Food Control xxx (2016) 1e6

Contents lists available at ScienceDirect

Food Control
journal homepage: www.elsevier.com/locate/foodcont

Development of conscious food handling in Hungarian school

cafeterias
Andra
th a, b, *, Zolta

s J. To
n Koller a, Csaba B. Ille

s b, Andra

s Bittsa

nszky a
a
InDeRe Institute for Food System Research and Innovation Nonprofit Ltd, Feh

ri út. 132-144, 1116 Budapest, Hungary
erva
b
n University, Department of Business Economics and Management, Pa
Szent Istva
ter Ka
roly u. 1, 2100 Go
€ do
€llo
}, Hungary

a r t i c l e i n f o a b s t r a c t

Article history: The last steps of food chain are particularly important, because this is when the food products reach the
Received 14 June 2016 consumer. In the catering sector, the responsibility of food handlers are very high in the prevention of
Received in revised form foodborne diseases. In this situation, the food handler's work must be conscious. This paper focuses on
7 September 2016
the issue of consciousness in food handling, which is the relationship between the level of knowledge
Accepted 8 September 2016
Available online xxx
and the implementation of right practice. The aim of this study is to establish a special food hygiene
training model and measure its efficiency. The essence of the training model is to increase the con-
sciousness of food handlers.
Keywords:
Food hygiene
Food hygiene training was tested at 33 school kitchens, where 145 staff participated. The program
Training method lasted for 6 months. Theoretical knowledge was evaluated, using self-administered tests, and food
Food handlers handling practice was measured through observation. Results before and after the intervention program
School canteens were compared.
Consciousness Deficiencies in hygienic knowledge and in food handling practice were identified in seven areas.
Food safety Significant increases were observed in theoretical knowledge in the areas of receiving (33.5%) and food
waste (11.7%). With regards to the food handling practice, some remarkable positive changes were
observed in the fields of storage (33.3%), dishwashing (24.7%), and cleaning (22.0%). Dishwashing, per-
sonal hygiene, and cleaning were the areas where such increases were observed, both in their knowledge
and practice, that is, consciousness was increased in these areas.
The parallel development of hygienic knowledge and food handling practice increased the con-
sciousness in food handling, which is indispensable for ensuring safe food practices. Increasing con-
sciousness make good practice instinctive in everyday work.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction
Foodborne diseases caused by hygienic contaminations or in-
fections are significant in the catering sector. These types of dis-
eases have considerable effect on the morbidity and mortality
indices worldwide (McIntyre, Vallaster, Wilcott, Henderson, &
Kosatsky, 2013). In the contract catering sector, the responsibility
of food handlers is crucial with regards to the supply of hygienic
and safe foods (Greig, Todd, Bartleson, & Michaels, 2007). It is
estimated that food handlers are responsible for 97% of all out-
breaks of foodborne diseases in the catering sector (Egan et al.,
* Corresponding author. InDeRe Institute for Food System Research and Innova-
tion Nonprofit Ltd, Fehe
rva

ri út. 132-144, 1116 Budapest, Hungary.

th).
E-mail address: andras.toth@indere.hu (A.J. To
2007). Food handlers' hands may be the carrier for harmful mi-
croorganisms, and thus may cause cross-contaminations or spread
harmful microorganisms due to possible gastro-intestinal infec-
tious diseases of the food handlers (Abdul-Mutalib et al., 2012).
Moreover, they will stay away from work less in case of illnesses
when compared to the workers in healthcare, although the risk of
spreading infections is similarly high in food handling (McIntyre
et al., 2013). Occurrence of infections caused by microorganisms
can be reduced through appropriate personal hygiene, including
hand hygiene.
It has been observed that despite the regular food hygiene
training of food handlers, incidence of foodborne diseases is still
significant. This was caused mainly by inadequate food handling
practices. Knowledge obtained is often not applied in practice
(Ehiri, Morris, & McEwen, 1997). Although several reports indicate
towards the failure of formal courses, researchers uniformly

http://dx.doi.org/10.1016/j.foodcont.2016.09.011
0956-7135/© 2016 Elsevier Ltd. All rights reserved.

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
2
th et al. / Food Control xxx (2016) 1e6
A.J. To
conclude that food hygiene education programs should be
encouraged (Seaman & Eves, 2006). Several reasons may be why
training programs are not effective. In several countries, the
implementation of regular food safety training programs for food
service workers is obligatory, however, its effectiveness are not
evaluated, and food handlers are not motivated to apply their
gained knowledge in practice (Park, Kwak, & Chang, 2010; Seaman
& Eves, 2010). Thus, there is a need to increase the efficiency of
trainings. An efficient training program should focus not only on
theoretical knowledge but on food handling practice as well
(Soares, García-Díez, Esteves, Oliveira, & Saraiva, 2013).
In Hungary, 17 outbreaks and 1467 cases were reported in the
contract catering sector in 2014, which is extremely high compared
to the previous years (2013: 702 cases; 2012: 519 cases). Data from
previous years show an increasing tendency about the number of
reported cases in contract catering sector (National Food Chain
Safety Office, 2014).
In Hungary, the daily intake of primary school children should
be 2200e2500 kcal containing different types of nutrients and 60%
of that is consumed during school time when children take three
meal at the school. During the most active years of their physical
and mental development, children's nutrition is consigned to the
service of catering company. Moreover, their immunity is lower
compared to adults, so risks of food borne disease are significantly
higher. Therefore, school catering is considered to be of great
importance worldwide. Healthy nourishment of children is bene-
ficial, not only for their physical development but also for their
cognitive abilities and behaviour (Ca
mara, Amaro, Barber
a, &
Clemente, 2005; da Cunha et al., 2013; Garayoa, Díez-Leturia,
Bes-Rastrollo, García-Jalo
n, & Vitas, 2014). In Hungary, the direct
costs of school meals are paid by the parents, but the additional
costs are paid by the owner institutions. Based on specific social
circumstances, parents may apply for state support for daily school
meals.
School meal services often operate from serving kitchens.
Serving kitchens are characterized through their isolation, where
there is no daily contact between the individual kitchens, and
consequently, the exchange of knowledge, where the development
of skills can be deemed as occasional. In case of cooking kitchens,
the outlook of the catering managers is significantly better and
more conscious (Wilson, Murray, & McKenna-Black, 2001). In
Hungary, professional qualifications are not a prescription for
serving kitchen staff, and therefore, risks arise from a lack of
knowledge, which significantly affects this field.
For risk reduction in a food service facility it is not enough to
improve physical facilities, but human resources should also be
improved (Garcia Martinez, Poole, Skinner, Ille
s, & Lehota, 2006).
Improving food safety means improving the food handlers'
behaviour (Yiannas, 2009, pp. 39e47).
The aim of this study is to evaluate the knowledge, attitude, and
practice (KAP) of the food handlers in Hungarian school catering
sector. Furthermore, this is required to develop and implement a
systematic training program based on the results of this evaluation,
and to measure the efficiency of the program as well. The research
Table 1
Phases and schedule of the training project.
Phases Knowledge
1. Knowledge survey
2. Theoretical and practical knowledge
3. Theoretical and practical knowledge
4. Theoretical and practical knowledge
5. Theoretical and practical knowledge
6. Knowledge survey

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
focuses on the issue of consciousness, and its effect on food safety.
2. Materials and methods
The project was carried out in 33 school kitchens of Budapest,
Hungary. The kitchens were being operated in primary and sec-
ondary schools. The schools were selected from almost all districts
of Budapest. Forty schools were selected, and 33 agreed to take part
in the intervention program. Out of them, 13 were cooking kitchens
and 20 were serving ones. At these cooking kitchens about 7e9
workers were employed, while the serving kitchens had about 1e3
workers. About 9000 portions were served at the 33 kitchens each
day. At the cooking kitchens, meals were prepared on the spot,
while, at the serving kitchens meals were delivered, and only ser-
vice was carried out on site. HACCP system was already imple-
mented in all units.
In the preparatory phase, the observation points for food
handling practices and a questionnaire for knowledge assessment
were defined. Expert group were set up with three food safety
engineers and three food hygiene and HACCP advisor, where all of
them had more than 10 years' work experience. The expert group
was trained for one week before the intervention program. Moni-
toring teaching and training were provided by them. The duration
of the project was 6 months, and kitchens were visited 6 times
altogether, once per months. The first visit was intended to assess
the situation at the school canteens. Education and training was
done during four visits, and an evaluation of the intervention
program was scheduled at the 6th visit (Table 1).
2.1. Assessment and development of theoretical knowledge
To assess the theoretical knowledge, multiple choice tests (true-
false or selecting from 4 or 5 answers) were applied (Questions are
listed in Supplementary material 1). The questionnaires were
developed, based on previous works (Jevsnik, Hlebec, & Raspor,
2008; Pichler, Ziegler, Aldrian, & Allerberger, 2014; To
th &

