Food Safety and Sanitation: Attitude and Regulations Compliance among Fast Food Restaurants

WEST VISAYAS STATE UNIVERSITY COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL Iloilo City

Food Safety and Sanitation: Attitude and Regulations Compliance Among Fast Food Restaurants

Kendrick A. Callao

Chapter 1 Introduction to the Study

This chapter is divided into five parts: (1) Background and Theoretical Framework of the Study, (2) Statement of the Problem and the Hypotheses, (3) Significance of the Study, (4) Definition of Terms, and (5) Delimitation of the Study. Part One, Background and Theoretical Framework of the Study, outlines the reasons for choosing the problem and theoretical framework upon which the study was anchored. Part Two, Statement of the Problem and the Hypotheses, identifies the main and specific problems of the research and the hypotheses tested. Part Three, Significance of the Study, cites the benefits that may be derived from the results of the investigation. Part Four, Definition of Terms, defines the important terms used in the study, both conceptually and operationally.

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Part Five, Delimitation of the Study, specifies the scope and coverage of the study. Background and Theoretical Framework of the Study Food safety regulation in its current form has been part of the Philippine landscape for decades. In 1976, the Code of Sanitation of the Philippines was passed and just recently in September of 2013 the Food Safety Act of 2013 was signed by the president. Both of these events were triggered by concerns with unsafe food products; concerns which have persisted throughout the years as the food industry and consumers are faced with food scares on a regular basis (DOH, 2011). The Food and Drug Administration began to collect baseline data of food safety practices in foodservice operations. The report of the FDA Retail Food Program Database of Foodborne Illness Risk Factors was released in 2006 and focused in and explored major risk factors that are attributed to foodborne diseases (FDA, 2004). The report indicated that full-service restaurants were 40% out-of-compliance with overall food code standards. Fast food restaurants were slightly better, with an overall out-of-compliance rate of 26%. These out-of-compliance rates are higher than other noncommercial food establishments such as hospitals, nursing homes, and elementary schools. In full-service restaurants, the most frequent out-of-compliance practices included cooling potentially hazardous foods to 70oF within two hours (85%), adequate hand washing (81%), and holding potentially hazardous foods at 41oF or below (81%). The report identified 15 practices that were in need of ―priority attention,‖ the most of any operation. The most

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common out-of-compliance practices in fast food restaurants included ready-toeat, potentially hazardous foods held for more than 24 hours (71%), holding potentially hazardous foods at 41oF or below (62%) and prevention of hand contamination (58%) (FDA, 2004). All of the top practices that are out-of-compliance in both fast food and full-service restaurants are directly related to employee food safety knowledge, attitude, and on-the-job practices of foodservice food handlers. Thus, these information and findings motivated the researcher to conduct this study. This study is anchored on Nightingale‘s environmental theory of sanitation. This theory stresses that good sanitation has a great impact on a person‘s health. One of the fine essential elements according to Nightingale is good sanitation. The theory also emphasizes that the main cause of any disease is the poor environment condition, and, to be able to improve the environment, the people must learn to practice good sanitation in every part of the globe. Likewise, proper health planning and environmental strategies must be implemented in order to live a healthy and blissful life (Pescadera, 2013) The theory of reasoned action (Ajzen and Fishbein, 1980) was also considered in the study. This theory stresses that a person's attitude toward a behavior consists of a belief that a particular behavior leads to a certain outcome and an evaluation of the outcome of that behavior. If the outcome seems beneficial to the individual, he or she may then intend to or actually participate in a particular behavior. Also included in one's attitude toward a behavior is the concept of the subjective norm. People may also be inclined (or not inclined) to participate in a behavior based upon their desire to comply

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with others. Laws or rules prohibiting a behavior may have an impact on one's attitude toward participating in a behavior. Ultimately, one's attitude toward a behavior can lead to an intention to act (or not to act as the case may be). This intention may or may not lead to a particular behavior. In this perspective, this study aimed to find out the attitude towards food safety and sanitation of food handlers and the level of regulations compliance of fast food restaurants. Figure 1 shows the conceptual framework. INDEPENDENT VARIABLE

DEPENDENT VARIABLE

Personal factors     

Sex Age Educational qualification Industry experience Job position

Attitude towards food safety and sanitation

Fast food restaurant characteristics   

Restaurant size Number of food handlers Restaurant type

Food safety and sanitation regulations compliance

Figure 1. Attitude towards food safety and sanitation and food safety and sanitation regulations compliance as influenced by certain identified factors.

WEST VISAYAS STATE UNIVERSITY COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL Iloilo City Statement of the Problem and the Hypotheses This study aimed to ascertain the attitude of food handlers towards food safety and sanitation, and the compliance of fast food restaurants to regulations on safety and sanitation. Specifically, the study aimed to answer the following questions: 1. What is the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are taken as an entire group and classified according to: (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position? 2. What is the level of compliance to regulations of fast food restaurants taken as entire group and classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type? 3. Are there significant differences in the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are classified according to: (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position? 4. Are there significant differences in the level of compliance to regulations of fast food restaurants classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type? 5. Is there a significant relationship between the food handlers‘ attitude towards food safety and sanitation and the fast food restaurants‘ compliance to regulations?

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In view of the preceding problems, the following hypotheses are advanced: 1. There are no significant differences in the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are classified according to: (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position. 2. There are no significant differences in the level of compliance to regulations of fast food restaurants classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type. 3. There is no significant relationship between the food handlers‘ attitude towards food safety and sanitation and fast food restaurants‘ compliance to regulations. Significance of the Study The study is beneficial to the following: Fast food restaurant owners and managers. This investigation may provide insight to restaurant owners and managers about their existing compliance to food safety and sanitation regulations and the requirements that they need to comply. Employees of fast food restaurants. Employees may be informed if they comply with safety and sanitation regulations and they will be provided with more knowledge and useful insights in proper food handling to ensure food safety of their customers. Hospitality educators. The results of this study may inform hospitality educators of how much and what more to teach to students regarding food safety and sanitation.

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They may also be aware of the extent of practical training they will apply so that the students will have ample knowledge and expertise in food handling. Future researchers. Future researchers may use this study as a springboard of related problems they will investigate in the future. Delimitation of the Study This is a study on the attitude of food handlers of selected fast food restaurants in Iloilo city towards food safety and sanitation and the compliance of selected fast food restaurants to food safety and sanitation regulations. The study was conducted during the second semester of academic year 2013-2014 using the survey-correlational research design. To gather data on the attitude towards food safety and sanitation and the regulations compliance of selected fast food restaurants, the researcher utilized two (2) data gathering instruments, the Sneed and Lin (2010) questionnaire on the attitudes of food handlers towards food safety and the Sanitary Inspection of Food Establishment Compliance Form (2012) of the Iloilo City Health Office. The participants of the study were the 200 food handlers of randomly selected fast food restaurants in Iloilo city. The food handlers were taken as an entire group and classified according to (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position. The participants were selected through two-stage sampling.

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GRADUATE SCHOOL Iloilo City The statistics that were employed in this study were frequency, percentiles, mean, standard deviation, t-test, one-way ANOVA, Scheffe test, Kruskal Wallis, Mann Whitney and Pearson‘s r. The data gathered for this study were subjected to a certain computer-processed statistics. The .05 alpha level was used as the criterion for the acceptance and rejection of the null hypotheses. Definition of Terms For clarity and better understanding of this study, important terms used were given their conceptual and operational meanings: Fast food restaurants--is a specific type of restaurant characterized both by its fast food cuisine and by minimal table service (Sarda, 2013). As used in this study, fast food restaurants referred to selected fast food establishments in Iloilo city. Food safety--is a scientific discipline describing handling, preparation, and storage of food in ways that prevent foodborne illness (Ang & Balanon, 2010). The same meaning was used in the study. Food sanitation--is the hygienic measures for ensuring food safety (McSwane, Rue & Linton, 2005). The same meaning was used in the study. Attitude--is a state of mind, feeling or disposition (McShane, 2010). As used in this study, attitude referred to the viewpoint of selected fast food restaurant food handlers in Iloilo city on food safety and sanitation.

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WEST VISAYAS STATE UNIVERSITY COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL Iloilo City Regulation--a rule designed to control the conduct of those to whom it applies; regulations are official rules and have to be followed (Morris, 2008). As used in this study, regulation referred to the mandatory requirement for sanitary inspection implemented by Iloilo City Health Office on food establishments Compliance--is the act or process of complying to a desire, demand, proposal, or regimen or to coercion (Morris, 2008). As used in this study, compliance referred to the observance of mandatory requirements by selected fast food restaurants for sanitary inspection as implemented by Iloilo City Health Office.

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Chapter 2 Review of Related Literature

This chapter presents literature and studies relevant to the present study. It is divided into four parts: (1) Food Safety and Sanitation, (2) Fast Food Restaurants, (3) Attitude and Compliance, and (4) Summary. Part One, Food Safety and Sanitation presents literatures related to food safety and sanitation, most of which deals with the proper practices and some implications of malpractice. Part Two, Fast Food Restaurants, includes studies and topics relevant to fast food restaurants. Part Three, Attitude and Compliance, lists related studies on attitude and compliance of food service establishments. Part Four, Summary, recapitulates the important ideas, studies and literature. Food Safety and Sanitation Food is a product that is rich in nutrients required by microorganisms and may be exposed to contamination with the major sources from water, air, dust, equipment, sewage, insects, rodents and employees (Ang & Balanon, 2010). Due to the changes in food production, handling, preparation techniques, as well as eating habits, the fact remains that food is the source for microorganisms that can cause illness. The US Centers for Disease Control and Prevention (CDC, 2010) revealed that the outbreaks of

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foodborne diseases which resulted from foods of animal origin had caused approximately 76 million illnesses, 325,000 hospitalizations and 5000 deaths each year. Data obtained from UK and USA suggest that 20–40% of such illnesses are associated with the consumption of contaminated food where catering establishments are the most frequently cited sources of sporadic and outbreak foodborne infection. The common food handling mistakes besides serving contaminated raw food also include inadequate cooking, heating, or re-heating of food, consumption of food from unsafe sources, cooling food inappropriately, and allowing too much of a time lapse. Food safety has become an issue of special importance for the retail food industry. There are many opportunities for food to be contaminated between production and consumption (Ang & Balanon, 2010). Food safety is especially critical in retail food establishments because this may be the last opportunity to control or eliminate the hazards that might contaminate food and cause foodborne illnesses. (Ang and Balanon, 2010). Even when purchased from inspected and approved sources, ingredients may be contaminated when they arrive at the food establishment. It is important to know how to handle these ingredients safely and how to prepare food in such a manner that the risk of contaminated food being served to clients or customers is reduced. Most cases of food poisoning happen in foodservice establishments and usually afflict a great number of people. Commercial food service establishments have been identified by the Center for Disease Control as the leading source of foodborne illness outbreaks (Bean et al., 2006). Statistics show that in the Philippines, the second highest

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death-related illness is intestinal disease. Outbreak of foodborne illnesses could be prevented if foodservice workers have proper training, techniques, and tools in food management. Food handlers play a major role in transmitting pathogens passively from contaminated sources such as transmitting pathogens from raw meat to a ready to eat food. Food handlers may also carry some human specific foodborne pathogens such as Hepatitis A, noroviruses, typhoidal Salmonella, Staphylococcus aureus and Shigella sp in their hands, cuts or sores, mouth, skin, and hair. Food handlers may also shed foodborne pathogens, such as E. coli O157:H7 and non-typhoidal Salmonella during the infectiousness period or less important during recovery period of a gastrointestinal sickness (Adams & Moss, 2008). Restaurants have a natural challenge that just comes with the territory: cleanliness and food safety (Stone, 2011). It seems not a day goes by without another horror story in the news about contaminated food products. Restaurants get routinely shut down by the Health Department. Even if things don‘t get that bad for the business, all it takes is for a delivery person to see a puddle of mud on the floor in the kitchen for a bad word-ofmouth campaign to start circulating about the establishment. The media reports cases of food poisoning on a daily basis in spite of the fact that the fast food business is flourishing. It seems fast food has become the American way and the public will go blindly forth ordering with the exception that the food has been prepared in sanitary conditions. From bug problems to breeding bacteria, fast food restaurants especially, have

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countless issues behind their counters. If one is the manager, awareness on his/her part is not enough; he/she has to be vigilant in ensuring that every employee knows and follows the rules to the letter. One of the most common causes of food poisoning is bacteria transfer, which is due to food not being properly cooked or kept at the proper temperature. With such a demand for fast food, it is often all too easy for the employees to compromise their duties for the sake of saving time, and before they know it, they have served a meal that carries a nasty risk of food poisoning. The rules should be followed every time, not some of the time, as is unfortunately sometimes the case. It is up to the management to see that the employees are properly doing their job, and, of course, effective management makes all of the difference in this endeavor. Close supervision is a necessity to help ensure that the work is being performed properly. Employees must care about their job and in return feel valued so that they will be more willing to perform their responsibilities correctly. Too often, factors like low pay, long hours and little recognition make employees more likely to burn out and do less than what is expected of them. Also, improper training of staff leads to improper fulfillment of job duties. Unclean areas like counters or tables where food has been prepared can also spread bacteria and cause food poisoning. That is why, it is important for employees to clean up after themselves and make sure that their work space is kept fastidiously clean. Also, food containers that have not been properly washed and stock that has not been properly rotated are havens for bacteria. Lastly, employees who do not wash their hands before returning to their work station can unknowingly

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spread bacteria and other diseases. That is why, it is of the utmost importance that employees wash their hands. Fast food restaurants should have at least one sink designated for hand washing only, with properly posted instructions, and including the necessary soap, and paper towels. Wearing gloves when in contact with food helps as added protection, but even gloves can touch unclean surfaces just like hands can, so they need to be changed after coming into contact with unsanitary surfaces and items. A safe working environment and sanitary atmosphere in the food service industry are always important (Gonzales & Sandique, 2007). Two terms frequently assumed to be one and the same are cleaning and sanitizing, but they have the same significant differences. They reported that to damage the good name and image of an establishment, an outbreak of illness can be expensive. There are possible legal costs combined with loss of revenue that may force an establishment to close. Alvarez (2010) asserted that food industry consists of food establishments involved in the production, manufacture, transport and distribution of food. Food production involves the activities taking place in farms, ranches, orchards and in fishing operations. Food manufacturing includes the harvest of raw materials and converts them into forms suitable for distribution. In addition, food processes must ensure food safety to prevent food poisoning, spoilage and food borne diseases. It is imperative to practice food safety by controlling the supply, maintaining sanitary facilities and training the employees to work observing food safety. Therefore, refrigeration before the preparation of foods is necessary to keep the food‘s internal temperature within the safe range. There

