Food Control 17 (2006) 118126 www.elsevier.

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Implementation of HACCP and prerequisite programs in food businesses in Turkey

Murat Bas *, Azmi Safak Ersun, Gokhan Kvanc
Department of Nutrition and Dietetics, Health Sciences Faculty, Baskent University, Baglca Kampusu, Eskis ehir Yolu 20 km, 06530 Ankara, Turkey Received 14 June 2004; received in revised form 22 September 2004; accepted 27 September 2004

Abstract The objectives of this study was to determine food safety practices and procedures related to the hazard analysis critical control point (HACCP) programme and prerequisite programme implementation in food businesses. One hundred and nine food businesses in Turkey were assessed for HACCP-prerequisite programmes and food safety practices. Only eight food businesses had implemented the HACCP system in food businesses. Directors and employees often have insucient knowledge regarding the basics of food hygiene. Results indicated that proper food safety practices and prerequisite food safety programmes for HACCP were often not being followed in many food businesses. Time and temperature errors and inadequate handwashing practices were wide in the most food businesses. Emphasis on implementing prerequisite programmes in preparation for HACCP is needed in food businesses. The problems of implementing HACCP in food businesses have been namely a low level of food hygiene management training, high sta turnover rate, lack of motivation, lack of nancial resources, inadequate equipment and physical conditions of the facility and failure of government. 2004 Elsevier Ltd. All rights reserved.
Keywords: Prerequisite programme; HACCP; Food businesses

1. Introduction The European Commission has recognized the importance of controlling food-poisoning outbreaks owing to the increasing number of meals consumed outside the home, in parallel with the ever-expanding range of pre-prepared meals. This changing consumer lifestyle emphasizes the need for better and eective ways of controlling food hygiene (Wilson, Murray, Black, & McDowell, 1997). Much more is known now about the extent of foodborne illnesses and how severe it can be, not just in terms of acute illness, but also in terms of long-term

Corresponding author: Tel.: +90 312 2341010/1605/1606; fax: +90 312 2341157. E-mail address: mbas@baskent.edu.tr (M. Bas ). 0956-7135/$ - see front matter 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.foodcont.2004.09.010

chronic diseases. The ability of foodborne illness to cause chronic complications is receiving new appreciation. In addition, there is a growing segment of the population, i.e., pregnant women, the elderly, the very young and individuals who are immunocompromised, that is particularly susceptible to foodborne illnesses (Woteki, Facinoli, & Schor, 2001). Prior to designing a HACCP plan, the food premises is expected to be able to demonstrate ongoing compliance with GMP, regulatory and market access requirements. Conrmation of eective prerequisites means that the HACCP team can focus on genuine design of a HACCP plan for the particular product and process selected, without having to repeatedly address hygiene requirements common to all processes, and applicable at most process steps in each HACCP ow diagram. The prerequisites will often be generic to all processes at an individual premises (Lee & Hathaway, 1998).

