Hygiene and Environmental Health Module: 11. Hygienic Requirements of Food and Drink Establishments

Study Session 11  Hygienic Requirements of Food and Drink Establishments

Introduction

Food and drink establishments are places where an individual gets food in the form of breakfast, lunch, dinner or snacks, accompanied by some form of drink. Unhygienic practices in food and drink establishments affect the health of the clients. In this session, you will be introduced to the hygiene requirements in food and drink establishments that are likely to be found at kebele level. You will learn how food items and equipment are handled in a hygienic manner, the public health importance of food handlers, and what client-focused hygienic services are required.

Learning Outcomes for Study Session 11

When you have studied this session, you should be able to:

11.1  Define and use correctly all of the key terms printed in bold. (SAQs 11.1 and 11.2)

11.2  Describe the categories of food and drink establishments. (SAQ 11.1)

11.3  Explain the hygienic requirements that are applicable in food and drink establishments. (SAQ 11.2)

11.4  Explain the hygienic behaviours required of food handlers. (SAQ 11.3)

11.5  List the sanitary facilities required in food and drinking establishments. (SAQ 11.4)

11.6  Describe the procedure for sanitary inspection in food and drinking establishments. (SAQs 11.2 and 11.3)

11.1  What is a food and drink establishment?

Food and drink establishments provide food and drink services to a relatively large number of users in the form of breakfast, lunch, dinner or beverages. Formal food and drink establishments are authorised to practise this service after being licensed by the local authorities. There also exist a number of informal food and drink establishments that provide a service without much interference from the local government. Food and drink establishments have a responsibility to provide safe food and drink to the consumers. The consumers have the right to demand safe food. If food is not prepared and handled in hygienic conditions, it spreads foodborne disease that could affect a large number of people at a time.

The local government (kebele) takes actions to ensure the hygienic functioning of these establishments on behalf of the public. The Ethiopian Regional and National hygiene and environmental health regulations can be exercised in the kebele by the presence of an appropriate expert who is authorised to enforce them. As a Health Extension Practitioner you can make a link with this authority through regular reporting to ensure that the necessary actions are taken to maintain safe practice.

11.2  Categories of food and drink establishments

There are several types of food and drink establishment in rural areas. Some may provide only food; others provide food and drinks such as soft drinks, beer and other alcoholic drinks; some provide only snacks and hot drinks. We describe below those establishments that are likely to be found at kebele level.

• Restaurants are food establishments that provide lunch and dinner (Figure 11.1) with accompanying drinks.

Figure 11.1  A typical lunch served in an Ethiopian restaurant. (Photo: Basiro Davey)

• Cafés provide hot drinks and snacks. Hot drinks include tea, coffee, milk, or a blend of milk and coffee (macchiato). The café must have water boiling equipment for coffee and tea preparation. Cakes and doughnuts (such as bombolino, chornake and sambusa) are served as snacks.
• Tea houses provide tea and snacks. Snacks are usually plain bread, sambusa and bombolino. Tea is served after mixing with boiled water in a kettle.
• Tej bet is a drink establishment that offers a local light alcoholic beverage made of fermented honey in water, called tej, which is served in large measures.
• Tela bet is an establishment that provides a local light alcoholic drink called tela. They are common in rural areas of Ethiopia.
• Areki bet is a drink establishment that provides a local drink containing more alcohol than tela or tej. It is consumed in smaller quantities.
• A grocery is an establishment that provides packed food and drink items. Groceries may also provide hot dishes.
• A butcher’s shop is a food establishment that offers meat for sale (Figure 11.2).

Figure 11.2  A butcher’s shop in Addis Ababa. (Photo: Basiro Davey)

• A bakery is a food establishment that offers plain bread for sale.
• A hotel is a food establishment that offers food, drinks of all types, and bedroom services. The capacity of service and the quality of foods and bedrooms in a rural hotel are less than those of urban hotels.

11.3  Hygienic requirements of food and drink establishments

This section outlines the basic hygienic requirements that are applicable for the food and drink establishments found at the kebele level. Knowing them will help you to make decisions when visiting them for inspections.

11.3.1  Licensing

There should be a system for licensing food and drink establishments in kebeles. The woreda health office is responsible for this licensing system. As the local Health Extension Practitioner, you may be requested to do a preliminary assessment to check the hygienic requirements and report to the woreda health office. Most categories of food and drink establishments can be licensed, though tela bet and areki bet do not require it because of their lower level of health hazards. Please note that the licensing procedure must follow regional and local regulations.

