FOOD HYGIENE/FOOD SANITATION

FOOD: It means edible substances whether in natural or manufactured state which, from public health perspective form part of human diet.

It is an established fact that good food is an essential recipe for humans’ health.

In contract, poor or food of poor quality may keep some people alive, however, for health and happiness, sufficient quality and sanitary food is
of paramount importance.

Food can cause poor health due to the following reasons:

1. If the food is insufficient (in quantity);

2. If or when unbalanced in its constituents;
3. If contaminated with pathogenic microbes, chemicals and physical substances.

MAGNITUDE OF FOOD BORNE DISEASES

This is a global health and economic problem. Previously, water was assumed to be the source of diarrhoeal pathogens. However,
epidemiological studies are increasingly showing that about ½ of cases are due to food. Generally, developing countries are most affected due
to the following reasons:

1. Low level of sanitation and poor and unsanitary practices.

2. Lack of proper storage facilities and transport facilities.
3. Use of untreated water.
4. Increasing number of food street vendors.
5. Engagement of untrained food handlers and non-medically fit food handlers.
6. Laxity in application of relevant legal measures (Public Health Acts. related to food hygiene/sanitation).

MICRO-ORGANS AND OTHER FOOD CONTAMINANTS

In food industry micro-organisms and other contaminants are classified as follows:

a) Bacteria – Vibro cholera, salmonella typhi, staphylococcus aureus, clostridium botulinum, E.coli, strain 0157:H7, etc.
b) Viruses- hepatitis A, (HVA) Rotavirus, Norwalk virus

c) Parasites – Tapeworm Spp, Trichinella spiralis.

d) Chemicals – pesticides, heavy metals, organic solvents, MSG – monosodium glutamate – used in Chinese food-enhancer.
e) Natural poisons – mushrooms, nitrates and erogotism.
f) Mycotoxins – fungi.

FURTHER CLASSIFICATION OF BACTERIA

Micro-organisms are further classified in relation to their disease or their impact on food.

a) Beneficial Bacteria (non harmful, e.g. lactobacillus)

They aid in manufacture of foods such as cheese, buttermilk, curded milk (lala) and condensed milk (water removed).

b) Benign Bacteria (neither harmful nor beneficial)

Majority of bacteria belong to this group, hence are termed as non-pathogenic bacteria.

c) Spoilage Bacteria (non-pathogenic but food destroyers)

They decompose food worldwide and cause enormous economic losses.

d) Pathogenic Bacteria (cause food borne illnesses)

They are responsible for food illnesses by virtue of their toxins and infective mode.

RELATIONSHIP OF BACTERIA AND TEMPERATURE

Bacteria are also classified in favour of their temperature survival.

a) Mesophilic bacteria
These thrive well at 15.6o – 49.0oC. All disease-causing bacteria fall under this category. Their multiplication is inhibited by either
warmer or colder temperatures.

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b) Thermophilic bacteria (heat lovers)
These thrive well at 43.4o – 54.4o C. A classical example is bacillus bacteria. They are responsible for food spoilage particularly the
canned foods.

c) Psychrophilic bacteria (cold lovers)

These thrive well at 7.2oC and below. They are frequently responsible for spoiling food stored too long in the refrigerator.

Remember that bacteria do not multiply in solid frozen foods, but freezing does not kill them either.

From public health point of view and for all practical purposes, growth and multiplication takes place within the temperature range of 7.2 o –
60oC. This temperature range is called “THE DANGER ZONE”.

CAUTION: Food should not remain within the danger zone for more than 4 hours and within zone of optimum growth (15.6 o –
49.0oC) for more than 2 hours.

In addition to temperature most bacteria grow well in oxygen and favourable pH and moisture.
Anaerobics: Are sensitive to O2 are capable of multiplying in sealed jars and cans.

Aerobics: Love oxygen and capable of multiplying on food surfaces, etc.

Facultatives: Adapt to presence or absence of O2 and majority are capable of causing food borne illnesses.