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The World Health Organisation has also published a denition for prerequisites (WHO, 1993) practices and conditions needed prior to and during the implementation of HACCP and which are essential for food safety and again mentions that these are described in Codex Alimentairus Commissions General Principles of Food Hygiene and other Codes of Practice. FDA emphasized the role of prerequisite program (PRP) for the implementation of HACCP (Grith, 2000). The concepts of prerequisite program (PRP) and how it will benet HACCP had been reported by Wallace and Williams (2001). It has been recommended that before HACCP is utilized, a prerequisite program is needed (Seward, 2000). If the PRP are not used, there probably will be a waste of resources and money and might cause more resistance for future utilization and HACCP system implementation. PRP, which support HACCP plan, also called standard operating procedures (SOP), includes good personal hygiene (employee hygiene practice), cleaning and sanitation programs, proper facility-design practices, equipment-maintenance, and supplier selection and specication programs (cross-contamination control) (National Restaurant Association Educational Foundation, 2002). In Turkey, there are many issues imposing risk on food safety due to industrialization and mass production, emergence of longer and more complex food chains, fast food consumption, street vendors and growing international trade and tourism. Besides, long-term ination and other economical causes; advertisements, growing eating out habits (fast foods, restaurant meals, etc.) are also the likely causes of food safety problems in Turkey. Good manufacturing practices (GMP), good hygiene practices (GHP), hazard analysis critical control points (HACCP) control and production systems are used to ensure food safety. In addition, food safety systems are used simultaneously with Total Quality Management and should be implemented at every stage of the food production from farm to the fork. HACCP system is important for maintaining food safety in food businesses, yet it seems that HACCP system is not implemented widely in Turkey. Further, prerequisite programs, dened as those procedures that address operational conditions providing the foundation for the HACCP system may not be in place. There have been no studies examining the extent to which food safety prerequisite programs are implemented in Turkish food businesses. Turkey has been a member of Food and Agriculture Organisation (FAO) and Codex Alimentarius Commission since 1948. Ocial ordinance regulations on food laws have been fullled according to the EU (Hascicek, Sarimehmetoglu, & Cakiroglu, 2004). The last regula tions in the Turkish Food Code (TFC) on foods were made in 2001, but they are considered inadequate, since

there are some deciency or errors in the Turkish Food Code. The purpose of this study was to determine food safety procedures and practices used in food businesses related to HACCP and prerequisite programmes in Ankara, the capital city of Turkey. At the same time, food safety criteria of food businesses dened in the Turkish Food Code and according to European Union legislations, and the lack of food safety and other issues were discussed.

2. Material and methods 2.1. Businesses This survey was conducted from September 2003 to April 2004 involving 109 food businesses in Ankara, Turkey. Assessments of the 109 food businesses were conducted over 8 months. Assessments were consisted of hospital food services (31), catering establishments (14), school food services (4), hotels (11), kebab houses (27), takeaways (14) and restaurants (18). Each food business was visited by personnel trained in HACCP and prerequisite programs, conducting face to face interviews and administrating questionnaire. 2.2. HACCP prerequisite programmes questionnaire A written questionnaire which consist of seven parts was developed specially for this study. Part I included 12 questions related to food businesses (such as number of employees, number of meals, implementation of HACCP systems, status of record keeping). Part II included 25 questions related with personal hygiene practices and procedures, including implementation of prerequisite programmes such as good manufacturing practices and hygiene procedures. Part III consist of 23 questions related with buildings, grounds and environmental hygiene procedures. Part IV included 18 questions related with equipment cleaning and sanitation procedures. Part V of the questionnaire consisted of a list of 33 practices that would indicate the presence of HACCP prerequisite programmes. Specic questions related to steps in the ow of food (purchasing, receiving, storage, production, and service) were also included. Part VI included 11 questions related to pest control procedures, and Part VII included 18 questions related to general sanitation procedures. All items were developed based on guidelines of the National Advisory Committee on Microbiological Criteria for Foods (Bryan, 1991), the Servesafe Course Book (National Restaurant Association, 1995) and Turkish Food Code (2001). Each item was responded on a 4-point Likert scale: Full compliance (3-point), minor deciency (2point), major deciency (1-point) and non-compliance

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(0-point). The score range was between 0 and 384. The scores were converted to 100-point. 2.3. Food safety practice questionnaire for directors The questionnaire consisted of a list of 18 food safety practices that would indicate the presence of HACCP prerequisite programmes. Specic questions related to steps in the ow of food (purchasing, receiving, storage, production, and service) were included. Each item was responded on a 3-point Likert scale: Always (2-point), Sometimes (1-point) and Never (0-point). The score range was between 0 and 36. 2.4. Field observation Observation of employee food-handling practices were conducted during the lunch meal period. They involved approximately 6 h of observation from preparation to service stage of meals. Two observers were trained by the researchers to conduct observations. The observers who were selected had educational backgrounds in nutrition and dietetics. The researchers explained each item on the observation tool and appropriate techniques. Observers were asked to make determinations for scoring; full compliance-indicated that the observed procedure was performed correctly 100% of the time by all employees during the audit, minor deciency-indicated that the observed procedure was a few false food-handling practices, major deciency-indicated that the observed procedure was repeated false food-handling practices and non-compliance-indicated that the observed procedure was performed incorrectly during the audit. In addition to observations, objective measurements such as food temperatures, temperatures of refrigerators and freezers and dish machine temperatures were done using recommended procedures. Food temperatures were checked with calibrated, tip-sensitive digital thermometers (FW 2000, Cooper Instrument Corp.). Thermometer (DFP450W, Cooper Instrument Corp.) were used to check high-temperature dish machines. 2.5. Pilot study The questionnaires were pilot tested by researchers with six food business directors. Items were added to ensure adequate coverage of areas and rewritten to increase clarity based on recommendations of the pilot test groups. 2.6. Statistical analysis All statistical analyses were conducted using SPSS for Windows (version 11.0, 2001, Chicago, IL). Means, standard deviations, and frequencies were computed for all variables.

3. Results 3.1. Characteristic of food businesses and directors One hundred and nine of the 120 food business directors replied to questionnaires (response rate of 90.1%). The principal characteristics of the food businesses and directors are presented in Table 1. About 28.4% of the employees in food businesses had received informal food hygiene training, and not a single person received formal training. The percentage of meals prepared each day was 23.8% of the food businesses more than 1000 meals. Only eight food businesses had implemented the HACCP system (4.7% of hospital food services, 42.8% of catering establishments and 25.0% of school food services). In addition, 7.3% of the food businesses had developed written procedures for food storage, personal hygiene and cleaning and disinfection. 3.2. Food safety practices Overall results indicated that proper food safety practices often were not being followed in many food businesses (Table 2). In the measuring and recording category, taking and recording end-point temperatures of all cooked food was the only practice that 10.1% food businesses directors always implemented. In the storage food safety category, the minority (19.3%) of food business directors reported properly labeled and dated of foods. In addition, ensuring food safety category, only 2.7% of food business directors reported sending food product samples to a laboratory for bacterial testing. 3.3. HACCP prerequisite questionnaire and observation Table 3 shows the selected items in prerequisite questionnaire of food businesses, the prevention and control of food-borne diseases. 10.1% of the food businesses routinely use gloves. For food temperatures taken by the study team, temperatures of hot foods were frequently (78.1%-non-compliance) below the recommended 63 C, while a majority of food businesses (78.1%-non-compliance) held cold foods above 4 C. Other common problem noted during assessments was improper cooling. Improper cooling practices were observed in 32.1% of the food businesses (non-compliance). Only six of the food businesses were observed proper personal hygiene practices. Prerequisite questionnaire scores in the food businesses are presented in Figs. 13. The mean personal hygiene practice scores of hospitals, catering establishments, schools, hotels, restaurants, kebab houses and takeaways were 50.1 10.8, 68.6 24.1, 63.3 33.3, 41.8 7.5, 41.1 8.0, 43.1 8.9 and 46.2 10.9, respectively (possible 100-pointFig. 1).

M. Bas et al. / Food Control 17 (2006) 118126 Table 1 Characteristics of the food business directors and food businesses (n = 109) Characteristics Director of food businesses Age 30 years and youngers 3150 years Older than 51 years Education level Graduate of primary school Graduate of secondary school Graduate of high school Graduate of college Years of food businesses 5 years or fewer 615 years 1625 years 26 years or more Food businesses Number of employees 20 or fewer 2150 51 or more Number of meals 250 or fewer 251500 5011000 More than 1000 Food hygiene training of employees Yes Implementation of HACCP system Yes Adoption of food hygiene practice manual Yes Developed food storage procedures Yes Developed personal hygiene procedures Yes Developed cleaning and disinfection procedures Yes n %

