Assessing Personal Hygiene Practices of Food Handlers in and Around a Tertiary Care Hospital: A Cross-Sectional Study in Sonitpur District of Assam

Food safety is a vital aspect of public health, especially in healthcare settings where individuals are more vulnerable to infections. Food handlers' personal hygiene habits are a key component among the many variables affecting food safety. Food handlers are directly involved in the preparation, processing, distribution, and storage of food, and the microbiological quality of food can be greatly impacted by their hygiene-related practices. Poor personal hygiene of food handlers may lead to food contamination, thereby increasing the risk of food-borne diseases among consumers [1,2]. Food-borne diseases remain one of the most frequent public health problems encountered in daily life worldwide. These illnesses result from the consumption of food contaminated with pathogenic microorganisms, toxins, or chemical substances, many of which can be introduced by improper handling practices. Poor hand hygiene among food handlers has been repeatedly linked to outbreaks of food-borne infections. Additional personal hygiene factors that increase the risk of contamination during food preparation and serving include dirty clothes, untrimmed nails, exposed hair, and inadequate wound or cut care [3].

Food-borne illnesses have a substantial financial impact on people, families, and healthcare systems in addition to the direct human cost of illness. Food-borne diseases in hospitals can result in longer hospital stays, more antibiotic use, and more diagnostic and treatment procedure [4]. Tertiary care hospitals are complicated settings where a wide range of people, including inpatients, outpatients, medical staff, attendants, and guests, are provided a lot of food every day. Food services in and around these hospitals may include central kitchens, ward pantries, staff cafeterias, and external food vendors. The variability in food handling settings and the involvement of multiple categories of food handlers increase the likelihood of inconsistent hygiene practices[5]. Personal hygiene practices encompass a range of behaviours aimed at minimizing contamination of food by harmful microorganisms. These include regular and correct handwashing, maintaining clean and appropriate work attire, keeping fingernails trimmed and clean, covering hair adequately, and refraining from food handling during illness. In healthcare settings, where the threshold for infection is lower, even minimal lapses in hygiene can have serious consequences [6]. Foodhandlers role is especially important in hospitals since infection prevention and control strategies are strongly related to food safety. Unsafe food can act as a vehicle for pathogens, contributing to hospital-associated infections that undermine patient recovery and increase healthcare costs. Therefore, assessing and improving personal hygiene practices among food handlers should be regarded as an integral component of patient safety and quality of care [7].

Despite the recognized importance of food handler hygiene, gaps often exist between knowledge and practice. Factors such as inadequate training, lack of supervision, heavy workload, insufficient facilities for handwashing, and limited access to protective clothing can negatively affect compliance with hygiene standards. Identifying these gaps through systematic assessment is essential for implementing effective corrective measures [8,9]. Kassa H, et. al; 2010, focused on evaluating personal hygiene practices among food handlers provides evidence necessary for informed decision-making and policy development. In and around tertiary care hospitals, this research gains added importance because it addresses both community and hospital-based food safety concerns. [10,11]. Assessing personal hygiene practices also contributes to raising awareness among food handlers about their responsibility in preventing disease transmission and adopt safe practices. In hospital settings, such a culture aligns with broader goals of infection control and patient-centred care [12]. Given the vulnerability of hospital populations and the complexity of food service systems in these settings, regular evaluation of hygiene practices is necessary to identify risks and implement effective preventive strategies. Strengthening personal hygiene among food handlers ultimately supports safer food, protects public health, and enhances the quality of healthcare delivery [13].

OBJECTIVE

The aim of the study was to assess the personal hygiene practices of food handlers in and around a tertiary care hospital in Sonitpur district of Assam, with the specific objectives of evaluating the level of knowledge regarding personal hygiene among food handlers and assessing their personal hygiene practices.

MATERIAL AND METHODS

This community based cross-sectional study was conducted among food handlers working in food establishments in and around Tezpur Medical College and Hospital, Tezpur, Assam from 1^st September 2024 to 30^th November 2024 (for a period of 3 months).