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should be separate areas for raw and cooked foods or meat and vegetable and fruits. Likewise separate chopping boards must be used for raw and cooked foods. Sanitized utensils and cutting boards must be used for raw and cooked foods. Sanitized utensils and cutting boards should always be used to avoid cross-contamination, (Maya Kitchen Culinary Arts Center, 2007). The word food safety (Roldan & Edica, 2008) covers practices to: prevent the growth and multiplication of bacteria; prevent food from contamination of bacteria, toxin and other harmful substances; prevent food spoilage; prevent occurrence of food poisoning and infection as well as the spread of disease; and retain nutritional and aesthetic qualities of food. Food safety in food establishment is assured when all the conditions of bacterial growth are controlled. This is done through time and temperature control, proper housekeeping maintenance, proper maintenance of cooking or serving equipment and facilities and consistent compliance to standards of hygiene, sanitation and food safety. Similarly Lee (2010) believes that food safety has increasingly gained the attention of authorities worldwide from the cases of food borne outbreaks. An increase in the diseases related to food borne illnesses has been seen from 2005 to 2008 in Malaysia. Occurrence of food borne illnesses can be attributed to many factors, one of it is the handling process of food preparation especially by food handlers. This is because hand can be a vector of dissemination of pathogens through cross contamination. The Good Hygiene Practices describes all practices regarding the conditions and measures

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necessary to ensure the safety and suitability of food at all stages of the food chain, which is an important process that will eventually lead to the safety in the kitchen. It covers proper storage of food items, maintenance of clean environment during food preparation and assurance of all dishes served are clean and free of bacteria that can potentially cause further contamination and prevent food borne illnesses. Foodborne illnesses according to Scott and Herbold (2010) pose a problem to all individuals but are especially significant for infants, the elderly, and individuals with compromised immune systems. Personal hygiene is recognized as the number-one way people can lower their risk. The majority of meals in the U.S. are eaten at home. Little is known, however, about the actual application of personal hygiene and sanitation behaviors in the home. Roldan and Edica (2008) asserted that cases of foodborne diseases can cause irreparable damage to the reputation of a food establishment. One single case of food poisoning can already discourage diners from coming back to the restaurant or canteen. A hygienic food handler can be an instrument in transmitting bacterial contamination and food borne disease. It is therefore important for every server to understand and practice the rules of safety in handling and serving food. Food borne diseases come from bacteria or microorganisms. These are tiny, living and active being that rapidly multiply in numbers under the right conditions. For example, when a kitchen or dining area is not properly maintained in terms of cleanliness and sanitation, it becomes vulnerable to the growth and multiplication of microorganisms or bacteria as well as pests. When this

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happens, diners suffer from typhoid fever, hepatitis and other related diseases. In addition, bacteria breeds in unsanitary, moist and slightly acidic environment like: dirty surroundings, wet, undisposed and uncovered garbage, stagnant and dirty water, crowded places like storerooms that are dirty, undisposed, uncovered left-over foods and dirty and unsanitized containers, pans and utensils. Foodborne illness or disease is a disease carried or transmitted to people by food. Payne and Theis (2006) further discussed that a more inclusive statement defines food borne illness as any illness or injury that results from something that has been eaten. Any food that is not fit for human consumption is spoiled. A spoiled food, however, does not necessarily have the potential to cause foodborne illness. Conversely, an unspoiled food is not necessarily safe to eat. Any food containing dangerous levels of microorganisms, toxins, chemical or physical contaminants, has the potential to cause food borne illness. Foodborne illness or disease is a disease carried or transmitted to people by food. A more inclusive statement defines foodborne illness as any illness or injury that results from something that has been eaten. Galvez (2007) believes that foodborne disease is caused by the consumption of food items that are contaminated by dangerous microorganisms also known as germs of microbes. This simply means that food borne illness is an illness that is carried by the food. This often referred as food poisoning by many professionals in the hotel and restaurant industry. Nevertheless, this term does not only constraint to a contaminated food but as well to contaminated beverages. Therefore, a person suffering from

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foodborne illness may experience the symptoms like diarrhea, vomiting, nausea, muscle cramps, stomach ache, body weakness and dehydration. Microorganism that cause food borne illness cannot travel on their own and contaminate food, but the microorganisms are transferred through the food via a process of cross contamination. For example, if an infected worker touches or get into contact with a food, he/she contaminates it. Although, cross contamination from an infected person may not be the only way that a food item may be contaminated, they could also be contaminated through the following: exposed to unsafe temperature for a long period of time, improper packaging of food items, poor hygiene and sanitation during the preparation of the food, improper reheating of food, and unsafe sources and suppliers. Cushman (2007; cited in Dirks, 2010), reported that foodborne illness outbreaks are on the rise and food safety continues to be a major concern since foodborne illnesses have potentials to attack patrons through a variety of ways. In a study conducted by Hedberg et al. (2006) to investigate the differences between outbreak and non-outbreak restaurants, researchers found that Norovirus, a RNA virus known for gastroenteritis outbreaks and is transmitted fecally, was confirmed or suspected in 42% of all restaurant food borne illness outbreaks. Bacteria Salmonella and Clostridium perfringens were the next common microorganisms found in outbreaks that accounted for 19% of identified outbreaks and suspected in 28% of outbreaks. Furthermore, the contributing factors of these outbreaks were infected employees who handled food and bare-hand contact with food.

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McCabe-Sellers and Beattie (2004) reported that the reasons for outbreaks include: epidemiological selection (outbreaks involving several people who are more likely to be traced back to the source that to individual cases), lack of quality assurance in foodservices, and most importantly a failure of food handlers to follow critical behaviors that mitigate the potential for foodborne illness. As a result of the different outlets for foodborne illness outbreaks, food-related scares have led to an increase of interest in improving food safety practices in foodservice operations as well as communicating the importance of sanitation to food workers. In addition, food will remain safe as long as critical behaviors are observed in food handling (Dirks, 2010). Food handlers in restaurants are epidemiologically more important than the domestic food handlers in the spread of food borne illnesses. Mohan (2006), further discussed that unhygienic practices like coughing and sneezing in the food preparation area, improper hand washing, wearing dirty clothes, etc. all may introduce a variety of microorganisms in the food. Foodborne disease is a common, but preventable, burden of illness worldwide. Almost one-half of every dollar spent on food in the United States is spent on food from restaurants. A growing body of data from foodborne disease outbreaks and studies of sporadic (non-outbreak-associated) gastrointestinal disease of various etiologies suggest that eating food prepared in restaurants is an important source of infection. These data suggest a critical need for action that is focused on preventing disease transmission within the food service industry. Clinicians should report all suspected foodborne disease

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to public health authorities to ensure appropriate epidemiologic investigation (Jones & Angulo, 2006). There is a critical need to focus intensely on specific, modifiable risks in the food production chain and to adopt new strategies to minimize risks even as studies and debates continue. Restaurants must follow strict policies of safe food handling. Consumers should avoid consumption of high-risk foods, such as undercooked eggs or undercooked ground beef, in any venue, including restaurants. Clinicians can help to ensure appropriate epidemiologic investigation and follow-up of suspected cases of foodborne disease by reporting them to local public health authorities (Jones & Angulo, 2006). More than 54 billion meals are served at 844,000 commercial food establishments in the United States each year; 46% of the money Americans spend on food goes for restaurant meals. On a typical day, 44% of adults in the United States eat at a restaurant. Of a mean 550 foodborne disease outbreaks reported to the Centers for Disease Control and Prevention each year from 1993 through 1997, less than 40% were attributed to commercial food establishments. Preventing restaurant-associated foodborne disease outbreaks is an important task of public health departments. Foodborne illness continues to be a public health burden, with most recent estimates of 9.4 million cases per year in the United States, resulting in 1,351 deaths. While foodborne illness is not traditionally tracked by race, ethnicity or income, analyses of reported cases have found increased rates of some foodborne illnesses among minority

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racial/ethnic populations. In some cases (Listeria, Yersinia) increased rates are due to unique food consumption patterns, in other cases (Salmonella, Shigella, Campylobacter) it is unclear why this health disparity exists. Research on safe food handling knowledge and behaviors among low income and minority consumers suggest that there may be a need to target safe food handling messages to these vulnerable populations. Another possibility is that these populations are receiving food that is less safe at the level of the retail outlet or foodservice facility (Quinlan, 2010). Foodborne illness continues to be a public health burden, with most recent estimates of 9.4 million cases per year in the United States, resulting in 1,351 deaths. The Foodborne Diseases Active Surveillance Network (2012), quantifies and monitors the incidence of laboratory-confirmed cases of Salmonella, Campylobacter, Listeria, Shigatoxin producing E. coli, Shigella, Yersinia and Vibrio. The FoodNet catchment area was not chosen to equally represent all racial and ethnic groups and even in the expanded FoodNet population, Hispanics and those living below the poverty level are underrepresented when compared to the general American population (6% vs. 12%, and 11 vs. 14%, respectively). Over the past decade, analysis of FoodNet tracking data to examine the burden of foodborne illness on minority racial and ethnic populations has revealed trends related to their demographics. Additionally, since 2008, FoodNet final reports each year have reported incidence rates of bacterial pathogens by race and ethnicity.

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Restaurants in the United States are regularly inspected by local, county, or state health department personnel. The guidelines of the U.S. Food and Drug Administration (2008) state that ―a principal goal to be achieved by a food establishment inspection is to prevent foodborne disease.‖ Although restaurant inspections are one of a number of measures intended to enhance food safety, they are a highly visible responsibility of local health departments. In many parts of the country, restaurant inspection scores are easily accessible to the public through the Internet or are disseminated through local news media. An inspection system that effectively addressed the goal of improving food safety would be uniform, consistent, and focused on identifying characteristics known to affect food safety. Foodborne infections can cause severe illnesses in the general population including healthy adults. However, older adults (those who are over 60 years old) tend to have more severe complications to these infections. Also, research has shown that elderly persons are more susceptible to foodborne illness infections and deaths (Buzby, 2002). According to Lee, Renig and Shanklin (2007) food quality involves more than food safety. Taste is just as important. In fact, during the research conducted by Lee et al., food quality was a consideration for those who have looked into assisted living facilities. Food quality at assisted living facilities has played a part in the determination of value received and overall quality of care received as the assisted living facilities. According to Ricaplaza (2008), West (1997) emphasizes that regardless of the type of foodservice, one commonly is to plan a minimum amount of space for a minimum

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job and a basis principle in planning foodservice facilities for efficient operation is the assembly line concept, which patterned traffic for receiving, storing and sanitation of the features of the setup are the purpose that must be kept in mind then planned the detailed arrangement within the food service area. Restaurants and other retail and institutional foodservice operations have become an integral part of today‘s society because dining out or purchasing food to-go or readyto-prepare has become routine for most Americans. The National Restaurant Association (NRA, 2005) reports that more than 70 billion meal and snack occasions will be eaten daily in restaurants and cafeterias in 2008. Given the number of people who dine out, the potential for foodborne illness resulting from food prepared in commercial foodservice operations is great. Therefore, foodborne illness and disease should be a significant concern for those who manage and own foodservice operations. The Center for Disease Control and Prevention (CDC, 2010) has estimated that foodbornerelated illnesses cause approximately six to 76 million illnesses, 325,000 hospitalizations, and approximately 5,000 deaths each year in the United States (Mead, et al, 2007). Both known and unknown agents attribute to the wide estimate range. Between 2003 and 2007, 50% of the illnesses caused by foodborne illness outbreaks were associated with food consumed in restaurants and other commercial food establishments. Some of these foodborne illnesses are mild and result in 24-hour flu-like symptoms, but many other cases have been severe enough to require hospitalization or cause death.

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The top three factors that contribute to foodborne illnesses are improper holding temperatures, poor personal hygiene, and cross contamination. All of which are directly related to the food handler‘s knowledge of food safety (Food and Drug Administration, 2004). Previous research has suggested that food safety training is a way to assure that proper practices are followed in restaurants, although research relating knowledge to behavior change has been inconsistent. Studies have found that food safety training is effective in increasing overall sanitation inspection scores in the microbiological quality of food and self-reported changes in food safety practices (McElroy & Cutter, 2004). Several states now mandate food safety certification for restaurant employees. In 2002, Schilling, O‘Connor, and Hendrickson reported that 16 states have state-mandated certification requirements and 34 states have some form of voluntary requirements. Several states were in the process of adopting the 2002 food code which requires operations to have at least one employee who can demonstrate knowledge about food safety. Foodborne diseases remain a major public health problem across the globe. The problem is more severe in developing countries because of lack of personal hygiene and food safety measures. As much as 70% of diarrheal diseases in developing countries are believed to be of foodborne origin. Foodborne disease outbreaks in hospitals have affected patients, staff, and visitors. Mishandling food promotes pathogen growth and disease, especially among patients with weakened immunity or achlorhydria. Although providing safe food to patients who are at risk of getting infections is a major duty of

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hospitals, epidemiological and surveillance data suggest that faulty practices in food- processing plants, food service establishments and home play an important role in the causal chain of foodborne diseases (Mukhopadhyay, 2012) Todd, Greig, Bartleson, & Michaels (2009) formed a workgroup and analyzed 816 foodborne outbreaks where food workers have been implicated in the spread of foodborne diseases. They have published a series of peer-reviewed papers in the journal of food protection from 2007 to 2011. In the third publication, they categorized the factor contributing to out- breaks into food worker error factors, bacterial proliferation factors, and important survival factors for pathogens. The most frequently reported food worker errors were handling of food by a person either actively infected by or carrying a pathogen, bare-hand contact with food, failure to properly wash hands when necessary, insufficient cleaning of processing or preparation equipment or kitchen tools. Such unhygienic practice would cause contamination of the food and cross-contamination of ready-to-eat (RTE) foods Food-borne diseases have been increasing in recent years, with a greater impact on the health and economy of developing countries than developed countries (WHO, 2007). According to the World Health Organization, in 2005 alone, 1.8 million people died from diarrheal diseases, and most of these cases were attributed to the ingestion of contaminated food and drinking water. Meals prepared and distributed in schools should receive special attention because the foods are intended for young children, a population with an increased risk for several diseases due to microbial pathogens in foods. To ensure

