Survey on hygiene and food safety among kitchen staff in preschools in Podgorica, Montenegro

Score regression model for self-reported food safety and hygiene practices

Model	B	SE	δ	t	p
1 (Constant)	73.307	5.51		12.59	0.00
Knowledge score	0.35	0.12	0.43	0.41	0.55
Attitude score	0.55	0.87	0.51	0.51	0.04*

Socio-demographic profile of food handlers in preschool kitchens in Podgorica (n=113)

Demographic variables	Category	n	%	Mean±SD %
Gender	Male	2	1.8
	Female	111	98.2
Institutions	Public	97	85.8
	Private	16	14.2
Age (Years)	<25	6	5.3	43.62±10.30
	25-34	13	11.5
	35-44	39	34.5
	45-55	38	33.6
	>55	17	15.0
Education level	Primary school	3	2.7
	Secondary school	100	88.5
	High vocational school	6	5.3
	University	3	2.7
	Other	1	0.9
Working experience in food service (years)	<1	4	3.5	12.68±8.54
	1-5	21	18.6
	5-10	23	20.4
	10-15	21	18.6
	15-20	19	16.8
	>20	25	22.1
Participation in training for safe food handling?	One time	24	21.2
	Multiple time	62	54.9
	Never	27	23.9
Has HACCP been implemented in your establishments?	Yes	94	83.2
	No	7	6.2
	Do not know	12	10.6
Did you attend and pass the hygiene minimum course, and get a certificate?	Yes	16	14.3
	No	96	85.7

Impact of socio-demographic characteristics on food handlers’ knowledge, attitude, and self-reported practices regarding food safety and hygiene in preschool kitchens (n=113)

Demographic	Food safety and food hygiene knowledge						Selfreported food hygiene practice
	Personal hygiene	Temperature control	Crosscontamination	Food storage	Equipment hygiene	Safe attitude
Age (years)	0.74	0.96	0.66	0.96	0.48	0.26	0.10
Educational level	0.43	0.18	0.19	0.08	0.02*	0.35	0.77
Food service working experience	0.42	0.20	0.54	0.47	0.40	0.76	0.43
Participation in training	0.82	0.76	0.29	0.03*	0.52	0.24	0.44
Previous working experience	0.49	0.56	0.03*	0.11	0.11	0.68	0.49
Implementation of HACCP	0.24	0.19	0.76	0.96	0.01*	0.16	0.46
Attending the “hygiene minimum” course certification	0.03*	0.74	0.11	0.00*	0.67	0.61	0.46

Comparison between self-reported and observed hygiene practices of food handlers (n=113)

Practices	Respondents, n (%)
	Selfreported practices	Observed practices	t	p
1. Do you wash your hands with water and soap before preparing food? Yes	113 (100)	21 (18.6)	-13.80	0.00*
2. Do you wash your hands with water and soap before eating? Yes	112 (99.1)	56 (49.6)	-0.06	0.00*
3. Do you wash your hands with water and soap after using the bathroom? Yes	113 (100)	94 (83.1)	-21.28	0.00*
4. Do you have short, neat nails, without nail polish? Yes	109 (96.4)	103 (91.2)	-2,11	0.00*
5. Do you light a cigar while working? No	111 (98.3)	106 (93.8)	2.74	0.00*
6. Do you touch your nose while working, or sneeze into your hands? No	108 (96.6)	26 (23.0)	-1.23	0.01*
7. Do you dry your hands after washing them properly (e.g. with a disposable towel or hand dryer)? Yes	108 (96.6)	75 (66.3)	-0.76	0.20
8. Do you wear a clean and suitable uniform before starting work? Yes	112 (99.1)	74 (65.4)	-0.72	0.93
9. Do you remove all adornments (earrings, rings, watches, and bracelets) before starting activities? Yes	113 (97.0)	101 (89.4)	-1.95	0.60
10. Is your hair completely covered while working? Yes	111 (98.2)	90 (79.7)	-0.26	0.61
11. Do you work when you have diarrhea? No	100 (88.5)	92 (81.5)	-0.94	0.68
12. Do you work when you have a cold? No	91 (80.5)	65 (57.5)	-1.31	0.00*
13. Do you work when you have lesions on your hands? No	95 (84.1)	61 (54.1)	-0.06	0.39
14. Do you have a certified sanitary card? Yes	102 (94.7)	111 (98.2)	-0.42	0.38
15. Do you eat or drink in your working area? No	86 (80.4)	20 (17.8)	-0.87	0.02*
16. Do you wear gloves when you handle ready-to-eat food or prepare sandwiches? Yes	98 (91.6)	16 (14.3)	0.54	0.02*
17. Do you separate raw (fresh salad) food from ready-to-eat food or serve it on the same plate? Yes	94 (87.8)	82 (73.2)	-1.51	0.30
18. Do you check the shelf life of food products while using them? Yes	106 (99.0)	108 (95.6)	-1.79	0.46
19. Do you keep ready-to-eat food at room temperature for over 4 hours? No	99 (92.5)	95 (84.8)	0.96	0.37
20. Do you clean food contact surfaces before and after serving and preparing food? Yes	102 (95.3)	63 (56.3)	-4.16	0.00*

Relationships between knowledge, attitude, and practice among food handlers in preschool kitchens

Domain	r value	p-value
Knowledge and attitude	0.19	0.04*
Knowledge and practice	0.35	0.72
Attitude and practice	0.00	0.93