11.3.2  Location of the food establishments

Food establishments need to be well away from any source of hazards such as marshy areas, waste disposal sites and flooding. The site must be conveniently accessible to staff and consumers. The establishments should be at a distance from public institutes such as schools and health facilities. Access to clean air and natural lighting is also important.

11.3.3  Condition of the building

The space available must be adequate to provide the kind of service that the establishment carries out. Depending on the nature of the establishment, the space may include a kitchen, dining room, drinking room, food storage sites, and a utensil washing site. Building structures and their interiors should permit good hygienic practices, including protection against cross-contamination of food surfaces between and during operations. The provision of a window for each room should ensure adequate lighting.

Structures within processing establishments should be soundly built of durable materials and be easy to maintain, clean and, where appropriate, disinfect. Floor and wall surfaces must be cleanable and washable. The surface of the walls must have a light colour that maximises the interior lighting. The roof must be cleanable and maintained free of dirt.

11.3.4  Sanitary facilities

Food and drink establishments need to offer sanitary facilities, which means handwashing facilities, latrines and urinals. The handwashing facility must have soap; a liquid soap is appropriate if this is available. Separate latrines for men and women are desirable. The number of these facilities depends on the number of clients visiting at peak hours. Generally, one handwashing facility and latrine for 30 clients is appropriate.

Food handlers should be provided with a separate latrine, handwashing and changing facilities at a convenient location. The availability of soap is essential for proper handwashing (Figure 11.3).

Figure 11.3  Soap is essential for proper handwashing. (Photo: Basiro Davey)

11.3.5  Access to water

Food and drink establishments require a sustained source of safe water to be used for personal hygiene, food preparation and utensil cleaning. A water tank is one option to ensure the availability of water at all times.

11.3.6  Waste management

Food and drink establishments produce organic wastes such as food remains, and liquid wastes as a result of hand and kitchenware washing. These wastes need to be handled properly without contaminating or polluting the immediate environment. Specific information on waste management can be found in the study sessions later in this Module.

11.3.7  Kitchen and food preparation site

The space and layout of the kitchen must be appropriate to accommodate the food preparation and kitchen processes. There must be separate sections for raw food preparation and handling cooked food.

The presence of a window and a chimney is essential in order to manage the indoor air pollution that is caused by biomass fuel burning.

The presence of facilities for washing hands and kitchenware is mandatory in a kitchen. Proper shelves for physically separating soiled and cleaned items are also a necessity.

The proper handling of kitchen refuse and liquid waste controls the spread of infestation and food contamination. Food scraps and leftovers must be placed in a covered container. The floor and tables need to be cleaned frequently during the processes of food preparation and cooking.

11.3.8  Cleaning dishes, drinking utensils and cutlery

The cleaning of soiled dishes is an important way of preventing communicable diseases. There is an established procedure that the person who is the dish washer must follow. ‘Dish’ in this section includes plates, cups, glasses, spoons, forks and other utensils.

The three bowl method for cleaning soiled dishes

The manual cleaning process requires three vats or bowls, each with a capacity of 20–30 litres (Figure 11.4). Washing equipment such as detergent (powdered soap) and a scraping cloth, sponge or cleaning brushes are also necessary.

Figure 11.4  The three bowl system for washing soiled dishes. (Photo: Abera Kumie)

The procedure shown in Box 11.1 uses the three bowl system, which is recommended for the rural setting where running water is unlikely to be available.

Box 11.1  Dishcleaning guidelines where there is no running water

1. Decide what to wash first: generally it is best to start with glasses and cups. However, the following description is for washing soiled plates.
2. Fill the first two bowls halfway with warm water (50ºC). Hot water (80ºC or above) is added to the third bowl. A detergent must be included in the first bowl.
3. Scrape the food from dish surfaces and collect it in a garbage container. Place the dish in the first bowl and wash with the detergent until the grease has gone. Washing plate by plate increases cleaning efficiency. Then place the washed item into the second bowl.
4. Rinse the dish well in the second bowl. Any remaining food particles and soap must be taken away by thorough rinsing. Then place the dish into the third bowl.
5. The process of dish washing in the third bowl is called sanitising which is a procedure to inactivate and remove the microorganisms that may be found on the surface of the dish. Sanitising is possible by rinsing the dish in hot water at a temperature of 80ºC for one to two minutes. Rinsing in warm water that contains chlorine (50–100 ppm) can replace the use of hot water. Immersing the rinsed dish for 15 seconds adequately sanitises.
6. Dry the dish with a clean cloth or air-dry it. The cleaned and dried dish is then placed in a shelf or rack that has a cover. Dishes must be kept under cover until used. Remove dishes that are not in good condition and replace them with new ones.
7. The water used for washing must be changed frequently as needed. The used water in the first bowl is more frequently changed than that in the second bowl. Continued use of dirty water must not be encouraged. The water temperature in the third bowl must be kept high.

Note that ppm stands for parts per million. It is a measure of the concentration of a substance in a solution.

Washing cups, glasses and spoons

The principle of cup washing is the same as that of washing soiled dishes. The three bowl system should be encouraged but two bowls is also acceptable, with warm water and detergent in the first bowl and hot water in the second. The first wash cleanses the grease, while the second bowl sanitises the cups. Cups must be dried with a clean piece of cloth or air-dried before use.

The glass-washing facilities for birle in tej bet should use a three bowl system. The first is used for washing with detergent, the second and third for rinsing.

When cold and hot running tap water is available, sinks with two compartments/bowls are sufficient because the hot running water is used for rinsing and sanitising (Figure 11.5).

Figure 11.5  Washing glasses in a sink with detergents, and cold and hot tap water. (Photo: Abera Kumie)

11.3.9  Maintaining hygienic kitchen equipment

All surfaces that come into contact with food should be constructed of appropriate materials and be well-maintained, for example, wooden boards must be smooth and metal tables should be plain and not corrugated. Any surface that is cracked, scored or has an irregular surface is difficult to clean and may harbour dirt. Chopping and cutting blocks for preparing meat or vegetables must be kept clean and covered. All utensils and equipment must be protected from possible contaminants including dust, dirt, insects, rodents and overhead drips. Equipment and food containers should be made of materials with no toxic effect and be designed to ensure that they can be easily cleaned, sanitised and maintained.

Surfaces such as chairs and tables that do not normally come into contact with food should also be clean and in good repair. Always use clean cloths to cover tables and change them whenever necessary.

11.3.10  Storing and serving foods

Perishable food items are easily spoiled if stored at room temperature. Foods such as meat should be kept in a refrigerator that can keep the temperature below 10ºC. Semi-perishable foods, such as potatoes and carrots, which are used on a daily basis, need to be stored on a well-ventilated shelf. Shelves must be 50 cm from the ground and well away from wall surfaces. A distance of 1 metre is adequate between shelves. Serving food to consumers should provide maximum health protection. Hot foods should be served while they are hot, and cold foods while they are cold. Foods must be thoroughly reheated if they have been at room temperature for longer than 1 hour.

11.3.11  Vector control

Vector management is a challenging task in food establishments.

11.3.12  Meat handling and butchery

Butchery may be available in kebeles. The food handler (butcher) must satisfy the hygienic practice of personal hygiene. The meat must be from approved sources, be fresh and be sold within one to two days. The handling of meat needs to be in a well-ventilated area and the presence of flies around the meat must be controlled. Knives, chopping boards and wrapping materials must be clean; the use of newspapers and similar items for wrapping must be discouraged. The walls, floor and ceiling must be free from any dirt.

11.4  Food handlers’ health and hygiene

As you have learned in previous study sessions, food handlers are a common source of foodborne diseases. The practice of good personal hygiene that you learned about in Study Session 3 is essential for anyone who handles food, especially in food and drink establishments where many customers could potentially be affected. A sick food handler with symptoms of diarrhoea, eye and ear discharges, skin infections, open cuts and wounds, or coughing should not continue working. They must be treated and be completely recovered before returning to work.

Food handlers must use personal protective devices such as clean aprons, overalls or gowns, footwear, and hair cover. As a Health Extension Practitioner you should be involved in training food handlers on food safety. The strict rules of handwashing after using the latrine or touching dirt and before handling food must be followed. Box 11.2 indicates some bad habits of food handlers that should be avoided.

11.5  Sanitary inspection in food and drink establishments

Health Extension Practitioners have the responsibility of safeguarding the health of the public by ensuring safe hygienic practice in food and drink establishments. Inspecting the food establishments (sanitary inspection) is a means of identifying or monitoring unsafe practices of food handling.

11.5.1  What is the purpose of the inspection?

Sanitary inspection is a set of activities concerned with the preservation of public health and the investigation of environmental hazards in food establishments. Sanitary inspection aims to investigate and detect:

• Food spoilage and its sources.
• Food contamination and its sources.
• Provision for hygienic procedures (dish and handwashing, food storage).
• Provision of sanitary facilities (latrine, water, shower, handwashing).
• The proper location of the establishment.
• The hygienic practice of food handlers.
• Proper waste management (storage, collection and disposal).
• The presence of vectors.