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high quality meals for students, catering services need to follow the regulations set forth by the Health Surveillance Committee. Despite the existence of specific regulations, the safety measures taken during school meal preparation are still inadequate, as most schools do not take into consideration the specific sanitary requirements needed for the various stages of food preparation (Santana, Almeida, Ferreira, & Almeida, 2009) Good personal hygiene and sanitary handling practices at work are an essential part of any prevention program for food safety. Although the majority of food handlers have the skills and knowledge to handle food safely, human handling errors have been implicated in most outbreaks of food poisoning (Todd, Bartleson, & Michaels, 2007). The inappropriate handling of foods by the food service industry has been implicated in 97% of food poisoning cases (Greig, Todd & Bartleson, 2007). There is no indication that food-borne illnesses are diminishing. Staphylococcus aureus is considered the third most important cause of food-borne diseases in the world (Normanno, 2005). There are two major aggravations to its presence: the toxins production and antimicrobial resistance. S. aureus produces eatstable enterotoxins with demonstrated emetic activity (SEs; SEA to SEE, SEG to SEI, SER to SET). According to the authors, SEs are a main cause of food poisoning that occurs after ingestion of foods contaminated with S. aureus by improper handling and subsequent storage at elevated temperatures. Symptoms are of rapid onset and include nausea and violent vomiting, with or without diarrhea. The illness is usually self-limiting and only occasionally it is severe enough to warrant hospitalization (Argudín, Mendoza, &

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Rodicio, 2010). The main reservoir of staphylococci in humans is the nostrils, although staphylococci can also be found on hands. The microorganism is responsible for enormous variety of infections, such as subcutaneous and skin infections, osteomielites, pneumonias, abscesses, endocarditic and bacteremia (Gelatti, Bonamigo, Becker, & d‘Azevedo, 2009). The prevalence of the bacteria in the population is so high that it is likely impossible to completely eliminate them. However, hand washing has been identified as one of the most important ways to prevent the spread of food-borne diseases. The incidence of foodborne (FbI) infections caused by organisms such as Listeria, Salmonella, and Escherichia Coli 0157 has declined since 2003. However, the Center for Disease Control notes that further efforts are needed to sustain these declines and to improve prevention of food infections. From August 2006 – May 2007, 628 cases of salmonella were attributed to peanut butter produced at a single facility in Georgia (CDC, 2007), while in September 2006 at least 123 people contracted cases of e-coli from uncooked fresh bagged spinach, resulting in a major product recall. These outbreaks illustrate the need for continuous employee and consumer education regarding food safety practices. Contaminated food and water have been known to be sources of illness in human societies since antiquity. Foodborne diseases are still among the most widespread health problems in the contemporary world. In rich and poor countries alike, they pose substantial health burdens, ranging in severity from mild indisposition to fatal illnesses. However, the burden of foodborne disease is not well defined globally, regionally or at

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country level (WHO, 2004). Estimates of the burden of foodborne disease are complicated by the fact that very few illnesses can be definitively linked to food. Often these links are only made during outbreak situations (Flint, Scott & Bloomfield, 2005). The ultimate goal for public health and food safety officials is not just stopping foodborne disease outbreaks once they occur, but preventing them from happening in the first place. Long-term prevention of foodborne outbreaks takes the actions of many partners in the food production chain, stretching from farm to table (CDC, 2010) Dr. Bryan (2004) reviewed the food handling errors that led to foodborne illness outbreaks reported to the Centers for Disease Control (CDC) between 2001 and 2002 and divided them into the following categories: failure to properly cool food, failure to thoroughly heat or cook food, infected employees who practice poor personal hygiene at home and at the workplace, foods prepared a day or more before they are served, raw, contaminated ingredients incorporated into foods that receive no further cooking, foods allowed to remain at bacteria-incubation temperatures, failure to reheat cooked foods to temperatures that kill bacteria, cross-contamination of cooked foods with raw foods, or by employees who mishandle foods, or through improperly cleaned equipment. The factors listed above can be divided into the following broad categories: contaminated ingredients, temperature control, personal hygiene, cross contamination, and sanitation. In a recent review of foodborne illness outbreaks in foodservice (Greig, Todd & Bartleson, 2007) an international group of food safety researchers reported 816 outbreaks linked to food handler practices, resulting in 80,682 cases of foodborne illness. In the

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review, nearly 60% of food handler-related outbreaks were due to two specific pathogens often liked to hygiene issues: norovirus and Salmonella. Despite the investment and focus on training, researchers suggest that the impact of food handler training programs is inconsistent and program evaluation is rarely conducted. Ideally, food safety in foodservice establishments begins with managers who are knowledgeable about the following: where contaminants exist, how they transfer to food, the steps to control or eliminate hazards. In a 2007 study (Pragle, Harding & Mack, 2007), researchers at Oregon State University explored factors that prevented food handlers from practicing good personal hygiene. Through focus groups, participants reported time pressures; inadequate facilities and supplies; lack of accountability; lack of involvement of managers and coworkers; and organizations not supportive of food safety as barriers to employing good personal hygiene. The U.S. Centers for Disease Control has been recently calling on food safety communicators to design new materials aimed at increasing food safety risk reduction practices from farm-to-fork. This priority was echoed at the Food Safety Inspection Service/NSF food safety education conference in March 2010: new messages and media are needed as the traditional communication tools aren‘t getting the job done. Ignorance, carelessness, and indifference on the part of food handlers result in insanitary conditions. Poor practices may be found even in establishments where considerable investment has been made in modern equipment. All food handlers should

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be educated in proper methods through demonstrations, discussions, posters and pictures. Assistance and advice may be obtained from local health departments which in many areas conduct periodic food-handler training courses. A sanitarian can often achieve more a well-directed educational program that he can by inspection. Food handlers should wear clean uniforms and keep their hands clean (Assoc. of Food Industry Sanitarians, 2004). Food safety is becoming a vital requirement of the hospitality industry. As the dollar amount spent by consumers on food away from home has increased, so too has the extent to which food products from the industry impact the health and well being of the nation. Many factors are shaping the industry‘s future: international and multinational; influences, globalization, increasing expectations, as well as, changing patterns of leisure (Manzano, 2013) Food safety is a critical issue facing the foodservice industry. An understanding of food safety procedures and potential factors that cause foodborne illness is very important for all food handlers. Cohen, Reichel, and Schwartz (2007) stated ―only knowledgeable, motivated, and skilled employees who are trained to follow the proper procedures together with management that effectively monitors employees‘ performances can ensure food safety.‖ Foodservice workers play a major role in prevention and control of outbreaks of foodborne illness.

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As the complexity of the food system grows, new safety challenges arise. Along with the variety of food products may come a variety of biological, chemical and physical hazards. Because of this, food production, distribution and preparation have come under intense scrutiny from government agencies, from consumers and from the industry itself (Berkoff, Allard, Arcand, Brazel, Joliffe & Choleva, 2008). Providing safe food begins during the hiring process (FDA, 2004). Studies show that many cases of foodborne illnesses can be linked directly to the lack of attention to personal hygiene, cleanliness, and food handling procedures. The Center for Communicable Disease issued a list of infectious and communicable diseases that are often transmitted through food prepared by infected food handlers. Examples of biological agents that cause these diseases are Hepatitis A virus, Salmonella typhi and Norwalk-like viruses. The presence of hair in food indicates unhygienic food preparation. Food handlers must wear a hair restraint at all times to prevent hair from falling into the food. Common hair restraints include nets, bonnets, and caps. Wearing a hair restraint also eliminates the contact of the hands with the head, thereby preventing contamination such as: a hair restraint must be worn before hand washing and working and a hair restraint must be properly worn and should not let a single strand of hair show. Work clothes that include a kitchen uniform and an apron must be worn inside the kitchen. Street clothes should never be worn to work as they may be sources of contamination. Apron helps reduce the transfer of microbes to exposed food.

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Because footwear can serve as a source of contamination, it is necessary to use footwear exclusively for kitchen use. Footwear worn outside should not be worn in the food preparation area to prevent the possibility of contamination. Facial masks prevent airborne microorganisms from the nose and mouth from getting into the food when talking, coughing or sneezing. These masks will also prevent direct contact of the hands with the nose and mouth, both of which are sources of contamination. Gloves act as barriers between the hands and food. However, these must not be made substitutes for proper hand washing. The single most important practice in preventing the spread of foodborne illness is proper and frequent hand washing. Since person-to-person contamination can play a significant role in the spread of some enteric pathogens, hand hygiene is a critical element in any outbreak prevention and control strategy. Diseases can spread through fecal-oral transmission. Infections which may be transmitted through this route include salmonellosis, shigellosis, hepatitis A, giardiasis, enterovirus, amoebiasis and campylobacterosis Because these diseases can spread through the ingestion of even the tiniest particles of fecal material, hand washing after using the toilet cannot be overemphasized. Diseases also spread through indirect contact with respiratory secretions. Microorganisms which may be transmitted through this route include influenza, streptococcus, respiratory syncytial virus (RSV), and the common cold. These diseases

WEST VISAYAS STATE UNIVERSITY COLLEGE OF BUSINESS AND MANAGEMENT

GRADUATE SCHOOL Iloilo City may be spread indirectly by hands freshly soiled by respiratory discharges. These can be avoided by washing the hands after coughing or sneezing and after shaking hands with an individual who has been coughing or sneezing. Diseases may also be acquired when hands are contaminated with urine, saliva or other moist body fluids. Microorganisms which may be transmitted by these body substances include cytomegalovirus, staphylococcal organisms, and the Epstein-barr virus. These germs may be transmitted from person-to-person or indirectly by the contamination of food or inanimate objects such as toys. As explained by McSwane, Rue, Linton, & Williams (2004), controlling temperature of food cooked is vital in assuring that food service establishment complies with food safety regulations. Food borne illness may be resulted from temperature abuse while preparing a dish. Time temperature abuse occurs when food has been allowed to stand for an extended period of time at temperatures favorable to bacterial growth. Mcswane et al further added that the abuse of temperature also may be caused by insufficient amount of cooking or reheating time and desired temperatures that should eliminate the existence of harmful microorganism. The usage of devices in measuring food temperature such as thermometers, thermocouples and infrared reading is essential in determining whether the fod were in the danger zone or otherwise (McSwane et al., 2004). Nott and Hall (2003) explained that the major purpose of cooking is to increase the palatability of food, the heating of many foods is essential to kill bacteria thereby increasing the foodstuff‘s safety and storage life. In practice, pasteurization and other

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sterilization processes require stringent assurance that all parts of the food product have been heated above a certain temperature for a defined period of time (Nott and Hall, 2003). Several studies have reported that poor holding and cooking temperature control was a main factor contributing to food borne outbreaks (Todd, 1997). Improper holding temperature of food can also contribute to the growth of certain bacteria through its spores because not all of these spores will be destroyed with heating processes (McSwane et al., 2004). Thus it is important for all food handlers to recognize their responsibilities in ensuring that all food prepared were monitored in every stage of its preparation. Potentially Hazardous Food (PHF) is any food capable of allowing germs to grow rapidly (Wiley, 2007). PHFs have the potential to cause food borne illness outbreaks. They are usually moist, have lots of protein and don‘t have very high or very low acidity (neutral acidity). Adding lemon juice or vinegar to foods slows the growth of the germs. Potentially hazardous foods requires strict time and temperature controls to stay safe. Food has been time/temperature abused anytime it has been in the temperature danger zone (41oF to 135oF or 5oC to 57.2oC) for too long. Potentially hazardous foods must be checked often to make sure that they stay safe. The caution sign includes a clock and thermometer to stress the importance of monitoring time and temperature. The clock is the reminder to check food at regular time intervals. The thermometer required must be properly calibrated, cleaned and sanitized.

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The hands of food service food handlers can be vectors in the spread of food-borne disease, mainly because of poor personal hygiene and cross-contamination (Ehiri and Morris, 2006). It was reported in 2009 by Guzewich and Ross that in 89 % of outbreaks caused by food contaminated by food handlers, pathogens were transferred by workers‘ hands. More recently, Strohbehn, Sneed, Peaz, & Meyer (2008) found in two US Food and Drug Administration studies (FDA), that inadequate hand washing practices by workers occurred in all types of retail food services. Inadequate hand washing was found to be a contributory factor in 31 % of outbreaks occurring in Washington State from 1990 to 1999 (Todd et al., 2009). Proper hand washing was defined by the FDA Food Code for retail establishments (2007) as an activity lasting for at least 20 seconds involving the use of warm running water, soap, friction for 10 to 15 seconds, rinsing and drying with clean towels or hot air. This procedure is described slightly differently in other sources and may include a single or double wash process, depending on the activity prior to hand washing (Sprenger, 2008). A single wash would involve using friction and soap only while the double wash would require the use of a nail brush before re-washing with friction. Strobehn et al. (2008) found that the correct procedure for hand washing was not used consistently and rates of compliance ranged between 0 % and 100 %, even in frail care and child care facilities. In another study, hand washing was reported as more likely to occur in restaurants where workers had food safety training (Green, Selman, Baneijee, Marcus, Medus, & Angelo, 2006). It has also been found that the hand hygiene practices

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of workers with more work experience (>10 years) was superior to inexperienced individuals and concluded that even workers with higher educational levels would still require specific training on food and personal hygiene (Aycicek, Aydogan, Kucukkaraaslan, Baysallar, & Basustaoglu, 2004). In a study by Walker, Protenard, & Forsythe (2003) UK food handlers were interviewed and 94 to 97 % identified the need to wash their hands after using the toilet, to wear protective clothing, to cover cuts with easily detectable plasters and that jewellery should not be worn in the kitchen as it can be contaminated by dirt and bacteria. However, in Turkey only 21.2 % of Turkish food handlers identified the need to wash their hands after using the toilet, handling raw foods and before handling RTE food (Bas, Ersane, & Kavane, 2006). Foodborne disease from biological contamination can happen at any time during the food preparation process. The processes of cooking, cooling and storage are particularly susceptible to contamination as preparers are required to prepare, move and store food. This paper will look at the food cooking, cooling and storing stages within a restaurant environment and address how some specific bacteria, viruses, and parasites can thrive and exist at each stage. It will also detail important steps and tools available to eliminate this threat (McSwane et. al, 2004). Biological contaminations that can lead to disease are caused primarily by bacteria, viruses and parasites. During the cooking, cooling or storing stages biological contamination can be prevented by ensuring proper time and temperatures are used to prepare the foods and adhering to proper hygiene, cleaning and sanitization procedures.