nszky, 2014), and on the content of Good Hygienic Protocol
Bittsa
effective in Hungary (Zoltai et al., 2013). The questionnaire
comprised of 34 questions related to 7 subjects (Table 2). Additional
information related to the respondent's gender, age, qualification
and number of years in a food business were also collected. Results
were given as a percentage of the maximum scores (34 ¼ 100%).
Questionnaires were evaluated by the experts and previously
tested at 3 kitchens by 26 food handlers. We tried to schedule test
writing sessions (1st and 6th visits) for afternoons, in order to avoid
necessary interruptions in the working processes. Storage was
evaluated only at the level of cooking kitchen workers (n ¼ 99).
2.2. Assessment and development of practice
The practices used at the kitchens were evaluated with the aid of
a checklist (Supplementary material 2) filled by food hygiene ex-
perts on the spot. Information was collected through direct obser-
vation. The checklist was developed based on previous works (da
Practice Theme
Practice monitoring Monitoring and survey of deficiencies
training Dishwashing, cleaning and food waste
training Receiving and storage
training Distribution and personal hygiene
training Monitoring and eliminating residual deficiencies
Practice monitoring Monitoring and survey of improvement

th et al. / Food Control xxx (2016) 1e6
A.J. To 3

Table 2
Subject matters and the number of questions in the questionnaire for surveying theoretical knowledge and in the checklist for the assessment of food handling practice.

Fields of survey Test for theoretical knowledge Checklist for practice

Number of questions Scoring Maximum points Observed scores Scoring Maximum points

Dishwashing 8 0/1 8 2 1e10 20

Cleaning 4 0/1 4 3 1e10 30
Personal hygiene 3 0/1 3 3 1e10 30
Receiving 3 0/1 3 4 1e10 40
Distribution 5 0/1 5 9 1e10 90
Food waste 3 0/1 3 5 1e10 50
Storagea 10 0/1 10 4 1e10 40

Evaluation (min-max) 34 0e34 34 30 30e300 300

a
Storage was observed only at the cooking kitchens.

th & Bittsa
Cunha et al., 2013; Liz Martins & Rocha, 2014; To
nszky,
2014). The observation points were divided into the same the-
matic areas like in the knowledge questionnaire. The checklist
consequently comprised of 30 points of observation (Table 2). The
observed points were scored by the experts on a ten-point rating
scale (minimum ¼ 1; maximum ¼ 10), and the results were eval-
uated as percentages of the maximum score (300 ¼ 100%). Storage
was evaluated only at the cooking kitchens (n ¼ 13).
maid.
HACCP training is compulsory for food handlers each year. It is
usually done by an instructor in a classroom, where in the end,
handouts are delivered and written examinations are organized.
These sessions usually do not contain practical education, there-
fore, they are more about education and not about training
(Yiannas, 2009, pp. 39e47). For semi-skilled food handlers, this is
the only source of food safety knowledge.

2.3. Training sessions 3.1. Identification of deficiencies in theoretical hygiene knowledge

Time span of the training sessions (2nde5th visits) was a
maximum of 2 h each, and the points of time for training were
previously agreed upon. Checklists and questionnaires were filled
in during the first visit, and they revealed the strengths and
weakness. The topic of the training sessions focused mostly on the
weaknesses. Each training session had a special topic (Table 1).
Training was instructed by a food safety expert, where the workers
were trained through personal communications. We considered it
important that trainings should not be too long, and various in-
adequacies should be discussed with the food handlers on spot
(Rennie, 1994; Seaman, 2010; Worsfold, Griffith, & Worsfold, 2004).
2.4. Data analysis
For statistical calculations, Microsoft Excel and IBM SPSS for
Windows software packages were used. Mean values of the the-
matic areas and 95% confidence intervals of the results were
demonstrated. Results both before and after the intervention pro-
gram were compared. Student's t-test was used to determine
whether there was any significant difference between knowledge
and practice both before and after the intervention. Differences
were considered to be significant at p < 0.05.
(results before intervention program e knowledge)
The results related to theoretical knowledge were summarized
in Table 3. Data analysis revealed that in less complex modules (e.g.,
personal hygiene), kitchen workers performed better, and in the
areas that were characterized by many components (e.g., receiving)
their performance was poorer. This observation is consistent with
the literature (Abushelaibi et al., 2015; Pichler et al. 2014; Walker,
Pritchard, & Forsythe, 2003).
Receiving proved to be the most problematic area. Upon the
receipt of goods, traceability and supervision of adequacy became
of utmost importance. Arrival of inadequate goods meant signifi-
cant food safety risks, and without adequate administration, the
failure could not be eliminated later.
In the area of distribution, the uncertainty of food handlers with
regards to the periods of edibleness and storability was apparent. In
certain cases, the rules were too strictly maintained. In many cases,
however, the risks caused by inadequate reheating would be dis-
regarded, as it was also observed in the literature. (Osaili et al.,
2013; Walker et al., 2003).
3.2. Identification of deficiencies in food handling skills (results
before intervention program e practice)

