Survey on Sanitary Conditions and Hygiene

Survey on Sanitary Conditions and Hygiene ABSTRACT Mauritius is known as a paradise island, attracting thousands of tourists each year. During the last two decades this sector has undergone a rapid development making it one of the most important pillars of our economy. Nowadays our country relies a lot on this industry as it is a source of revenue for foreign currency. Our hotels accommodate the majority of this population. Hotels provide them with basic accommodation such as lodging and food facilities. Therefore any wrong management in this sector can make drastic changes to our economy. The Government did a lot to promote this sector, by amending laws protecting the environment while other authorities are working hard to avoid propagation and controlling communicable diseases. Therefore hotels have an important role in maintaining a good hygienic level and also in the fight of controlling any diseases or infections by reporting them to the authorities concerned. Thus a study was carried out to study the general sanitary practices of medium size hotels of Mauritius. Fifty hotels were selected at random throughout the island. Two survey questionnaires were designed. Questionnaire 1 was designed for my personal view to assess the hygienic conditions of food preparation area, rooms and other facilities available whereas questionnaire 2 was designed to assess the knowledge of the food handlers concerning various issues. After carrying out the surveys, it was found that simple hygienic practices were lacking among the food handlers. Moreover some hotels sanitary conditions were not satisfactory concerning certain issues, thus not complying with the recommended laws. Good sanitary facilities were not provided by the hotels management. CHAPTER 1 INTRODUCTION Overview A hotel is an establishment providing paid lodgement on short time basis. It provides basic accommodation consisting of room with bed, toilet and bathroom and water facility. It also provides food for room service daily and has its own restaurant (Wikipedia, 2010). Therefore it must have a high level of hygiene. Hotels accommodate adults, children and old persons. People coming from all parts of the world. These people are strangers with different life styles and different personal hygiene levels. A good degree of hygiene in the hotel establishment is therefore necessary to counteract any hygienic problems that may arise. Therefore hotels must provide services of good quality with trained personnel. The level of hygiene of staffs must be considered as priority. The workers must cope with all sanitary regulations for themselves to be clean and not to be the cause of any infection spread. Hotels are regulated because of cleanliness reason and sanitary practices which help to prevent the spread of diseases and parasites. Inspections are made to ensure they operate safely complying with all regulations such as Public Health Act, Safety and Health Act or the Food Act. (FAQ, 2010). From a research carried out by Environmental Health Division in the United States, inspections carried out by the inspectors were mainly to have a visual examination for overall cleanliness and soundness of building construction. Moreover simple inspections were done concerning proper washing of dishes like cups and glasses, proper laundering of bed and bath linens. Other inspections performed were to look in the maintenance of other room furnishings and for the absence of rodents and insects that are of great importance in preventing diseases. These inspections are effected according to the Tourist Accommodation Regulation (Environmental Health, 2010). Hotels are inspected at least once per year and sometimes much more depending on complaints arising from the public. In United States, Fire Marshal approval is an important factor else no permit is delivered (Environmental Health,2010). . In Mauritius hotels license are issued after approval of an EIA and compliance of all health codes. Food hygiene training is an important factor in hotels. Adopting a safe food handling practice is an important factor for effective management of food safety. A study carried out by the International Journal of Environmental Health Research on food hygiene training practices by interviewing managers and food handlers. It showed that most of the food handlers had undertaken formal food hygiene training courses but many others did not and still were preparing food, including high risk foods. Pre-training support and on-going supervision was absent, thus limiting its effectiveness. It is believed that food handlers are in many cases causes of food contamination (Taylor and Francis, 2008). Researches effected in Wales, showed many that hotels were criticised for a number of failures. Numerous high risk foods were kept past their use by dates. Chopping boards were in a state that could no longer be disinfected properly due to their worn state while mouldy plastic bread containers were also spotted. Other hotels were criticised for inadequate level of food