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GRADUATE SCHOOL Iloilo City Additionally, reducing or eliminating cross contamination will also prevent contamination. Different bacteria have different temperatures that they need to thrive. These temperatures can range from as low as freezing to as high as 200 (93.3 C) degrees Fahrenheit. Most bacteria however thrive in the temperatures close to a human body's temperature of 98.6 (37 C) degrees Fahrenheit. The food industry often refers to the temperature range between 41 (5 C) and 135 (57 C) degrees Fahrenheit as the food temperature danger zone or that range of temperature when most foodborne microorganisms will rapidly grow. As food moves through the cooking, cooling and storage stages it must pass through this zone as quickly and safely as possible. Time, temperature, cleanliness and cross contamination are all key to keeping food safe during these stages (CDC, 2010). The Training Manual of National Environmental Health Association (2010) has indicated that costs associated with preventing foodborne contamination at a restaurant include providing employees with the proper training, equipment and tools they need to avoid contamination. Businesses that fail to prevent foodborne disease run the risk of losing the trust of its customers, jeopardizing its business and preventing it from remaining competitive. If food is not cooked, cooled, and stored properly, foodborne disease is not prevented which may lead to loss of reputation or customers. It could additionally lead to lower profits, fines, lawsuits, and even closure of the business. One example of one outbreak severely affecting a restaurant due to food contamination happened in 2003 in Pittsburgh, Pennsylvania. A Chi-Chi restaurant customer contracted

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hepatitis and as a result had to have a liver transplant. The illness was traced back to the restaurant and the customer received a settlement of $6.25 million. Failure to meet food safety regulations, legislation and inspections could cause the establishment to incur additional costs to correct citations. From a fiscal standpoint foodborne disease costs in the United States are $152 billion per year according to a report from the Pew Charitable Trust. The World Health Organization reports that in industrialized countries, the percentage of the population suffering from foodborne diseases each year has been reported to be up to 30%. Clearly preventing foodborne disease should be an establishment's highest priority from both a monetary and moral viewpoint. According to McSwane et. al. (2004), bacteria can survive as a result of inadequate cooking. They can also multiply with prolonged cooking at low temperatures and bacterial spores can even survive boiling. Examples of some virulent bacteria that can be a problem in the cooking stage are Staphylococcus Aureus, Salmonella and Bacillus Cereus. All can cause nausea, vomiting and cramping and can be avoided by cooking food according to proper times and temperatures, preventing cross contamination and using proper hand washing techniques. Symptoms from illnesses caused by these bacteria starts anywhere from 30 minutes and lasting a day as in the case with Bacillus Cereus to starting as late as 48 hours after contact and lasting three days as in the case of the Staphylococcus Aureus bacteria. E. coli 0157:H7 is another trouble causing bacteria that can cause diarrhea and kidney failure and can be prevented with the use of proper sanitization methods. E. coli symptoms can show up as late as 72 hours and last for up to

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three days. Viruses, such as Hepatitis A and Norovirus, cause fever, nausea, vomiting and cramping and can be transmitted during the cooking process by cross contamination and poor hygiene. Norovirus symptoms appear in approximately 48 hours and can last two days. Hepatitis A symptoms do not appear until 15 to 50 days after contact and can last anywhere from several weeks to several months. This long period before symptom onset makes tracing contamination difficult. Parasites such as Anisakis spp. and Cyclospora cayentanensis can be transmitted to customers through poor hygiene and uncooked or under cooked foods and also cause vomiting and diarrhea respectively (CDC, 2010). Bacteria & viruses can thrive in dry storage and survive in refrigerated storage. Bacteria can multiply in refrigerated storage if the temperatures are too high or if foods are allowed to spoil. Many have the misconception that freezing kills bacteria. In fact freezing simply keeps bacteria from multiplying. Once food is thawed the bacteria is able to grow once more. In dry storage bacteria can multiply if food becomes damp. Viruses such as Hepatitis A can be spread from infected people to produce, salads and ready-toeat foods. Other storage related contamination problems include pests. Pests can carry bacteria and viruses such as Salmonella, the Poliomyelitis virus and the Hantavirus. As described previously Hepatitis A symptoms include nausea, vomiting, diarrhea and fever while Salmonella symptoms include fever, diarrhea and cramps. Hantavirus victims may feel fatigued, run a fever and experience muscle cramps. The Poliomyelitis virus causes headache, fever and vomiting (McSwane et al., 2004). Refrigerated foods are stored in a

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variety of different refrigeration storage areas. These can be as simple as a standalone reach-in refrigerator or a larger walk-in or walk-through refrigeration room. Different foods require storage at different temperatures. For example, NEHA (2010) recommends storing fresh meat between 32 (0 C) and 41 (5 C) degrees Fahrenheit at a humidity level between 85 and 90 percent and fresh poultry between 30 (-1.1 C) and 36 (2 C) degrees Fahrenheit at a humidity level between 75 and 86 percent. The refrigeration unit's environment should be checked for the proper temperature whenever it is used. This can be achieved by manually checking the unit's internal thermometer or automatically accomplished with wide area temperature monitoring and alarm systems. The actual food temperatures should be checked at the beginning of the day and the end of the day and whenever there is a temperature fluctuation within the refrigeration unit. This can be accomplished by performing spot checks using either probe or infrared thermometers. Monitoring both ambient and food temperatures is necessary from a safety perspective and keeping accurate records of these temperatures is vital for restaurants to comply with federal, state and local regulations as well as documenting compliance for their own safety procedures. Freezers keep frozen food at 0 (-17.7 C) degrees Fahrenheit or below. At this temperature foods can have a much longer shelf life. Fresh meat for example stored at 0 (-17.7 C) degrees Fahrenheit can last several months. The freezer temperature should be checked daily and should be defrosted regularly if it is not a frost free unit. Temperature controls and equipment such as wireless temperature monitoring systems or data loggers

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should be used to verify consistent temperature ranges. Dry storage is used for items not requiring refrigeration such as foods packaged in cans, bottles and bags. NEHA (2010) recommends that the dry storage area should ideally be maintained at a temperature between 50 (10 C) and 70 (21 C) degrees Fahrenheit at a humidity level of 50 to 60 percent. This will ensure that the food shelf life is maximized. Thermometers, temperature control systems or wireless temperature monitoring systems are used for maintaining and recording consistent temperatures. These tools should be monitored on a regular basis. An often deadly misconception is that food is done and safe to eat when it turns brown. In fact according to the USDA one out of every four hamburgers turns brown before its internal temperature has reached its safe temperature. Different foods require different minimum internal temperatures to be determined safe but typically they range from 140 (60 C) to 165 (73.9 C) degrees Fahrenheit. In addition to reaching this temperature the product must be held at that temperature for a set period of time. As an example the USDA lists eggs as requiring an internal temperature of 145 (62.8 C) degrees Fahrenheit maintained for 15 seconds whereas a thicker pork roast they state requires a temperature of 145 (62.8) degrees Fahrenheit maintained for three minutes (USDA, 2009). Consumers doubting the need for using temperature as a gauge should consider one CDC report that stated in 2007 one foodborne outbreak resulted in seven food poisoning victims in Long Island, New York and county health officials believed that all

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contracted the E.coli bacteria from under cooking hamburger meat. One of the victim's kidneys shut down as a result of the infection. Another report stated that in 1993 there were over 500 confirmed illnesses with four deaths from an E.coli outbreak associated from eating undercooked hamburgers from just one restaurant chain. The only safe method to determine if a food is cooked is to take its internal temperature with an accurate thermometer. Accurate probe and bi-metal thermometers are effective tools to prevent undercooking (WHO, 2004). HACCP is an internationally recognized food safety assurance system that concentrates prevention strategies on known hazards; it focuses on process control, and the steps within that, rather than structure and layout of premises. HACCP establishes procedures whereby these hazards can be reduced or eliminated and requires documentation and verification of these control procedures. Whilst HACCP has been widely adopted by the food manufacturing industry and the larger companies in the hospitality and catering sector, there have been concerns about implementation by smaller businesses. Barriers to the implementation of HACCP in small businesses have been identified which include lack of expertise, absence of legal requirements, fnancial constraints and attitudes (WHO, 2009). According the the Center for Disease Control and Prevention (2010), poor hygiene has also been linked to outbreaks of foodborne disease. The Center for Science in the Public Interest or CSPI reported that one Salmonella outbreak at one quick service restaurant sickened thirty-eight people and may have killed one. The cause was

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determined to be linked to employees not washing their hands before handling food. According to the CDC and industry experts, 70 to 80 % of foodborne illnesses are caused by improper hand washing. Many people have the misconception that washing their hands a couple times per day is sufficient in preventing transmission of bacteria when in fact hand washing should take place anytime before, between and after touching raw food and after touching any part of a person's body or cleaning. Equipment and utensils must likewise be cleaned and sanitized. Further support for the value of personal and equipment cleanliness comes from the FDA that reports that a virus, such as the human influenza virus, can survive on surfaces for up to eight hours. Management must ensure that employees are familiar with the proper methods of cleaning and sanitizing equipment and utensils. Despite training, it has also been found that food service workers commonly reported risky food handling practices (Green et al., 2005). A quarter of the workers were of the opinion that that they did not always wash their hands while a third did not always change gloves between touching raw meat or poultry and RTE food. A number of studies indicate that although training may bring about an increased knowledge of food safety, it does not always result in a positive change in food handling behavior. However, hand washing knowledge and behaviour has been reported to improve significantly after training (Roberts, Barret, & Sneed, 2005). Food service establishments (FSE) such as restaurants, hotels, bars, and cafeterias are considered an important source of foodborne outbreaks as studied in various

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European countries (Hughes, Gillespie, & O‘ Brien, 2007). There are several studies that have discussed that the main causes of microbial contamination typically occurring in foodservice establishments are contaminated supplies, dirty food contact surfaces, poor personnel hygiene practices, inappropriate storage temperatures, and insufficient cooking (Käferstein, 2003; Griffith & Clayton, 2005; WHO, 2007; EFSA, 2007; Jones, Parry, O‘ Brien, & Palmer, 2008). Food safety depends on good standards of hygiene applied at all stages of the food production process. Many such rules are enforced by legislation. Food safety also depends on the industry identifying and controlling risks by regular risk assessment. Risk assessment is the process of working out how big a risk is, i.e. how likely it is that someone may be harmed or something may be damaged. One method of doing this is called Hazard Analysis and Critical Control Points (HACCP). HACCP requires the food manufacturer or producer to look at every stage of production and identify any hazards (mainly the growth of food poisoning bacteria, but also the amount of product in a pack, packaging faults and foreign bodies falling into food. Steps should be taken to prevent remove or reduce the hazards. Once the hazards are under control, they should be closely monitored to make sure that everyone involved in production is carrying out hazard control procedures (Knowles, 2003). According to Stellman and Mager, (2008) the increasing separation of the consumer from the food production sector that has accompanied urbanization globally has resulted in a loss of the traditional means used by the consumer to ensure the quality

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and safety of food, making the consumer dependent on a functional and responsible food processing-industry. Increased dependence on food processing has created the possibility of exposure to pathogen-contaminated food from a single production facility. To provide protection from this threat, extensive regulatory structures have been established, especially in the industrialized countries to protect public health and to regulate the use of additives and other chemicals. Harmonization of regulations and standards across borders is emerging as an issue to ensure the free flow of food among all the world‘s countries. The Association of Food Industry Sanitarians (2004) indicated that ignorance, carelessness and indifference on the part of food handlers result in unsanitary conditions. Poor practices may be found even in establishments where considerable investment has been made in modern equipment. All food handlers should be educated in proper methods through demonstrations, discussions, posters and pictures. Assistance and advice may be obtained from local health departments which in many areas conduct periodic food-handler training courses. A sanitarian can often achieve more by a well-directed educational program that he can by inspection. Food handlers should wear clean uniforms and keep their hands clean. In the book of Berkoff (2008), she pointed out that as the complexity of the food system grows, new safety challenges arise. Along with the variety of food products may come a variety of biological, chemical and physical hazards. Because of this, food production, distribution and preparation have come under intense scrutiny from

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government agencies, from consumers and from the industry itself. According to Tull (2004), in the food industry, there are health and safety hazards at each stage throughout production, retail, preparation and consumption of every product. Responsibility for ensuring high standards of health and safety at each stage of the production process rests with every worker, who must be given clear instructions and training by their manager concerning the use of machinery and tools, the storage of food products, the control of microorganisms, the use of dangerous chemicals, first aid and safety procedures. Managers are also responsible for providing their workers with rest rooms and toilet facilities and must display health and safety notices for both their workers and the public to read and follow. According to the FDA Food Code (2009), hands shall be washed in a separate sink. Automatic hand washing facilities maybe use by food workers to clean their hands. However, the system must be capable of removing the types of soils encountering in the food operation. Food employees may not clean their hands in a sink used for preparation or ware washing, or in a services sink used for the disposal of mop water and liquid waste. Perdigon (2005) acknowledged that human beings are the single most common source of food contamination. They spread bacteria and other microorganisms by unclean hands. Skin infections are well as by coughing and sneezing. Dirty people are most dangerous because they can carry the natural contamination found in clean and healthy people.

