Food Control 73 (2017) 372e381

Contents lists available at ScienceDirect

Food Control
journal homepage: www.elsevier.com/locate/foodcont

Food safety knowledge and practices of food handlers, head chefs and
managers in hotels' restaurants of Salvador, Brazil
Larissa Tannus Rebouas a, Lidiane Barbosa Santiago a, Larissa Silva Martins a,
Ana Cla ~o Nazare

udia Rios Menezes b, Maria da Puricaa
Arajo a,
a, *
Rogeria Comastri de Castro Almeida
a
Department of Food Science, Nutrition School, Av. Arajo Pinho, n
32, Canela, Salvador, BA, Cep: 40.110-160, Federal University of Bahia, Brazil
b ~o de Geremoabo, s/n, Ondina, Cep: 40.170-290, Salvador, BA, Brazil
Pharmacy Faculty, Federal University of Bahia, Rua Bara

a r t i c l e i n f o a b s t r a c t

Article history: This study aimed to assess the knowledge level, attitudes and practices of food handlers, and knowledge
Received 21 June 2016 and practices of head chefs and managers in hotels' restaurants of Salvador, Brazil. Data collection was
Received in revised form done through the application of interviews with 265 food handlers and with 32 head chefs and man-
15 August 2016
agers. In addition, the inuence of the presence of nutritionist in restaurants was evaluated. The results
Accepted 16 August 2016
showed that 88.0%, 96.6% and 76.0% of handlers had knowledge, attitudes and practices appropriate for
Available online 18 August 2016
personal hygiene, respectively. However, some errors were observed such as the non-use of disposable
gloves when handling or distributing food (39.6%), tasting food with their hands (28.7%), and usually
Keywords:
Food handlers
talking while handling food (52.5%). Statistical analysis did not indicate a signicant association between
Head chef the knowledge, attitudes and self-reported practices by handlers. However, it was found association
Manager between handlers that presented good satisfaction with the job and handlers that introduced appro-
Knowledge priate practices. Regarding to chefs and managers, the results indicate that the knowledge was unsat-
Hotels' restaurants isfactory, even 75% of respondents have training certicate in food safety. A signicant percentage of
respondents were unaware of the legislation adopted in restaurants (37.5%), and only 43.8% of them
knew the recommended cooling temperature for food preservation. However, adequate practices to
reduce cross-contamination was observed. Still, the presence of the nutritionist in restaurants inuenced
positively on the adoption of the current legislation in hotels' restaurants, as well as in the participation
of the handlers in training, showing in this way the creation of a positive culture among the handlers.
2016 Elsevier Ltd. All rights reserved.

1. Introduction
In 2014, Brazil hosted the World Cup and received a million
tourists from 203 nationalities. In addition, Brazil will host in 2016
the World Olympic Games.
In order to improve the sanitary prole of the host cities where
the games of the World Cup and Olympic games will be held, the
Ordinance Number 817/2013 was created, which aims to provide
subsidies for assessment of risk criteria proposed for food services
and specic strategies of communication to consumers in order to
increase transparency and strengthen health surveillance actions
(Brasil, 2013a).
* Corresponding author. Current address: Nutrition School, Federal University of
Bahia, Salvador, BA, Brazil.
E-mail address: rogeriac@ufba.br (R.C.C. Almeida).
In Bahia, state in Brazil, traditional foods are very diverse and
therefore one of the richest in the world. The typical ingredients as
well as the spices and seasonings give color, exuberance, beauty
and unique avor, making the food even more attractive. Salvador
city has 400 hotels, out of which 74 have their own restaurant and
most of them offer at least breakfast service. Large hotels offer food
service for external audiences, in addition to the guests.
Food safety is fundamental in food service because of the high
numbers of meals served every day. Food-borne outbreaks result-
ing from such mass restaurant facilities have been reported
worldwide (Jones & Angulo, 2006).
Foodborne disease has several origins such as chemical and
parasitic; however, microbiological sources stand out for posing a
great risk to public health. Outbreaks of foodborne disease are
resultant from various factors, and among them, one of the most
implicated is inadequate personal hygiene (Pichiler, Ziegler,

http://dx.doi.org/10.1016/j.foodcont.2016.08.026
0956-7135/ 2016 Elsevier Ltd. All rights reserved.
 L.T. Rebouas et al. / Food Control 73 (2017) 372e381
Aldrian, & Allerberger, 2014). Several studies have demonstrated
the presence of pathogenic microorganisms in food handlers'
hands, which makes them an important vehicle of foodborne dis-
eases (Ferreira et al., 2013; Soares, Almeida, Cerqueira, Carvalho, &
Nunes, 2012). Therefore, improper handling is responsible for most
cases of foodborne disease, including the inappropriate use of
temperature during food preparation and conservation, cross
contamination, poor personal hygiene and inadequate equipment.
Attitude of food handler is also a crucial factor that may inuence
food safety behavior and practices (Al-Shabib, Mosilhey, & Husain,
2016).
According to Pichiler et al. (2014), thirty-one percent of the
outbreaks occurred in the European Union were associated with
restaurants, cafes, pubs, bars and hotels, and 17% was linked to
catering for schools, kindergartens, residential institutions, tem-
porary mass events and workplace canteens. In Brazil, data from
epidemiology surveillance show that restaurants and patisseries
occupied the third ranking position in the foodborne disease
occurrence. Bahia, in the northeast Brazil, is the state that shows
the highest record of foodborne disease (Brasil, 2011).
A recent meta-analysis has shown that food safety training in-
creases knowledge and improves attitudes about hand hygiene
practices and that refresher training and recurrent emphasis on
good food handling behavior may have ongoing positive effects on
hand washing practices among food handlers (Soon & Baines,
2012). However, several studies report that the increase of knowl-
edge in food safety does not always ensure that good hygiene
practices are being implemented (Ansari-Lari, Soodbakhsh, &
Lakzadeh, 2010; Buccheri et al., 2010; Ferreira et al., 2013; Park,
Kwak, & Chang, 2010). Important barriers can be responsible for
that, such as supervisors and colleagues' inhibitory attitudes, time
pressure and/or lack of staff, as well as structural factors, such as
facilities and accessibility to supplies (Laikko-Roto & Nevas, 2014;
Soares et al., 2012).
Some reports have shown that kitchens' supervisors or man-
agers that have certicates have been more proactive during the
food handlers' training than those that do not have certicates
(Laikko-Roto & Nevas, 2014; Roberts & Barret, 2009). The presence
of supervisors with certicates has also been suggested as impor-
tant to reduce non-compliance (Cates, Muth, et al., 2009; Kassa,
Silverman, & Baroudi, 2010) and help to prevent foodborne dis-
ease outbreaks in restaurants (Hedberg et al., 2006).
The objectives of the present study were to evaluate the
knowledge level, attitudes and practices adopted by food handlers,
and knowledge and practices in food safety of head chefs and
managers in the hotels' restaurants of Salvador, in northeast Brazil.
2. Material and methods
2.1. Sampling
Hotels with more than 100 beds located in Salvador, Bahia, in
northeast Brazil, were chosen for the study. We screened 400 ho-
tels, of which 74 has their own restaurant, and 48 of them had 100
or more beds. Of these, 23 agreed to participate in the study
(response rate of 47.92%). The hotels were stratied per group,
according to their leadership/management of the restaurant. The
group 1 was comprised of restaurants which had only one manager,
group 2 by restaurants that had a manager and a head chef, the
group 3 by restaurants that had a manager, a head chef and a
nutritionist for part-time, and the group 4 by restaurants that a had
manager, a head chef, and a nutritionist for full-time shift.
This descriptive, cross-sectional study was conducted among 18
managers, 14 head chefs (a response rate of 100%) and 265 food
handlers (a response rate of 87.46%) from 23 hotels' restaurants.
373
Nutritionists were not interviewed.
Informed consent, previously approved by the Ethics Committee
of the School of Nutrition of the Federal University of Bahia, was
provided by each participant.
2.2. Data collection
2.2.1. Assessment of knowledge, attitudes and practices of food
handlers
A structured questionnaire based in previous study of Angelillo,
Viggiani, Greco, and Rito (2001), Ansari-Lari et al. (2010), and
Jevsnik, Hlebec, and Raspor (2008) was designed to assess the food
handlers' knowledge, attitudes and practices. The questionnaire
was peer-reviewed and underwent a pilot study with 23 food
restaurants' handlers before the nal version was distributed to
food handlers.
The questionnaire was divided into ve distinct parts. Part 1:
demographic information including age, sex, education level, per-
sonal income, length of employment and participation in training.
Part 2: information about the employees' work satisfaction (10
questions), addressing work load, satisfaction with profession,
fullling the norms and rules, conditions to guarantee food safety,
relationship between work team and managers/supervisors, and
answers were graded on three levels of intensity: disagree, indif-
ferent, and agree. Part 3: addressing knowledge (18 questions);
each question consisted of three optional answers, true, false, I do
not know/I do not remember. The food handlers were asked about
their knowledge regarding preparation and food conservation, food
borne diseases, their personal hygiene, cross-contamination and
time and temperature control of foodstuffs. Part 4: containing 14
questions concerning food safety attitudes; each question consisted
of three optional answers, right, wrong and I do not know/I do not
remember. The questions distribution was under the following
criteria: personal health, personal hygiene, hand washing, cross
contamination, and food handling. The term attitudes was used
according to Princeton University denition: a complex mental
state involving beliefs and feelings and values and dispositions to
act in certain ways (http://wordnet.princeton.edu/) (Sharif & Al-
Malki, 2010; Soares et al., 2012). Part 5: addressing practices of
personal hygiene and hand hygiene (21 questions), each question
consisted of ve optional answers, never, rare, sometimes,
frequently, and always. These questions focused on issues
regarding personal hygiene, cross contamination, diseases carried
by food, microorganisms, temperature control and hygiene
practices.
Food safety knowledge was evaluated according to Soares et al.
(2012), and for each correct answer was given one point whilst
incorrect answer or I do not know answer was scored zero point.
Handlers that had a score less than 70% of accuracy were regarded
to have insufcient knowledge and those that had scores equal to
or greater than 70% accuracy were considered to have good
knowledge. The cut-off point for the analysis of the results was
higher than that reported in other studies (Angelillo et al., 2001;
Bas, Yuksel, & Cavusoglu, 2006) because most handlers inter-
viewed had already received some type of training.
2.2.2. Assessment of knowledge and practices of head chefs and
mangers
Face to face interviews were used to obtain data. The ques-
tionnaire contained 44 questions, covering six areas: (1) de-
mographics; (2) training; (3) food storage and delivery; (4) food
handling; (5) personal hygiene/cleaning; and (6) food preparation.
All questions were multiple choice with an if other, please specify
option (adapted from Bolton, Meally, Blair, Mcdowell, & Cowan,
2008).
374 L.T. Rebouas et al. / Food Control 73 (2017) 372e381
The questionnaire, and the interview procedures were pre-
tested in a pilot study with ten managers and four head chefs in
seven randomly selected restaurants in Salvador area, to conrm
question clarity, identify response options and to estimate the
probable duration of the interview.
Both English questionnaires were translated into Portuguese
and adapted to the Brazilian food law and food handling
requirements.
The nal survey instruments were launched between February
and September 2014.
2.3. Statistical analysis
Data analysis was performed using the software SPSS for Win-
dows, version 17.0. The descriptive statistics and Pearson's chi-
square test were used for analysis. Results with a p-value <0.05
were considered statistically signicant.
3. Results
3.1. Assessment of knowledge, attitudes and practices of food
handlers
The participants of this part of the study included 265 food
handlers, who comprised 22 from group 1 (restaurants that had
only one manager), 25 from group 2 (restaurants that had a man-
ager and a head chef), 71 from group 3 (restaurants that had a
manager, a head chef and a nutritionist for part-time), and 147 from
group 4 (restaurants that had a manager, a head chef, and a
nutritionist for full-time).
3.1.1. Demographic characteristics
The majority of respondents were female, with a mean age of 35
years. Education levels varied with 52.8% of the participants having
a rst to third grade and 30.9% had complete or incomplete sec-
ondary school level. Personal income was more prevalent between
1 and 2 minimum wages (48.7%). The handlers declared a mean of
112 months' professional experience (0e528 months), and a mean
of 39 months (0e360 months) work experience in the restaurant of
this study.
It was found that most of respondents attended training and 17%
never participated in any training related to food safety. The han-
dlers claimed to have taken part, at the average of two training for
the past six months; however, 44.0% reported not having partici-
pated in any training during this period.
3.1.2. Employees' work satisfaction
In relation to satisfaction with the service, 69.9% of the handlers
responded positively to this question. In this question the ambiv-
alence of the answers in two issues stands out, i.e., while 55.8% of
handlers would choose the same profession, 64.9% would leave its
function if was offered a job in another sector. Most of them do not
talk about personal issues with colleagues or supervisors. Many of
the handlers (95.1%) said that they perform their work in accor-
dance with the rules established and 83.8% determined that the
work load was adequate. Still, 91.7% of them believed that their
work provided every condition to guarantee the food safety, and
96.6% believed that the meals served did not represent a risk for the
guest's health.
3.1.3. Knowledge, attitudes and practices
Tables 1e3 summarizes the results of the knowledge assess-
ment, food handlers' attitudes and self-reported practices. Most of
the handlers demonstrated a good knowledge, responded asser-
tively about personal and hands hygiene (88.0%). Although, most of
the food handlers (88.01%) were aware of the fundamental hygienic
measures in the workplace, such as washing their hands and wear
gloves (Table 1), only 9.1% answered correctly the number of steps
involved in the washing hands process. The question identied as
at high risk of foodborne disease was not answered correctly by
85.7% of respondents, as well as 33.2% of them did not know that
hepatitis A is a foodborne disease.
In relation to attitudes (Table 2), all participants believed that
the properly food handling is an essential part of their re-
sponsibility at work. However, 9.1% did not agree/did not know that
food handlers should wear gloves when touching food ready-to-eat
or when they have bruises on their hands. In the hands hygiene
self-reporting practices evaluate, it was found that 76.1% answered
properly about frequency in which the procedure was performed
(Table 3). The hotels were divided into risk and protection groups,
considering the presence of the nutritionist in the restaurant, so we
categorized the answers as risk and protection. For this, the
option sometimes was grouped with never, and rare and
frequent options with always option. Thus, it was observed that
88.7% of the respondents related handwashing procedures prop-
erly; 60.4% said that to wear disposable gloves when handling or
distributing food, and 32.4% said not washing their hands before
using disposable gloves. More than half (52.5%) of the handlers
reported talking while handling foods and 28.7% said that they
prove the food with their hands.
3.1.4. Evaluation of good hygiene practices using a checklist
The food handlers' practices covering only the items involving
hand hygiene practices and issues related to them in the restau-
rants were also evaluated using a check list form (Brasil, 2013b). For
this, the hotels were stratied into two groups, risk and protection,
according to presence or not of the nutritionist in the restaurant
(part or full-time).
Association between good hygiene practices (check-list form)
and food handlers self-reported practices, by restaurant category,
was demonstrated in Table 4. Although the self-reporting practices
of the food handlers has been adequate, the results of the check list
form demonstrated that most handlers (91.3%) did not obey a fre-
quency suitable for cleaning of their hands. Also, a considerable
portion of the hotels (n 54) did not have adequate resources to
sustain the adoption of good hygiene practices. This association was
signicant. Also, it was observed that the statements food handlers
take a leave of the work place when they suffer lesions or showed
infections symptoms and hands are washed carefully before
starting work, before and after food handling, after any service
interruption, after touching contaminated materials, after return-
ing from the toilet, whenever it is necessary, had a signicant
association with the presence of nutritionist in restaurants of the
hotels (protection group) (p 0, 014; p 0.034, respectively),
suggesting that the presence of the nutritionist in restaurants
promotes adoption of appropriate practices, or at least practice
knowledge that should be adopted in the production area.
On comparison between the groups in the hotels' category
regarding the handlers satisfaction, bivaried analysis (Table 5)
showed a signicant association (p < 0.05), i.e., the food handlers of
the hotels classied as protection group believed that the work-
load was adequate (p 0.000).
3.1.5. Knowledge Assessment and head chefs and managers'
practices
Evaluation of knowledge level of head chefs and managers in
food safety is shown in Table 6.
Out of the total of 32 participants in the survey, 18 were man-
agers and 14 chefs. More than 56% of them were male and 50% were
aged 35e44 years.
 L.T. Rebouas et al. / Food Control 73 (2017) 372e381 375

Table 1
Knowledge of food handlers about personal/hands hygiene.

Questions Right (%) Wrong (%) I do not know (%)

1. Washing hands before working reduces the risk of food contamination. 99.6 0.4 0.0
2. Using gloves while handling food reduces the risk of food contamination. 94.3 5.7 0.0
3. Eating and drinking in the work place increase the risk of food contamination. 87.9 10.6 1.5
4. Wearing hairnet or a cap, gloves and masks is an important practice to reduce the risk of food contamination. 97.7 2.3 0.0
5. Using hands to add ice in the glass/cups offered risk to guest. 98.5 1.1 0.4
6. Using restroom at work only for urinary do not oblige you to wash your hands. 94.3 5.7 0.0
7. A health person can cause illness during food handling. 94.3 3.4 2.3
8. Food handler with infectious disease should take an eave and should not work on the activities. 98.9 0.8 0.4
9. All the people, including children, adults, pregnant women and elderly have the same risk of foodborne disease. 85.7 13.6 0.8
10. Foodborne diseases can be prevented and controlled by good hygiene practices. 98.9 1.1 0.0
11. Bacteria are normally found on the surface of human skin. 86.4 9.8 3.8
12. Hand-washing procedures contain six steps. 6.5 9.1 23.4
13. Dirty nails are one of the simplest ways to spread bacteria. 98.9 0.8 0.4
14. Cuts on ngers or hands carry millions of bacteria. 99.6 0.0 0.4
15. Jewels should not be worn for food handlers when preparing food, as it can harbor dirt and bacteria. 100.0 0.0 0.0
16. Dishcloths can replace hand towels for wiping hands. 81.1 18.1 0.8
17. Hepatitis A is transmitted through raw food contaminated by lack of proper hygiene. 63.8 3.0 33.2
18. Foodborne diseases can affect your health and have economic effect on society. 95.8 1.5 2.6

The average number of clients per week in restaurants ranged
from 20 to more than 4000. The number of people employed in
food-handling operations in each restaurant also presented great
variation, and more than 50% of them had 1e20 years employed in
food handling.
The participants presented a good training in food safety, with
participation in training courses, which ensured a certicate for
75% of the interviewees and 21.9% obtained diploma. It was found
that 3.1% of the respondents, despite of reporting to have received
training on food safety, did not possess any certicate.
Although 96.9% of respondents have informed that they had
food safety qualication, the knowledge level attained was only
53%, being this percentage considered unsatisfactory (<70%).
The knowledge results about the current legislation on food
safety, showed that 37.5% of respondents were unaware of which
legislation was adopted in the restaurants, and the concept of
hazard analysis and critical control points (HACCP) was not uni-
versally understood. About 35.0% of the respondents knew what
the HACCP means and 50% did not know or have provided another
meaning.
Although most chefs and managers (62.5%) reported to perform
food inspection continuously, a considerable part of them stated
that this inspection was so sporadic (Table 6). The inspections were
based on resolutions of the National Health Surveillance Agency
(ANVISA) and resolution of the establishment.
A signicant portion (71.9%) of restaurants owned thermometer
in refrigerators and 62.5% in freezers, which does not mean the
performing of temperature monitoring daily. It was found that only
43.8 percent of the respondents knew the correct temperature to
cool the food. Most head chef and managers comply with the
established, i.e., 12.5% store raw meat on the bottom shelf, while
59.4% use a unique cooler.
The respondents used a variety of practices to reduce cross-
contamination, such as using separate cutting boards for raw
meat and ready-to-eat food and most of them (59.4%) used a sys-
tem of coded color boards. A variety of practices for cleaning of the
knives was also related, including the use of a system of two knives
(25.0%), washing immediately after use (56.3%) and color-coding
(6.3%).
In relation to refrigerator cleaning it was reported the use of
detergent (53.1%), detergent and sanitizer (21.9%), liquid soap
(9.4%), liquid soap and sanitizer (6.3%), and alcohol (3.1%). The same
was observed for equipment cleaning; most respondents reported
using detergent (62.5%), while some used detergent and sanitizer
(12.5%) or just (9.4%) sanitizer. To assist in the cleaning, the par-
ticipants stated to use disposable cloths (15.6%), sponges (43.8%), or
dish cloths (6.3%), paper towels or similar (3.1%).
A total of 81.3% of participants stated that the establishments
have a sink for washing hands and a similar percentage (84.4%)
stated that the same is provided with tap water, soap, antiseptic

Table 2
Food handlers' attitudes toward personal and hand hygiene.

Questions Disagree Agree Do not know/Do

(%) (%) not remember (%)

1. Cleaning my hands can prevent foodborne diseases. 1.1 98.5 0.4

2. Properly food handling is an essential part of my responsibility at work. 0.0 100.0 0.0
3. Changing my behavior in food handling when I know that what I am doing is incorrect, favors the safe food production. 8.7 90.6 0.8
4. It is essential to maintain a high degree of personal hygiene while I work. 0.0 99.6 0.4
5. Food handlers who suffer from foodborne illness should leave and should not work on the activities. 4.9 91.3 3.8
6. Food handlers must make sure that their nails are short and clean. 0.0 99.6 0.4
7. It is important that hand-washing technique be xed in food preparation facilities and bathrooms. 0.8 98.9 0.4
8. Handlers must use clean paper towels to dry their hands. 3.4 96.2 0.4
9. Handlers must change gloves between handling raw foods and preparing food. 2.3 97.4 0.4
10. Food handlers should wear gloves when touching food. 8.3 90.9 0.8
11. The employee's health condition must be evaluated prior to their admission. 0.0 99.6 0.4
12. The use of gloves is an important attitude in reducing contamination risk of non-packaged foods. 4.5 94.7 0.8
13. Food handlers who have bruises on their hands must not touch food without gloves. 1.5 98.5 0.0
14. Food hygiene training for handlers is an important issue to reduce the risk of food contamination. 0.8 99.2 0.0
376 L.T. Rebouas et al. / Food Control 73 (2017) 372e381

Table 3
Food handler's self-reported practices toward personal and hand hygiene.

Questions Never (%) Rare (%) Sometimes (%) Frequent (%) Always (%) Risk (%) Protection (%)

1. Do you wear gloves when handling ready-to-eat foods? 10.6 3.4 25.6 18.1 42.3 39.6 60.4
2. Do you practice proper hand-washing procedure? 0.8 1.1 9.4 24.2 64.5 11.3 88.7
3. Do you wash your hands before putting gloves? 11.7 7.1 13.6 13.6 54.0 32.4 67.6
4. Do you wash your hands after removing or change gloves? 7.5 4.6 10.9 12.8 64.2 23.0 77.0
5. Do you wash your hands before handling raw foods? 2.6 0.8 6.4 14.4 75.8 9.8 90.2
6. Do you wash your hands after handling raw foods? 2.2 2.3 8.3 15.5 71.7 12.8 87.2
7. Do you wash your hands before handling ready-to-eat foods? 1.5 2.7 4.5 16.2 75.1 8.7 91.3
8. Do you wash your hands after handling ready-to-eat foods? 3.0 2.6 5.3 15.5 73.6 10.9 89.1
9. Do you wear nail polish at work? 82.3 8.3 5.6 2.3 1.5 9.4 90.6
10. Do you use your hands to eat foods? 63.4 7.9 11.7 5.7 11.3 28.7 71.3
11. Are your ngernails short and clean? 1.5 1.9 4.9 14.3 77.4 8.3 91.7
12. Do you use antiseptic in the hand-washing procedure? 1.1 1.1 5.7 12.5 79.6 7.9 92.1
13. Do you dry your hands with clean hand towels? 2.3 0.7 3.0 11.4 82.6 6.0 94.0
14. Do you use jewellery when preparing foods? 80.4 8.3 4.2 0.8 6.3 11.3 88.7
15. Do you talk while preparing foods? 28.3 19.2 42.6 2.3 7.6 52.5 47.5
16. Do you use antiseptic in the hand washing after using the bathroom? 0.4 0.0 1.5 9.4 88.7 1.9 98.1
17. Do you eat, drink and smoke while preparing foods? 73.2 9.8 12.8 0.4 3.8 17.0 83.0
18. Do you wash your hands after nose-wiping or scratching your body? 4.2 3.4 12.0 15.8 64.6 19.6 80.4
19. Do you wash your hands when returning to work after break? 1.9 1.1 3.0 11.7 82.3 6.0 94.0
20. Do you wash your hands after handling waste food or rubbish? 0.8 1.1 1.9 11.7 84.5 3.8 96.2
21. Do you touch food when your hands or ngers are cut and not properly covered? 89.4 6.4 8.0 0.8 2.6 4.2 95.8

and paper towels. However, no establishment had brush in the sink.
The majority of respondents know they must wash their hands
with antibacterial soap and tap water (56.3%) after handling food.
Additionally, 71.9% of the respondents claimed to encourage
handwashing.
A variety of practices was reported by heads and managers to
food preparation. It was observed that some head chefs and/or
managers, although in small number, still perform the meat defrost
at room temperature (12.5%). Only 37.5% of the interviewees
mentioned using the temperature probe to check if red meat is
sufciently cooked, and a similar percentage (31.3%) also used the
probe to check the poultry and pork. Still there is the practice of
serving rare meat, prepared in accordance with the specications of
the customers ' taste. A high percentage of respondents (90.7%)

Table 4
Association between good hygiene practices (RDC 516/2004, Brasil, 2004) and food handlers self-reported practices, by restaurant category.

Check-list form (%) Practice Restaurant P valor R P P valor

category

70% <70%

Compliance 158 87 0.620 7 16 0.000

No compliance 14 6 9 0

Facility-design (layout)
Toilet facilities have washbasin in suitable number and suitable products to C 65.2 175 19 0.022* 39 155 0.498
hands hygiene (towel paper, liquid soap, antiseptic, trash with automatic lid, NC 34.8 70 1 17 54
clean hand towel, or another safe system for hands drying).

Food handlers
Food handlers take a leave of the work place when they suffer lesions or showed C 65.2 182 17 0.287 35 164 0.014*
infections symptoms. NC 34.8 63 3 21 45
Hands are washed carefully before starting work, before and after food handling, C 8.7 25 5 0.045* 0 30 0.003*
after any service interruption, after touching contaminated materials, after NC 91.3 220 15 56 179
returning from the toilet, whenever it is necessary.
Do not smoke, talk, sing, eat, drink, sneeze or cough, money handling, or do C 73.9 166 15 0.503 33 148 0.09*
another attitude that can contaminate food. NC 26.1 79 5 23 61

Food preparation
Processing areas with washbasin in suitable number and suitable products to C 56.5 168 19 0.013* 32 155 0.013*
hands hygiene (towel paper, liquid soap, antiseptic, trash with automatic lid, NC 43.5 77 1 24 54
clean hand towel, or another safe system for hands drying)
During food preparation the workers that handle raw food wash their hands C 13 34 2 0.627 0 36 0.001*
before handling ready-to-eat foods NC 87 211 18 56 173

Store, transport and distribution of prepared foods

In store, transport and food distribution, the handlers adopt procedures to C 26.1 90 9 0.761 0 99 0.000*
minimize the food contamination risk, using hands antisepsis and utensils or NC 69.6 142 10 56 96
gloves.