hygiene awareness among its staff while another had a leaking cellar roof (Woodrow, 2009). Other researches reported that in United States, there were cases where rooms were causes of sickness where housekeeping staff was not properly doing their job (Conrad,2008). In New York, during an inspection it was observed that a hotel room was infested by bed bugs, mice and other vermin (Riverside Studio, 2009). Studies carried out in other parts of the world have demonstrated that hotels often lack a good hygiene level. Carelessness of workers lead to food contamination and other infections. However our country is not the best compared to them. This study is being carried out to investigate the level of hygiene in our medium size hotels of Mauritius. AIMS AND OBJECTIVES Aims of the study The aim of the study is to assess the level of hygiene present in medium size hotels of Mauritius. Food handlers are to be assessed concerning food hygiene practices in food processing area. Housekeeping staffs are to be assessed about the importance of hygiene in rooms and also evaluating the level the knowledge of workers concerning communicable diseases. Recommendations were also made for improvements. Objectives of the study The objectives of the study are to: Taking a sample size of at least 50 hotels around Mauritius to have an overview evaluation of the level of hygiene over the whole island. Carry out a survey for my personal view of hygiene in hotels. Carry out a second survey to assess the knowledge of workers about hygienic importance in their working place Compare the sanitary facilities available in these hotels to the law requirements. Analyse the data and to make propose recommendations for improving the level of hygiene and the sanitary facilities available. CHAPTER 2 LITERATURE REVIEW Hygiene Hygiene is described as the science of preserving health in connection to cleanliness. It compromises all those measures necessary to detect and prevent infection and intoxication which may be harmful to health. The aim of a good hygiene is to provide consumers with both a good service and safe food. It involves all measures directed to ensure a safe and good quality product and service. Hygiene is an important factor in a business as it helps to protect and also promote ones reputation. In order to have all these, it is a must to comply with all Acts Regulations made in the law (schurmann,2008). Food poisoning Food poisoning is one result of poor hygienic practices. We are surrounded by tiny living organisms that cannot be seen without a microscope. These organisms are called microorganisms. Some are harmless whereas those which are harmful are called pathogens. They are found everywhere. An example is Staphylococcus aureus living on the skin as a normal flora. The same bacteria if in contact with food, can cause food poisoning. This is one of the most common food poisoning bacteria. Another example is E.Coli living naturally in our intestines for breaking down of food, but when in the urinary tract, it causes serious infections (Frazier W, 1995). Contamination can be made by different bacteria such as Bacillus cereus, Clostridium perfringens and Clostridium botulinum. The symptoms arising when consuming food harboring these harmful bacteria are familiar to most people. They are namely vomiting, headache, abdominal pain and diarrhea. There is loss of fluid through vomiting and diarrhea in most severe cases. Those who are more prone to such risk are youngs and elderly or already ill people. Therefore sanitary conditions play an important role in preventing such disease to happen. Necessary precautions must be taken at all stages in food preparation and most important when this concerns bulk production of food as in hotels (JFraser,Microbiology Book). To prevent food poisoning there are three main things that can be done: stop the bacteria from multiplying by : Bacteria reproduce very if they get suitable conditions: moisture, food, warmth, and time Therefore it is important to prevent such conditions by using proper storage. stop bacteria getting onto the food Keeping food covered Handling food as little as possible Keeping raw and cooked foods separate Keeping animals and pests out of the kitchen Disposing of rubbish in covered bins destroy the bacteria in the food only a few bacteria are able to survive temperatures higher than 70o C. This is why it is important to cook food thoroughly. Food such as meat and vegetables should be chopped into small pieces to ensure cooking. Food that is reheated, should be used only once. The left overs should be discarded. Frozen food should be well defrosted before cooking as it may happen that inner part remain uncooked. Food borne diseases Food-borne disease arises when contaminated food is ingested containing a pathogen. This pathogen causes problems only because of the fact that it reproduces inside the human body which provides all necessary factors for its development. Poor food handling and bad sanitation practices are commonly the cause of food-borne diseases in food establishments. One