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Biological hazards in food include harmful microorganisms like bacteria, parasites, fungi, viruses and prions (proteinaceous infectious particles) (Ang and Balanon, 2010). Further emphasized that among the microorganisms bacteria are the most common food contaminants that cause foodborne diseases. Pathogenic bacteria may cause foodborne infection or foodborne intoxication. Foodborne infection occurs when a person consumes low numbers of pathogens together with the food, which then multiply in the body and invade vital organs. Therefore foodborne intoxication, on the other hand, is due to the ingestion of toxins, which is produced by bacteria, in food. Staphylococcus aureus is the most common toxin-producing bacteria. Hazard Analysis Critical Control Point (HACCP) is an operational system used to select and implement effective control measures to ensure the safety of a food product. HACCP focuses on potentially hazardous foods (PHF) and how they are handled. PHF have the ability to support rapid and progressive growth of infectious and toxin-producing microorganisms. Further emphasized that in every food establishment has their own set of procedures often simply described as the way we do things. Many retail and food service establishments have implemented effective food safety management systems by establishing controls for food preparation methods and processes common in their operations. Waggoner (2004) reported that there are thousands of types of bacteria in the environment, but most of them do not cause harm. For example, there are some types of bacteria that are beneficial and keep the digestive tract healthy. When harmful bacteria,

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also known as pathogens, enter the food and water supply, they can cause foodborne illness and even death. Spoilage bacteria can cause foods to smell and taste bad. Moreover, these bacteria can be harmful, but probably will not cause illness. Diseasecausing bacteria are more serious because they usually do not make the food smell or taste bad, but they can cause illness. Furthermore, the food-borne infections are due to pathogenic organisms. Each hand washing sink must be provided with hand cleanser (soap or detergent) in a dispenser and a suitable hand-drying device. Hand sanitizing lotions and chemical hand washing/ Proper washing helps to remove visible hand dirt and the microorganisms it contains. Hand sanitizing lotion must never be used as a replacement for hand washing. Epidemiological research has indicated that the majority of reported foodborne illness outbreaks originate in food service establishments and case control studies have shown that eating meals outside the home is a risk factor for obtaining a foodborne illness In addition, research on foodborne illness risk factors has indicated that most outbreaks associated with food service establishments can be attributed to food workers‘ improper food preparation practices, and observation studies have revealed that food workers frequently engage in unsafe food preparation practices. These findings indicate that improvement of restaurant workers‘ food preparation practices is needed to reduce the incidence of foodborne illness. Food worker intervention programs are needed to effect this improvement. However, health researchers have argued that an understanding of current practices and factors affecting those practices is necessary before behavior change

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efforts can be successful (Green et al., 2005). Food safety in retail foodservice is increasingly important to consumers. Trends that impact food safety concerns include the increasing number of meals eaten away from home, increasing consumer awareness about food safety, an aging population, changes in the foodservice workforce, changing technology in work environments, changes in food procurement, foodservice risk factors, and food defense concerns. Each of these trends has implications for dietetics practice, both in working with consumers and managing foodservice operations (Sneed & Strohnehn, 2008) Allan Liddle (2004) stated that the seeds of consumer and employee lawsuits lie everywhere for restaurant operators and seem easily germinated. The good news, some operators, is that many, if not most, lawsuits can be prevented through management practices that pay the additional dividends of lower insurance rates, increased productivity and enhanced loyalty from customers and workers. Attorneys and foodservice professionals indicate that an appropriate anti-litigation strategy for modern times calls for detailed hiring and firing guidelines, pre-employment screening to weed out potentially violent or otherwise undesirable job candidates, regularly updated and widely posted policies against discrimination or harassment of any kind, awareness of, and adherence to, prevailing wage-and-hour laws, the maintenance of safe work and public areas and ongoing worker education related to safely preparing and handling food. A number of independent and chain operators augment those basics with a wide array of additional practices that may be considered litigation limiters. For example. Bruegger‘s

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Bagel Bakeries recently contracted with sanitation experts to help establish high standards and audit company and franchised units for compliance (Nation‘s Restaurant News, 2005). Food safety and sanitation is an important public health concern. In the United States, it is estimated that 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths are attributed to foodborne illness each year. The annual cost of foodborne illness is estimated to be from $10 to $83 billion. For some individuals, foodborne illness may result in a mild, temporary discomfort. Because older adults are a highly susceptible population, foodborne illness may have serious or long-term consequences, and may be life threatening. Older adults are vulnerable to foodborne illness for several reasons. They have weakened immune systems. As part of the aging process, the ability of their immune system to function at normal levels decreases. A decrease in the level of diseasefighting cells is a significant factor in making the average older adult highly susceptible to harmful microorganisms in food. They have inflammation of the stomach lining and a decrease in stomach acid: The stomach plays an important role in limiting the number of bacteria that enter the small intestine. During the natural aging process, an older persons stomach tends to produce less acid. The decrease or loss of stomach acidity increases the likelihood of infection if a pathogen is ingested with food or water. Their sense of smell and taste declined. Many contaminated foods do not smell or taste bad. However, for foods like spoiled milk, a person who does not notice "off" odors and flavors is more likely to eat the food and more likely to become ill. Older people are living on their own.

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For an older person, preparing meals may pose special challenges. A widower who has not cooked for himself may not know how to prepare food safely. A person receiving home-delivered meals may not be familiar with safe handling and storage practices for meals and leftovers (Mead, et al., 2005) The causes of foodborne illness are multifaceted. Some major risk factors of foodborne illness are related to employee behaviors and preparation practices in food service establishments. The principle known risk factors include: Improper holding temperatures, Inadequate cooking, such as undercooking raw shell eggs, Contaminated equipment, Food from unsafe sources, Poor personal hygiene, and others such as, pest and rodent infestation and improper food storage (FDA,2003). In the study of Green (2005) .A few workers reported unsafe hand hygiene practices, such as not washing their hands when changing gloves and using sanitizers instead of washing their hands. Several workers said they sanitized but did not wash and rinse their equipment after working with raw meat and did not check the temperature of all the meat they cooked because they believed they could determine food doneness through other methods (e.g., appearance and feel of the food). Others said they did not check the temperature of food being reheated or cooled. Most workers, however, reported safe food preparation practices. For example, workers described a variety of situtions in which they washed their hands and changed their gloves, and said they cleaned their work surfaces and equip-ment after preparing raw meat or poultry and checked the temperatures of held food. These findings indicate that the participants were aware of and

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engaged in multiple food safety practices. Previous research, however, suggests that food workers (and consumers) report engaging in food safety practices more frequently than they actually engage in those practices This phenomenon is likely the result of the social desirability bias, which is the tendency for people to report greater levels of so-cially desirable behavior (such as safe food preparation practices) than they actually engage in, or to report their best behavior rather than their typical or worst behavior. Although it is not possible to determine the extent to which our participants over-reported their safe food preparation practices, it is likely that they do not engage in these practices as frequently as they have reported. Food safety and sanitation regulations. The increasing separation of the consumer from the food production sector that has accompanied urbanization globally has resulted in a loss of the traditional means used by the consumer to ensure the quality and safety of food, making the consumer dependent on a functional and responsible foodprocessing industry. Increased dependence on food processing has created the possibility of exposure to pathogen-contaminated food from a single production facility. To provide protection from this threat, extensive regulatory structures have been established, especially in the industrialized countries to protect public health and to regulate the use of additives and other chemicals. Harmonization of regulations and standards across borders is emerging as an issue to ensure the free flow of food among all the world‘s countries (Stellman et al. 2008).

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Gary Trainor (2012) emphasized that business and corporate management compliance refers to the company obeying all the legal laws and regulations in regards to how they manage the business, their staff, and their treatment towards their consumers. Therefore, the concept of compliance is to make sure that corporations will act responsibly. Although food premises are regularly inspected, little information is available on the effect of inspections on compliance records, particularly with respect to the impact of the frequency of inspection on compliance. High-risk food inspection premises were randomly assigned three, four or five inspections per year. Results indicated that no statistical difference existed in outcome measures based on frequency inspection. When premises were grouped based on the average time between inspections, premises with greater time between inspections scored better compliance measures relative to premises that were inspected more frequently. The study was also unique for the level of consultation and collaboration sought from the public health inspectors (PHIs) assigned to the Food Safety Program. Their knowledge and experience with respect to the critical variables associated with compliance were a complementary component to the literature review conducted by the research team (Journal of Environmental Health, 2008). Grading systems for retail food facilities have become a heated topic of debate among health professionals. Perceptions may vary with the individual players, which Owen (2000) emphasized that the underlying purpose of a grading system can range from enhancing legal compliance to establishing incentives for organizational change, to

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communicating risks with the public. He further stresses that whether the trigger event for a grading policy is local news coverage of food safety issues or a deliberate vision of policy makers, the effectiveness of the system should be evaluated through a policy analysis that seeks to understand individual perceptions and the underlying purpose of a grading system. Therefore, the reliability and interpretation of risk communication is not a shared value among all the players. The effectiveness of a program could be undermined. However, the current controversy presents opportunities as well as challenges (Journal of Environmental Health, 2008) Labensky and Hause (2007) stresses that although local health department regularly inspect all food service facilities, continual self-inspection and control are essential for maintaining sanitary conditions. Therefore, one way to ensure compliance is to frequently check and record the temperature of Potentially Hazardous Foods (PHF) during cooking, cooling and holding. Maintaining written time and temperature logs allow management to evaluate and adjust procedures as necessary. Furthermore, whatever system is followed, all personnel must be constantly aware of and responsive to risks and problems associated with the safety of the food they serve. Food safety act of 2013. With the signing into law on August 23, 2013 of the Republic Act (RA) 10611 otherwise known as the ―Food Safety Act of 2013‖ by H. E. Benigno S. Aquino III, President of the Republic of the Philippines, the food safety regulatory system in the country including the Good Manufacturing Practices (GMP) and

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the Hazard Analyses at Critical Control Points (HACCP) audits shall be strengthened (http://nmis.gov.ph/ date accessed October 9, 2013). Food safety attitude. Attitude is a psychological tendency that is expressed by the degree to which a person has a favorable or unfavorable evaluation or appraisal of the behavior in question (Ajzen, 1991). The attribution theory (Weiner, 1974), specifically the dispositional attribution which is a tendency to attribute people‘s behaviors to their dispositions; that is, to their personality, character, and ability. In the study, the fast food restaurants‘ food handlers‘ disposition is their attitude, which is positive or negative towards food safety and sanitation. Theory of planned behavior (Ajzen, 1991), in psychology, is a theory about the link between beliefs and behavior. The concept was proposed by Icek Ajzen to improve on the predictive power of the theory of reasoned action by including perceived behavioural control. It is one of the most predictive persuasion theories. It has been applied to studies of the relations among beliefs, attitudes, behavioral intentions and behaviors in various fields such as advertising, public relations, advertising campaigns and healthcare. The theory states that attitude toward behavior, subjective norms, and perceived behavioral control, together shape an individual's behavioral intentions and behaviors. One way to explore behavioral intention and the cognitive beliefs underlying the formation of intention is through the use of the theory of planned behavior (TpB). The

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TpB states that behavior intention is based on a person‘s attitude (one‘s evaluation of the behavior), subjective norm (one‘s perception that those who are important to the person think he or she should or should not perform the behavior), and perceived behavioral control (one‘s ability to perform a behavior or barriers which would prevent one from performing a behavior) (Ajzen and Fishbein, 1991). According to Ajzen‘s (1991), in the theory of planned behavior, attitude relates to one‘s own personal views about a behavior. Attitude may also be defined as positive or negative views of an ―attitude object‖ i.e. a person, behavior or event. Theoretically, Ajzen (1991) have indicated that attitude is a partial indication of behavior. Attitude towards an event, object, function or person may be favourable or unfavourable. According to Ajzen (1991), an individual evaluates an event or object positively or negatively and positive and negative evaluation is the main dominant characteristic of an individual‘s attitude. Attitude and manager perceptions about food safety programs have been well researched and it has been found that manager‘s attitudes impact the success of food safety programs and decreasing the number of foodborne illness outbreaks (Howes et.al., 2005). In a study of 36 restaurants that received favorable scores on their previous inspection, restaurant managers who had a favorable attitude about food safety were likely to score higher on inspection reports than those who did not have a favorable attitude. They also found that only 23% of the restaurants surveyed had a manager or

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employee certified in food safety. Of the 36 restaurants surveyed that received favorable scores, 44% had an employee certified in food safety (Roberts, 2003). If a person holds a negative attitude about a behavior, he or she will be less likely to partake in the behavior compared to one who has a positive attitude about the behavior. Attitude was also found to be a significant predictor of behavioral intention. Obviously, if a manager has positive attitudes about food safety, they will more likely initiate the behavior (Roberts, 2005). The responsibility of having positive attitude towards food safety does not only lie on the shoulder of the management team. Students and even food handlers should take their own initiatives to enhance their knowledge in the matter and profiling themselves to be more positive. Pilling, Brannon, Roberts, Shanklin and Howells (2008) found that food handlers perceive many barriers to implementing food safety programs. Food handlers noted that lack of time, training and resources, along with employee attitude, availability of hand sinks, and inconveniently located resources were barriers to hand washing within a foodservice operation (Pilling et al., 2008). It is undeniable that not all of teaching institutions in the developing countries which involved in the culinary field is equipped with the proper and more manageable facilities. It is well known that improving knowledge does not necessarily lead to changes in attitude or behavior (Ajzen & Fishbein, 1980). However, the gap between knowledge and behavior is regarded as an affective dimension. Various studies have shown that the efficacy of training in terms of

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changing behavior and attitudes to food safety is questionable (Mortlock, Peters, & Griffith, 2003). Besides knowledge, attitude is also an important factor that ensures a reduction trend of foodborne diseases. Howes, McEwen, Griffiths & Hanis (2006) indicate the correlation of positive behaviour, attitudes and continued education of food handlers towards the maintenance of safe food handling practices. On the other hand, Bas et al. (2004) in their study found that the attitude scores of the food handlers toward foodborne diseases prevention and control was poor (44.2 ± 13.2) as well as safety practice scores were very low (48.4 ± 8.8). According to Howes et al., a study in the USA showed that approximately 97.0% of foodborne outbreaks were due to improper food handling practices in food service fields. Previous reports indicate that besides poor hand and surface hygiene, lack in personal hygiene amongst food handlers was also one of the most commonly reported practices that gave rise to foodborne illness (Collins, 2006). This shows that if food handlers take serious note on the cleanliness of their hand, body and clothing, this will help in preventing incidence of cross-contamination from occurring (Sneed et al. 2004). Fast food restaurants. Researchers defined fast-food restaurants as chain restaurants that have two or more of the following characteristics: expedited food service, takeout business, limited or no wait staff, and payment tendered prior to receiving food (Block, 2004).