C Compliance.
NC No compliance.
R Risk.
P Protection.
*Pearson Chi-square test.
 L.T. Rebouas et al. / Food Control 73 (2017) 372e381 377

Table 5
Bivaried analysis between knowledge and self-reported practices and other variables.

Knowledge Practice Check list

70% <70% P valor 70% <70% P valor C NC P valor

Hotel category R 55 1 0.849 50 6 0.312 0 56 0,000*

P 206 3 195 14 172 37
Check list C 170 2 0.529 158 87 0.620
NC 91 2 14 6
Education R 98 1 0.607 93 6 0.479
P 163 3 152 14
Length of employment Y 216 3 0.684 201 18 0.366
N 45 1 44 2
Income Y e e e 95 5 0.222
N e e e 150 15
Training in personal hygiene/hand Y 233 3 0.384 220 16 0.177
N 28 1 25 4
Work satisfaction R 4 0 0.181 79 2 0.038*
P 180 81 166 18

R risk.
P protection.
C compliance.
NC no compliance.
Y yes.
N no.
*p < 0,05.

stated to adopt this practice.
Finally, it was veried that 53.1% of respondents knew how use
the bain marie, and to ensure that the food is at the proper tem-
perature, 62.5% said to use the thermometer directly in food, while
12.5% of them didn't know how to monitor this temperature.
Ready-to-eat foods not served were stocked mostly correctly (75%)
and 15.6% of those surveyed reported to have discarded food that
was not consumed.
Interesting to mention that differently from the results found in
the analysis with food handlers, the presence of nutritionist in the
restaurants shows no association with head chefs and managers'
knowledge.
4. Discussion
In this study we evaluated the knowledge, attitudes and prac-
tices of food handler and head chefs and managers of hotels' res-
taurants with more than 100 beds in Salvador city.
For the study with food handlers, a total of 265 questionnaires
were collected in which the majority of the respondents were fe-
male. The ratio of female respondents to male respondents re-
ected the role of female as hotels' restaurants food preparers in
Salvador. Also, it was found that most of respondents attended
training and had an average of 39 months' work experience.
Training for caterers has been shown to improve food safety
knowledge and hygiene awareness and may result in improved
food safety practices. According to Soares et al. (2012), training
programs are an integral part of creating a positive culture of food
safety, and must occur periodically, in order to promote changes in
people's behavior through attitudes and practices that encourage
the production of a food safe by reducing the risk of foodborne
disease.
Although almost all of handlers had reported training and
answered correct the questions about practice in hand hygiene,
results of this present study showed that the majority of them did
not know the steps for hand washing. Tan, Bakar, Karim, Lee, and
Mahyudin (2013) also veried similar results. Several studies have
demonstrated the presence of pathogenic microorganisms in the
handlers' hands that make them an important vehicle of these due
to inadequate personal hygiene (Campos et al., 2009; Ferreira et al.,
2013; Soares et al., 2012). And even the handlers considered
healthy host millions of pathogenic bacteria that can contaminate
food through the mouth, nose, throat and intestinal tract (Soares
et al., 2012). So, the knowledge about the steps for hand washing
is essential to avoid foodborne diseases occurrence.
Unlike most studies conducted for the evaluation of the triad,
knowledge, attitude and practice, the results of the statistical
analysis in this work did not indicate a signicant association be-
tween the knowledge levels, attitudes and self-reported practices
by handlers. However, it was found association between handlers
that presented good satisfaction with the job and handlers that
introduced appropriate practices.
Work performed by Lim, Chye, Sulaiman, Suki, and Lee (2016)
demonstrate that food safety knowledge and attitude of the food
preparer in the house was not correlated.
Differently, Ansari-Lari et al. (2010), and Vo, Le, Le, Minh, and
Nuorti (2015) found in their studies that there was a signicant
positive correlation between knowledge and attitude of food
handler.
The question identied as groups of foodborne disease risks was
not answered correctly by majority of respondents. The same was
observed in studies developed by Ansari-Lari et al. (2010) and
Soares et al. (2012). Still, more than 50% of handlers related talking
during food handling and some of them tasting food with their
hands.
Although some self-reporting practices have been adequate, the
evaluation using a checklist demonstrated that most handlers do
not obey a frequency suitable for hand hygiene.
The hotels were divided into risk and protection groups,
considering the presence of the nutritionist in the restaurant,
regardless of their frequency of days at the restaurant (full or part of
time). It was found that a considerable number of the hotels (17 in
the risk group and 54 in the protection group) did not have
adequate facility-design (layout) to provide the adoption of good
practices on hand hygiene. However, it was veried association
between hotels category and knowledge and satisfaction of the
food handler with a job, i.e., the hotels' handlers which were clas-
sied as protection believed that the workload was adequate, and
that even the healthy person handling foods could cause disease.
Also, in the practices evaluation, it was observed that the statement
378 L.T. Rebouas et al. / Food Control 73 (2017) 372e381

Table 6
Knowledge and practices of head chefs and mangers in food safety.