The study population comprised food handlers working in various food establishments including hotels, restaurants, hostels, street vending units, and institutional kitchens located in and around Tezpur Medical College and Hospital, Sonitpur district, Assam. Inclusion criteria included food handlers who were present at the time of the study and provided informed consent. The exclusion criteria were: (1) Food handlers unavailable at the time of the study, and (2) those unwilling to participate.

A sample size of 103 was selected through purposive sampling. Ethical considerations: Ethical approval has been obtained from the Institutional Ethics Committee (IEC) of Tezpur Medical College and Hospital, Tezpur, Assam.

Data collection was done through a predesigned and pretested interview schedule. Sections included information pertaining to socio demographic profile, knowledge levels, attitude and practices obtained by predesigned pretested schedule. Written informed consent was taken after explaining the purpose of the study.

Collected data were entered into Microsoft Excel and analysed using descriptive statistical methods. Frequencies and percentages were calculated to summarize sociodemographic characteristics, knowledge levels, and hygiene practices of food handlers, where necessary tabulation of results was done. Results were not subjected to any form of inferential statistic, as the nature of the study was exploratory.

RESULTS

A total of 103 respondents were included in the study, the majority of whom belonged to the 18–40-year age group, accounting for 86 individuals (83.49%). Participants aged 18 years or younger comprised 11 respondents (10.68%), while those older than 40 years formed the smallest group with 6 respondents (5.82%), indicating a clear predominance of young adults in the study population. Out of the 103 respondents, the majority were males, accounting for 80.58% (83), while females constituted 19.42% (20). This indicates a clear male predominance among food handlers in the study population. Nearly half of the respondents 47 (45.6%) had an education level below the 10th standard, while 39 (37.8%) were illiterate. Only 17 (16.5%) of the food handlers had completed education up to the 10th standard, indicating an overall low educational status. The majority of respondents 61 (59.22%) were food handlers from hotels and restaurants. This was followed by those from institutional settings 27 (26.21%), while street vendors constitute   15 (14.5%) of the study population.

Only 36.89% of respondents reported having undergone training or certification related to proper food preparation. In contrast, a substantial majority (63.10%) had not received any formal training in food preparation practices. The majority of respondents demonstrated knowledge about hygienic food storage, accounting for 75.7% of the study population. In contrast, 11.6% reported having no knowledge, while 12.6% were uncertain about proper food storage practices.A majority of respondents (62.13%) reported having knowledge regarding proper food handling practices. However, 7.76% indicated no knowledge, while a substantial proportion (30.11%) were uncertain about appropriate food handling. 30% had knowledge about transmission of disease by dirty hands.Majority of the respondents believed that proper handwashing during preparation reduces food borne illness which constitute 70.2%, those aware that cooked food be stored properly covered constitute 68%. Respondents who were aware that food handlers is an important source of food borne illness were 61%, while those who consider food stall be kept clean were 54%.

Majority (71.2%) of the respondents washed hands before handling food, while 63.4% washed hands after handling waste. 96.2% respondents bath regularly, while 70.1% used to regularly wash their clothes. Only half of the respondents (53.2%) used to wear gloves and apron before food preparation, while 65.3% keep finger nails trimmed and clean, and 82.1% of respondents properly store and cover food after preparation. Most respondents (68.85%) reported maintaining physical hygiene during food preparation and handling in hotels and restaurants. .More than half of the respondents (55.55%) reported maintaining physical hygiene during food preparation and handling in institutional settings.  Respondents (53.39%) reported flu-like illness in the last three months, while 29.12% suffered from diarrhoea and 18.4% from eczema. These findings suggest a notable burden of hygiene-related illnesses among the food handlers.

Table 1: Socio demographic characteristics of food handlers (n=103)

Table 2: Knowledge of food handlers regarding food safety:

Table 3: Attitude of food handlers on food hygiene

Table 4: Practice of food handlers on food hygiene: