Basic Food Safety and Sanitation Management

(Part I)

Training on FOOD SAFETY for Metro Manila Sanitation Inspectors

Eurotel, EDSA, Quezon City
June 7, 2016

Engr. ROLANDO ILAYA SANTIAGO, MMPA, MPH

Supervising Health Program Officer
Environmental and Occupational Health Office
DEPARTMENT OF HEALTH
Topics covered :

1. What is Food Safety?

2. Basics of food safety, sanitation and management.

3. Importance of Food Safety and its impact on health.

Food
any raw, cooked or processed edible substances,
beverages or ingredient used or intended for use or
for sale, in whole or in part for human consumption.

(IRR on Food Establishments, Chapter III, PD 856)

Safe and Wholesome

Refers to food that has been passed as fit for

human consumption using the criteria that it :

will not cause food borne infection or

intoxication when properly handled and
prepared with respect to the intended use;

does not contain residue in excess of set limits;

it is free of obvious contamination;

 is free of defects that are generally recognized as
objectionable to consumers

has been produced under adequate hygiene control

(GMP and HACCP)

has not been treated with illegal substances as

specified in Regulatory and Food Standards
Do you know what is
in your food?
What would
you like to
have today?

Main Menu

Hepatitis A

Typhoid

Cholera
What would Appetizers
you like to
have today? Ascaris lumbricoides
Ova

Trichuris trichura ova

Giardia lamblia cyst

Entamoeba histolytica
cyst

Escherichia coli

Shigella sp.

Salmonella sp.
What would Snacks
you like to
have today? Paragonimus Westermani

Capillariasis

Heterophyidiasis

Taeniasis

Echinotomiasis
Three (3) kind of hazards in food

1. Biological hazards include bacteria, viruses, parasites

and fungi are commonly associated with humans and
with raw products

2. Chemical hazards are toxic substance that may occur

naturally (e.g. aflatoxin, red tide) or may be added
during the processing of food (nitrites, pesticides,
fertilizers and others)

3. Physical hazards are foreign substances in the food

such as metal, hair, insects, glass, personal property
and others
Food Safety?

Assurance that food will not cause harm when prepared

and/or eaten according to its intended use.
Food Hygiene

All conditions and measures necessary to ensure the

safety and suitability of food at all stages of the food
chain
FOOD SAFETY and SANITATION MEASURES

To prevent food borne diseases and spoilage of food

and materials, proper food surveillance and control
are among the major activities in the field of food
safety and sanitation

Effective measures for the prevention of food borne

diseases and the provision of safe and wholesome
food may be achieved through proper control of food
establishments, food handlers, food and food
materials and provision of environmental sanitary
facilities.

Achievement of a successful control defends on the

cooperation of food handlers and enforcement of the
rules and regulations on food sanitation.
 Diagram of several entry points at which food
can be contaminated

Markets
Wholesalers
Distributors
Trader

Farm Transporter Retailers Table

Processors
Manufacturers
Food Establishments
Air and Sea Ports

Food Chain
 Flow scheme from food production to food consumption

HAZARDS

production of raw materials nutrients, natural toxins, microbial

toxins, environmental contaminants

Reaction products, additives,

food processing contaminants

storage and transport Chemical contamination, microbial

contamination

food preparation chemical contamination, microbial

contamination

intoxication by chemical contaminants,

food consumption foodborne infections, food poisoning
 Food safety is a multisectoral concern

Government Regulators

Food Industry

Consumers
Food Safety

Ensuring safe and healthy food is an important prerequisite of

food security, whether in developed or developing countries. Noraini
Othman, Vice Chair of the codex Alimentarius Commission

Internationally recognized needs :

- to guarantee human health and safety through the prevention
of food borne diseases;

- to reduce food losses and increase food availability; and

- to promote international economic trade through significant

increases in both quantity and variety of food being moved
across borders
Food Safety : a public health priority
Food borne disease takes a major toll on health

Up to one-third of populations of developed countries are

affected by food borne illnesses each year

In the USA estimated 76M cases of foodborne illnesses per

year resulting in 325,000 hospitalization and 5,000 deaths

The problem is even more widespread in developing countries

Food and water borne diarrheal diseases are leading causes of

illness and death in less developed countries with an estimated
2.2M deaths annually, most of whom are children
Food Safety : an essential public health issue

Serious outbreaks of food borne diseases on every continent in

the past decade illustrate both the public health and social
significance of these diseases.