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4. Discussion The hazard analysis critical control points (HACCP) system is a food safety management strategy which has been widely tested, and established as an eective means of preventing food-borne diseases were correctly implemented (Codex, 1993; WHO, 1993). The main idea behind HACCP is that it is possible to identify potential hazards and faulty practices at an early stage in food production, processing or preparation. These can then be controlled in order to prevent or minimize risk to health of the consumer or economic loss from food spoilage. HACCP involves the identication of hazards associated with any stage of food production, processing or preparation, the assessment of related risks, and the determination of steps where control is critical to achieving safety (National Advisory Committee on Microbiological Criteria for Foods NACMCF, 1992). HACCP system is important for maintaining food safety in food businesses, yet it seems that HACCP system is not implemented widely in Turkey. Further, prerequisite programs, dened as those procedures that address operational conditions providing the foundation for the HACCP system may not be in place. There have been no studies examining the extent to which food safety prerequisite programs are implemented in Turkish food businesses. However, prior to eectively implementing HACCP, food business should already have in place various practices including ingredient and product specications, sta training, cleaning and disinfectant regimes, hygienically designed facilities and be engaged in good hygienic practices (GHP) (WHO, 1993). An important nding from this study was that HACCP not been widely used and that this had a negative impact on the general food hygiene standards and food-handling practices of personnel. Although, HACCP has yet to become a legal requirement for the Turkey food industry. Therefore, New European Union (EU) hygiene regulations, which will apply to member states from 2005/2006, will require all sectors of the food chain expect primary producers to adopt full HACCP system (Worsfold & Grith, 2003). In this study, 4.7% of food business directors reported that they had implemented HACCP programs. This is slightly lower than food businesses in United Kingdom. HACCP is also a preferred approach to retail food safety because it provides the most eective and ecient way to ensure that food products are safe (McSwane, Rue, & Linton, 2003). Walker and Jones (2002) stated that the UK Government is committed to require 30% of UK food businesses to implement full HACCP by April 2004. In another study, 22% of school food-service directors indicated that they had implemented a comprehensive HACCP plan, while only 11% indicated that they had a HACCP team in place (Youn & Sneed, 2002). In our

22 78 9 5 15 31 58 6 36 44 25

20.1 71.6 8.3 4.6 13.8 28.4 53.2 5.5 33.0 40.4 22.9

67 16 26 52 20 11 26 31 8 8 7 16 14

61.5 14.7 23.9 47.7 18.3 10.1 23.9 28.4 7.3 7.3 6.4 14.7 12.8

Sections of operational control procedure scores, pest control procedure scores and general sanitation procedure scores in prerequisite questionnaire were presented in Fig. 2. The mean general sanitation procedure scores of food businesses were 52.1 14.7 (hospitals), 66.4 26.7 (catering establishments), 65.7 28.2 (schools), 47.5 5.98 (hotels), 44.8 8.7 (restaurants), 45.7 11.7 (kebab houses) and 50.7 15.2 (takeaways). In addition, the total mean scores of prerequisite questionnaire for food businesses were 58.1 7.1 of the hospitals, 70.4 22.2 of the catering establishments, 68.4 30.5 of the schools, 55.6 4.8 of the hotels, 50.1 7.2 of the restaurants, 50.8 7.8 of the kebab houses and 55.9 8.1 of the takeaways (Fig. 3).