FOODS AND PH RELATIONSHIP

Foods pH 0 – 14 Scale

Lemons 2.2 – 2.6

Vinegar 2.9 – 3.0
Pears 3.9 – 4.0
Tomatoes 4.0 – 4.6 Bacteria ceases to multiply as
Many vegetables 5.0 – 5.6 pH decreases towards 4.5 and
Peas, maize 6.2 – 6.3 less.
Egg yolk 6.4 – 6.5 Foods favoured by pathogens.
Milk Proteineous foods 6.5 – 6.6 Most bacteria causing food
Meat (perishable foods) 7.0 and lower borne illnesses multiply within
Egg white 8.0 and higher this pH range.

(DIAGRAM)

VULNERABLE GROUPS

The impact of exposure to pathogens and agents via food is dependent on the following factors:

a) Pathogen load
b) Virulence of the pathogen
c) Age - Infants Most susceptible groups due to undeveloped
- Children and aging immune system.
- Elderly

d) State of individual - pregnant women, malnourished.

- immuno suppressed (HIV/AIDS, cancer patients).
- stressed individuals
- hospitalised persons and consumption of antibiotics.

ECONOMIC LOSSES DUE TO FOOD BORNE ILLNESS

1. Cost of investigation -(Recall the most recent Embu and Makueni aflotoxin outbreaks).
2. Health care costs
- General practitioners costs.
- Hospital costs.
- Cost of medicines.
- Transport (ambulance) costs.

3. Cost of families and societies

- Cost attributable to loss of productivity and absenteeism.
- Cost attributable to pain, suffering and death.
- Direct costs of illness to families.

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 4. Cost of commercial enterprises
- Closure of business
- Fines and legal pursuit
- Loss of customers due to lost reputation
- Loss of food due to condemnation of food implicated in outbreaks.

INVESTIGATION OF FOOD BORNE OUTBREAK

Once there is an outbreak, approach the situation like an outbreak of cholera, typhoid or chemical poisoning. That means call upon DHMT or
constitute one.

The team should have the following members:

- MOH
- DH Matron (Matron)
- Nutritionist
- District Environmental Health Officer.
- Laboratory Technologist
- Health Educator

A. Collect Cases and Case Histories of the Complaints and Consider:

1. Time – the person at the food and time you are interviewing (window/incub).
2. Place – where? (schools, church/wedding, party, harambee etc).
3. Persons – gender and age and interview food handlers.
4. Type(s) of food – fast food, proteineous, etc.
5. How it was kept – try to establish whether guarded and temperature was maintained.
6. Who were the handlers – food handlers, community ordinary people.
7. Use log of food-related or disease complaints

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Complaint Onset of Number ill Predominant Suspected Food Eating Place other
Number illness Symptoms or Signs than Home (72 hrs)
01 8/2 1 Diarrhoea Roast beef Nandos
02 10/2 12 Diarrhoea Chips & sausage Wimpy
03 ? 2 Vomiting Ham Village Market
04 16/2 1 Vomiting & Diarrhoea Barbecued Chicken Fred’s Restaurant
05 16/2 3 Diarrhoea Chips & sausage Wimpy
06 16/2 1 Diarrhoea & Vomiting Roast beef Nandos

NB: Review the log each time an entry is made (if possible use computer) to disclose any cluster of cases.

B. Collect Samples

1. Leftover foods or food(s) in the store.

2. Vomitus.
3. Faeces and rectal swabs.
4. Food containers.
5. Water, beverages, milk and milk products e.g. cheese, ice creams, chocolates.

The collected specimens should be labelled and taken to the laboratory immediately for analysis.

MAKEEPIDEMIOLOGIC ASSOCIATIONS

To determine whether an outbreak is an incident. This is determined when two or more persons have the same: - Disease,
- Similar symptoms,
- Excrete same pathogens and
- There is a time, place and/or person(s) association
between the persons.

In addition, a food borne outbreak is one in which a common food ingested by such persons. However, a single case of suspected botulism,
mushroom poisoning, paralytic shell fish poisoning or a rare disease can be considered an incident and warrants further investigation.