Query Response %

1. Gender Male 56.2

Female 43.8
2. Which of these is your age group? Under 18 0.0
19e24 0.0
25e34 28.1
35e44 50.0
45e54 18.8
55e64 3.1
Declined to answer 0.0
3. What is the average number of customers, that eat in the restaurant, in a Over 20, but less than 100 3.1
typical week? Over 100, but less than 200 6.3
Over 200, but less than 300 18.8
Over 300, but less than 400 9.4
Over 400, but less than 500 12.5
Over 500, but less than 1000 18.8
Over 1000, but less than 2000 15.6
Over 2000, but less than 3000 6.3
Over 4000 6.3
4. How many people are employed in food handling operations in each 1e10 37.5
restaurant? 11e20 34.4
21e30 15.6
Over 30 12.5
5. What kind of qualications did the head chefs achieve through training? Certicate 75.0
Diploma 21.9
None/trained in restaurant 3,1
6. What piece of legislation covers hygiene in catering? Brazilian law: ANVISA (RDC 216, 275, etc.) 46.9
Region law e DIVISA 9.4
Food safety (general regulations) 3.1
Do not know. 3.1
7. What did the head chefs understand by HACCP? Hazard analysis critical control point 37.5
Food safety system 34.4
Process control 3.1
Temperature control 3.1
Documentation procedures 9.4
Other 9.4
Do not know 40.6
8. Who audits/inspects your suppliers? Head chef 21.9
Nutritionist 18.8
Head chef and Nutritionist 15.4
Restaurant manager 12.5
Another member of the kitchen staff 6.3
External auditor 6.3
Consultants 18.8
9. How often are your supplies inspected? Continuously 59.4
Once a day 3.1
Every time there was a delivery 9.4
Once a week 15.6
Once a month 3.1
Other 9.4
10. To which standard do you audit/inspect your suppliers? ISO 0.0
ANVISA 37.5
Developed own 37.5
(continued on next page)
Health board 3.1
SENAC guides and others 0.0
Other (ANVISA developed own) 18.8
Do not know 3.1
11. At what temperature do you think your refrigerator should be kept? Less than 1
C 9.4
1e5
C 34.4
6e10
C 15.6
Unsure 6.3
Do not know 18.8
12. Do you have a thermometer or equivalent in your refrigerator? Yes 71.9
No 28.1
Not usually 0.0
13. Do you have a thermometer or equivalent in your freezer? Yes 62.5
No 37.5
Not usually 0.0
14. Do you have a thermometer or equivalent in your cold room? Yes 50.0
No 15.6
Not usually 34.4
15. Do you monitor the temperature using a temperature probe? Yes 53.1
No 46.9
16. When raw meat is refrigerated, where is it stored? Bottom shelf 12.5
 L.T. Rebouas et al. / Food Control 73 (2017) 372e381 379

Table 6 (continued )

Query Response %

Separate fridge 59.4

Middle shelf 6.3
Cold room 3.1
Do not know 3.1
17. How do you ensure your cutting board after cutting raw foods are not Rinse it under tap water, middle detergent and chlorine 25.0
subsequently used with food which won't be cooked? Color coded 59.4
Dishwasher or equivalent machine 0.0
Rinse it under cold water 3.1
Wash it with detergent and tap water 3.1
Do not know 9.4
18. What material are your cutting boards made from? Plastic 100
Wood 0.0
Glass 0.0
19. How do you ensure knives used to cut raw foods are not subsequently Two knife system 25.0
used on foods that won't be cooked? Color-coding 6.3
Wash after each use 56.3
Other 6.3
Do not know 3.1
20. How is the dirty/used knife cleaned? Wash it with detergent, tap water and mild bleach 40.7
Dishwasher or its equivalent 0.0
Wash it with detergent and tap water 50.0
Do not know 9,3
21. How do you clean your refrigerators/freezers? Detergent 53.1
Washing up liquid soap 9.3
Detergent and sanitizer 28,2
Baking soda 0.0
Sanitizer 6.3
Alcohol 3.1
22. How do you clean your worktops? Detergent 62.5
Washing up liquid soap 3.1
Detergent and sanitizer 9.4
Liquid soap and sanitizer 9.4
Sanitizer 12.5
Alcohol 3.1
(continued on next page)
23. Do you have a designated sink for cleaning your hands? Yes 81.3
No 18.8
24. Is this sink, designated for cleaning hands providing hot water and soap? Yes 84.4
No 15.6
25. How do you clean your hands after handling raw meat? Wash them with antibacterial soap and tap water 71.8
Wipe them on a tea towel/dish cloth/j-cloth 0.0
Wash them with ordinary soap and tap water 25.1
Other 3.1
26. Was there any incentive/campaign to hand washing and personal Yes 71.9
hygiene? No 28.1
27. What do you use to clean your fridge/worktops with? J-cloth or similar disposable cloth 15.6
Sponge 43.7
Disposable cloth and sponge 21.9
Dish cloth 6.3
Towel paper or similar 12.5
28. How do you usually defrost frozen meat? Defrost cycle in the microwave 6.3
In the refrigerator or cold room 78.1
Leave it out at room temperature 12.5
In a basin with cold water 0.0
Cook meat frozen 0.0
Not applicable 3.1
29. How do you know the meat looks sufciently cooked? When it has the correct probe reading. 37.5
When the juice runs clear 0.0
When the meat looks cooked in the side 18.8
When it has a brown and crisp outer coating 3.1
When it has been in the cooker for the stated time 12.5
Touch 0.0
Experience 9.4
Do not know 6.2
Other 12.4
30. How do you know poultry and pork is sufciently cooked? When it has the correct probe reading. 31.3
When the juice runs clear 0.0
When the meat looks cooked in the side 9.4
When it has a brown and crisp outer coating 6.3
When it has been in the cooker for the stated time 15.6
Touch 0.0
Experience 18.8
Other 15.6
Do not know 3.1
(continued on next page)
380 L.T. Rebouas et al. / Food Control 73 (2017) 372e381