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Table 2 Food safety practices implemented in food businesses (n = 109) Food safety practices Measuring and recording Take and record end-point temperatures of all cooked food Take and record temperature of food on the cooling Take and record temperature of food on the reheating Take and record dish machine temperature Take and record temperature of cold food on the service Take and record temperature of hot food on the service Refrigeration-freezer temperatures are checked at least daily Chlorine test kit or thermometer is used to check sanitizing rinse Storage PHFs are stored below ready-to-eat foods in refrigerator units Food is covered to protect from overhead contamination Food is properly labeled and dated The FIFO method of inventory is being practiced Ensuring food safety Follow appropriate personal hygiene practices Send food product samples to a laboratory for bacterial testing Use gloves/utensils and needed Food slicer is sanitized between uses when used with PHF All small equipment and utensils including cutting boards, are sanitized between uses Work surfaces are washed and sanitized between uses Total score (mean SD) = 29.8 24.6 Always n (%) 11 (10.1) 8 (7.3) 7 (6.4) 6 (5.5) 8 (7.3) 8 (7.3) 10 (9.2) 5 (4.6) 59 22 21 102 (54.1) (20.2) (19.3) (93.6) Sometimes n (%) 58 (53.2) 16 (14.7) 4 (3.7) 2 (1.8) 16 (14.7) 16 (14.7) 2 (1.8) 5 (4.6) 23 (21.1) 80 (73.4) 15 (13.8) 5 (4.6) 18 (16.5) 5 (4.6) 31 (28.4) 2 (1.8) 16 (14.7) 57 (52.3) Never n (%) 40 85 98 101 85 85 97 99 (36.7) (78.0) (89.9) (92.7) (78.0) (78.0) (89.0) (90.8)

27 (24.8) 7 (6.4) 73 (67.0) 2 (1.8) 20 101 67 92 73 39 (18.3) (92.7) (61.4) (84.4) (67.0) (35.8)

71 (65.2) 3 (2.7) 11 (10.2) 15 (13.8) 20 (18.3) 13 (11.9)

study, 6% reported to have a HACCP team, and 17% reported to have a person responsible for HACCP implementation. In addition, a few directors reported to have standard operating procedures for storing food (6.4%), personal hygiene (14.7%) and, cleaning and disinfection (12.8%). About, 93% of directors do not have food hygiene practice manual. Similarly, Worsfold and Grith (2003) reported that many small food businesses lacked written hygiene procedures, performance standards and personal hygiene rules. One prerequisite program is training, and recent Turkish Food Code changes mean that all Turkish food businesses must now provide food hygiene training com mensurate with the work activities of their sta (Saglam, 2001). However, the ndings of this study indicated that 28.4% of managerial sta and 56.3% of basic food handlers have not received basic food hygiene training. In a study, 55% of the 444 food handlers surveyed had undertaken formal food hygiene training, and 63% of managers had undertaken formal food hygiene training in UK food businesses (Walker, Pritchard, & Forsythe, 2003). Food hygiene training should be a priority for both managers and sta as indicated by the fact that operations with individuals who have food safety certication used more appropriate food safety practices. Whereas, the success of a HACCP program also depends on the education and training of employees on the importance of their role in maintaining food safety. An understanding of HACCP and the related prerequisite programs, as well as a commitment from management, must be established to make HACCP successful (King, 1992).

Since temperature treatment is frequently the critical control point in a production process, the issue of poor temperature understanding could be a major hindrance of eective HACCP implementation (Walker et al., 2003). In the current study, the most frequently observed poor food handling was related to time and temperature. The most food businesses were not taking and recording food temperatures. In a few food businesses where food temperatures were checked, temperatures were not recorded. Only 36.7% food business directors were not reported for taking end-point temperatures of all cooked food at any time during pre-preparation. Cooling food temperatures have never been determined in 78.0% of the food businesses. The other common observed food safety problem was the failure to food thawing. Food thawing at room temperature also was mostly observed. For the food temperatures checked by the research team, temperatures of cold foods were frequently (in 65 of the 109 food businesses) more than the recommended 4 C, while a majority of operations (in 75 of the 109 food businesses) held hot foods below 63 C. Dramatically, the necessary temperature of readyto-eat foods are not reported in Turkish Food Code. This situation is a great deciency for the Turkish Food Code. Walker et al. reported that less control was evident for the important stages of cooking, chilling and reheating in UK food businesses (Walker et al., 2003). In addition, the survey conducted by Walker et al. (2003) indicated that poor results (60%) for the implementation of HACCP in small and medium size food businesses in UK centered around their temperature control and record keepings.