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A fast food restaurant also known as quick service restaurant responds to the universal desire for inexpensive and reliable fare that is freshly prepared, portable and ready on demand. People were finding ways to escape the dinner table long before the 4th Earl of Sandwich wrapped dried meat in bread c. 1762 so as not to interrupt his work or his gambling. Cornish pasties and their descendants go back at least as far as the 13th century; the South Asian samosa is believed to date to the tenth century. In 1867, Charles Feltman, a German butcher, opened up the first Coney Island hot dog stand in Brooklyn, New York, though the origin of the term is in dispute (McGinley & Spurr, 2004). The food intake of the people of any country is related to a number of factors like income of consumers, employment status, educational level and cultural differences (Dowler, 2007). Due to global change, the life styles of people change gradually. They spend more money on fast food rather than spending on higher education, computers, books, magazines, newspapers, videos, and recorded music (Schlosser, 2008). Fast foods have been defined by Bender and Bender (2005) as a broad term used for a restricted menu of food that lend themselves to production techniques. Suppliers tend to specialize in product such as hamburger, pizza, chicken and sandwiches. Fast food means quick service -the food already prepared and held, limited menu items and no table service. The World's Columbian Exposition of 1893 (Chicago) and the St. Louis World's Fair of 1904 were credited with mass promotion of a number of portable foods, including the hot dog, the ice cream cone and iced tea. The "diner" concept dates back to 1872, when Walter Scott of Providence, RI outfitted a horse-drawn lunch wagon with a simple

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kitchen so that he could bring hot dinners to workers. As automobiles became popular and affordable following the First World War, drive-in restaurants were introduced. Walter Anderson built the first White Castle in Wichita, KS in 1916, introducing the limited menu, high volume, low cost, high speed hamburger restaurant. Partnering with Billy Ingram in 1921, they formed the first hamburger chain. Featuring a grill and a fryer that was open to customers' viewing, the restaurants were designed to build confidence in the notion that low cost could coincide with high product quality. (McGinley & Spurr, 2004). A and W Root Beer took its product out of the soda fountain and into a roadside stand in 1919 and began franchising its syrup in 1921. Howard Johnson pioneered the concept of franchising restaurants in the mid-1930's, formally standardizing menus, signage and advertising. Wichita, KS was the home of another fast food innovation, the "Valentine Diner", a portable steel sandwich shop introduced by Arthur Valentine in 1938. Valentines could be purchased with a low down payment and financed through a lock box into which the owner was to deposit 50 cents daily. Circuit riders stopped by monthly to collect this fee; deadbeats discovered that their wagons had been hauled away. Curb service was introduced in the late 1920's and was mobilized in the 1940's when carhops strapped on roller skates. The term "fast-food" was coined in 1951, the same year the drive-through window and speaker system was introduced to chain restaurants by Jack-in-the-Box in San Diego, CA (McGinley & Spurr, 2004)..

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In addition to economic and cultural impact, the growth of the fast-food industry has had significant implications for the health of the country (DeMaria, 2003). Thus, fast-food restaurants have had a major influence on the incidence of food-borne infections, workplace injuries, and most importantly from a cardiovascular standpoint, obesity. The epidemic of obesity affecting the U.S. has been well documented. The condition affects not only adults, more than half of whom are overweight or obese, but also children, in over 25% of whom these conditions are found. As of 1999, nearly 50 million adults in the U.S. were obese or super-obese. Although the precise cause of this epidemic has not been fully defined, it is clear that it cannot be attributed to genetic changes. Rather, obesity appears to be due to a combination of environmental factors that includes the consumption of excess calories and the reduction of physical exertion. In this regard, the fast-food industry has likely contributed to the increased caloric intake of many Americans. Specifically, the size of portions served at these restaurants has increased in response to competitive pressures. Thus, Burger King now sells a triple decker, and the slogan of Little Caesar‘s pizzas is ―Big, Big.‖ A large Coke at McDonald‘s is 32 ounces (310 calories), and Super Size Fries have 610 calories, while a Double Western Bacon Cheeseburger and Cross Cut Fries at Carl‘s Jr. restaurant contains 73 grams of fat. Given the documented consumption of fast food in our country, the contribution of this dietary content to obesity is apparent. Moreover, the introduction of fast food overseas has been accompanied by a similar increase in obesity in those countries (McGinley & Spurr, 2004).

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Eating away from home is becoming more common, and fast food restaurant use in particular is growing even more rapidly (Schlosser, 2004). In 1970, money spent on away-from-home foods represented 25% of total food spending; by 1995, it comprised 40% of total food spending and by 1999 it reached a record 47.5% of total food spending. It is projected that, by 2010, 53% of the food dollar will be spent away from home.3 Fast food has been defined as food purchased in self-service or carryout eating places without waiter service. Between 1977 and 1995, the percentage of meals and snacks eaten at fast food restaurants increased 200%, while other restaurant use increased 150%. Fast food outlets are especially popular among adolescents. The average adolescent visits a fast food restaurant twice a week and fast food outlets provide about one-third of the away-from-home meals consumed by adolescents. As away-fromhome foods represent an ever-larger proportion of total energy intake, their nutrient profile becomes more important to examine. Away-from-home foods are higher in fat and energy compared with foods eaten at home. In 1995, away-from-home foods accounted for 27% of eating occasions, but 34% of energy intake. At-home foods comprised 31% fat; by contrast, away-from-home foods comprised 38% fat energy. Although about a quarter of Americans eat fast food every day, with 2001 sales reaching over $110 billion in the United States alone (Schlosser, 2004), few worry about the safety of the food. Most consumers operate under the assumption that health inspectors' visits to fast-food restaurants prevent and correct risks that can arise from unsafe practices that food handlers are trained to avoid. Yet, little data are available that

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document the extent to which hazardous practices occur. Research in this area generally focuses on managerial strategies to improve inspection scores, rather than on everyday behind-the-scenes operations. In fact, consumers possess very limited knowledge about the practices of employees who actually prepare the food, which details the observations of a college student with extensive work history in the fast-food industry (Dundes & Swan, 2008) In the Wall Street Jourmal, fast food restaurants are taking a new course. In the hope of appealing to more-sophisticated consumers, fast-food chains are moving beyond simple cheeseburgers and tacos, adding fancier ingredients such as portabella mushrooms, citrus-herb marinated chicken and pepper bacon. The move is driven by a growing foodie culture as well as the success of chains like Chipotle Mexican Grill Inc. CMG -0.42% and Panera Bread Co. PNRA -1.64% , a category known as "fast casual," where customers still order at a counter but are paying for something up a notch from a burger, fries and a shake. Both Chipotle and Panera did well during the economic downturn by attracting customers who were trading down from full-service restaurants but still wanted freshly prepared food at affordable prices. Long criticized for selling prepackaged, frozen and made-in-advance sandwiches, fast-food chains are trying to steer away from the perception of processed food by emphasizing the freshness of their products. While fresh ingredients cost more than canned and frozen ones, chains say it is worth it for brand building, and higher quality gives them more pricing power. Early signs indicate it is working. Taco Bell, a unit of Yum Brands Inc., YUM +0.29% recently

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introduced a "Cantina Bell" line of Chipotle-like burritos and salad bowls made with fresh avocados and cilantro dressing. (Jargon, 2012) People everywhere love to go to restaurants, whether it is fast food, pizza or a sizzling steak dinner. Restaurants compete for customers every day. They realized that an adequate staff scheduling is critical to providing the kind of quality customer service that brings people to the establishment and keeps them coming back (Clavel, 2012). Restaurant operation depends on its size and various management levels. Restaurants range from unpretentious lunching or dining places catering to people working nearby, with simple food served in simple settings at low prices, to expensive establishments serving refined food and wines in a formal setting. Typically, customers sit at tables, their orders are taken by a waiter who brings the food when it is ready, and the customers pay the bill before leaving. Every establishment according to Stone (2011) should go above and beyond the norm to ensure that food is properly handled. Customers, before ordering their next meal at the restaurant, are these days taking a close look at the employees and the environment if they can. They may not be able to spot what goes on behind the scenes, but they trust their instincts for what they are able to observe. This is one more reason why it is better not to understaff. Operators should ensure that the expectations of employees are reasonable, and they should hold regular training programs. Even taking a few hours out of a day between meal time to conduct a food safety drill, involving the whole team , will go a long way to promoting healthy practices in the kitchen. Dropping in for a spot

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check every now and then will also be effective. To prevent employees from resenting surprise inspection, must be done to help out for an hour or so during the shift. Through this, there is an opportunity to set a good example, as well as boost morale by showing the staff that the boss work beside them as equals. Attitude and Compliance. Presidential decree 856 Code of Sanitation Section 18 (2007) states that owners, managers, and operators of food service should secure a sanitary permit from the local health authority before establishing and operating their business trade. Moreover, Section 19 stipulated that no person should be employed in any food establishments without health certificate issued by the local health authority. Individual attitudes towards compliance have been shown to be a function of social or cultural norms (Naylor, 2009). If such attitudes would carry over to actual compliance, enhancing these norms, as through increasing overall trust in government, is a desirable policy instrument to compliment the usual enforcement options. Askarian, Kabir, Aminbaig, Memish & Jafari (2006) presented findings that strong associations were found among knowledge, attitude, and practice. Attitude has a lot of influence on compliance, as shown in the study of Armonio, et al (2002) and Suchitra and Devi (2007). Such also was the case supported by Askarian, et al (2006), as it indicated that attitude mediated the relationship between knowledge and compliance. Pittet (2004) supported this statement and aptly termed it ―behavior modification‖. It was vital, therefore, to find ways to improve attitude in order to improve compliance.

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GRADUATE SCHOOL Iloilo City On the other hand, attitudes vary greatly in how strong they are (Converse, 1970). Strong attitudes are especially important to understand as they have greater resistance to change and greater impact on behavior (Krosnik & Petty, 1995). However, when something substantially affects people, their attitude towards it are likely to be strong (Crano, 1995). Managers of these businesses must comply with regulation and deal with inspectors. Therefore we assume that their attitudes towards them are likely to be strong. In a study conducted by Kaplowitz & Eyck (2006), The greatest predictor of manager‘s attitudes towards regulation is how safe they perceive the food supply to be. The belief that their customers are concerned about safety also indirectly affects this attitude, but less that their own beliefs. This is surprising, as majority ordinarily think of business people as having their policies driven primarily by the demands of the market rather than by their personal preferences and beliefs. The Report of the FDA Retail Food Program Database of Foodborne Illness Risk Factors was the Food and Drug Administration‘s (FDA, 2004) first attempt to develop baseline data about compliance of retail foodservice operations‘ risk factors for foodborne illness. Only 60% of full-service and 74% of quick service restaurants were found to be in compliance with current health code requirements. These are lower percentages than found in non-commercial foodservice operations, such as hospitals, nursing homes, and elementary schools.

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GRADUATE SCHOOL Iloilo City A follow-up study by the FDA (2004) found that 13% of full-service restaurants were out of compliance for purchasing food from unsafe sources, 42.7% for poor personal hygiene, and 63.8% for improper holding time and temperature. The percentages of quick service restaurants out of compliance with these risk factors were lower with 2.3%, 31.2%, and 41.7%, respectively. Because of the relatively high incidence of restaurants that are ―out of compliance‖ with risk factors and food safety, restaurant managers should focus on those behaviors that are known to cause foodborne illnesses and emphasize them in training. According to Mohammad (2009) the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program collects data from 10 American states regarding diseases caused by pathogens commonly transmitted through food. In 2005 data, Foodnet sites reported 205 foodborne disease outbreaks to the national Electronic Foodborne Outbreak Reporting System; 121 (59%) were associated with restaurants. Etiology was reported for 159 (78%) outbreaks; the most common etiologies were norovirus (49%) and Salmonella (18%). In 1998, the Food and Drug Administration (FDA) conducted a study to ascertain the rate at which food handlers were in compliance with standards established in the food code. Summary The review of the related literature aimed at finding support for the present study on food safety and sanitation: attitude and regulations compliance of fast food restaurants. It was likewise the purpose of the review to offer a clear investigation of the

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concepts and importance of the key variables in the present investigation by presenting the different views and findings pertaining thereto. The first part of the study is in line with the related practices that deal with the proper way of applying food safety and sanitation and what are the effects of its negligence. Food safety has become an issue of special importance for the retail food industry. There are many opportunities for food to be contaminated between production and consumption. (Ang & Balanon, 2010). Food safety is especially critical in retail food establishments because this may be the last opportunity to control or eliminate the hazards that might contaminate food and cause foodborne illnesses. Even when purchased from inspected and approved sources, ingredients may be contaminated when they arrive at the food establishment. It is important to know how to handle these ingredients safely and how to prepare food in such a manner that reduces the risk of contaminated food being served to clients or customers. Most cases of food poisoning happen in foodservice establishments and usually afflict a great number of people. Commercial food service establishments have been identified by the Center for Disease Control as the leading source of foodborne illness outbreaks (Bean et al., 1996). Statistics show that in the Philippines, the second highest death-related illness is intestinal disease. Outbreak of foodborne illnesses could be prevented if foodservice workers have proper training, techniques, and tools in food management.

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The responsibility of having positive attitude towards food safety does not only lie on the shoulder of the management team. Food handlers should take their own initiatives to enhance their knowledge in the matter and profiling themselves to be more positive. Pilling, Brannon, Roberts, Shanklin and Howells (2008) found that food handlers perceive many barriers to implementing food safety programs. Food handlers noted that lack of time, training and resources, along with employee attitude, availability of hand sinks, and inconveniently located resources were barriers to hand washing within a foodservice operation (Pilling et al., 2008). Restaurants that cause foodborne illnesses stem from human error. Inspectors emphasize that it is imperative for workers to wash hands or change gloves before starting work, and as often as needed during food preparation and serving. Researchers defined fast-food restaurants as chain restaurants that have two or more of the following characteristics: expedited food service, takeout business, limited or no wait staff, and payment tendered prior to receiving food (Block et al., 2004). A fast food restaurant also known as quick service restaurant responds to the universal desire for inexpensive and reliable fare that is freshly prepared, portable and ready on demand. Individual attitudes towards compliance have been shown to be a function of social or cultural norms (Naylor, 2009). If such attitudes would carry over to actual compliance, enhancing these norms, as through increasing overall trust in government, is a desirable policy instrument to compliment the usual enforcement options.

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GRADUATE SCHOOL Iloilo City Attitude and employee perceptions about food safety and sanitation have been well researched and it has been found that employee‘s attitudes impact the success of food safety programs and decrease the number of foodborne illness outbreaks (Howes et.al., 2005).