FBD most seriously affect children, pregnant women, the elderly

and those already sick with other diseases.

FBD also have also economic consequences for individuals,

families, communities, businesses and countries imposing
substantial burden on health-care systems and markedly reduce
economic productivity.
New challenges to food safety

Changing patterns of food production and distribution are seen

with the integration and consolidation of agricultural and food
industries and the globalization of the food trade.

These can bring about both known and new food borne
diseases that can become prevalent. For example, the
international spread of meat and bone meal prepared from cattle
affected by bovine spongiform encephalitis (BSE).
Other factors for food safety as a public health issue

Increasing urbanization

Increasing wealth and urban lifestyle

Lack of facilities patronage of street foods in developing

countries

Global food trade

 Major issues in food safety
Microbiological hazards bacteria, viruses, parasites

Chemical hazards pesticides and veterinary drug residues,

food additives, naturally occurring toxins and industrial
contaminants

Physical hazards

Other areas of concern

Surveillance of food borne illness

New technologies genetic engineering, irradiation of food,
ohmic heating and modified-atmosphere packaging
Capacity building need of many developing countries to be
equipped to respond to existing and emerging food safety
problems
Importance of Food Safety and its Impact on Health
A 10-year Meta-analysis of Foodborne Illness Outbreaks

FETP Investigations, 2005-2015. (courtesy of DOH-EPIDEMIOLOGY Bureau)

Food is a basic need of every human being.

Over the century, food preparation has drastically

changed and food safety became a growing concern.

In the Philippines, increasing cases of food poisoning

pose a greater public health threat, with serious
economic consequences.
Objectives

to identify factors that contribute to foodborne disease

outbreaks

to contrast and combine results involving different

epidemiologic investigation of foodborne disease
outbreaks

to recommend control and preventive measures

Definition

Food Poisoning - illness caused by the consumption

of food or water contaminated with bacteria and/or
toxins, or with parasites, viruses, or chemicals

A food-borne illness (FBI) outbreak is defined by the

following 2 criteria: (1) Similar illness in a minimum of
two people, (2) evidence of food as the source.
METHODOLOGY
Descriptive Study
Archives of Epidemiology Bureau Library was
searched for all foodborne illness outbreaks
investigated by FETP Fellows from January 1, 2005-
June 30, 2015.
 Table 1. Criteria for Confirmation of Food Vehicle Responsible for
Foodborne Illness (Rooney, et.al. 2004)

Confirmation Status Criteria

Confirmed vehicle Isolation of agent from ill individuals and food, and exposure that
preceded infection by a period of time consistent with proposed
biologic mechanisms, AND combination of on-site investigation and
statistical evidence from epidemiological study.
Presumptive vehicle On-site investigation demonstrating source and mode of
contamination of food and survival of agent in food OR
epidemiological investigation determining that there has been an
association between eating and becoming ill.
Suspected vehicle A food type that is often identified as a vehicle of foodborne illness
prepared in a manner by which contamination, survival, or growth
could have occurred but outbreak pathogen not detected in food OR
descriptive epidemiology suggesting that the outbreak is food-related
and excluding obvious alternative explanations OR food implicated in
the outbreak report/publication but no information on epidemiology or
microbiology available.
Unknown Food Investigation determining an association between eating and
vehicle becoming ill, but a specific vehicle not identified.
RESULTS
Fig 1. Foodborne Illness Outbreak by Year (N=20)
FETP investigations, January 1, 2005 - June 30, 2015.

Number of FBI Investigated

4

0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Year
Figure 2. Foodborne Illness Outbreaks by Month (N=20),
FETP investigations, January 1, 2005-June 30, 2015.

Number of FBI Outbreaks Investigated

6

Month
Profile of Foodborne Illness Cases
1,021 cases
Majority, 525 (51%) were females
44 deaths
406 hospitalized
Age range: 8 months to 82 years old (median
= 34y/o).
Onset of symptoms: 3 minutes to 27 days.
Figure 3. Foodborne Illness Outbreaks by Signs and
Symptoms(N=20)*,
FETP investigations, January 1, 2005-June 30, 2015.

Signs and Symptoms

Vomiting

Abdominal Pain

Nausea

Diarrhea

Dizziness

Fever

Headache

0 10 20 30 40 50 60 70 80 90 100
Percentage

*Mul&ple Responses
Table 2. Foodborne Disease Outbreaks by Region (N=21),
FETP investigations, January 1, 2005-June 30, 2015.
Region Number of Outbreaks
NCR
Manila 3 (15%)
San Juan 1 (5%)
Central Luzon (Region III)
Tarlac 2 (10%)
Bulacan 1 (5%)
IV-A (CALABARZON)
Laguna 1 (5%)
Rizal 1 (5%)
VIII (Eastern Visayas)
Eastern Samar 1 (5%)
Western Samar 1 (5%)
XIII (CARAGA)
Surigao del Norte 1 (5%)
Surigao del Sur 1 (5%)
I (Ilocos Region)
Pangasinan 1 (5%)
II (Cagayan Valley)
Cagayan 1 (5%)
IV-B (MIMAROPA)
Oriental Mindoro 1 (5%)
V (Bicol Region)
Sorsogon 1 (5%)
VI (Western Visayas)
Iloilo 1 (5%)
VII (Central Visayas)
Bohol 1 (5%)
X (Northern Mindanao)
Misamis Oriental 1 (5%)
Total 20 (100%)
Figure 4. Foodborne Illness Outbreaks by Place of Event (N=20),
FETP investigations, January 1, 2005-June 30, 2015.

Place of Event

Home

School

Food Establishment

Hotel

Others

0 10 20 30 40 50 60 70 80 90 100
Percentage
Figure 5. Foodborne Disease Outbreaks by Nature of Event
(N=20),
FETP investigations, January 1, 2005-June 30, 2015.

Nature of Event

Family meal at home

School Recess

Conference

Birthday

Graduation

Baptism

Wedding

Drinking Spree

Anniversary
0 10 20 30 40 50 60 70 80 90 100
Percentage
Figure 6. Common Cause of Foodborne Disease Outbreaks
(N=20),
FETP investigations, January 1, 2005-June 30, 2015.

Common Causes

Bacteria

Toxin

Chemical

Other Causes

0 10 20 30 40 50 60 70 80 90 100
Percentage
Figure 7. Foodborne Illness Outbreaks by Pathogen (N=20),
FETP investigations, January 1, 2005-June 30, 2015.
Pathogen

S. Aureus

Salmonella

Chelonotoxin

Saxitoxin

Unknown

V. Parahemolyticus

Organophosphate

Oxalic Acid

Pending Result
0 10 20 30 40 50 60 70 80 90 100

Percentage
Fig 8. Foodborne-illness Outbreaks by Confirmation Status
(N=20)*,
FETP, January 1, 2005-June 30, 2015.

Suspected
10%

Presumptive
25%

Confirmed
65%
Figure 9. Contributing Factors in the Occurrence of Foodborne
Disease Outbreaks (N=20)*,
FETP investigations, January 1, 2005-June 30, 2015.

Factors

Improper Food Handling

Inadequate temperature controol

Infected/suspected food handler

Time delay between food preparation and

being eaten

Consumption of poisonous foood

Unknown

0 10 20 30 40 50 60
Percentage
Table 3. Required permits/trainings of food handlers and food establishment
(N=20)*,
FETP investigations, January 1, 2005-June 30, 2015.

Required Permits/Trainings Number of Outbreaks

License to Operate 4* (20%)

Sanitary Permit 2* (10%)

Food-handlers training 1* (5%)

*available data (N=7).