Sanitary inspections are carried out for two reasons: first, to provide education and advice to the owners, and second, for the purpose of providing a licence if you are asked to do so in the absence of the woreda environmental health worker.

11.5.2  When to inspect

There must be a baseline survey of food and drink establishments using a survey checklist. Appendix 11.1 (at the end of this study session) is an example of the sort of surveillance form you could use for your survey. The survey result must enable you to classify the food establishments by hygienic status and to set priorities for inspection. The number of food establishments in your kebele determines the workload of the inspection. You do not have to inspect tela bet and areki bet, as noted above, because of their lower hazard level. Each food establishment should be inspected at least once every year. However, since the number of food and drink establishments in the kebele setting is probably low, often less than ten, then inspecting each four times a year should be possible.

11.5.3  Informing the owners about the sanitary inspection

It is always useful to warn the owners about your inspection visit, including the date, time and purpose. This is useful because your job is promoting food safety and hygienic practice, and your warning may encourage them to check and improve their practices. The kindness and help you get from the owner will facilitate your decisions about the appropriate hygienic instructions to give.

11.5.4  How and what to inspect

Upon arrival at a food and drink establishment you should introduce yourself and announce politely the purpose of your inspection in order not to embarrass the owner. Interviewing food handlers, physical observation and the use of a checklist are the main tools for data collection. Information is also collected by interviewing the owner and the food handlers. The sanitary inspection checklist in Appendix 11.1 can be used for subsequent visits as well as the baseline survey.

The inspection starts by checking the physical presence of latrines and handwashing facilities meant for the clients. The inspection is based on the food preparation flowchart and is carried out in a sequential manner: food storage, kitchen, dining room and drinking rooms (Figure 11.7).

Figure 11.7  The food inspection flowchart.

The handling of raw food is inspected in the food storage room. The use of refrigerators for perishable food items (meat, eggs, juice, fruits and vegetables) is checked. Semi-perishable foods such as potatoes and onions need to be stored on shelves that are properly ventilated and free from any vectors.

In the kitchen the use of detergents, the presence of three dishwashing bowls (or a sink with running water) and the practice of personal hygiene must be closely checked. There should be no vectors such as flies and cockroaches in the kitchen area. The food handler’s health is rapidly checked by doing a physical examination for the presence of active infections (skin, eye, ear infections or nasal discharges). The proper use of apron, gown or overalls, hair cover and appropriate footwear by the food handler is also investigated.

The strict separation of kitchen tables for cooked food items and raw food needs to be inspected. The presence of obvious indoor air pollution is also important to note.

In the dining room, the condition and cleanliness of the tables, chairs, floor, walls and ceiling should be observed. The presence of vectors and proper waste management facilities must be inspected in all parts of the food processing and serving areas. The proper handling of kitchen waste in a garbage container, and the presence of a waste bin in dining areas, should be checked.

As you make your inspection, record the information on the checklist. Do not write much on the checklist while inspecting because the owner may not be comfortable about it. Pay attention to critical situations such as dishwashing practice, handwashing practice, vectors and waste handling.

11.5.6  Concluding the sanitary inspection

Discuss your findings with the owner, and explain what hazards and unacceptable hygienic practice you have found. Please also point out what is good. Explain clearly your suggestions for improvement and the urgency of the timescale. It is important that you educate and persuade the owner to implement your advice. Tell the owner that you may revisit the food establishment in future to check what has been improved. You need to keep all the inspection reports for future reference and you should report to the kebele and woreda offices if improvement is not achieved after repeated efforts.

Summary of Study Session 11

In Study Session 11, you have learned that:

1. There are several kinds of food and drink establishment that provide food and drinks to the public.
2. The operation of food and drink establishments needs to meet basic hygienic requirements in order to safeguard the public.
3. The Health Extension Practitioner needs to focus on the establishments that are relevant to the public at kebele level.
4. The basic hygiene requirements are the same in all food and drink establishments.
5. Sanitary inspection is a way of detecting potential hazards that could affect clients if they consume spoiled or contaminated food.
6. Sanitary inspection of food and drink establishments requires good planning. Its purpose is to promote food hygiene and safety by advising and instructing the owners of the establishments. Sustained follow-up and monitoring help to achieve hygienic practice.

Self-Assessment Questions (SAQs) for Study Session 11

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 11.1 (tests Learning Outcomes 11.1 and 11.2)

Match the following food and drink establishments with the services provided.

Type of establishment	Service offered
Butcher	Bedrooms
Tea house	Tibs for lunch
Restaurant	Plain bread or chornake
Hotel	Raw meat

Answer

Appendix 11.1