M. Bas et al. / Food Control 17 (2006) 118126 Table 3 Selected items of HACCP prerequisite questionnaire and observation in food businesses (n = 109) Observed practices Full-C. n Personal Proper personal hygiene practices observed* Sta observed with hair restraints and clean uniforms* Sta with infections restricted/excluded Sta observed washing hands as needed* Building, grounds, environment Proper handwashing sink is located in food preparation area with proper drying and in accessible* Walls, oors, ceiling, lightning adequate for food production* Food contact surfaces are clean, designated, and maintained* Areas are properly ventilated, clean and maintained* Premise maintained inside and outside* Non-food contact surfaces clean and maintained* Equipment Small equipment and utensils are air dried* Work surfaces are clean to sight and touch* Product and process control Use gloves/utensils and needed* Foods are properly labeled and dated* Adequate cooking to required internal temperatures for PHF* Hot foods held above 63 C* Cold foods held at 4 C or below* Leftovers are reheated rapidly to 74 C in 2 h* Rapid cooling methods in place to achieve 6021 C hours; 214 C in four additional hours* Take and record end-point temperatures of all cooked food Take and record temperature of food on the cooling Take and record temperature of food on the reheating Take and record dish machine temperature Dry storage temperatures are between 10 C and 21 C* Raw and cooked foods are stored separately* Food stored in proper containers* 00 Food is stored at least 6 above oor throughout the facility* Trays are dry and clean* Pest Screens are on open windows and doors in good repair* No evidence of pests is present* General sanitation Kitchen garbage cans are clean* Chlorine test kit or thermometer is used to check sanitizing rinse
*

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Min. D. % 5.5 37.6 11.0 18.3 5.5 28.4 14.7 12.8 63.3 45.8 18.3 11.9 10.1 16.5 10.1 7.3 7.3 6.4 14.7 36.7 36.7 36.7 36.7 54.1 20.2 10.1 31.2 42.2 29.4 35.8 35.8 7.3 n 18 49 15 52 73 9 37 53 21 17 16 57 31 16 58 4 4 4 37 23 80 18 41 14 6 43 43 4 % 16.5 45.5 13.8 47.7 67.0 8.3 33.9 48.6 19.3 15.6 14.7 52.3 28.4 14.7 53.2 3.7 3.7 3.7 33.9 21.1 73.4 16.5 37.6 12.8 5.5 39.4 39.4 3.7

Maj. D. n 65 19 53 33 21 41 21 17 16 20 9 15 43 31 27 12 12 38 21 25 7 29 34 34 27 27 12 % 59.5 17.4 48.6 30.2 19.3 37.6 19.3 15.6 14.7 18.4 8.3 13.8 39.4 28.4 24.8 11.0 11.0 34.9 19.3 22.9 6.4 26.6 31.2 31.2 24.8 24.8 11.0

Non-C. n 20 29 4 9 28 35 25 3 22 64 24 24 44 13 85 85 60 35 69 69 69 69 2 51 49 37 85 % 18.3 26.6 3.7 8.3 25.7 32.1 22.9 2.8 20.2 58.7 22.0 22.0 40.4 11.9 78.0 78.0 55.0 32.1 63.3 63.3 63.3 63.3 1.8 46.8 45.0 33.9 78.0

6 41 12 20 6 31 16 14 69 50 20 13 11 18 11 8 8 7 16 40 40 40 40 59 22 11 34 46 32 39 39 8

Full-C.: full compliance, Min. D.: minor deciency, Maj. D.: major deciency, Non-C.: non-compliance. Indicates observation by research team.

