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Food Safety in Eating Establishments: Assessing Conformance of Eating

Establishments to Food Safety and Standards Regulations

Article in Indian Journal of Community Medicine · October 2021

DOI: 10.4103/ijcm.IJCM_440_20

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ISSN 0970-0218

Oct-Dec 2021 / Vol 46 / Issue 4

Indian Journal of Community Medicine • Volume 46 • Issue 4 • October-December 2021 • Pages 1-***

Indian Journal of
Community Medicine
Official Publication of Indian Association of Preventive and Social Medicine
www.ijcm.org.in
 Short Communication

Food Safety in Eating Establishments: Assessing Conformance

of Eating Establishments to Food Safety and Standards
Regulations
Surinder Kumar, Puja Dudeja1, Prerna Shankar2, Simrandeep Kaur3
Department of Community Medicine, Armed Forces Medical College, 2Department of Community Medicine, Station Health Organisation, Pune, Maharashtra,
3
Department of Pathology, SGRD Medical College, Amritsar, Punjab, 1Department of Pathology, AFMC, Pune, India

Abstract
Introduction: In view of the rising burden of the foodborne illnesses and the rise of eating out culture in India, food safety has assumed greater
significance. The Food Safety and Standards Authority of India has prescribed food safety and standards regulations (FSSRs) for commercial
eating establishments (EEs). The present study was carried out to ascertain conformance of the EEs to these regulations. Methodology: It was a
cross‑sectional study conducted on 74 EEs in a metro city in western Maharashtra from May to October 2019 using an interviewer‑administered
study tool based on FSSR 2011. The study tool covered critical domains such as food hygiene, equipments, health and personal cleanliness,
training of food handlers, and product information. Results: Seventy‑four EEs included 29 restaurants, 21 bakeries, and 24 snack bars. The
score ranged between 42.3% and 73.3%. Of 74, 20 (27%) EEs were placed in poor category (score <50%), Only 3 EE scored >70% and were
rated as very good. Only 13 (17.6%) EEs were cleaning the food contact surfaces adequately, i.e. before and after each use, whereas 38 (51.4%)
were not cleaning food contact surfaces at least daily. The knowledge regarding food handlers as potential carriers of disease was poor with
60.81% of the respondents having no knowledge about it. Conclusion: The study found significant gaps in EEs with respect to studied food
safety domains of FSSR 2011.

Keywords: Food handlers, food safety, food safety regulations, Food Safety and Standards Authority of India

Introduction country.[5] The actual numbers are expected to be much higher

in India, owing to considerable underreporting and availability
Our food travels a long journey from farm to fork, and can
of over‑the‑counter antibiotics combined with self‑medication.
get contaminated at any point in this journey. Safe food saves
lives, whereas unsafe food predisposes individuals to risk of At the same time, the food service industry in India is one of
foodborne illnesses (FBI). Billions of people worldwide are the fastest developing industries in the country. This growth is
at risk and as per the WHO estimates 33 million DALYs were being driven by the younger population and rapid urbanization
lost due to foodborne diseases in the year 2010.[1] The first‑ever and globalization. More and more people are coming out of
estimates of global burden of FBI revealed that every year, their towns to work in metro and mini metro cities. Moreover
every tenth person on this globe falls ill due to consumption of in urban India, where both the spouses work, it leaves lesser
unsafe or contaminated food, and 420000 people die of FBIs time to cook and contributes to growth of eating out culture.[6]
annually.[2] In India, there were 11,387,897 reported cases and
2135 reported deaths due to acute diarrheal illnesses, enteric Address for correspondence: Dr. Surinder Kumar,
fever, and viral hepatitis combined, in the year 2011.[3] In Department of Community Medicine, Armed Forces Medical College, Pune,
Maharashtra, India.
the year 2016, a total of 16,528,349 cases and 2517 deaths E‑mail: dr_vashisht@yahoo.co.in
were reported due to the above‑mentioned three diseases.[4]
The data from the Integrated Disease Surveillance Project, of
This is an open access journal, and articles are distributed under the terms of the Creative
past 3 years, show the upward trend of these diseases in the
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
Access this article online is given and the new creations are licensed under the identical terms.

Quick Response Code: For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

Website:
www.ijcm.org.in
How to cite this article: Kumar S, Dudeja P, Shankar P, Kaur S. Food safety
in eating establishments: Assessing conformance of eating establishments
to food safety and standards regulations. Indian J Community Med
DOI:
10.4103/ijcm.IJCM_440_20
2021;46:697-700.
Received: 03-06-20, Accepted: 13-07-21, Published: 08-12-21

© 2021 Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow 697
 Kumar, et al.: Conformance of eating establishments to FSSR