Table 6 (continued )

Query Response %

31. In your estimation, what percentage of customers prefer their meat 1-10% 50.0
rare? 11-20% 9.4
21-30% 6.3
31-40% 6.3
41-50% 3.1
51-60% 3.1
Over 60% 12.5
Do not know 6.3
32. What temperature is the food in the Bain Marie? Above 63
C 53.1
Bellow 63
C 15.6
At 63
C 0.0
Do not know 12.5
Not applicable 18.8
(continued on next page)
33. How do you know the food is at that temperature? Probe food 62.5
Probe water 6.3
Read dial 0.0
Do not know 15.6
Not applicable 15.6
34. How do you store food that is cooked/uneaten? Allowed to cool then placed in the refrigerator 50.0
Allowed to cool then frozen 25.0
Discarded 15.6
At room temperature 0.0
Other 0.0
Not applicable 9.4
35. What temperature do you reheat this food to? Above 63
C 62.5
Bellow 63
C 6.3
Served cold 0.0
Do not know 15.6
Not applicable 15.6

Adapted from Bolton et al. (2008).

use disposable gloves when handling or distributing food, washing
their hands before using gloves, using an antiseptic in cleaning
hands and drying hands with paper towels had a signicant as-
sociation with the presence of nutritionist in restaurant's hotel.
This results suggested that the presence of the nutritionist in
restaurants promotes adoption of appropriate practices, or at least
knowledge of practice that should be adopted in the safety meals
production.
Related to the study with restaurants' head chefs and managers,
the results showed that the men were majority, and most of the
respondents were aged 25 years or older. Similar result was found
in a study developed in a company in Portugal, in which only men
were employed at management position and most participants
were aged 36 years or older (Martins, Hogg, & Otero, 2012).
The participants showed good performance in food safety
because they had participated in training courses, and most of them
had certicate. According to Cavalli and Salay (2007), the level of
the workers' formal schooling, participation in training courses,
and the positive experience in the professional area, are factors that
contribute to food safety.
Due to the variety of roles and functions being exercised by
managers throughout history, even conceptual gaps are identied
and related to their performance (Barros et al., 2011). In this
context, the lack of time management can be seen as one of the
major barriers to food handler training (Roberts & Barret, 2009),
which may reect the adoption of inappropriate practices.
The low level of knowledge of head chefs and managers as
veried in this study is worrying, considering that any action with
the aim of ensuring food safety should be the essential to
contamination control in the restaurants. Thus, the inspection of
raw material on delivery and storage is a control point and the
present investigation showed certain fragility in this item, since in
some restaurants the supplies were inspected by other people.
Unlike our results, Bolton et al. (2008) in a study developed with
200 chefs and managers of restaurants in Ireland, found that there
is a high risk of cross-contamination in kitchens of restaurants
through tools and work surfaces, since most of the study partici-
pants said that they do not use color-coding to the knives and
cutting boards.
Related to hand hygiene, the results showed that the investi-
gated hotels did not have any supplies for washing and drying
hands. The same was observed in study by Bolton et al. (2008),
where few establishments provided brush to wash their hands,
suggesting that the contaminants may not be removed efciently.
In the practice of defrosting foods, it was veried that some head
chefs and/or managers, although in small number, still perform the
meat defrost at room temperature. Work reported by Santos et al.
(2010), when assessing various forms of food defrosting, found
that the best method to reduce bacteria levels in the product was
the use of the microwave, followed by cooling and nal defrost at
room temperature.
According to Adams and Moss (2008) the temperature control is
one of the main tools for the control of microbial growth and when
done inappropriately is one of the leading causes of proliferation
and permanence of the microbial hazard.
All restaurants investigated had technicians, but part of them
had not implemented the good manufacturing practices (GMF) and
standards operation procedures (SOP). This is worrying, because
Brazil legislation is mandatory for GMP and SOP implementation. It
is due mainly to nancial difculties in adequacy of the physical
structure, and lack of conscious and compromised professionals in
the establishments.
5. Conclusion
This study concluded that food handlers of the hotels' restau-
rants have good knowledge levels, attitudes and self-reported
practices. However, the knowledge level about the steps used in
 L.T. Rebouas et al. / Food Control 73 (2017) 372e381
handwashing was unsatisfactory by most participants, and some
self-reported practices represent a risk to food safety. In addition,
the average measure reached at the evaluation or in compliance
through the checklist was low and most of the restaurant had no
facility-design (layout) adequate to provide adoption of good
practices for hand hygiene. Most handlers received training on food
safety and personal hygiene, however it is necessary a recycling of
these trainings, since most of them related not to have participated
in training in the last six months. Still, the presence of the nutri-
tionist in restaurants inuenced positively on the adoption of the
current legislation in hotels' restaurants, as well as in the partici-
pation of the handlers in training, showing in this way the creation
of a positive culture among the handlers.
The knowledge level of restaurants' chefs and managers was
unsatisfactory, although most reported to have training in food
safety. It is observed that part of the responsibility for the organi-
zation and supervision of the restaurants had no knowledge about
the legislation adopted in the establishments and did not concep-
tualize properly the HACCP system. The knowledge level of
restaurants' chefs and managers was unsatisfactory, although most
reported to have training in food safety.
Acknowledgements
This research was supported in part by Coordenaa ~o de Aper-
feioamento de Pessoal de Nvel Superior (CAPES) (CAPES/PROAPE:
U$300.00 approximately) from Brazilian government. The authors
thank Fundaa ~o de Amparo a
 Pesquisa do Estado da Bahia (FAPESB)
(FAPESB: U$10,200.00 approximately) for scholarship support.
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