Risky business

About 60% of foodborne disease outbreaks are linked to commercial caterers and eating establishments. Even though a large proportion of foodborne illness are avoidable, we are in a very risky business unless we can ensure food safety practices are followed. Infected food handlers are responsible for about 12% of all foodborne disease outbreaks.

A recent study in the UK focused on poor food safety practices in kitchens. It looked at rates of Food Risk Increasing Behaviours (FRIBs) among the public and professional chefs in order to more accurately reveal rates of illicit behaviours. The study’s objectives were to:

1. Determine the prevalence of FRIBs amongst working chefs, catering students and the public.
2. Investigate whether food malpractices are correlated with observable characteristics among the general public (gender, age, attitudes to risk, etc).
3. Investigate whether food malpractices are more likely in certain types of commercial establishments (food safety score, price band, awards won) and correlated with observable characteristics of chefs and catering students (gender, position etc).
4. Explore the implications of the prevalence of poor practices for food hygiene and human health.

Knowing that food handling behaviours can create or worsen food safety hazards, four behavioural statements were presented to chefs and catering students:

1. I always wash my hands immediately after handling raw meat, poultry or fish.
2. I have worked in a kitchen within 48 hours of suffering from diarrhoea and/or vomiting.
3. I have worked in a kitchen where meat that is ‘on the turn’ has been served.
4. I have served chicken at a barbecue when I wasn’t totally sure that it was fully cooked.

Behaviours 1 and 2 relate to food hygiene basics and should feature every business’s HACCP. These behaviours have the potential to contaminate food with bacteria and represent two extremes of HACCP failing. The need for good hand hygiene is likely to be the most commonly communicated food hygiene message and should therefore be simple and accessible to respondents. Working within 48 hours of suffering from diarrhoea and/or vomiting contravenes UK regulations which state that “managers must exclude staff with these symptoms from working with or around open food, normally for 48 hours from when symptoms stop naturally”.

Behaviours 2 and 3 were of interest because these are unlikely to be identified by direct observation of kitchen behaviours or an inspection. Behaviour 2 was also selected as it was identified as a significant issue in one of the highest profile outbreaks of food poisoning in recent years in the UK, in which over 400 diners fell ill after eating at the Michelin-starred restaurant ‘The Fat Duck’ and has been identified as a factor in other outbreaks.

Behaviour 3 relates to serving meat that is spoiling and is a previously unexplored behaviour suspected of being practised in some catering establishments which has potential implications for foodborne illness.

Behaviour 4 was selected for investigation because undercooked chicken and barbecued meat are known risk factors for campylobacteriosis, the most commonly reported gastrointestinal bacterial pathogen in humans in the EU since 2005.

The study employed a randomised response protocol that ensured respondent privacy and protected the interviewer from being aware of potential malpractice. The technique allowed the prevalence of true bad behaviours in the sample to be estimated but precluded determination of any individual’s behaviour.

Four target groups were identified for sampling: chefs, catering students with restaurant experience, catering students without restaurant experience and the public. Each group was asked a set of additional questions on characteristics which may help to explain their food hygiene behaviours. For chefs and working students these included questions on: kitchen position, the type of restaurant they work in, average price of a main meal, food hygiene rating score and whether their kitchen had won awards or accolades. Members of the public were asked about their experience of food poisoning, their level of concern about food poisoning and their cooking role at home. Demographic information (age, gender, education level etc) was collected from all respondents.

The results indicate that, inter alia, the probability of serving meat on the turn was 11% higher for those with a university education. University graduates were also more likely to have worked within 48 hours of experiencing diarrhoea and vomiting, as were those who believed they were more at risk of food poisoning than the average person.

The proportion of chefs and catering students not handwashing immediately after handling raw meat, poultry or fish was about half that of the public sample, at 7.4%.

The rates of serving of food within 48 hours of an episode of diarrhoea and vomiting were similar for the public and professionals at about 30%. In the UK such behaviour contravenes Food Hygiene Regulations, which state that: “No person suffering from, or being a carrier of a disease likely to be transmitted through food or afflicted, for example, with infected wounds, skin infections, sores or diarrhoea is to be permitted to handle food or enter any food-handling area in any capacity if there is any likelihood of direct or indirect contamination.” Managers are required to exclude staff with symptoms such as diarrhoea and vomiting from working with or around open food, normally for 48 hours from when symptoms stop naturally.

A high proportion of chefs and students admitting to having worked in a kitchen where meat ‘on the turn’ has been served is also of concern for public health. There are no comparative rates of this behaviour in other studies, although the practice is a long-established means of reducing costs in restaurants.

The rate of serving chicken at barbecues when unsure it was fully cooked was higher among the chefs and catering students than the public (16% versus 13%), contrary to the expectation that the professionally trained would be less prone to this behaviour.

This study suggests that behaviours that may be important risk factors for foodborne disease are widely prevalent and likely to be missed by direct observation studies and restaurant inspections. There are likely to be varied and multiple causal factors behind the behaviours.

Such risk increasing behaviour is not solely confined to ‘low-end’ restaurants.

Lack of time, staff and resources are consistently identified as barriers to compliance with safe food procedures such as handwashing. There is a clear economic imperative to serve meat ‘on the turn’ and existing behavioural norms within commercial kitchens will affect new members of staff employed within them. The motives leading to workers opting to (return to) work while still posing risk of transmission after illness is multifaceted. Ignorance, the economic losses associated with not working, fear of losing one’s job and the desire not to let down colleagues (or the family business) are all possible causes of the behaviour.

The research, published in journal PLOS ONE, found that avoiding eating where such behaviours take place is not easy for the public, because chefs working in award-winning kitchens were more likely to have returned to work within 48 hours of suffering from diarrhoea and vomiting, and not washing hands was more likely in upmarket establishments — despite over a third of the public agreeing that the more expensive a meal was, the safer they would expect it to be.

Chefs working in restaurants with a good Food Hygiene Rating Scheme score were just as likely to have committed the risky behaviours at some time in their career or to have worked with others who had.

The full paper, entitled ‘Estimating the prevalence of food risk increasing behaviours in UK kitchens’, is well worth a read and can be found here.

Image credit: ©stock.adobe.com/au/PavelPrichystal