3. Results and discussion The results related to hygiene practice are summarized in
Table 4. In food handling practice awareness was seldom to be
A total of 145 food handlers filled the knowledge test both
before and after the intervention program. People who filled only Table 3
one test were excluded from the data analysis. At the cooking Results of knowledge (n ¼ 145) before and after the intervention program. Means in
the percentage of food handlers (and 95% confidence interval of the difference) are
kitchens 99 people participated, while, at the serving kitchens, 46
indicated.
food handlers took part in the program. A great majority of these
workers (85%) were women. The age of 75% of the food handlers Factors Before training After training

was above 40 years. Seventy-four percent of the workers did not 1. Dishwashing 64.8 (61.4e68.2) 72.8 (69.2e76.4)a
have any qualifications related to the catering sector, and 40% 2. Cleaning 78.7 (75.0e82.4) 86.0 (82.7e89.3)a
3. Personal hygiene 80.6 (76.5e84.6) 88.4 (85.3e91.5)a
workers had work experience of less than 1 year in this field. Before
4. Receiving 49.5 (45.6e53.4) 83.0 (76.3e89.6)a
the first survey, all workers participated in regular food hygiene 5. Distribution 73.3 (70.2e76.5) 77.7 (74.5e81.0)
training. On the cooking units four different kind of jobs were 6. Food waste 78.1 (74.1e82.2) 89.9 (86.9e92.9)a
assigned: catering manager, cook, storekeeper and kitchen maid. 7. Storageb 61.9 (59.2e64.6) 63.6 (60.4e66.8)
On serving units, only the kitchen maids were employed. There is a
Change is statistically significant at p < 0.05.
b
no educational requirement to work as a storekeeper or kitchen Storage was analysed only at cooking kitchens (n ¼ 99).

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
4
th et al. / Food Control xxx (2016) 1e6
A.J. To
Table 4
Results of practice (n ¼ 33), both before and after the intervention program. Means
in percentage of kitchens (and 95% confidence interval of the difference) are
indicated.
Factors Before training After training
1. Dishwashing 53.2 (48.5e57.9) 76.4
2. Cleaning 74.2 (70.3e78.2) 88.9
3. Personal hygiene 77.3 (73.2e81.4) 88.8
4. Receiving 81.2 (78.0e85.7) 90.0
5. Distribution 71.9 (67.6e76.2) 90.0
6. Food waste 77.6 (67.4e87.7) 79.4
7. Storageb 57.7 (47.5e67.9) 88.5
a
Change is statistically significant at p < 0.05.
b
Storage was observed only at cooking kitchens (n ¼ 13).
found even if any procedure was carried out in compliance with the
regulations. It was assumed by food safety experts that in several
cases food handlers acquired their food handling practice at home,
and used it as part of their daily routine.
In the area of dishwashing, the adequacy of the facilities was
mostly deficient. Antibacterial sponges were used only at a few
kitchens. Plates, utensils and trays were dried several times with
textile kitchen-cloth. Great deficiency were observed in the sepa-
ration of cleaning tools and in the proper dosing of detergents. With
regards to personal hygiene, uncertainty appeared while wearing
jewellery and watches. Most of the workers kept the working area
clean, washed their hands before starting work, but wiped their
hands several times on their apron or their body, wore jewellery,
used the kitchen towels for other purposes than those meant for.
The use of hand jewellery increased the bacterial count on the
hands. However, this wrong practice can be eliminated through
training and control (Acikel et al., 2007).
They were aware of the correct course of hand-washing, but the
necessary facilities could not be found at the washbasins in the
preparatory premises, therefore, it can be supposed that after
certain working processes (e.g., preparation of meat), they did not
wash hands. Similar observations are reported in the literature
(Abdul-Mutalib et al., 2012; Dworkin, Udompat, Panchal, & Liu,
2011; Tan, Bakar, Abdul Karim, Lee, & Mahyudin, 2013).
Characteristic deficiencies in the area of receiving included
misuse of thermometers, contingency of temperature measuring,
and the absence of appropriate administration. Workers com-
plained about the shortness of time. In the field of distribution, the
workers disregarded the temperature of meals, and paid little
attention to measuring the temperature. Similar problems emerged
in the USA as well (Panchal, Liu, & Dworkin, 2012). Before the
intervention, workers generally did not know, and did not control
the temperature of food. Due to the lack of supervision, reheating (if
necessary) did not take place. As for the phase of serving, workers
took into consideration the number of consumers and started to
serve meals sooner, and therefore, hot meals got cold quickly.
As for the food waste, the lack of knowledge in the unavailability
of technical conditions raised some problems. Characteristic defi-
ciency in the improper storage of food waste until delivery was
noted (refrigerated storage was not available at any kitchens). De-
ficiencies were often found in the administration. Food waste
management was also found to be one of the most problematic
areas earlier (da Cunha et al., 2013; Lockis et al., 2011; To
th &
Bittsa
nszky, 2014).
In the field of storage, the greatest deficiencies were found in
appropriate labelling. Inspections by the authorities focused mostly
on this field, therefore, it was particularly important to comply with
the right practice. Storage, receiving and waste disposal are the
fields usually not prioritized by the food handlers (da Cunha et al.,
2013).