example is the gut bacteria Escherichia coli causing food-borne disease. It may be present through faecal or other source of contamination. E.coli caused 20 deaths and 200 other cases in Lanarkshire, Scotland in 1996 which needed to be treated during the outbreak. This bacteria is particularly dangerous because few bacterial cells, possibly 20 minimum need be ingested by a person to cause severe symptoms( Maff, 2000). A study carried out in Mekelle Town in Ethiopia to determine the sanitary conditions in 420 establishments including small hotels showed that latrines, hand washing basins, proper type of solid waste disposal and tap water were available at 96.9% , 57.1 % , 39.2% and 93.6% respectively. Proper dish washing and food storage practices were observed at 46% and 52% respectively. But poor personal hygiene among the workers and food handlers were observed. Staphylococcus aureus and E.Coli were found in utensils at a high level which can only result from poor hygienic practices of the workers. (Ethiop.J.Health Dev. 2007). It was observed that sanitary conditions were maintained but however there were conditions where there was non adherence in workers. Our country is not an exception to such food-borne outbreaks. The sanitary inspectors of the Ministry of Health are here to give support to avoid such problems. Water borne diseases Water contamination is common worldwide. The category affected is mainly young people and elders having a poor immune system. A study was carried out in India about the water hygiene behaviours in hotels and restaurants few years ago. It showed that contamination in drinking water is made by man and usually due to improper storage, handling and serving which leads to serious water borne diseases. It has been noticed that in a drinking water sample of 340, 69.1% were non-potable water and 73.2 % had presence of E.Coli due to human faecal matter. Causes to this outbreak were poor hygiene behaviours, storage and handling practices which was known to deteriorate the water quality. This could have been improved by educating the workers and food handlers in these hotels and restaurants. This can result to illness of mainly diarrhoea and vomiting, whereas other symptoms include fever, abdominal pain, headache and giddiness (Pubmed,2003). General sanitary requirements in hotels People normally visit a hotel for short-term basis. There is a continuous flow of incoming and outgoing people. Different people from different countries stay in same room. Therefore rooms must be well sanitized and disinfected after each visit. Aeration and ventilation is important. Cleanliness and sanitary practices play an important role in maintaining this balance. It helps to prevent the spread of diseases and parasites not only to tourists but also our general population. Hotels are therefore inspected to make sure that it copes with the law and that they operate safely following the Health Codes (Lockyer,2003). Points that are inspected and controlled for aiming a good cleanliness and soundness of building facility are : Absence of pests such as rodents and insects Proper handling and storage of trash Proper laundering of bed linens and bed Proper washing of utensils such as plates ,cups and glasses No hazards due to infrastructure of building facility Cloakroom accommodation for staffs Proper services such as power, heat, water General maintainance of area to eliminate potential breeding places for mosquitoes or other vectors No domestic animals in area Fire safety and emergency exits Good hygiene rules Consumer satisfaction is prior to all. Thus a good service and hygienic food and water are important. Rooms should be well maintained. Housekeeping department plays an important role. It is the backbone of any good hotel. Employees of housekeeping department are made responsible for maintenance, as they have to visit each room every day to set the room for same the guest or the next guest. During their routine visit, they check all the possible electric point, water points, gadgets, while replacing linen, soap, shampoo, towel, etc other important factors are listed below. Sanitary design premises should be assessed and designed in such a way to reduce health hazards. Personal Hygiene and Food handlers One must be educated about hygiene and to start oneself should be hygienic in all aspects and should possess a food handlers certificate. Cleanliness Working environment should be maintained clean. There should be a high standard of cleanliness, most important for those handling food stuffs. Awareness knowledge of hygiene practices in work place, communicable diseases awareness. Hands Skin Hand is the main route for contamination. Therefore to avoid food poisoning bacteria to get in contact with food, water and soap must be used for washing time to time. Mouth, nose ear it is the route for staphylococcus bacteria to enter food through coughing, sneezing and scratching. Therefore necessary precautions should be taken be avoid these during food preparation. Sanitary conditions in restaurants A good