Similarly, previously conducted researches indicated that time and temperature errors and inadequate handwashing are two practices identied as concern in school food service (Brown, McKinley, Aryan, & Hotzler, 1982; Kim & Shanklin, 1999; Richards et al., 1993). The hands of food service employees can be vectors in the spread of foodborne diseases because of poor personal hygiene or cross-contamination (Fuerst, 1983). In our study, inadequate handwashing practices were observed in most food businesses. Although handwashing may have been observed, frequency and poor technique (length of time, not using sanitizer etc.) were

problems noted. In a study of Iowa school food-services, researchers identied several food-handling issues. About one-third of the observed employees either did not wash their hands frequently enough or use appropriate handwashing techniques (Henroid & Sneed, 2004). In addition, we observed that the majority of the employees did not wear hair restraint, and employees were observed eating and drinking in the food-service areas. Besides, failure in food-handling practices were related to the cleaning and sanitation of utensils, equipment, and facilities. The most common poor practice

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Personal Hygiene

100 90 80 70 60 50 40 30 20 10 0
H os pi ta l C at er in g l Sc ho o H ot

Building,Grounds,Environmental Hygiene Equipment Cleaning and Sanitation

Fig. 1. The mean personnel hygiene scores, buildings, grounds, environmental hygiene scores and equipment cleaning and sanitation scores of the food businesses.

100 90 80 70 60 50 40 30 20 10 0
nt H os pi ta l C at er in g l H ot el Sc ho o es ta ur a

Operational Control Procedures

Pest Control Procedures General Sanitation Procedures

Fig. 2. The mean operational control procedure scores, pest control procedure scores and general sanitation procedure scores of the food businesses.

100 90 80 70 60 50 40 30 20 10 0

70.422.2 58.27.1

68.430.5 48.74.8 50.17.2 50.87.8 55.98.1

l ta pi os H

g in er at C

ol ho Sc

el ot H

t se an ou ur H ta b es ba R Ke

a ke Ta

ay w

Fig. 3. The mean HACCP prerequisite questionnaire total scores of the food businesses.

was the failure to use test strips to check sanitizer concentration, a practice that was observed in only 5 of the 109 food businesses. Therefore, dishes were not frequently sanitized and dishroom personnel often was inadequate. Cleaning and sanitizing of the food contact surface was not observed in 39 of the food businesses. Some food storage practices were inappropriate, such as boxes being stored on the oor, raw meats stored

above other food items, and inadequate labeling and dating of food in storage. Sanitizing issues, such as not checking temperature or sanitizer concentrations and not using sanitizing agents on food contact surfaces, also were identied. Similarly, these observations of several poor food-handling practices are consistent with food safety practices observed in previously conducted studies in dierent countries (Angelillo, Viggiani, Greco, & Rito, 2001; Giampaoli, Cluskey, & Sneed, 2002). Unfortunately, there is no regular record for foodborne outbreaks in Turkey. Therefore, the cause of microbiological problems in Turkish food businesses have not been reported. Restaurant meals have been implicated in foodborne disease outbreaks. The Public Health Laboratory Service in England has identied the catering industry (hotels, restaurants) as the main contributor to general outbreaks of Salmonella, Clostridium per fringes, Bacillus cereus and Staphylococcus aureus (Sockett et al., 1993). On the other hand, many have shown that the microbiological quality of the meals served in food businesses has considerably improved following the introduction of the HACCP system (Beumer, Vrouwenvelder, & Brinkman, 1994; Bryan, 1990). There is evidence that standard of hygiene was better during preparation and cooking in catering premises with documented hazard analysis systems compared to those operating undocumented system (Walker & Jones, 2002). During the hazard analysis step, risk should be estimated. Hazards that have little or no risk, or unlikely to occur, can often be monitored and controlled by standard operation procedures (SOPs; routine employee hygiene practices, cleaning procedures, etc.) and good manufacture practices (GMP) and need not necessarily be critical control points addressed by the HACCP system (McSwane et al., 2003). In this study, all food businesses prerequisite questionnaire scores were unsatisfactory in relation to facilities that were considered prerequisites for HACCP, i.e., personal hygiene, equipment cleaning and sanitation, and general sanitation procedures. The lowest scores were for the section of personal hygiene practices of hospitals, catering establishments, schools, hotels, restaurants, kebab houses and takeaways were 50.1 10.8, 68.6 24.1, 63.3 33.3, 41.8 7.5, 41.1 8.0, 43.1 8.9 and 46.2 10.9, respectively (Fig. 1), section of general sanitation procedures 52.1 14.7 (hospitals), 66.4 26.7 (catering establishments), 65.7 28.2 (schools), 47.5 5.98 (hotels), 44.8 8.7 (restaurants), 45.7 11.7 (kebab houses) and 50.7 15.2 (takeaways). In nearly half of the food businesses physical conditions were found to be insucient. In most of the food businesses, there was insucient amount of handwashing stations, store rooms and toilets for the employees in this study. On the contrary, Walker et al. (2003) reported that the prerequisite activities scored satisfactory with the exception