Using the lob sheet compare and tally with:

a) Make time
b) Place
c) Person association
d) Type of meal.
Number of Persons who ate Specific Foods Number of Persons who did not eat Specific Foods
Foods Ill Not Ill Total % Ill Ill Not Ill Total % Ill Difference in
%
Chicken & 88 33 121 73 11 26 37 30 +43
Chips
Ugali & Beef 50 16 66 76 49 43 92 53 +23
stew
Milk 59 39 98 60 40 20 60 67 -7
Fish & Rice 12 6 18 67 87 53 140 62 +5
Potatoes & 22 14 36 61 77 45 122 63 -2
beans
The food implicated is chicken and chips because of the percentage difference of +43 (+43%).

INTERPRET RESULTS

1. Compare data analysed epidemiologically with laboratory results.

2. Relate incubation periods with the organisms, which demonstrate such.
3. History of the way food was processed, stored or prepared can reveal points of contamination.
4. If necessary interview food handlers again and look for inconsistencies in their answers to establish whether contamination/mishandling
occurred.

FEEDBACK

- Compile a report for relevant stakeholders.

- Submit to relevant policy maker, MOH, city/town councils.
- Include the impact – convince stakeholders to maintain/increase quality and sanitary measures.

ANALYSIS

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From appropriate calculations and analysis, the illnesses can be classified, affected group identified and acceptance whether an outbreak based
on association of a common source has occurred.

An Epidemic Curve Vs Propagated Curve

An Epidemic Curve Propagated Curve

- Depicts outbreak from common source e.g. food - From person to person e.g. flu
- Characterised by a sharp rise followed by a peak and a fall being - Characterised by a relatively slow, progressive rise.
less abrupt than rise
HANDOUT pp.33 Procedures to investigate food borne illnesses.
CONTROL MEASURES

Control measures should aim at addressing the following aspects:

a) Pay serious attention to food chart or flow diagram.

b) Effectively apply the approved legislative or code of conduct.
c) Application of Hazard Analysis and Critical Control Point (HACCP). It is a rational and scientific method of food safety assurance.
It consists of systematic identification and assessment of hazards and determination of effective control measures.

a) Flow Diagram: Production to Consumption

Farm, Garden, Processing Preserving

Fish rearing etc

Packaging Distribution or Storing

Distributing

Cooking 1. Cooling & storing

(to eat later)
2. Cooling & eating

In order to prevent or control food borne outbreaks, sanitary practices, applications and procedures must be applied (Quality Control) in or at all
stages of food processing and handling. Hence the term “Food Hygiene/Food Sanitation”.

Food Sanitation is therefore concerned with the prevention or elimination of pathogenic micro-organisms, chemical or physical agents from
the point of production to the point of consumption of food.

B. (i) LEGISLATIVE MEASURES/CODE OF CONDUCT

The Food, Drugs and Chemical Substances Act 254 and the Public Health Act. Cap 242 Part X and IX Sections 127-135 A require that:
1. Wholesome food remains so by being free from contaminants through out the eight stages indicated in the flow diagram.
2. The Act empowers any Medical Officer of Health (MoH), Environmental Health officer to conduct unannounced inspection(s) in
food establishments, grocery stores, transporting vehicles, cargo, airline, etc.
3. The Act empowers him/her to issue citations to food establishments or dealers who fail to maintain the prescribed sanitary or public
health requirements.
4. The Act empowers the officer to close the food establishment if it does not comply.
5. Confiscate and condemn and destroy food unfit for human consumption.

B. (ii) FOOD CONTROL AND ADMINISTRATION

In Kenya policy and legislation is under several agencies and ministries.

1. Ministry of Agriculture/Livestock
- Ensures safe use of agrochemicals as well as vetting
- Inspect locally grown, sold, export foods, animals and vice versa
- Ensures for quantity of food

2. Ministry of Health
- Deals with sanitary measures and quality assurance

3. Kenya Bureau of Standards (KBS)

- Deals with setting up the quality standards i.e. specifications, dates, etc.

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4. Consumer Organization
Usually an NGO – is a dog watch. Voice of the people to see if implementation is being done.

C. HACCP Concept

1. Conduct hazard analysis i.e. identify hazard, Hazard: Biological, chemical or

evaluate risk based on close observation
and apply preventive measures physical agent.
To control the identified hazards
2. Determine Critical Control Points (CCP) CCP: Applied to control/
eliminate hazard e.g. temp/cooking,
disinfecting/sanitising, chilling, practising high level
of sanitary practices

3. Establish Critical Limits (CLs) CLs: Criterion which separate

acceptability fromunacceptability e.g.
- reputable source versus non reputable food source.
- stainless steel equipment
versus non-stainless

4. Establishment of monitoring procedures: Monitoring: Observations, measurements of control of parameters to assess whether a
CCP is under control.