In view of the increasing burden of FBIs and the rise of eating Results
out culture in India, food safety becomes extremely important.
The EEs consisted of 29 restaurants, 21 bakeries, and 24
The Food Safety Standards Authority of India (FSSAI) has
snack bars. The lowest score obtained was 42.33% and the
come up with a checklist for inspecting hygiene and food
highest was 73.26%. The EEs were placed in one of the four
safety standards of eating establishments (EEs). However, categories based on the score obtained. Out of 74, 20 (27%)
there are no studies on conformance to this checklist. Hence, EEs scored below 50% and were places in poor category and
the present study was carried out to ascertain conformance of only one EE scored above 80% and was rated as excellent.
the EEs to food safety standards regulations (FSSR) of 2011 There were only two EEs in very good category [Table 1].
and to educate the food handlers as well as the managers of The storage practices of raw and cooked foods were also
these EEs regarding safe food handling practices. evaluated and the results were disheartening. None of the
EEs scored >60% even as 49 (66.22%) EEs had a score
Methodology of <40% and were classified as “very poor” in terms of
It was a community‑based cross‑sectional descriptive study storage practices [Table 1]. The food items were stored
in utter disregard of the recommendations. Storage areas
conducted in cantonment area of a metro city in western
were shoddy and poorly maintained with pest infestation.
Maharashtra from May to October 2019. A list of EEs
Vegetarian food was stored with meat and poultry items. Raw
operating in the cantonment area was obtained from the
and cooked food was being stored together. Chutneys used in
cantonment board consisting of 106 EEs. All EEs were
various food preparations were prepared in bulk for a month
approached to be part of the study; however, 32 EEs (12
or so and stored in unhygienic conditions.
bakeries, 11 snack bars, and nine restaurants) were under the
process of applying/renewal of their food business license The EEs were scored on the personal cleanliness, knowledge,
and were apprehensive hence did not volunteer. They were and practices of food handlers working there [Table 2].
excluded and 74 volunteering EEs were included in the study. Only 5 (6.76%) EEs were found to be “very good” having
Informed consent from food business operator (FBO) of the EE scored >70%. This domain included of handwashing
was obtained and they were told that the exercise was intended practices, changing clothes before work, use of gloves,
for research purposes only. An interviewer‑administered practices such as smoking or chewing tobacco or touching
study tool based on FSSR 2011 checklist was prepared. The body parts/hair or tasting food with fingers, and wearing any
study tool covered critical domains such as food hygiene, jewelry or watch or bands on hands/wrist during handling
food. The knowledge regarding food handlers as potential
equipments, health and personal cleanliness, training of food
carriers of disease was dismal with 60.81% of the respondents
handlers, and product information.
having no knowledge about it. Facilities for handwashing of
Each question in the tool scored between 1 and 3 (poor, the food handlers were not present in 60.81% of the EEs; in
satisfactory, and good). Based on this, each EE was given 62.16% of the EEs, the food handlers were not practicing
a separate score on conformance to FSSR 2011. Each EE handwashing as recommended. The handwashing practices
was evaluated separately after excluding items that were were inadequate at most of the EEs [Table 3]. The food
not applicable to the EE under study. Since all items of the handlers were permitted to handle currency in 56 (75.7%)
tool were not applicable to all EEs, the maximum attainable EEs. Although provision of soap for food handlers to wash
score was different for each EE. For comparability among hands was not part of the checklist, the investigators observed
all EEs, the percentage score was calculated for each EE the EEs were resorting to cost‑cutting measures by not
based on the respective maximum score and score attained.
The status of conformance of each EE with respect to FSSR
Table 1: Status of conformance of eating establishments
2011 was graded as per the percentage score attained. Each
of the EEs was placed in one of the four categories, namely Score based on conformance to FSSR 2011
poor, satisfactory, good, and excellent based on the score Score (%) Classification EEs, n (%)
attained. <50 Poor 20 (27.02)
50.1-60 Satisfactory 45 (60.81)
The EE was visited during nonbusiness hours to avoid
60.1-70 Good 6 (8.11)
disturbing the usual business of the EE. The average time taken
70.1-80 Very good 3 (4.05)
was 40–45 min for inspecting and scoring each of them. All >80 Excellent Nil
items listed in the questionnaire were inspected personally by
Score based solely on food storage practices
the authors, and scoring was endorsed during the visit itself.
<40 Very poor 49 (66.22)
Recommendations tailored to the requirement of each EE were
40.1-50 Poor 20 (27.03)
given at the end of inspection and interview. The food handlers
50.1-60 Satisfactory 5 (6.76)
were encouraged to ask their queries regarding food safety >60 Good Nil
during the interaction. The data were compiled and analyzed To FSSR 2011 (n=74). FSSR: Food safety and standards regulations,
using Microsoft Excel. EE: Eating establishments