Score (%)

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of cleaning and disinfection in UK food businesses (Walker et al., 2003). HACCP programmes are designed and implemented to produce the safest food possible on the basis of current scientic information and practical experience. HACCP programmes cannot guarantee that all foods will be safe. HACCP programmes must include a written document that describes how food safety concern will be controlled in a specic process at a specic location. The specic process and specic location must comply with established GMPs and SSOPs as HACCP foundation programmes before the HACCP programme can be developed and implemented (FDA, 2000; Schmidt & Rodrick, 2003). The development of HACCP systems in food establishments can be made simple and less time consuming by spreading the entire procedure over a period of time. A caterer for instance, can start with auditing of suppliers and establishment of control and monitoring procedures for receipt of products. This may only take a fortnightly meeting of the catering manager, chefs and other food handlers for a given period of time. In addition, this would help to ensure that one step is functioning eectively before the next is embarked upon (Eheri, Morris, & McEwen, 1997). The study done by Walker and Jones (2002) claimed that poor implementation of prerequisites for food safety caused sicknesses in this food business and they suggested that the establishment of PRP could provide a solid foundation to develop HACCP. PRP includes various practices in kitchen, such as ingredient and product specications, sta training, cleaning and sanitation procedures, hygienically designed facilities, etc. (Walker et al., 2003).

5. Conclusions As a conclusion, food businesses need to implement prerequisite programmes so that they can be ready for HACCP implementation. Written standard operating procedures need to be developed and implemented in Turkish food businesses. The problems of implementing HACCP in Turkish food businesses have been namely a low level of food hygiene management training, high sta turnover rate, lack of motivation, lack of nancial resources, inadequate equipment and physical conditions of the facility, and failure of government. Governments role in developing food safety program is very important. One of the major problems is that the food workers often lack of interest and they often have a negative attitude toward food safety programs in Turkey. Food safety approach in European Union is based on information gathering, analysis, scientic recommendations, control, residue monitoring and early warning system. With respect to adaptation law of European Union, the Turkish Government must do some new reg-

ulations on Turkish Food Code and, however, need to increase the number of control in food businesses. The ndings of this study demonstrated that food-service sta has lack of food safety knowledge. Therefore substantive food safety training should be provided for all food-service sta before they begin to work continuous food safety training as well. In addition, the signicance of HACCP implementation needs to be claried and emphasized in hospital foodservice since lack of prerequisites were identied as the main barrier to compliance in this study. Directors should emphasize the signicance of food safety training for their sta for the health of consumers. Developing and implementing written standard operating procedures in food businesses is one of the rst steps to build eective HACCP systems. The tools required to support food safety in food service operations, such as thermometers, test stripes etc. should also be provided. Besides, directors may identify areas in which they can develop services that can be marketed to food businesses related to training and prerequisite and HACCP program development and implementation. Finally, since most food business directors presently have limited understanding of the prerequisite programs and HACCP strategy, and of the procedures to implement it, it is necessary that the regulatory authority claries the goals of the strategy, and provides eective information to ensure uniformity in the application of its principles. Necessary legal arrangements have to be made on employment, employment security, obligations, mandates and responsibilities of working in food enterprises in Turkey. Training will be provided for those who would work on food production, preparation and marketing and to those who would work on food inspection and related legal arrangements will be made by pertinent Ministries.

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