Food handlers’ attitudes towards food safety (n=113)

Statements	Respondents, n (%)					Mean±SD%
	Strongly disagree	Disagree	Uncertain	Agree	Strongly agree	95.72±4.53
Safe food handling is an important part of my job responsibilities. (Agree)	0 (0.0)	1 (0.9)	0 (0.0)	30 (26.5)	82 (72.6)
I think that it is good to maintain a high degree of personal cleanliness while working. (Agree)	0 (0.0)	0 (0.0)	0 (0.0)	27 (23.9)	86 (76.1)
Learning more about food safety through training courses is important to me. (Agree)	0 (0.0)	0 (0.0)	0 (0.0)	30 (26.5)	83 (73.5)
Cleaning my hands effectively can prevent foodborne diseases. (Agree)	0 (0.0)	0 (0.0)	0 (0.0)	27 (23.9)	86 (76.1)
I should take leave and should not work on the food premises if I am suffering from foodborne illness. (Agree)	0 (0.0)	0 (0.0)	0 (0.0)	25 (22.1)	88 (77.9)
The way we store food affects its safety (Agree)	0 (0.0)	4 (3.5)	0 (0.0)	28 (24.8)	81 (71.7)
Long fingernails could contaminate food with foodborne pathogens. (Agree)	0 (0.0)	0 (0.0)	0 (0.0)	28 (24.8)	85 (75.2)
Food handlers should be medically examined every six months. (Agree)	1 (0.9)	0 (0.0)	0 (0.0)	21 (18.6)	91 (80.5)
Food handlers can be a source of foodborne outbreaks. (Agree)	0 (0.0)	2 (1.8)	5 (4.4)	33 (29.2)	73 (64.6)
Food handlers with wounds, bruises, or injuries on their hands must not touch or handle food. (Agree)	2 (1.8)	3 (2.7)	0 (0.0)	34 (30.1)	74 (65.5)
Expired food should not be consumed, even without changes in smell and taste. (Agree)	1 (0.9)	1 (0.9)	2 (1.8)	22 (19.5)	87 (77.0)
Foodborne outbreaks are natural life events. (Disagree)	7 (6.2)	14 (12.4)	12 (10.6)	30 (26.5)	50 (44.2)

Knowledge of food handlers related to food safety and hygiene knowledge (n=113)

Knowledge	Respondents, n(%)			Mean±SD %
	Yes	No	Do not know	77.25±2.69
Personal hygiene				89.76±2.69
Should you wash your hands before using gloves? Yes	89 (82.4)	16 (14.8)	3 (2.8)
Can the same gloves also be used for handling fruit and handling meat? No	3 (2.8)	105 (97.2)	0 (0.0)
Does hair contain different types of bacteria and can it be a source of food contamination? Yes	96 (89.7)	4 (3.7)	7 (6.5)
Temperature control				69.60±0.91
The procedure of freezing foods does not kill bacteria but rather slows down their growth. Yes	84 (79.2)	14 (13.2)	8 (7.5)
The correct method for thawing frozen meat is with water from a boiler or at room temperature overnight. No	55 (50.9)	40 (37.0)	13 (11.5)
Food may be stored at room temperature for 2 hours after cooking before storing in the refrigerator. Yes	87 (80.6)	17 (15.0)	4 (3.5)
The correct temperature range for a refrigerator storing food is 1 to 4 °C, and the freezer is below -18 °C. Yes	99 (81.7)	5 (4.6)	4 (3.7)
The optimum temperature range for bacteria growth is between 5-61 °C (danger zone). Yes	76 (71.0)	12 (11.2)	19 (17.8)
Cross-contamination				71.84±0.85
Vegetables should be chopped first and then washed. No	10 (9.3)	96 (88.9)	2 (1.8)
Do you use the same knife for raw and cooked meat or chopping vegetables? No	5 (4.6)	103 (95.4)	0 (0.0)
Bacteria cannot enter physically damaged canned food. No	45 (41.7)	52 (48.1)	11 (10.2)
Staff cannot eat or drink in the food preparation area. Yes	36 (33.3)	71 (65.7)	1 (0.9)
Do you use the same board for cutting raw meat and chopping vegetables? No	6 (5.6)	101 (93.5)	1 (0.9)
Food storage				86.60±0.87
Raw (fresh) food should be kept on the lower shelves of the refrigerator. Yes	81 (75.0)	19 (21.4)	6 (5.6)
Preparation of food in advance is likely to contribute to food-borne illnesses. Yes	87 (80.6)	14 (13.0)	7 (6.5)
Food samples are taken from each meal for quality control and stored in the refrigerator for 48 hours. Yes	103 (95.4)	4 (3.7)	1 (0.9)
Frozen food must not be refrozen after thawing. Yes	103 (95.4)	4 (3.7)	1 (0.9)
Equipment hygiene				68.48±1.04
Bacteria can grow on broken and cracked dishes. Yes	100 (88.5)	6 (5.6)	2 (1.8)
Washed dishes and equipment should be wiped with a dishcloth. No	17 (15.9)	88 (88.2)	2 (1.8)
Is the detergent sufficient to ensure the efficiency of the cleaning equipment? No	45 (41.7)	59 (54.6)	4 (3.6)
Refrigerators should be opened and checked often. No	77 (71.3)	21 (19.4)	10 (8.9)
Sinks used for washing raw materials can be used for washing hands. No	6 (5.3)	99 (91.7)	3 (2.7)