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
3.3. Results of knowledge and practice after intervention
Results on the theoretical knowledge and practice are summa-
rized in Tables 3 and 4 respectively. More significant improvements
were achieved in practice. Storage improved over 30% (mean) could
(70.8e82.0)a be achieved through the proper definition of appropriate labelling.
(84.9e93.0)a An improvement with a mean value of over 20% was measured in
(85.4e92.4)a
the fields of dishwashing and cleaning. In these areas, improvement
(87.0e93.0)a
(87.5e92.6)a was caused by the correct use of facilities, the correct calibration of
(69.3e89.5) detergents for dishwashing and cleaning, and the standardization
(79.3e97.6)a of the cleaning plan. Improvement with a mean value of over 10%
was measured in the fields of distribution, personal hygiene, and
receiving. In the areas of both distribution and receiving, mea-
surement and keeping temperatures, handing of goods and the
correct follow-up practice of these actions improved. While using
the facilities (e.g., core thermometer) and in the process of
administration (filling in the recording sheets for serving and
temperatures), developments were observed. Improvement below
10% was observed only in the area of food waste. Here, the de-
ficiencies occurred mostly due to local conditions. In this field, we
laid emphasis upon the separate physical treatment of food wastes
(collection leftovers at the consumer's sink, emptying wastes into
collective pots, washing up and disinfection of dishes, transporting
leftovers and documentation), and the execution of all these pro-
cesses were not possible in most kitchens.
As for the changes in theoretical knowledge, the most significant
results (improvement of 33.5%) were achieved in the field of
reception. It occurred due to the comprehension of the essence of
traceability, and for the theoretical attainment of compliance ex-
aminations. Results above 10% were observed in the field of food
waste, where we focused on the awakening of consciousness which
was related to the difference in the consumers' and plants'
pollution.
3.4. Consciousness in food safety
The theoretical basis of the intervention program included the
four stages of competence learning model (Flower, 1999). This
theory explained the stages of obtaining new skills. The first stage is
called unconscious incompetence, when a worker does not know the
task, and therefore, he/she does not know how it should be per-
formed. In other words, the workers do not know about what they
do not know. For example, many food handlers do not know the
difference between cleaning and disinfection, therefore, the
cleaning process would not be appropriate. Theoretical education
could be an effective tool to step forward. The second stage is the
conscious incompetence, when the worker knows what he/she has
to do, but still cannot perform it. For example, a worker learns the
difference between cleaning and disinfection but still cannot use
detergents and disinfectants correctly. Training and practice brings
the worker into the third stage, which is called conscious compe-
tence. At this stage, the food handlers know their tasks and perform
it well. For example the worker knows the difference between
cleaning and disinfection and uses the appropriate chemicals
correctly. If a worker performs their task several times, he/she
reaches the last unconscious competence stage. At this stage, the
worker does not think about how to perform the task properly. He/
she just does it. For example, when worker wash their hands after
toilet use. Usually, this process is unconscious at the kitchens. The
worker should reach an unconscious competence stage through
conscious competence. In this case, the workers are aware of the
significance and risks involved in their tasks, and they can perform
it quickly and accurately. Conscious food handling is of great
importance, especially when a worker has to solve uncommon
situations. However, it is often observed that workers actually