hygiene is required in food premises to make sure food is safe. It prevents food poisoning and prevent spreading of any communicable diseases resulting from careless personnel or caterers handling food stuffs. Rules such as Cleanliness, Cooking, Chilling and Cross Contamination should be well observed while handling food. Food safety and hygiene practice using Hazard Analysis Critical Control Points (HACCP) is recommended by WHO and FAO to maintain a good quality of food and services (Silva, 2001). Trained personnel should preferably be employed. Facilities such as proper dustbins, wash hand basins and toilets should be made available for the workers. Points that should be observed in aiming a good and safe food hygiene are: ood handlers Certificate Floors (smooth clean) Ceilings / Walls maintained properly Utensils properly washed sterilized Proper sanitary design of kitchen Fly proof and rodent proof Storage accommodation of foods Disposal of waste (Solid and Liquid) Drainage system Wash hand easily available Good aeration / temperature /Humidity Work area spacious enough for workers Showers facility for workers(Working Day / Night) Hygiene in kitchen All employees working in food premises either in the task of preparation, handling or serving food should possess a food handler certificate after having followed a medical inspection by a doctor. They should have a satisfactory knowledge of hygiene and cleanliness and be aware of possible problems caused of improper food handling. Health education plays an important role in promoting food and personal hygiene. All staffs should be given appropriate training. Health inspectors have an important work in providing health education by promoting awareness of dangers of food poisoning and poor hygiene practices Medical certificate The law states that every food handler involved in food business should be in possession of a valid medical certificate. This food handler certificate is issued by a G.M.O and is valid for only 3 years and has to be renewed each year. This certifies that its owner is in good health and is not suffering from any communicable diseases (Food Regulation, 1999) (refer to Appendix 2). Obtention of medical certificate The person has to call at the Health Office of the Ministry Of Health of his region with his national identity card and with two photo passport. An appointment is given for a session of talk on hygienic practices and after due accomplishment, the latter is examined by a Regional Public Health Superintendent (RPHS). Thereafter if the person is observed to be in good health, the certificate is obtained(Food Regulation,1999) Working environment The standard of cleanliness of factory and its workers is a reflection of the standard of efficiency of management and the morale of the working population. Provision has been made in the Occupational Safety and Health Act 2005 concerning welfare of workers and overcrowding in place of work. It says that a place of work shall not be overcrowded as it can cause risks of health injury of the employees. It is mentioned that the space allowed shall not be less than 11 cubic metres per workers (OSHA, 2005, Appendix 3). Kitchen is an example where there is often overcrowding of workers in hotels. Smoking The personnel should be well educated and trained about hygiene in a workplace. Employees should not smoke during work, mainly during preparation of food or while handling any food stuffs or utensils. Smoking is prohibited by law in any public places and moreover smoking in a food preparation area can pass diseases from an individual to another. Customers also can be contaminated. Smokers can transfer harmful bacteria from their mouth to food and thereafter, consumers of these foods may ingest these bacteria in turn. These bacteria can be harmless on the carrier but harmful to another person. Communicable diseases Any person suffering from a communicable disease, boils, sores, acute respiratory infection or bleeding wounds should not be allowed to work in any food premises. A list of these diseases is listed in (Appendix 4). All communicable diseases should also be reported to the Health Offices for treatment. Therefore all employees should possess their food handler certificate and renew it every year by a doctor to ensure that safe food and services are provided to customers. The law has made provisions concerning infectious or communicable diseases. It is said that the occupier of any premises in which a patient resides shall give notice to Sanitary Authority or if visited by a medical practitioner and it is confirmed that the patient is suffering from an infectious disease, health inspector of the region shall made aware of the existence of the disease , name of the patient, the situation of the premises and name of the occupier. (Public Health Act,Appendix 5). Preventing food contamination We should not forget the motto PREVENTION IS BETTER THAN CURE . Prevention of food contaminations is a must. Appropriate preventive measures should be taken. Employees should give attention to personal hygiene