) inspection history, (2) interval, and (3) pre-announcement. Results indicate that minor non-compliances that do not impair food safety often precede future more severe non-compliances (5.3% non-compliance rate if full compliance at previous inspection compared to 16.8% non-compliance rate if minor non-compliances at previous inspection [Fisher’s exact test, p < 0.0001]), and that longer inspection intervals are associated with a decrease in inspection grades (5.9% difference in inspection intervals for inspection with full compliance compared to inspections with severe non-compliances [Generalized estimating equations, p = 0.02]). In addition, pre-announcement of the inspection affects the inspection grades, severe non-compliances were 2.4 times more common at unannounced inspections compared to pre-announced inspections. To conclude, there is an association between inspection grades and inspection history, inspection interval, and inspection announcement.

Smart Supervision for Food Safety in Food Service Establishments in China: Challenges and Solutions

ABSTRACT

Foodborne diseases are a burden in countries worldwide. Several countries have successfully implemented policies that establish innovative systems for the inspection and grading of food service establishments (FSEs), which have greatly contributed to a reduction in foodborne diseases. China's government has also responded by developing policies to protect consumers' food safety, including the routine inspection policy and the risk-based grading policy. However, implementation of both policies has been poor to date. The aim of this study was to identify regulatory challenges and design a smart supervision solution. The results of a national survey showed that the major barriers to policy implementation were a heavy individual workload, the high turnover rate of FSEs, lack of a monitoring and evaluation system, lack of social support, low development of food safety training programs in FSEs, and a lack of financing. A smart supervision solution to these challenges was designed based on mobile Internet and two-dimensional (2D) barcode technology. A pilot application in Jilin province assisted local supervisors in carrying out regulatory work on FSEs, which proved the feasibility of smart supervision. This study can be used as an example for food safety supervision in other regions, and it can assist other governments that wish to implement similar policies to ensure food safety in their countries.

HIGHLIGHTS

Regional Character, Restaurant Size, and Food Safety Risk: Evidence from Food Safety Violation Data in Gansu Province, China

ABSTRACT

Restaurants are a place where food is prepared and cooked directly for customers. Food safety in restaurants is a public health concern and a multidisciplinary issue that needs to be explored. To protect the health of consumers and identify external factors that may affect food safety risk, this study explores how economic development and population density at the local level relate to food safety inspection outcomes in restaurants of different sizes. Using food safety violation data from 2017 and 2018, we categorized restaurants in Gansu Province, China, into small and large ventures to examine the relationships among regional character, restaurant size, and food safety risk. Data were analyzed using Mann-Whitney U tests and negative binomial regression models. Our results show that large restaurants have a higher food safety risk than small restaurants. Moreover, the region with the lowest level of economic development had the highest food safety risk, while the region with the lowest population density had insufficient local inspections. By providing insight into which establishments demonstrate the highest food safety risks, our findings contribute to the development of processes that seek to effectively identifying food safety risks.

HIGHLIGHTS

Food safety assessment and risk for toxoplasmosis in school restaurants in Armenia, Colombia

We assessed the risk for toxoplasmosis in 10 school restaurants in Armenia (Quindio, Colombia). We analyzed the presence of Toxoplasma gondii DNA in the food, water, and living and inert surfaces of school restaurants, and we correlated these findings with the results of food safety inspection scores and with the prevalence of specific anti-T. gondii antibodies in children who ate at these restaurants. Of the 213 samples, 6.1% were positive using PCR to test for T. gondii DNA. Positive samples were found in meat, water, cucumber, guava juice, inert surfaces, and living surfaces. In 60% (6/10) of the public school restaurants, there was at least one PCR T. gondii-positive sample. In 311 serum samples from children who attended the restaurants, 101 (33%) were positive for IgG and 12 (3.9%) for IgM anti-T. gondii. The median of the compound score for the fulfillment of inspection for food safety conditions was of 60.7% (range 50-72). Higher T. gondii PCR positivity in surfaces, food, or water at each restaurant was correlated with lower inspection scores for water supply and water storage conditions. Lower scores in physical infrastructure and disinfection procedures and higher scores in furniture were correlated with a higher prevalence of IgG anti-T. gondii in children who ate at those restaurants. Inspection scores can identify restaurants with a higher risk for the presence of T. gondii.