Conclusion and Discussion

There were 20 foodborne disease outbreaks, mostly were due

to improper food handling and inadequate temperature control
of the implicated food.

Most of these outbreaks were caused by bacterial

contamination.

Most of the outbreaks were caused by contamination of

Staphylococcus aureus.

The most common way for food to be contaminated by the

bacteria is through contact with infected food handler.

Equipments and surfaces by which was prepared and house

flies can also cause contamination.
 The Sanitation Code of the Philippines requires all food caterers,
regardless of type and enterprise size, to secure sanitary permits
and health certificates for all their employees prior to operation. In
this study, only four food establishments had license to operate,
and majority of the food-handlers does not comply with the required
sanitary permits and food-handlers training.

Most foodborne disease outbreaks occurred at home.

Oftentimes there are no observable indications of spoilage, (i.e bad

smell) even when a food is dangerously contaminated.

Washing hands is very helpful to prevent bacterial contamination.

Inadequate temperature control was also a common factor

Keeping cold food cold and hot food hot is a general principle in
food safety
Recommendations

Department of Health

To sustain or intensify food borne disease surveillance system.

To conduct nationwide advisories and campaign about food safety.

To involve other stakeholders in the food safety campaign.

Department of Education

To regulate and regularly monitor the food vendors in the school

premises.

To monitor compliance of the canteen food handlers to sanitation

code and in acquiring necessary health permits.

To utilize or construct functional handwashing area in the school

and to emphasize to the students the importance of handwashing.

To regularly coordinate with DOH and other stakeholders

regarding school food safety.
Local Government Units

To have a registry of all food establishments and

food handlers present in the locality.

Regular monitoring of food establishments for

compliance of the sanitation code of the Philippines.

To require food handlers to secure health certificate

regularly.

To enact closure to the non-compliant food

establishments or food handlers.
Food Establishments

To comply with the required food safety and sanitation

code standards.

To secure necessary permits and trainings prior to the

operation.

To identify critical control points in food preparation and

handling, and implement control measures to prevent
contamination.

To strictly implement proper kitchen and personal hygiene

among food handlers.

To purchase products to be used in food preparation only

to the safe and registered dealers.
 WHO 10 Golden Rules in Safe Food Preparation

Choose food processed for safety

- all food must be obtained from approved sources
- meat shall come from licensed slaughterhouses
- seafoods shall not come from sources in any manner
polluted by sewage, chemicals and other toxic substances
- always look for expiry dates
- avoid buying canned foods with dents, bulges, deformation
broken seals and improperly seams.

Cook food thoroughly

Temperature on all parts of the food should reach 70C
 WHO 10 Golden Rules in Safe Food Preparation

Eat cooked foods immediately

eat cooked foods as soon as they come off the heat
preferrably within 2 hours from preparation

Store cooked foods carefully

store in a refrigerator or ice box below 10C (cold) or in a
hot box kept continuously at above 60C

in storing large amount of food, shallow containers should

be used instead of large deep ones because the temperature
may not be maintained in all portions of the container
 WHO 10 Golden Rules in Safe Food Preparation

Reheat cooked foods thoroughly

- all portions of the food should reach 70C
- reheat leftovers only once

Avoid contact between raw and cooked foods

 WHO 10 Golden Rules in Safe Food Preparation

Wash hands repeatedly

- wash hands thoroughly before start preparing food as well
as after every interruption
- after preparing raw foods, such as fish or shellfish, wash
hands again before start handling other foods

Keep all kitchen surfaces meticulously clean

- cloths that come into contact with dishes and utensils should
be changed every day and boiled before reuse.
- separate cloths for cleaning the floors also requires frequent
washing
 WHO 10 Golden Rules in Safe Food Preparation

Protect foods from insects, rodents and other animals

- storing foods in tightly sealed containers
- use food cover for foods that will not be immediately eaten and for
left overs

Use clean and safe water

- boil or chlorinate it before using in preparing foods
 Public advisory!

These are ...

H ygienic
E asy to follow
A cceptable
L ets DOH it
T o prevent illness and maintain
H ealthy Living
Thank you and be safe eating!