and the working habits in a hotel kitchen. Body should be kept clean by washing and bathing. Hands should be washed at least on every occasion when entering food preparation zone. Hands and arms should he washed thoroughly using soap and water after each visit to the toilet. Avoid use of common towel (use paper that are disposable). Wear clean and washable overall preferably white Keep hands away from mouth, nose ,hair ,ear while working Do not eat while handling food/ preparation Do not wipe hands on overall Use spoons, forks , tongs instead of hands in preparation Avoid useless blabbering while working Smoking, spitting should e avoided in working area Obey food safety signs Keep work area clean Staff facilities maintained in good hygienic conditions A research carried out in 2004 in a popular hotel of Egypt after a major outbreak of Hepatitis A where 351 tourists was contaminated showed that there was poor sanitation, no proper health education and medical examination. An infected worker with imperfect hand hygiene and who was in contact with sewage-contaminated water was the source of this huge outbreak. (Eurosurveillance, 2006) Concerning food safety, the WHO has initiatives for surveillance programme with objectives of a development of an international food safety network, application of HACCP and development of a safety information system. (WHO, 2004). Storage of food Food storage is important industrially. Hotels prepare food for hundreds of persons daily. Therefore a good storage system is necessary. Area should be pest proof, warm, clean and not humid. There are three main categories of food requiring different storage methods. Dry food should be kept in a warm place and not humid to avoid spoilage by microorganisms growth. Chilled food should be stored at an appropriate low temperature, and precautions should be taken in case of electricity cut. Canned food should be verified before using. Stock rotation is important concerning canned products. It is important that you rotate and use your food storage (Caldwell M, 2006). Storage of water An ample supply of water should be provided with adequate facilities for its storage and adequate protection against contamination. Water is used both in food preparation and rooms for toilets and bathrooms. Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to people with poor immune system. A study conducted in United States described how gastroenteritis is a common outbreak in hotels. Unsteady state flow and stagnation in distribution systems affect the biological stability of drinking water which promotes bacterial accumulation (Dippold L et al, 2000). Therefore it is important that tanks are fitted tightly with lids and that they are regularly cleaned and sampled for chemical and bacteriological analysis. Cleaning frequency is an important factor. The tanks should be verified in case of rusting of any parts and dates should be noted at each cleaning done. (Logan G, 2008). Tanks should be cleaned at least once every trimester for proper maintainance to avoid microorganism proliferation. Waste disposal A hotel can be considered as a microcosm in itself having the potential of producing all kinds of waste that is hazardous. Hazardous waste comes in many different shapes and forms: it can be liquid, solid, gas or sludge, and more often it is poured down sinks directly or discharged to regular waste stream (Patel A, 2008). The types of waste generated in hotels and their sources are listed below. However there are two main types of hotel waste, solid(dry),known to be non-biodegradable and liquid(wet),biodegradable wastes. The risk and problem that arises are odour, unaesthetic and it acts as breeding place for vector of diseases (flies, rats, rodents), thus a nuisance to health (Wagh V, 2005). Solid waste Solid waste is described as materials of no longer value and which is not meant to be discharged through pipe. These dry wastes comprise of plastic bottles, papers, plastic wrappers, HDPE bags etc. These wastes should not be mixed with the wet waste which may produce bad odor and dirty look. They should be disposed in dry places for storage until collection is done (Wagh V, 2005). Liquid waste Liquid waste is simply discharged in sinks. Wet waste comprises of food and vegetable. Most hotels kitchen sinks are fitted with a garbage disposer (garburator) which is a device installed under the kitchen sink between drain and pipe which shred waste into pieces enough to pass them through plumbing. Grease traps are also fitted to prevent drains to be blocked from fats, oil and grease. Some hotels also provide septic tanks to avoid potential problems that may occur in case there is blockage of main sewage pipes provided by the Government. Elimination of mosquito breeding places The hotels management does the necessary to avoid spreading of diseases. Potential breeding places for vectors are eliminated by draining all roofs water accumulation at least twice a week and insecticides are sprayed. All ponds and garden water are regularly checked and all bottles or containers