698 Indian Journal of Community Medicine ¦ Volume 46 ¦ Issue 4 ¦ October‑December 2021

 Kumar, et al.: Conformance of eating establishments to FSSR

Table 2: Personal cleanliness practices of the food Discussion

handlers The findings of our study and interaction with the staff at EEs
Activity Practice EEs, n (%) enabled us to find significant issues affecting food safety. Irwin
Food handlers smoking or chewing Never 45 (81.0)
et al. suggested regular scoring of EEs as an aid to predict the
tobacco in food preparation area Sometimes 23 (31.1) risk of outbreak of FBI.[7] Use of a standard checklist for this
Always 6 (8.1) scoring gives an objective assessment and can help follow‑up
Food handlers spitting in food Never 29 (39.2) the hygiene and standards of EE with rising or falling of score
preparation area Sometimes 11 (14.9) in subsequent inspections. Conformance to the FSSR 2011
Always 34 (46.0) means high food safety and resultant lesser chances of FBI.
Touching hair or other body parts Never 2 (2.7) Every person visiting the commercial EEs rightfully expects
such as eye, nose, and ear Sometimes 44 (59.5) to have safe food, even as all the EEs are obliged to do that.
Always 28 (37.3) The lack of knowledge, poor practices, and profiteering pose
Cover nose when coughing or Never 17 (23.9) as a hurdle in the way to fulfill their obligation.
sneezing in food preparation area Sometimes 51 (68.9)
Always 6 (8.1)
In a longitudinal study conducted by Dudeja and Singh in
Trimmed hair of food handler Never 31 (42.9)
Chandigarh, conformance of EEs in and around a tertiary
Sometimes 34 (46.0) care hospital was studied. The minimum and maximum
Always 9 (12.2) preintervention scores were 41.28% and 77.25%, respectively,
EE: Eating establishments while in our study, it was 42.33% and 73.27%. The authors in
an earlier study reported 33.33% EEs having “poor” scores and
only 5.55% EEs able to get “very good” grading; in the present
Table 3: Handwashing practices of food handlers at study, 27.03% and 4.05% of EEs were classified as “poor”
eating establishments (n=74) and “very good,” respectively.[8] A significant knowledge
Activity/practice EEs, n (%) gap was found among food handlers in Chennai by Manes
Wash hands before commencing day’s work MR et al. in similar domains. They found that the knowledge
Never 28 (37.8) score was higher among food handlers having a medical
Sometimes 43 (58.1) fitness certificate.[8] Handwashing practices were found to be
Always 3 (4.1) inadequate. Handwashing has been proven to reduce the risk of
Wash hands after handling raw food diarrheal diseases.[9] Green et al. observed that there are about
Never 58 (78.4) nine activities which warrant handwashing in a restaurant.[10]
Sometimes 11 (14.9)
Always 1 (1.4) Handling of currency by food handlers poses an additional risk
Do not handle raw food 4 (5.4) of transmission of disease‑causing pathogens. Currency notes
Wash hands after handling soiled equipment or utensil handled by food handlers have been found to be contaminated
Never 54 (73.0) with a variety of pathogens in a study conducted in Lucknow.[11]
Sometimes 18 (24.3) The pathogen load varies with type of currency, its physical
Always 1 (1.4) condition, and denomination, lower denomination currency
Not applicable 1 (1.4) was found to be more contaminated.[12,13]
Wash hands after coughing, sneezing, or blowing nose
Handwashing is the simplest yet effective intervention for
Never 37 (50.0)
safe food. The EEs must provide soap for handwash and
Sometimes 35 (47.3)
Always 2 (2.7)
handwashing should be encouraged. The FBO/manager should
EE: Eating establishments handle all the currency, food handlers, especially those dealing
with clients, should not be permitted to handle currency. The
providing soap to food handlers. The EEs are supposed to practice of customers paying the bill on the dining table along
provide a changing room along with a facility for storage of with custom of paying tip to food handler serving the food
personal belongings to food handlers; however, 65 out of 74 promotes handling of currency by food handlers. Therefore,
studied EEs were not having any facility for food handlers zero handling of currency by food handlers cannot be achieved
to change clothes. without active involvement of customers and the management
to find alternative ways and means.
Only one of the 74 EEs was having a supervisor who had
Substantial gains can be made by no or low‑cost interventions
attended a recognized food hygiene course. The FSSAI has
such as improving storage, handwashing practices, not wearing
clearly laid out norms for labeling of food items; however, 38
jewelry items, and changing clothes before commencing work
out of 46 bakeries and sweet shops did not mention the date
among others.
of processing or manufacturing of the packaged food item.
Interestingly, these EEs were using FSSAI logo along with The nonparticipation by 32 EEs may have introduced bias in
their FSSAI license number on the label. the study.

Indian Journal of Community Medicine ¦ Volume 46 ¦ Issue 4 ¦ October‑December 2021 699

 Kumar, et al.: Conformance of eating establishments to FSSR

Conclusion 5. IDSP. A Monthly Surveillance Report from Integrated Disease

Surveillance Programme National Health Mission January 2017. Vol. 2.
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Financial support and sponsorship 7. Irwin K, Ballard J, Grendon J. Results of routine restaurant inspections
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Conflicts of interest 8. Manes MR, Liu LC, Dworkin MS. Baseline Knowledge Survey of
There are no conflicts of interest. Restaurant Food Handlers in Suburban Chicago: Do Restaurant Food
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Journal of Environmental Health.2013;76:18-27.
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