Dimensioning of the physical area and required number of food handlers for school food services

ABSTRACT Objective We aimed to establish equations for dimensioning of the physical area and determining the required number of food handlers in food services of schools and to compare them with reference equations. Methods It was visited 44 municipalities located in the states of São Paulo (n=36) and Rio de Janeiro (n=8) between 2013 and 2014. The physical area for school food services was evaluated using a measuring tape. For all food services, we calculated the Maximum Attendance Capacity, which is the sum of small and large meals served during the busiest shift. A validated checklist was used to evaluate food safety practices. Linear regression models were developed to establish the proposed equations. Results In total, we evaluated 205 school units. Based on the data, the following equations were established: Equation A: area of production=15.22+(maximum attendance capacity×0.02), which estimates the minimum area needed for a school food service; and Equation B: the number of food handlers=2.17+(maximum attendance capacity×0.002), to determine the minimum number of food handlers needed. These equations were established based on school food services that presented adequate food safety practices (i.e., low health risk). Conclusion It was established new equations for calculating the size of the physical area for school food services and the required number of food handlers. These new equations can be used as a starting point in management planning of a school food service.

Food safety performance and risk of food services from different natures and the role of nutritionist as food safety leader

Abstract The objective of this study was to evaluate the food safety performance of food services and its associated factors. The study involved 84 food businesses in the city of Santos as follows: street food kiosks and beach kiosks (street food), commercial restaurants, hospitals and school meal services (institutional food services). A food safety checklist with 81 items was applied. The overall percentage of adequacy was lower in street food kiosk (49.7%) and beach kiosk (62.0%) than in restaurants (69.7%), hospitals (83.9%) and schools (86%). Institutional and commercial restaurants showed higher scores of food safety performance than street food services, mainly regarding risker practices. The variables positively associated with food safety performance in commercial restaurants were: presence of a nutritionist as leader and adequate structure. These results show that street food services need, in a mediate way, the implementation of new strategies and regulations to improve food safety. A nutritionist acting as food safety leader may improve the food safety performance at commercial restaurants.

Towards more consistent and effective food control: learning from the views of food business operators

We surveyed the opinions of Finnish food business operators (FBOs) about the uniformity of local official food control and its importance for dairy, fishery and meat plants. A total of 136 FBOs responded to the questionnaire. Most FBOs considered official food control to be important for food safety and were generally satisfied with its quality. However, they often did not perceive official food control as being uniform, and 23% even considered it arbitrary. Small-sized FBOs were particularly critical of the relevance of control actions. The better the FBOs assessed their cooperation with the inspector, the higher they assessed the quality, uniformity and benefits of official food control. The cooperative approach in control practices should be emphasized to support the positive views of FBOs about official food control, thus promoting food safety. Cross-audits among local food control units are recommended to improve the FBOs' experience of uniformity of food control.

Inspection Score and Grading System for Food Services in Brazil: The Results of a Food Safety Strategy to Reduce the Risk of Foodborne Diseases during the 2014 FIFA World Cup

In 2014, Brazil hosted one of the most popular sport competitions in the world, the FIFA World Cup. Concerned about the intense migration of tourists, the Brazilian government decided to deploy a food safety strategy based on inspection scores and a grading system applied to food services. The present study aimed to evaluate the results of the food safety strategy deployed during the 2014 FIFA World Cup in Brazil. To assess food safety, an evaluation instrument was applied twice in 1927 food service establishments from 26 cities before the start of the competition. This instrument generated a food safety score for each establishment that ranged from 0.0 (no flaws observed) to 2565.95, with four possible grades: A (0.0-13.2); B (13.3-502.6); C (502.7-1152.2); and pending (more than 1152.3). Each food service received a stamp with the grade of the second evaluation. After the end of the World Cup, a study was conducted with different groups of the public to evaluate the acceptance of the strategy. To this end, 221 consumers, 998 food service owners or managers, 150 health surveillance auditors, and 27 health surveillance coordinators were enrolled. These participants completed a survey with positive and negative responses about the inspection score system through a 5-point Likert scale. A reduction in violation scores from 393.1 to 224.4 (p < 0.001) was observed between the first and second evaluation cycles. Of the food services evaluated, 38.7% received the A stamp, 41.4% the B stamp, and 13.9% the C stamp. All positive responses on "system reliability" presented a mean of 4.0 or more, indicating that the public believed this strategy is reliable for communicating risks and promoting food safety. The strategy showed positive results regarding food safety and public acceptance. The deployed strategy promoted improvements in the food safety of food services. The implementation of a permanent policy may be well accepted by the public and may greatly contribute to a reduction in foodborne diseases (FBDs).