Relating Food Handlers' Knowledge, Attitude, and Self-Reported Practices on Food Safety and Hygiene to the Performance of Food Safety Assurance System: A Multiple Case Study in Government Hospital Kitchens

Government hospital kitchens in Malaysia have been certified with Good Manufacturing Practices (GMP) and Hazard Analysis Critical Control Point (HACCP) to ensure that cooked food is clean and safe for consumption. However, the performances of the Food Safety Assurance System (FSAS)-certified government hospital kitchens have not been evaluated. Although researchers in Malaysia have assessed the knowledge, attitude, and self-reported practices (KAP) on food safety (FS) and hygiene among food handlers, they did not relate the influence of food handlers' KAP on the performance of the FSAS. The objective of the study was to relate food handlers' KAP on FS and hygiene to the FSAS performance in government hospital kitchens in Selangor and Kuala Lumpur, Malaysia. Four government hospital kitchens implementing different kinds of FSAS certification were evaluated. Critical sampling locations were identified, and samples were taken and examined for Escherichia coli, Total Yeast and Mould Count (TYMC), Staphylococcus aureus, Total Plate Count (TPC), and Salmonella. The average scores of knowledges on FS and hygiene for <= 30 years age group, <= 5 years in the employment group, and food handlers with tertiary education were the highest and significantly different compared with the other groups. The FS output of government hospital kitchens implementing stringent FSAS was better (score of 2-3) than kitchens implementing less stringent FSAS (score of 2). The multinomial logistic regression analysis showed that the correlations among the overall percentage scores of KAP and the FS output were not significant (p > 0.05). Therefore, it appeared that food handlers' KAP on FS and hygiene did not influence Salmonella, E. coli, and S. aureus levels and, therefore, the FSAS' performance.