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Chapter 3 Research Design and Methodology

This chapter is divided into three parts: (1) Purpose of the Study and Research Design, (2) Method, and (3) Data Analysis Procedure. Part One, Purpose of the Study and Research Design, outlines the objectives and hypotheses of the study and identifies the theories related to food safety and sanitation. Part Two, Method, introduces the participants and research instruments and outlines the procedure followed in the conduct of the study. Part Three, Data Analysis Procedure, provides the statistical tools used to analyze and interpret the data. Purpose of the Study and Research Design This descriptive-correlational research aimed to ascertain the food handlers‘ attitude towards food safety and sanitation and the fast food restaurants‘ compliance with safety and sanitation regulations. The survey-correlational method of research was employed in this investigation. Fraenkel and Wallen (2003) explained that the major purpose of survey research is to describe the characteristics of a population. In essence, information is collected from a group of people in order to describe some aspects or characteristics (such as abilities, opinion, attitudes and or knowledge) of the population of which the group is part. In correlation research, sometimes called associative research, the relationships among two

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or more variables are studied without any attempt to influence them. In their simplest form, correlational studies investigate the possibility of relationships among the two variables, although in investigations of more than two variables are common. Method Participants. The participants of this investigation were the 200 randomly selected food handlers in fast food restaurants in Iloilo City. The food handlers were taken as an entire group and classified according to sex, age, educational attainment, industry experience, and position. The participants were selected through two-stage sampling. The names of the 59 fast food restaurants in Iloilo City were written on slips of paper, rolled and placed inside a box. Then the lottery technique was employed, whereby 12 fast food restaurants were drawn and served as basis of where the participants were chosen. As shown in Table 1, in terms of sex, 71 or 36% were males, while 129 or 64% were females. In terms of age, 80 or 40% were below 20 years old, 85 or 41% were between 20-30 years old, 28 or 14% were 31-40 years old and 10 or 5% were over 40 years old. When grouped according to educational attainment, 41 or 20% were high school graduates, 153 or 77% were college graduates and 6 or 3% were post-graduates. In terms of industry experience, 87 or 43% had less than a year of experience, 86 or 44% had 2-5 years of experience, 17 or 8% had 6-10 years of experience and 10 or 5% had more than 10 years of experience. When grouped according to job position, 178 or 89% were line/staff and 22 or 11% were managers.

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Table 1 Distribution of Participants Category

f

%

A. Entire group

200

100

Male Female

71 129

36 64

C. Age < 20 20-30 31 and above 40 and above

80 85 28 10

40 41 14 5

D. Educational attainment High School College Post Graduate

41 153 6

20 77 3

E. Industry experience 1 year and less 2-5 years 6-10 years Over 10 years

87 86 17 10

43 44 8 5

F. Job position Line/staff Manager

178 22

89 11

B. Sex

Table 2 shows the categories of restaurants. In terms of number of food handlers, 7 or 58% had less than 30 food handlers while 5 or 42% had over 30 food handlers. When grouped according to restaurant size, 6 or 50% had less than 40 seating capacity, 4 or 33% had 40-80 seating capacity, while 2 or 17% had more than 80 seating capacity. In

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terms of type of restaurant, 9 or 75% were Chain restaurants, while 3 or 25% were independent restaurants. Table 2 Distribution of Fast Food Restaurants Category

f

%

A. Entire group

12

100

B. Number of food handlers Less than 30 Above 30

7 5

58 42

C. Restaurant size < 40 seats 40-80 seats > 80 seats

6 4 2

50 33 17

D. Type of restaurants Chain Independent

9 3

75 25

Data-gathering Instrument. To gather data on the level of food handlers‘ attitude towards food safety and sanitation and the regulations compliance of selected fast food restaurants, the researcher utilized two (2) data gathering instruments: the Sneed and Lin (2010) questionnaire on the attitudes of food handlers towards food safety and sanitation and the Sanitary Inspection of Food Establishment Compliance Form (2012) of the Iloilo City Health Office. Attitude towards food safety and sanitation. The Sneed and Lin (2010) questionnaire on the attitudes of food handlers towards food safety and sanitation

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determined the level of attitude towards food safety and sanitation of food handlers of the randomly selected fast food restaurants in Iloilo City. The items were measured using a five-point Likert scale. To interpret the mean scores obtained, the following scale and interpretation were used: Mean Scores

Interpretation

3.01 - 5.00

Positive

1.00 - 3.00

Negative

Regulation Compliance. The Sanitary Inspection of Food Establishment Compliance Form of the Iloilo City Health Office indicated the items needed by the fast food restaurants to comply. The perfect score is 100 and non-compliance of an item will earn a demerit of 5 points. The following total points were interpreted as follows: Total Points

Interpretation

90-100

Complied to a high extent

70-89

Complied to a moderate extent

50-69

Complied to a low extent

Below 50

Not complied

Procedure. Prior to the actual data gathering, the researcher secured permission from the office of the managers of the chosen fast food restaurants to conduct the study.

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After which, the researcher explained to them the purpose and the mechanics of the study. The data for the compliance of sanitary inspection of food was taken from City Health Office of Iloilo City. Data Analysis Procedure The data gathered for this study were subjected to certain computer-processed statistics. Frequency count. Frequency count was used to determine the number of participants and restaurants belonging to a class or category. Percentage analysis. To determine which portion of the participants and restaurants that belong to a class or category of the variables, the percentage analysis was used. Mean. The mean score was used to determine the food handlers‘ attitude towards food safety and sanitation. Standard deviation. The standard deviation was employed to find out the homogeneity or heterogeneity of the participants‘ attitude towards food safety and sanitation and restaurants‘ compliance to regulations. t-test for Independent samples. The t-test for independent samples set at .05 alpha level was used to determine the significant difference that existed between twolevel categories. One-way analysis of variance (ANOVA). To find out the significant differences among three or more categories, the one-way ANOVA was employed.

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Mann-Whitney test. The Mann-Whitney test was used to determine the significant differences in the level of regulations compliance of fast food restaurants classified according to number of food handlers and type of restaurant. Kruskal-Wallis test. To find out the significant difference in the level of regulations compliance of fast food restaurants classified according to restaurant size, the Kruskal-Wallis test was employed. Pearson’s product moment of coefficient correlation (Pearson’s r). The Pearson‘s product moment coefficient of correlation was employed to ascertain the relationship between the attitude towards food safety and sanitation and compliance to regulations. The .05 alpha level was used as the criterion for the acceptance and rejection of the null hypotheses.

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Chapter 4 Results

Chapter 4 is divided into two parts: (1) Descriptive Data Analysis, and (2) Inferential Data Analysis. Part One, Descriptive Data Analysis, reports the descriptive data and their respective analyses and interpretations. Part Two, Inferential Data Analysis, presents the inferential data and their respective analyses and interpretations. Descriptive Data Analysis Attitude towards food safety and sanitation of food handlers of fast food restaurants. Data in Table 3 revealed that, generally, the food handlers had positive attitude toward food safety and sanitation whether taken as entire group or classified according to certain categories. This was revealed by the obtained mean scores which fell within 3.01 – 5.00 scale. The obtained deviations which ranged from 0.26 – 0.49 revealed the narrow dispersion of the obtained means, indicating homogeneity of the food handlers‘ attitude towards food safety and sanitation.

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Table 3 Attitude Towards Food Safety and Sanitation Among Food Handlers in Fast Food Restaurants Category

M

Description

SD

4.54

Positive

0.34

Male Female

4.53 4.55

Positive Positive

0.33 0.34

Less than 20 21-30 31 and above 40 and above

4.52 4.52 4.60 4.72

Positive Positive Positive Positive

0.31 0.35 0.40 0.26

D. Educational attainment High school College Post graduate

4.47 4.56 4.54

Positive Positive Positive

0.36 0.32 0.49

E. Experience 1 year and less 2-5 years 6-10 years Over 10 years

4.57 4.47 4.58 4.76

Positive Positive Positive Positive

0.29 0.37 0.36 0.26

F. Job Position Line/staff Manager

4.53 4.63

Positive Positive

0.33 0.37

A. Entire group B. Sex

C. Age

Mean Scores

Interpretation

3.01 – 5.00

Positive

1.00-3.00

Negative

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GRADUATE SCHOOL Iloilo City Level of food safety and sanitation regulations compliance among fast food restaurants. Data in Table 4 showed that with the exception of fast food restaurants with more than 80 seating capacity who had high extent (M = 90.00) of compliance, the fast food restaurants had complied with food safety and sanitation regulations to a moderate extent whether taken as an entire group and classified according to number of food handlers and type of restaurant. These were revealed by the obtained scores which fell between 79-89 scale. The obtained standard deviations which ranged from 0.00-5.00 revealed the narrow dispersion of the means indicating the homogeneity of fast food restaurants in terms of regulations compliance.

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Table 4 Level of Compliance to Food Safety and Sanitation Regulations among Fast Food Restaurants Category

M

Description

SD

A. Entire group

86.67

Moderate extent

3.26

B. Number of food handlers Less than 30 More than 30

85.71 88.00

Moderate extent Moderate extent

3.45 2.74

C. Restaurant size Less than 40 seating capacity 85.83 40-80 86.25 More than 80 Seating capacity 90.00

Moderate extent Moderate extent High extent

3.76 2.50 0.00

D. Type of restaurant Chain Independent

Moderate extent Moderate extent

2.64 5.00

87.22 85.00

Total Points

Interpretation

90-100

High extent

70-89

Moderate extent

50-69

Low extent

Below 50

No compliance

Inferential Data Analysis Differences in the attitude towards food safety and sanitation among food handlers of fast food restaurants classified according to categories. The t-test result in

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Table 5 revealed no significant differences in the attitude towards food safety and sanitation among food handlers of fast food restaurants grouped according to sex (t (198) - .309, p = .76), and job position. (t (198) – 1.341, p = .182).

Table 5 t-test Results for the Difference in the Attitude Towards Food Safety and Sanitation Among Food Handlers of Fast Food Restaurants when Grouped According to Sex and Job Position Category A. Sex

M

df

t-value

Sig.(2 tailed)

Male Female

4.53 4.55

198

0.309

0.76

Line/staff Manager

4.53 4.63

198

1.341

0.182

E. Position

The one-way Anova in Table 6 revealed that significant differences existed in the attitude towards food safety and sanitation among food handlers in fast food restaurants classified according to educational attainment (f (3,196) = 3.56), p = .015), and industry experience. (f (3,196) = 71.32), p = .00). No significant difference existed in the attitude towards food safety and sanitation among food handlers of fast food restaurants classified according to age (f (3,196) = 1.45) p = .23).

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Table 6 One-way ANOVA Results for the Differences in the Attitude Towards Food Safety and Sanitation Among Food Handlers of Fast Food Restaurants Classified According to Educational Attainment, Industry Experience and Age df Category Educational attainment Industry Experience Age

Sum of squares

Mean square

Between groups

Within groups

Total

Between groups

Within groups

Total

Between groups

Within groups

F

Sig.

3

196

199

2.11

38.77

40.88

.70

.20

3.56

0.015

3

196

199

68.63

62.87

131.50

22.88

.32

71.32

0.00

199

.49

22.22

22.71

0.16

0.11

1.45

0.23

3

196

High school educated participants (M = 4.47) had significantly lower scores in terms of their attitude towards food safety and sanitation compared with college educated (M = 4.56) and post graduate educated (M = 4.54) participants. Those who had 2-5 years of industry experience (M = 4.48) had lower scores in terms of their attitude towards food safety and sanitation compared with those who had 1 year and less experience (M = 4.57), those that had 6-10 years of experience, (M = 4.59) and over 10 years of experience (M = 4.76) respectively. Difference in the level of food safety and sanitation regulations compliance among fast food restaurants. The Mann-Whitney test result in Table 8 revealed no significant difference in then food safety and sanitation regulations compliance among

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fast food restaurants when grouped according to number of food handlers and type of restaurant. (W = 39.00, p = .24) (W = 15.50, p = .411)

Table 7 Mann-Whitney Test Results for the Differences in the Level of Food Safety and Sanitation Regulations Compliance Among Fast Food Restaurants in Iloilo City Classified According to Number of Food Handlers and Type of Restaurant Category

Mean Rank

Sum of Ranks

W

Sig.

< 30 > 30

5.57 7.80

39 39

39.00

0.240

Chain Independent

6.94 5.17

62.50 15.50

15.50

0.411

Number of food handlers

Type of restaurant

The Kruskal-Wallis test result in Table 9 revealed no significant difference in the regulations compliance among fast food restaurants when grouped according to restaurant size. (H (2) = 2.804, p = .246)

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Table 8 Kruskal-Wallis Test Results for the Differences in the Level of Food Safety and Sanitation Regulations Compliance Among Fast Food Restaurants in Iloilo City Classified According to Restaurant Size Category

N

Mean rank

6 4 2

5.75 5.88 10.00

Chisquare

df

Sig.

2.804

2

0.246

Restaurant Size

< 40 40-80 > 80

Relationship between attitude towards food safety and sanitation of food handlers and compliance to regulations of fast food restaurants. Data in Table 10 showed that the attitude towards food safety and sanitation of food handlers and the restaurants‘ compliance were negatively and not significantly related, r = - .157, p = .626.

Table 9 Relationship between Attitude towards Food Safety and Sanitation of Food Handlers and Regulations Compliance among Fast Food Restaurants.

Variable Attitude

r -.157

Regulations compliance p .626

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Chapter 5 Summary, Conclusions, Implications and Recommendations

This chapter is divided into four parts: (1) Summary of the Problems, Method and the Findings, (2) Conclusions, (3) Implications, and (4) Recommendations. Part One, Summary of the Problems, Method, and Findings, presents the important points of the study and the findings. Part Two, Conclusions, cites the conclusions drawn from the results of the investigation. Part Three, Implications, delineates the relationships between the findings of the present study and the existing theories related to attitude towards food safety and sanitation and compliance to regulations. Part Four, Recommendations, gives recommendations based on the findings, conclusions, and implications. Summary of the Problems, Method, and Findings This study aimed to ascertain the attitude of food handlers towards food safety and sanitation, and the regulations compliance of fast food restaurants to regulations on safety and sanitation. Specifically, the study aimed to answer the following questions: 1. What is the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are taken as an entire group and classified according to:

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(a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position? 2. What is the level of compliance to regulations of fast food restaurants taken as entire group and classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type? 3. Are there significant differences in the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are classified according to: (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position? 4. Are there significant differences in the level of compliance to regulations of fast food restaurants classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type? 5. Is there a significant relationship between the food handlers‘ attitude towards food safety and sanitation and the fast food restaurants‘ compliance to regulations? In view of the preceding problems, the following hypotheses are advanced: 1. There are no significant differences in the attitude of food handlers of fast food restaurants towards food safety and sanitation when they are classified according to: (a) sex, (b) age, (c) educational qualification, (d) industry experience, and (e) job position. 2. There are no significant differences in the level of compliance to regulations of fast food restaurants classified according to: (a) restaurant size, (b) number of food handlers, and (c) restaurant type.