th et al. / Food Control xxx (2016) 1e6
A.J. To
know the task but performs it inaccurately. This may be caused by
frustration and demotivation, which is unfortunately a common
phenomenon in school kitchens. If we know something it is not
always equal what we do (Yiannas, 2009, pp. 39e47). The corre-
lation between the knowledge and practice of food handlers is
variable as demonstrated by others (Gomes-Neves, Araújo, Ramos,
& Cardoso, 2007; Han, Yang, Shon, & Rho, 2005).
Our assessment focused simultaneously, but independently, on
theoretical knowledge and food handling practices. The
questionnaire-based assessment revealed the food handlers'
knowledge, and the observations provided information about the
level of competence, both before and after the intervention pro-
grams. The consciousness and competence of food handlers were
changed during the intervention program (Tables 3 and 4). In the
areas of dishwashing, personal hygiene and cleaning the knowl-
edge and practice simultaneously increased. In the field of food
waste, the increase in knowledge was significant, while any
development of practice was observed in the areas of receiving,
distribution, and storage.
Education and training had to be systematically repeated, in
order to minimize foodborne hazards (Abdul-Mutalib et al., 2012).
Such educational topics are needed for stabilizing the food han-
dlers' knowledge in those fields, where their knowledge seems to
be deficient. At the same time, irrelevant information has to be
avoided, which would be regarded as a waste of time, and might
reduce their interest (Seaman, 2010). Knowledge deficiency of
kitchen workers is mostly related to handling ready-to-eat foods,
existence, and the reproduction of bacteria. Therefore, organizing
continuous supervision (monitoring) in this field is crucial (Tan
et al., 2013). Several factors influence the health conditions and
hygiene practices of catering units, therefore, the responsible per-
sons have to continuously provide monitoring, motivation of food
handlers, structural reforms, and quality assurance of both foods
and raw materials (da Cunha et al., 2013).
Workers had no possibilities to acquire appropriate practice for
their lack of trainings. Inspections were carried out at multiple
locations by the authorities, but these inspections focused only on
stopping the wrong practice, background knowledge, and answers
which are related to the whys and wherefores, which were not
considered to be important. So, the inspections carried out either
by the authorities or by internal staff member did not provide any
help or widen knowledge, but rather, examined and filled workers
with fear. This process resulted in the stage where the kitchen staff
made effort to meet with the requirements of authorities, but they
would not focus on lowering risk (Green & Kane, 2014). Managers
should recognize the significance of the systematic handling and
development of catering activities e and which activity can guar-
antee safe food production.
3.5. Observation on training courses
When specifying training topics, we took into consideration
those areas where theoretical knowledge and/or practice employed
were inadequate. The period immediately after the training pro-
gram is critical for acquiring new skills (Seaman, 2010), and
therefore, it must be considered that the time span between
meetings should be about 2 weeks for repetition and questioning,
while, in other cases, minimum of one month. It is necessary to
consciously establish contact between the operating management
and the personnel of the kitchens, and also to methodically arrange
for personal meetings. The survey and the series of trainings were
accepted at the kitchens with some reservations, but at the same
time, the program did not encounter any marked opposition. These
systematic and frequent visits helped in the acceptance of the
trainer and motivated food handlers (Bader, Blonder, Henriksen, &

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
5
Strong, 1978).
4. Conclusion
Consciousness is an effective tool to increase food safety levels
at the school kitchens. A conscious food handler will make less
mistakes, even in uncommon situations, and will solve the prob-
lems raised without any help. The most significant value of this
work is to increase the workers' commitment towards food safety,
as well as to develop the organizational culture of the catering units
in this particular direction.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://
dx.doi.org/10.1016/j.foodcont.2016.09.011.
References
Abdul-Mutalib, N.-A., Abdul-Rashid, M.-F., Mustafa, S., Amin-Nordin, S.,
Hamat, R. A., & Osman, M. (2012). Knowledge, attitude and practices regarding
food hygiene and sanitation of food handlers in Kuala Pilah, Malaysia. Food
Control, 27(2), 289e293. http://dx.doi.org/10.1016/j.foodcont.2012.04.001.
Abushelaibi, A. M., Jobe, B., Afifi, H. S., Mostafa, B.-E., Murad, A. A., &
Mohammed, A. K. (2015). Evaluation of the effect of person-in-charge (PIC)
program on knowledge and practice change of food handlers in Dubai. Food
Control, 50, 382e392. http://dx.doi.org/10.1016/j.foodcont.2014.09.013.
Acikel, C. H., Ogur, R., Yaren, H., Gocgeldi, E., Ucar, M., & Kir, T. (2007). The hygiene
training of food handlers at a teaching hospital. Food Control, 19(2), 186e190.
Bader, M., Blonder, E., Henriksen, J., & Strong, W. (1978). A study of food service
establishment sanitation inspection frequency. American Journal of Public
Health, 68(4), 3.
Ca
mara, F., Amaro, M. A., Barbera
, R., & Clemente, G. (2005). Bioaccessibility of
minerals in school meals: Comparison between dialysis and solubility methods.
Food Chemistry, 92(3), 481e489. http://dx.doi.org/10.1016/j.foodchem.2004.
08.009.
da Cunha, D. T., Fiorotti, R. M., Baldasso, J. G., de Sousa, M., Fontanezi, N. M.,
Caivano, S., … Camargo, M. C. R. (2013). Improvement of food safety in school
meal service during a long-term intervention period: A strategy based on the
knowledge, attitude and practice triad. Food Control, 34(2), 662e667. http://
dx.doi.org/10.1016/j.foodcont.2013.06.003.
Dworkin, M. S., Udompat, P., Panchal, P., & Liu, L. (2011). A comparison of overall
versus duty-specific food poisoning prevention knowledge among restaurant
food handlers. Food Protection Trends, 31(11), 664e671.
Egan, M. B., Raats, M. M., Grubb, S. M., Eves, A., Lumbers, M. L., Dean, M. S., et al.
(2007). A review of food safety and food hygiene training studies in the com-
mercial sector. Food Control, 18(10), 1180e1190. http://dx.doi.org/10.1016/
j.foodcont.2006.08.001.
Ehiri, J. E., Morris, G. P., & McEwen, J. (1997). Evaluation of a food hygiene training
course in Scotland. Food Control, 8(3), 137e147. http://dx.doi.org/10.1016/
S0956-7135(97)00005-4.
Flower, J. (1999). In the mush. Physician Executive, 25(1), 64e66.
Garayoa, R., Díez-Leturia, M., Bes-Rastrollo, M., García-Jalo
n, I., & Vitas, A. I. (2014).
Catering services and HACCP: Temperature assessment and surface hygiene
control before and after audits and a specific training session. Food Control, 43,
193e198. http://dx.doi.org/10.1016/j.foodcont.2014.03.015.