are removed and bushes like the grass are well maintained. The Ministry Of Health also provide services for spraying insecticides on a regular basis (MOH, 2009 Health surveillance of tourists Tourist can be responsible for spreading of diseases. One recent case notified was in 2009 where the first case of H1N1 flu virus was detected in a French tourist. The Ministry Of Health has provided officers for this specific duty. Health surveillance Officers are responsible to contact every incoming passengers in order to know their health condition on arrival to Mauritius. The hotel management plays an important role as they need to report any kind of communicable diseases occuring in their residence (MOH Health, 2009). The Ministry Of Health has a list of infectious and communicable diseases that are controlled closely as shown in (Appendix 4). CHAPTER 3 : METHODOLOGY Methodology A survey was carried out and two questionnaires were designed where one was for personal view and opinion about the working place and food handlers and the second, to assess the workers and their knowledge to food hygiene.50 hotel in all were chosen throughout Mauritius. Random selection will give a broader view of hygiene in hotels around the island. List of hotel was obtained from the Tourism Authority at Port-Louis and some details obtained at the Municipality and Health offices. The Questionnaires Questionnaire for Personal View of Foodhandlers, Checklist for Kitchen and environment (room, garden, Swimming pool). (Appendix 6) Questionnaire for personal hygiene for the workers (Appendix 7) The questionnaire (Appendix 6) is a checklist concerning the number of workers, personal hygiene at sight, state of preparation area and toilet in the hotel kitchen. The workers who were pointed were mainly cooks, waiters and maids who work in hotel restaurant. A walkthrough was done where access was granted by the management in the kitchen to assess the level of hygiene of the workers and to inspect if they practice personal hygiene. The toilets were also seen and mess rooms. The second part of the questionnaire was dedicated for rooms and the environment such as garden. Points that were observed during the walkthrough inspection were: No of Personnel Sanitary conditions Water availability Lighting Ventilation Refuse disposal Toilets and bathrooms The second questionnaire was designed for food handlers to assess their knowledge about hygienic practices and food poisoning. CHAPTER 4: RESULTS Results and Findings Possession of food handlers certificate among workers General personal hygiene among workers The below bar chart shows the general personal hygiene maintained among workers at work and it can be concluded that 98% of them keep their hands clean, 94% keep their fingernails clean, 75% have their hair covered, 100% keep their body clean. But it could also be observed that only 25% of them keep their overall clean and 13% of them had nail varnish. Wall conditions of kitchens The wall conditions of the kitchens were surveyed and was found to have the following structures ; 82% of them are waterproof, 88% can be observed to be clean, 93% are washable, 82% are without crevices, 94% are painted white and 86% of them are tiled up to 2 meters from floor. Ventilation From figure 6, it can be seen that 83% of the hotels had adopted a good ventilation system using air conditioner for ease of workers while 17% of them did not have appropriate ventilation system. Lighting Figure 7 describes the lighting condition in the preparation area. 78% of the hotels were seen to provide a good lighting system for the workers and 22% had lighting system not satisfactory. Provision for refuse disposal Refuse disposal availability was surveyed and was found that 50% had foot operated pedal bins,70% of the garbage bins were cleaned and disinfected regularly,75% had their bins covered while 95% removed them daily. Room management Room conditions were observed to be at 72% satisfactory. 28% was seen to have a bad room management. Frequency of changing Blanket on bed From Fig 10. it can be observed that 80% of hotels changes bed blanket regularly,5% on a weekly basis and 15% when it seems necessary to do so that is when seen dirty. Bathroom and toilets sanitary conditions From the result obtained during the survey, it has been found that toilets and bathrooms in rooms are at 70% and 75% clean respectively. . Detergents Distribution The figure below gives detail of the type of detergents commonly used in hotels for sanitizing and cleaning purposes and their percentage used. Knowledge of food poisoning During the survey it was observed that only 40% of workers interviewed had a satisfactory knowledge of food poisoning and answered yes to the question whereas the other part could not give explanation food poisoning. Validity of food handlers certificate Professional training by employer From the survey carried out among workers, it was found that among the 70% of workers who were in possession of a food handlers certificate, only 55% of them were valid while 15% of them were