5. Establish Corrective Actions: Corrective Action: Action to be taken when

monitoring results indicate loss of CCP or deviation
from the appropriate controls e.g. adjust, temp; cook
enough time, use vehicles for food transport only,
especially fruits and foods eaten when raw
sick/carrier food handler.

6. Establish verification procedures: Verification: Application method procedures, tests, determine compliance
with HACCP and whether there is need for HACCP modification.

7. Establish documentation procedure: Codes, records, etc.

OTHER CONTROL METHODS

1. Dishwasher - Large scale hotels and restaurants, institutions e.g. universities, health care facilities
Wash, Rinse and Sanitise Some of sanitizers include Calcium/Sodium hypochlorites and
Quaternary ammonia
salts

Calcium/Sodium hypochlorites and Quaternary ammonia

salts
2. 3 Compartment Sink - Small scale hotels, kiosk, rural hotels,small run institution

Warm water + Detergent Hot water Chemical Solution

-------------------------------- -----------------------------------
---------------------------------

SINK 1 SINK II SINK III

(WASH) (RINSE) (SANITIZE)
Use concentrate Quaternary ammonic
salts

ENVIRONMENT OF THE KITCHEN

1. Keep foods either cold < 7°C or above 60°C.

2. Layout:
→ Work counters should be smooth and no cracks with provision of wash sinks
→ Separation of work areas for raw and cooked foods.
→ Use separate cutting boards, knifes, etc. for raw and cooked foods.

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3. Surfaces:
→ Should be smooth, impermeable and easily cleanable, e.g. stainless steel, rubber etc. because they hardly harbour disease.
→ Wooden boards are not sanitary. If you use them, scrub with soap and rinse with bleach (a table spoonful of bleach to
4.5litres of water).
→ Other preferred chemical disinfectants:
 Hypochlorites Concentration and dilution is usually
 Quaternary ammonia provided on the container

GARBAGE AND INSECT CONTROL

To be able to control insects (flies, roaches, etc.). Provision of dustbins with tight lids (covers) is necessary. It should be placed over one metre
above the ground. Additionally, collection of garbage must be done regularly and the building and the site for containers must be maintained in
a very clean state.
FOOD HANDLERS

Normally a healthy person may harbour pathogens in the nose, throat, and GII. This is why the following KAP is crucial for food handlers.

Personal Hygiene
→ Hands should be thoroughly washed with soap and dried with a paper towel (not blower).
→ Lesions/cuts should be covered
→ No smoking at all and when on duty
→ Use of white uniform is highly recommended (NO STREET CLOTHES)

ROLE OF MANAGEMENT

(a) Should have provisions for hand washing and lockers. Indeed this is a Public Health Act requirement otherwise the MoH/Public
Health Officer would not approve for the operational license.
(b) Should provide soap/detergents and uniforms.
(c) Conduct pre-medical examination (Public Health Act requirement) and regular medial exams.
NB: Food handlers licenses/certificates are issued by either the Ministry of Health, Municipal Health department or the Urban
Council Health department.
(d) Continuous Health Education
→ Should be conducted quarterly: Purpose
 Correct mistakes
 Provide orientation to the new employees
 Reinforce KAP

Table 1: Hazardous Micro-organisms and parasites

Grouped on the basis of risk severity

Severe Hazards Moderate Hazards (Potentially Extensive Spread) Moderate Hazards Limited Spread
Clostridium botulinum types Listeria monocytogens Salmonella spp Bacillus aureus
A,B,E, & F Comphylobacter jejuni
Shigella typhi; paratyphi A+B Enterovirulent Escherichia coli (EEC) Staphylococcus aureus
Hepatitis A & E
Brucella abortus; B.Suis Streptococcus pyogenes Vibrio cholerae, non
Vibrio choleraeol Rotovirus
Vibrio vulnificus Norwalk virus group Vibrio parahaemolyticusz
Taenia solium Entamoebahystolytica
Trichinella spiralis Diphyllobothriumlatum Yersinia enterocolitica
Ascaris lumbricoides Gardia lumblia
Cryptosporidium parvum Taenia saginata