s, C. B., & Lehota, J. (2006). Food safety
Garcia Martinez, M., Poole, N., Skinner, C., Ille
performance in European union accession countries: Benchmarking the fresh
produce import sector in Hungary. Agribusiness, 22(1), 69e89. http://dx.doi.org/
10.1002/agr.20073.
Gomes-Neves, E., Araújo, A. C., Ramos, E., & Cardoso, C. S. (2007). Food handling:
Comparative analysis of general knowledge and practice in three relevant
groups in Portugal. Food Control, 18(6), 707e712. http://dx.doi.org/10.1016/
j.foodcont.2006.03.005.
Green, R. M., & Kane, K. (2014). The effective enforcement of HACCP based food
safety management systems in the UK. Food Control, 37, 257e262. http://
dx.doi.org/10.1016/j.foodcont.2013.09.016.
Greig, J. D., Todd, E. C., Bartleson, C. A., & Michaels, B. S. (2007). Outbreaks where
food workers have been implicated in the spread of foodborne disease. Part 1.
Description of the problem, methods, and agents involved. Journal of Food
Protection, 70(7), 1752e1761.
Han, E.-H., Yang, H.-S., Shon, H.-S., & Rho, J.-O. (2005). A study on the investigation
of sanitary knowledge and practice level of school foodservice employees in
Jeonju. Journal of the Korean Society of Food Science and Nutrition, 34(8),
1210e1218. http://dx.doi.org/10.3746/jkfn.2005.34.8.1210.
Jevsnik, M., Hlebec, V., & Raspor, P. (2008). Food safety knowledge and practices
among food handlers in Slovenia. Food Control, 19(12), 1107e1118. http://
dx.doi.org/10.1016/j.foodcont.2007.11.010.
Liz Martins, M., & Rocha, A. (2014). Evaluation of prerequisite programs
6
th et al. / Food Control xxx (2016) 1e6
A.J. To
implementation at schools food service. Food Control, 39, 30e33. http://
dx.doi.org/10.1016/j.foodcont.2013.10.040.
Lockis, V. R., Cruz, A. G., Walter, E. H. M., Faria, J. A. F., Granato, D., & Sant'Ana, A. S.
(2011). Prerequisite programs at schools: Diagnosis and economic evaluation.
Foodborne Pathogens and Diseases, 8(2), 213e220.
McIntyre, L., Vallaster, L., Wilcott, L., Henderson, S. B., & Kosatsky, T. (2013). Eval-
uation of food safety knowledge, attitudes and self-reported hand washing
practices in FOODSAFE trained and untrained food handlers in British Columbia,
Canada. Food Control, 30(1), 150e156. http://dx.doi.org/10.1016/j.foodcont.
2012.06.034.
National Food Chain Safety Office. (2014). Food-borne diseases in 2014 (in Hungari-
an). Retrieved from https://www.nebih.gov.hu/data/cms/173/014/honlapra_
EM_jelentes_2014.pdf.
Osaili, T. M., Abu Jamous, D. O., Obeidat, B. A., Bawadi, H. A., Tayyem, R. F., et al.
(2013). Food safety knowledge among food workers in restaurants in Jordan.
Food Control, 31(1), 145e150. http://dx.doi.org/10.1016/j.foodcont.2012.09.037.
Panchal, P. K., Liu, L. I., & Dworkin, M. S. (2012). Food safety knowledge is lower
among spanish- speaking than among English- speaking restaurant food han-
dlers in chicago. Food Protection Trends, 32(1), 16e25.
Park, S.-H., Kwak, T.-K., & Chang, H.-J. (2010). Evaluation of the food safety training
for food handlers in restaurant operations. Nutrition Research and Practice, 4(1),
58e68. http://dx.doi.org/10.4162/nrp.2010.4.1.58.
Pichler, J., Ziegler, J., Aldrian, U., & Allerberger, F. (2014). Evaluating levels of
knowledge on food safety among food handlers from restaurants and various
catering businesses in Vienna, Austria 2011/2012. Food Control, 35(1), 33e40.
http://dx.doi.org/10.1016/j.foodcont.2013.06.034.
Rennie, D. M. (1994). Evaluation of food hygiene education. British Food Journal,
96(11), 20e25.
Seaman, P. (2010). Food hygiene training: Introducing the food hygiene training
model. Food Control, 21(4), 381e387. http://dx.doi.org/10.1016/j.foodcont.2009.
08.005.
Seaman, P., & Eves, A. (2006). The management of food safetydThe role of food