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3. There is no significant relationship between the food handlers‘ attitude towards food safety and sanitation and fast food restaurants‘ compliance to regulations. This survey-correlational study, conducted from December to January 2014, utilized 200 randomly selected food handlers in fast food restaurants in Iloilo City. Twostage random sampling method was used. Two data-gathering instruments were utilized to obtain the data for the study; the Sneed and Lin (2010) questionnaire on the attitude towards food safety and sanitation of food handlers and the Sanitary Inspection of Food Establishment Compliance Form of the Iloilo City Health Office. To interpret the obtained data, the researcher employed the frequency, percentage analysis, mean and standard deviation as descriptive statistics, while the one-way ANOVA, t-test, Mann-Whitney, Kruskal-Wallis and the Pearson‘s r, all set at .05 significance level were employed for inferential analysis. Results of the investigation were as follows: 1. Food handlers of fast food restaurants had positive attitude towards food safety and sanitation whether taken as an entire group or classified according to certain categories. 2. With the exception of fast food restaurants with more than 80 seating capacity that had high extent of compliance, the fast food restaurants had complied with food safety and sanitation regulations to a moderate extent whether taken as an entire group and classified according to categories.

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3. The food handlers differed significantly in their attitude toward safety and sanitation when they were classified according to educational attainment and experience, but they did not differ significantly when they were classified according to sex, age and job position. 4. The fast food restaurants did not differ significantly in their level of compliance to regulations when they were classified according to number of food handlers, restaurant size, and type of restaurant. 5. Finally, the attitude towards food safety and sanitation of food handlers and regulations compliance among fast food restaurants were negatively and not significantly related. Conclusions In view of the findings, the following conclusions were drawn: 1. It appears that the food handlers of fast food restaurants are conscious of the importance of health and sanitation. Their positive attitude towards food safety and sanitation maybe attributed to their knowledge on the detrimental effects of unsafe food and non-hygienic practices to the health of their clients. 2. Generally, the fast food restaurants appear to have complied with 14-17 requirements out of 20 enumerated in the Code of Sanitation of the Philippines for restaurants. The findings seem to indicate that the fast food restaurants still have to follow more recommended corrective measures required by the City Health Office to improve their ratings.

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3. Sex, age and job position were factors found not to significantly influence food handlers‘ attitude towards food safety and sanitation. It may therefore be construed that regardless of whether one is a male or female; young, mid-adult or older; a line staff or a manager, one‘s attitude remains comparable. Educational attainment and industry experience are factors found to significantly influence the attitude towards food safety and sanitation. This seems to show that those who have higher education have more understanding of the importance of providing safe food. On the other hand, foodhandlers who have worked longer in the industry have internalized and appreciated the value of food safety and sanitation and its impact in the industry they work in. 4. Number of food handlers, restaurant size, and type of restaurant were factors found not to significantly influence the level of regulations compliance of fast food restaurants. It may therefore be construed that regardless of whether fast food restaurants have few or many food handlers; have small, medium or big seating capacity; and is a chain or independent restaurant, the level of regulations compliance remain comparable. 5. One‘s attitude towards food safety and sanitation is not a factor that significantly affect the regulations compliance of fast food restaurants. Therefore, a positive or a negative attitude does not guarantee adherence to certain food safety and sanitation regulations.

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Implications The results of the study have important implications both for theory and practice. The present investigation found out that food handlers of fast food restaurants have a positive attitude towards food safety and sanitation. This result is similar with the findings of the study conducted by Sneed (2004) where food handlers got mean scores ranging from 4.2 to 4.8 out of 5 points. Furthermore, Parcel (2003) stressed that a person‘s behavior is influenced by his/her beliefs and attitudes. Also, Rahman et al. (2012) found in their study that positive attitude formation leads to positive behavior. Attitude is an important factor that ensures a reduction trend of foodborne diseases. Howes et al. (2006) found the correlation among positive behaviour, attitude and continued education of food handlers towards the maintenance of safe food handling practices. On the other hand, Bas et al. (2004) in their study found that the attitude scores of the food handlers toward foodborne diseases prevention and control was poor and their scores on safety practice were very low. A positive attitude towards food safety and sanitation of food handlers of fast food restaurants in Iloilo City provides evidence that the food handlers perceive positively their responsibility to ensure the safety of their customers. Food handlers are responsible in maintaining a high standard of personal hygiene, and must be equipped with proper knowledge, skills, and training in maintaining food safety and sanitation in the food and beverage they serve (Pescadera, 2013).

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In another theory according to Sandique (2007), a safe working environment and sanitary atmosphere in food service industry are always important. An outbreak of an illness can be expensive and can damage the good name and image of an establishment. There are possible legal costs combined with loss of revenue that may force an establishment to close. For practice according to Roldan and Edica (2008), food safety covers certain practices like prevention of growth and multiplication of bacteria; prevention from food contamination of bacteria, toxin, and other harmful substances; prevention of food spoilage; prevention of food poisoning and infection, and spreading of disease; and retaining nutritional and aesthetic qualities of food. Food safety in a food establishment is assured when all the conditions of bacterial growth are controlled. This is done through time and temperature control; proper housekeeping maintenance; proper maintenance of cooking and serving equipment and facilities; and consistent compliance to standards of hygiene, sanitation, and food safety. Roldan and Edica stated that the case of food borne diseases can cause irreparable damage to the reputation of a food establishment. One single case of food poisoning can already discourage diners from coming back to the restaurant or canteen. Unhygienic food handlers can be instruments in transmitting bacterial contamination and food borne disease. It is, therefore, important for every food handler to understand and practice the rules of safety in handling and serving food. For example, when a kitchen or dining area is not properly maintained in terms of cleanliness and

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sanitation, it becomes vulnerable to the growth and multiplication of microorganisms or bacteria as well as pests (Roldan & Edica, 2008). In a study of 36 restaurants that received favorable scores on their previous inspection, restaurant managers who had a favorable attitude about food safety were likely to score higher on inspection reports than those who did not have a favorable attitude. They also found that only 23% of the restaurants surveyed had a manager or employee certified in food safety. Of the 36 restaurants surveyed that received favorable scores, 44% had an employee certified in food safety (Roberts, 2003). The research study also revealed that fast food restaurants have a moderate level of regulations compliance. Because of this, the risk factors and incidences attributed to food safety and sanitation in these establishments is in a downward trend. In the study conducted by the FDA (2004) only 60% of full-service and 74% of quick service restaurants were found to be in compliance with current health code requirements. These are lower percentages than found in non-commercial foodservice operations, such as hospitals, nursing homes, and elementary schools. A follow-up study by the FDA (2004) found that 13% of full-service restaurants were out of compliance for purchasing food from unsafe sources, 42.7% for poor personal hygiene, and 63.8% for improper holding time and temperature. The percentages of quick service restaurants out of compliance with these risk factors were lower with 2.3%, 31.2%, and 41.7%, respectively. Because of the relatively high incidence of restaurants that are ―out of compliance‖ with risk factors and food safety, restaurant

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managers should focus on those behaviors that are known to cause foodborne illnesses and emphasize them in training. Labensky and Hause (2007) stressed that although local health departments regularly inspect all food service facilities, continual self-inspection and control are essential for maintaining sanitary conditions. Therefore, one way to ensure compliance is to frequently check and record the temperature of potentially hazardous foods during cooking, cooling and holding. Maintaining written time and temperature logs allows management to evaluate and adjust procedures as necessary. Furthermore, whatever system is followed, all personnel must be constantly aware of and responsive to risks and problems associated with the safety of the food they serve. Results also revealed that the attitude towards food safety and sanitation of food handlers is not significantly related to the level of regulations compliance of fast food restaurants. This contradicted studies of Roup et al. (2009) where attitude has a lot of influence on compliance, as shown in the studies of McGovern (2000); Armonio, et al (2002); Chan and associates (2007); Suchitra and Devi (2007); and Gammon and associates (2008). Such also was the case supported by Askarian et al. (2006), as it indicated, that attitude mediated the relationship between knowledge and compliance. Pittet (2004) supported this statement and aptly termed it ―behavior modification.‖ It was vital, therefore, to find ways to improve attitude in order to improve compliance.

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Recommendations In view of the findings, conclusions and implications, the following are recommended: 1. Fast food restaurant owners and managers should continue to encourage their food handlers to update themselves about food safety and sanitation thru trainings and seminars. 2. Aware of the level of regulations compliance among fast food restaurants, owners, managers and staff should continue to work for better compliance ratings. Attention should be focused on requirements not complied. 3. Replication of this study to a wider scope is highly recommended. Aside from the food handlers‘ attitude towards food safety and sanitation and regulations, researchers may include other variables such as knowledge and practices and other participants may be included other than food handlers.

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APPENDICES

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Appendix A Data Gathering Instruments

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Appendix A Data Gathering Instruments Dear Respondents: This data-gathering instrument is intended to gather data for a graduate research entitled, Food Safety and Sanitation: Attitude and Compliance of Fast Food Restaurant. You are in the best position to supply the needed data for the purpose. In this regard, kindly supply the information required on the space provided. Please do not leave any item unanswered. Thank you very much. KENDRICK CALLAO Researcher Part 1 Respondent‘s Profile Name (Optional): _______________________________________ Date: _____________ Name of Establishment (Optional): ___________________________________________ Sex: Male

[ ] Female [ ]

Age: Less than 20 21-30 31-40 Above 40

[ [ [ [

Industry Experience (in years): Under 1 1–5 6-10 Over 10

] ] ] ]

Educational Attainment: High School

[ ] College Level [ ] Post-Graduate [ ]

[ [ [ [

] ] ] ]

Job Position: Line Staff Manager

[ ] [ ]

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Part 2 Attitude towards food safety and sanitation Directions: Go over each item carefully and put a check (√) mark on the space that indicates how much you agree or disagree with each statement. Please do not leave any item unanswered. Legend: SA-Strongly Agree; A-Agree; NS-Not Sure; D-Disagree; SD-Strongly Disagree SA A NS D SD 1. I think sanitation is an important part of my job responsibilities. 2. I believe that good employee hygiene can prevent foodborne illness. 3. I think that it is the responsibility of all food handlers to ensure that food is safe to serve. 4. I am willing to change my food handling behaviors when I know they are incorrect. 5. I am willing to obtain more food safety knowledge. 6. It is more important to have tasty food rather than safe foodb. 7. I select a place to eat based on its reputation for good sanitation and cleanliness. 8. I think that managers should educate employees on personal hygiene and sanitation regularly. 9. I think that only full-time employees should receive food safety training. 10. I believe that food safety knowledge does not only benefit my work but also my personal life. 11. I am willing to attend a food safety training course. 12. I believe that food safety knowledge will make me more confident about my work.

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Republic of the Philippines OFFICE OF THE CITY HEALTH OFFICER City of Iloilo SANITARY INSPECTION OF FOOD ESTABLISHMENT

Establishment: ____________________________ Category: ______________________ Owner/Manager : _________________________________________________________ Address: _________________________________ Sanitary Permit No. ______________ No. of Personnel: __________________________ No. with Health Certificate ________ ITEMS 1. Protection of Prepared Foods

2. Suitability of Kitchen 3. Cleanliness of Utensils 4. Construction of Premises 5. Maintenance of Premises 6. Toilet Provision 7. Handwashing Facilities 8. Water Supply 9. Liquid Waste Management 10. Solid Waste Management 11. Wholesomeness of Food 12. Vermin Control 13. Cleanliness and Tidiness 14. Protection of Food 15. Personal Cleanliness 16. Housekeeping and Management 17. Condition of Appliances and Utensils 18. Sanitary Condition of Appliances and Utensils 19. Disease Control (Health Card) 20. Miscellaneous (Issuance of Sanitary Permit) TOTAL DEMERITS ---

DEMERIT

RECOMMEND CORRECTIVE MEASURES

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Note: Non complying items are indicated with an (x). Every item is weighted a demerit of 5. The rating of the establishment is therefore 100 – (Number of demerit x 5). The result expressed as a percentage (5) rating. PERCENTAGE RATING 100% Less demerit score

SANITATION STANDARD PERCENTAGE RATING EXCELLENT ----------------------90-100%

VERY SATISFACTORY ---------------- 70-89% SATISFACTORY ------------------50-69% Received by: _______________________ Owner/Operator

Inspected by: _________________________________ Sanitation Inspector __________________________________ Date

Note: Original Copy – Owner/Manager

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Appendix B Letter to the City Health Officer

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Appendix B Letter to the City Health Officer January 22, 2014 MR. URMINICO M. BARONDA, JR. M.D. City Health Officer Iloilo City

Sir:

Warm Greetings! I am presently writing a master‘s thesis entitled, Food Safety and Sanitation: Attitude and Regulations Compliance among Fast Food Restaurants, in partial fulfillment of the requirements for the degree, Master in Hospitality Management, at West Visayas State University. In connection with this, I would like to request for the results of compliance required by the City Health on Sanitary Inspection of Food Establishment. These results will be used as data for the above mentioned study. Your favorable action regarding this request will be highly appreciated. Thank you very much.

Very truly yours, (SGD.) KENDRICK A. CALLAO Researcher

Noted: (SGD.) PROF. LOURDES F. ESPESOR Dean, College of Business and Management

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Appendix C Letter to the Managers

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Appendix C Letter to the Managers

January 22, 2014 ____________________ ____________________ ____________________ ____________________ Sir/Ma‘am:

Warm Greetings! I am presently writing a master‘s thesis entitled, Food Safety and Sanitation: Attitude and Regulations Compliance among Fast Food Restaurants, in partial fulfillment of the requirements for the degree, Master in Hospitality Management, at West Visayas State University. In this connection, may I respectfully request permission from your office to allow me to administer my instrument among your food handlers. I am hoping for your favorable response regarding this request. Thank you very much.

Very truly yours, (SGD.) KENDRICK A. CALLAO Researcher

Noted: (SGD.) PROF. LOURDES F. ESPESOR Dean, College of Business and Management