Table 2: Type of Chemical Hazards and Examples

Naturally occurring chemicals

- Mycotoxins (e.g. aflatoxins) from mold
- Scombrotoxin (histamine) from protein
- Decomposition
- Ciguatoxin from marine dinoflagellates
- Toxic mushroom species
- Shellfish toxins (from marine dinoflagellates)
- Paralytic shellfish poisoning (PSP)
- Diarrhetic shellfish poisoning (DSP)

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- Neurotic shellfish poisoning (NSP)
- Amnesic shellfish poisoning (ASP)
- Plant toxins
- Pyrrolizidine alkaloids
- Phytohemagglutinin

Added chemicals

Agricultural chemicals:
Pesticides, fungicides, fertilizers, insecticides, antibiotics + growth hormones
Polychlorinated biphyenyls (PCBs)
Toxic elements and compounds

HYGIENE & HACCP

Hazard Analysis and Critical Control Point (HACCP) is a systematic approach in identifying, evaluating and controlling food safety
hazards.

Food safety hazards are:

- Biological
- Chemical, or
- Physical agents that are reasonably likely to cause illness or injury in absence of control

HACCP principles/concept was established and adopted by US-National Advisory Committee on Microbiological Criteria for Foods
(NACMCF) in 1988. It was further adopted by CODEX Committee on Food Hygiene in 1997. The following seven (7) Principles were
adopted:

Principle 1: Conduct a hazard analysis

Principle 2: Determine the critical control points (CCPs)
Principle 3: Establish critical limits
Principle 4: Establish monitoring procedures
Principle 5: Establish corrective actions
Principle 6: Establish verification procedures
Principle 7: Establish record-keeping and documentation procedures

The following table provides biological hazards associated with foods:

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 MICRO-ORGANISMS AND AGENTS CAUSING FOOD ILLNESS

I. BACTERIA
NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL
PERIOD
Clostridium botulinum (spore Botulism – due to toxins (Heat labile) Nausea, vomiting, diarrhoea and paralysis of Canned with low acidity. Stored canned foods at room temperature.
forming) voluntary muscles 65% fatal. Incubation Damaged and improperly canned. Boil canned foods for 15 min.
period: 12 – 36 hrs Don’t use suspected or damaged canned foods.
Staphylococcus aureus Staph. intoxication (Heat stable) Nausea, vomiting, abdominal cramps, Protein foods – meat, eggs, chicken, Keep food above 60oC or below 7.2oC.
diarrhoea. Fatal cases rare. cream fillings Food workers suffering from colds, influenza –
2 – 6 hrs should not handle food.
Salmonella Salmonellosis – infection (Typhoid Nausea, vomiting, abdominal cramps, Gravy, meat, poultry, undercooked Cook food well.
fever) dirrhoea, sometimes fever. eggs, left overs. Avoid danger zone.
12 – 24 hrs. Control rodents and insects.
C. perfringens (spore forming) Food poisoning. Similar to salmonella and staph. Meat, gravy and poultry Hand washing. Keep food out of danger zone
Some strains – heat resist 8 – 22 hrs temperature. Clean food equipment well.
Bacillus cereus Bacillus intoxication Nausea, vomiting and diarrhoea. Fried rice Keep food out of danger zone. Eat food
1 – 6 hrs immediately after cooking.
Vibrio parahaemolyticus Infection, may be intoxication Nausea, vomiting, diarrhoea, fever, Most sea foods Thorough cooking, avoid cross-contamination.
headache, abdominal cramps, bloody stools. Clean equipment well.
15 – 24 hrs
Vibrio cholerae Enterotoxin (intoxicated cholera) Diarrhoea, vomiting, dehydration. Raw sea foods Use clean water for cooking. Cook food
Note: profuse watery diarrhoea (rice water). thoroughly, personal hygiene, avoid use of right
1 – 3 days soil. Hand washing.
NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL
PERIOD
Shigella Shigellosis – infection. Diarrhoea, vomiting, dehydration. All foods contaminated by hands and Carriers should not handle food. Rodent and fly
(Bacillary dysentery) Note: profuse watery diarrhoea (rice water) flies control. Use clean and safe water. Personal
1 – 3 days hygiene
Escherichia coli Gastro-enteritis Diarrhoea, nausea, vomiting. Various foods and water Infected workers, should not handle food. Avoid
5 – 48 hrs danger zone temp. thorough cooking, proper
cleaning of equipment.