th, A. J., et al., Development of conscious food handling in Hungarian school cafeterias, Food Control (2016),
Please cite this article in press as: To
http://dx.doi.org/10.1016/j.foodcont.2016.09.011
hygiene training in the UK service sector. International Journal of Hospitality
Management, 25(2), 278e296. http://dx.doi.org/10.1016/j.ijhm.2005.04.004.
Seaman, P., & Eves, A. (2010). Perceptions of hygiene training amongst food han-
dlers, managers and training providers e A qualitative study. Food Control,
21(7), 1037e1041. http://dx.doi.org/10.1016/j.foodcont.2009.12.024.
Soares, K., García-Díez, J., Esteves, A., Oliveira, I., & Saraiva, C. (2013). Evaluation of
food safety training on hygienic conditions in food establishments. Food Control,
34(2), 613e618. http://dx.doi.org/10.1016/j.foodcont.2013.06.006.
Tan, S. L., Bakar, F. A., Abdul Karim, M. S., Lee, H. Y., & Mahyudin, N. A. (2013). Hand
hygiene knowledge, attitudes and practices among food handlers at primary
schools in Hulu Langat district, Selangor (Malaysia). Food Control, 34(2),
428e435. http://dx.doi.org/10.1016/j.foodcont.2013.04.045.

th, A. J., & Bitts

To anszky, A. (2014). A comparison of hygiene standards of serving
and cooking kitchens in schools in Hungary. Food Control, 46, 520e524. http://
dx.doi.org/10.1016/j.foodcont.2014.06.019.
Walker, E., Pritchard, C., & Forsythe, S. (2003). Food handlers' hygiene knowledge in
small food businesses. Food Control, 14(5), 339e343. http://dx.doi.org/10.1016/
S0956-7135(02)00101-9.
Wilson, M. D. J., Murray, A. E., & McKenna-Black, M. A. (2001). Contract catering: A
positional paper. International Journal of Hospitality Management, 20(2),
201e218. http://dx.doi.org/10.1016/S0278-4319(01)00003-2.
Worsfold, D., Griffith, C. J., & Worsfold, P. (2004). A survey of environmental health
officers' views of food hygiene training. British Food Journal, 106(1), 51e64.
Yiannas, F. (2009). Educating and training to influence behavior. In Food safety
culture. New York, NY: Springer New York. http://dx.doi.org/10.1007/978-0-
387-72867-4_5.
Zoltai, A., Alp

zs, I., Dusnokine
ari, G., Asztalos, I., Bala
-To

th, Z., Fehe
…, & Wolf, A.

r, A.,
(Eds.). (2013). Good hygiene practice - catering guide (Útmutato
a vend

ta
egla
s

es


etkeztet

higi

es jo eniai gyakorlata
hoz). Budapest: Special Administration Office
for Agriculture. Retrieved from http://elelmiszerlanc.kormany.hu/download/2/
e7/90000/Vende
gk

s GHP_egyse
ato
ges szerkezet.pdf.