مدیریت ایمنی غذا، نقش آموزش بهداشت غذایی در بخش خدمات بریتانیا The management of food safety—the role of food hygiene training in the UK service sector

۱٫ Introduction Foodborne illnesses have been described as one of the most widespread problems of the contemporary world (Wheelock, 1989; Notermans, et al., 1994) and their notified incidence has increased significantly (Todd, 1989; Mossel, 1989). Wheeler et al. (1999) estimated that for every infectious intestinal disease (IID) case detected by national laboratory surveillance, of which foodborne disease is only a part, there are 136 in the community. Therefore, the actual incidence of foodborne illness throughout the world could be much higher than official statistics suggest. The recent increase in incidence of certain foodborne diseases has been attributed to many different factors, including, population growth, rapid urbanisation, changes in food preparation habits, a growth in food service establishments, increased consumption of food outside the home, and a lack of food safety training and education amongst food handlers and consumers (Motarjemi and Ka¨ferstein, 1999). Analyses of foodborne disease notifications throughout the world have shown that the majority of outbreaks result from malpractice during food preparation in small food businesses, canteens, residential homes, and other places where food is prepared for human consumption (Motarjemi and Ka¨ferstein, 1999). Ninety-nine per cent of all food operations in the UK are classified as small food businesses (DTI, 1999), with the vast majority of retailers and caterers in particular, defined as ‘micro’ businesses, as they employ fewer than 10 food handlers (Mortlock et al., 1999). Therefore, a lack of adequate training and education of the food handlers within such premises could pose significant public health risks. For many years, based on associations between poor hygiene practices in food premises and levels of staff food hygiene training (Audit Commission, 1990), the UK food industry has relied on nationally accredited/foundation level food safety education or training to provide the knowledge food handlers need to make safe and informed decisions about their food safety practices. Unfortunately, few hygiene courses have been properly evaluated and although positive responses towards, and knowledge of good hygiene practices have been indicated, these do not necessarily translate into positive behaviours (Mathias et al., 1994; Riben et al., 1994; Powell et al., 1997). Commercial catering outlets (restaurants, hotels, public houses, canteens, and caterers), in the UK, were associated with 53.6% of the total foodborne outbreaks surveyed by the Public Health Laboratory Service–Communicable Disease Surveillance Centre between 1995 and 1996 (Evans et al., 1998). Griffith (2000) estimated that 70% of foodborne outbreaks originated in the food service sector, and the UK Food Standards Agency (FSA, 2001) set the figure even higher at 88%, thus justifying a focus on the food service sector in the FSA’s strategy to reduce the incidence of foodborne disease. Some authors, however, suggest that these figures, to some extent at least, reflect the higher levels of notification of such incidences (Potter, 1994; Wall et al., 1996). Under notification has previously been attributed to doctors’ ignorance of the legal requirements (Harveys, 1991; Voss, 1992) and their failure to appreciate the importance of notification (Warden, 1998; Heap, 1992). This paper explores the role of food hygiene training as a critical element in the management of food safety within the service sector, and thus as a means of reducing the incidence of foodborne illnesses throughout the UK. Examining the current nature of food hygiene training within the UK, the physical and psychological barriers to training, the transference of knowledge into practice, the evaluation techniques currently used to assess the effectiveness of training, whilst making recommendations for the extension of some previous evaluation models. ۲٫ Training and education of the food handler Current UK regulations require that food handlers are supervised and instructed and/or trained commensurate with their work activities (The Food Safety (General Food Hygiene) Regulations, 1995). Such training may be classroom-based, computer-based or hands-on, and may or may not be formally accredited. Whilst practical in-house hands-on training is still the traditionally favoured approach for smaller businesses (Hendry et al., 1992), accredited food hygiene courses are offered by a number of awarding bodies including the Chartered Institute of Environmental Health, The Royal Institute of Public Health; The Royal Society for the Promotion of Health; The Royal Environmental Health Institute of Scotland and The Society of Food Hygiene Technology. These awarding bodies offer different levels of training; designed to match the levels of occupational structure found in most food businesses, from trainee to management. The courses aim to give the candidate relevant knowledge at a specific level so that the candidate can make informed decisions about food safety. Whilst, it is important to recognise that formal training might ensure greater consistency and quality (Manning, 1994), improper training could present a greater risk to food safety than no training at all (Ackerley, 1989). The Joint Hospitality Industry Congress (JHIC, 1997) prepared an ‘‘Industry Guide to Good Hygiene Practice: Catering Guide’’ (IGGHP), translating legislative requirements (including training) into practical actions. It suggests various levels of training depending upon the food handler’s competence, experience, and career development; in summary the IGGHP suggests a simple framework for training commensurate with the employee’s duties. An example is shown in Table 1. Three stages of training are described beginning with the essentials of food hygiene (Stage 1), which should take place before commencing work and can be incorporated into the company induction programme. This induction training must cover personal hygiene, personal health and essential kitchen hygiene (Worsfold, 1996). Any new food handlers in Categories A, B, or C must receive written or verbal instruction in the above areas. Billsborough (1999) suggested that between half and 1 h should be allowed for this type of training, as further training will follow. Hygiene awareness instruction (Stage 2) develops further hygiene awareness and the IGGHP recommends that it be provided within 4 weeks of starting work, although this may be extended to 8 weeks for part-time staff (UK Department of Health, 1997). The basic principles of food hygiene should be covered and related to the business and the jobs of individual employees. Training at this level should take about 3 h and can be provided in modules. This has the advantage of giving the trainee the opportunity to assimilate each module before starting on the next. The final stage is for food handlers with high-risk duties (Categories B and C) who require training beyond the informal Stage 2 in order to comply with legislation, although this need not lead to a qualification (UK Department of Health, 1997). Formal training or Stage 3 is subdivided into three levels and should be similar in content to that provided by courses leading to a recognised qualification. Level 1 training requires about 6 h of education and should be provided within 3 months of employment (UK Department of Health, 1997). It should provide training in the basic principles of food hygiene, similar to Stage 2 but with the addition of design of premises and legislation. Levels 2 and 3 of training cover food hygiene in more detail, as well as the management of Hazard Analysis Critical Control Point (HACCP) systems. Formal certificated training (Stage 3) is offered by all of the previously mentioned awarding bodies. Much has been written about training in the general business field, but surprisingly little has been written specifically on training in the food industry, and much of what has been written is rather specific in nature and has been limited to discussions of single segments—primarily hotels and restaurants (Barrows, 2000).