II. PARASITES

NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL

PERIOD
Entamoeba histolystica Amoebic dysentery (Amebiasis) Abdominal pain, diarrhoea, containing blood Raw vegetables and fruits Cook food thoroughly, safe water personal
and mucus. cleanliness.
3 – 4 weeks
Taenia saginata Taeniasis (tape worm) Hunger, anaemia, loss weight, abdominal Raw or insufficiently cooked beef Proper meat inspection, cook beef thoroughly;
pain adequate human excreta disposal.
8 – 14 weeks
Taenia solium Taeniasis (pork tape worm) Vague discomfort, hunger pains, loss of Raw or insufficiently cooked food – Proper inspection of pigment, adequate cooking.
weight. pork.
8 – 14 weeks
Trichinella spiralis Trichinosis (roundworm) Fever, oedema about eyes, muscular pains, Pork, bear meat Cook to internal temperature 66oC. Cook
chills, laboured breathing. adequately. Avoid feeding swine on inadequately
4 – 28 days heat-processed garbage.

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 III. MYCOTOXINS (TRUE FUNGI)

NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL

PERIOD
Aspergillus flavus Aflotoxin (aflotoxication) Liver of cancer, kidney carcinoma, bile duct Groundnuts, rice, maize, wheat, milk, Harvest when dry, dry food before storing
proliferation. seeds
Inc. not established
Asp. Flavus B-mitropropanoic Toxic to man and animals Cereals Dry well, moisture free, avoid suspicious foods.
Aerate stored foods.
Penicillium – puberulum and P. Penicillic acid (natural contaminants) Carcinogenic Maize Dry maize before storing. Aerate; avoid fungi
cyclopium looking maize

IV. HEAVY METALS

NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL

PERIOD
Antimony Antimony poisoning Nausea, vomiting, diarrhoea, pain. High acid foods and beverages Avoid use of antimony made utensils. Don’t
15 min – 1 hr. store high acid foods in grey enamel ware.
Cadmium Cadmium poisoning Nausea, vomiting, abdominal pains, shock. High acid foods, beverages, cake Avoid use of cadmium coated utensils.
15 – 30 min decorations
Copper Copper poisoning Metallic taste, nausea, vomiting, diarrhoea. Foods contaminated with copper Avoid storing in copper utensils
Min – 8 hrs pipes, utensils
Lead Lead poisoning Metallic taste, throat pain, abdominal Accidentally contaminated. High Don’t use lead containing vessels or utensils.
cramps, vomiting, diarrhoea, bloody stools, acid foods and beverages stored in Avoid storing pesticides same place with food.
burning of mouth. lead containing vessels
30 min or more

NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL

PERIOD
Tin Tin poisoning Bloating, nausea, abdominal pains, High acid foods and beverages, Avoid using of uncoated tin containers for storing
diarrhoea, headache. tinned foods high acid foods.
30 min – 2 hr
Zinc Zinc poisoning Pain in mouth and abdomen, nausea, High acid foods and beverages Avoid storing food in galvanized zinc containers.
vomiting, dizziness.
10 min – 3 hr

V. NATURAL POISONS

NAME DISEASE SYMPTOMS AND INCUBATION FOODS FAVOURED METHODS OF CONTROL

PERIOD
Mushroom Mushroom poisoning from group Drowsiness, muscular spasms, visual Indicated mushrooms Avoid eating mushrooms which are not identified
containing ibotenic acid and disturbances. Excessive salivation by specialists.
muscarine 15 min – 2 hr
Group containing amatoxins, Gastrointestinal disturbances followed by Indicated and named mushrooms. Avoid unidentified mushrooms
phallotosins or gyromitrin hepatic and or renal failure.
5 – 18 hr

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