Food handlers play an important role in the transmission of foodborne diseases. 108 asymptomatic food handlers work in RSU canteens and have never been checked for intestinal bacteria and parasites, which might be a potential source of infection for customers. This study is aimed at estimating the prevalence of enteropathogenic bacterial and intestinal parasitic infections among food handlers in Rangsit University canteens, central Thailand. A total of 79 food handlers were enrolled, and each provided one stool sample (response rate of 73.2%). Females comprised 93.7% of study participants, and the largest age group was 41–50 years (34.2%). The prevalence of enteropathogenic bacteria in stool cultures was 2.5%, and only
Food handlers directly handle food or beverages or contact equipment used for food preparation. Asymptomatic food handlers play a significant role in food safety and are unaware of their potential to transmit foodborne diseases [
Foodborne diseases are a major cause of morbidity and mortality globally. Enteropathogenic bacteria, including
Prevalence rates of intestinal parasites in food handlers by wet mount method range from 3.7 to 52.2%. In separate studies, in Ethiopia, 14.8% [
Intestinal parasitic infections were assessed in food handlers in universities due to rapid growth of student population and campus facilities. Infection rate of parasitic infection using direct mount and concentration technique was 25.2% in Haramaya University cafeterias, eastern Ethiopia [
Enteropathogenic bacteria such as
Gastrointestinal illnesses in Thailand, from Bamrasnaradura Infectious Diseases Institute revealed parasitic infections by wet smear, cultured in Jones’ medium, modified acid-fast staining and Gram-chromotrope staining was 26.8%; bacterial infections by culture was 14.5%. The majority of intestinal parasitic and bacterial infections were of
Thai Bureau of General Communicable Diseases Department reported 18.1% helminthiases (
In Pathum Thani province, Thailand, parasitic infections were 13.9–20.8% in school-aged children [
A cross-sectional study was conducted from May to July 2019 on the main campus of the Rangsit University (RSU) campus, located in the Lak-Hok subdistrict of Muang Pathum Thani District, Pathum Thani province, 28 km from the center of Bangkok and 16 km from Muang Pathum Thani. RSU canteens consist of 53 facilities, including kiosks, that serve food and drink and cater to 23,000 students (RSU registration information, 2019). There were 108 asymptomatic food handlers working during the period of this study.
The inclusion criteria include all food handlers who had direct contact with food and drink working in the Rangsit University student canteens and who provided informed consent were included. The exclusion criteria include food handlers who had diarrhea and fever, had taken antibiotics or antiparasitic drugs in the previous month or during data collection, and those who provided incomplete questionnaires were excluded from the study.
The sample size was determined using a single population proportion formula considering the following assumptions:
However, as the total number of the population was
The minimum sample size was 75 food handlers. All food handlers were asked for participation by direct contact if they were working and met the criteria above for food safety inside the campus.
A structured questionnaire was used for face-to-face interviews to determine general demographic characteristics and information on type of work, age, sex, religion, ethnicity, educational level, responsibility, experience, and income. Personal hygienic status of each food handler on handwashing, fingernail trimming, and use of uniform and food sanitation training were included in questionnaire. A clinical sign of fever or diarrhea and if the person had taken antibiotics or antiparasitic drugs was asked as first screening.
One stool sample was collected from each participant in a clean stool cup. Stool macroscopic examination was observed and recorded before processing. All the stool samples were divided into two parts: one part for culturing within 2 hrs onto blood agar (Oxoid), MacConkey agar (Difco), and
All samples were independently examined in a blinded fashion by two microscopists. Expert microbiologists and parasitologists reread all positive samples and 10% of randomly selected negative samples.
Data were entered, checked for accuracy, and then analyzed descriptively (frequencies and percentages) using IBM SPSS software for Windows (Version 21.0).
Every individual with at least one positive test was considered positive for intestinal infections. The epidemiological of enteropathogenic bacterial and intestinal parasitic infections were reported on the percentage of prevalence and type of organism. Demographic data and personal hygienic status were analyzed and presented as frequencies.
Ethical clearance was obtained from the Ethical Review Committee, Rangsit University, Thailand (ethical clearance no. RSUERB2019-026). Written informed consent was obtained from study participants. Food handlers found to be positive for enteric pathogens and parasites were instructed to see a doctor at the hospital for treatment, depending on the type of species identified. All the participants were trained in proper handwashing techniques.
A total of 79 food handlers (74 females (93.7%) and five males (6.3%)) out of 108 potential participants (73.2%) responded. The mean age of participants was
Sociodemographic data of food handlers in RSU student canteens (
Demographic characteristics | Frequency | % of total |
---|---|---|
Types | ||
Beverage | 15 | 19.0 |
Food | 48 | 60.8 |
Staff | 16 | 20.3 |
Sex | ||
Male | 5 | 6.3 |
Female | 74 | 93.7 |
Age (years) | ||
≤20 | 1 | 1.3 |
21–30 | 12 | 15.2 |
31–40 | 13 | 16.5 |
41–50 | 27 | 34.2 |
50–60 | 15 | 19.0 |
>60 | 11 | 13.9 |
Religion | ||
Buddhism | 75 | 94.9 |
Islam | 4 | 5.1 |
Ethnicity | ||
Thai | 73 | 92.4 |
Laos | 2 | 2.5 |
Burmese | 3 | 3.8 |
Cambodian | 1 | 1.3 |
Education | ||
Illiterate | 21 | 26.6 |
Primary and secondary school | 52 | 65.8 |
No answer | 6 | 7.6 |
Responsibility | ||
Owner | 18 | 22.8 |
Cook | 18 | 22.8 |
Seller | 30 | 38.0 |
Owner and seller | 9 | 11.4 |
Cook and seller | 3 | 3.8 |
Prepare food/wash dishes and clean | 1 | 1.3 |
Experience (years) | ||
<1 | 6 | 7.6 |
1-5 | 43 | 54.4 |
6-10 | 11 | 13.9 |
>10 | 16 | 20.3 |
No answer | 3 | 3.8 |
Incomes (Baht) | ||
<9,000 | 26 | 32.9 |
9,001-16,000 | 42 | 53.2 |
16,000-30,000 | 6 | 7.6 |
>30,000 | 5 | 6.3 |
Out of 79 stool cultures tested for enteropathogenic bacteria, two samples (2.5%) were positive for
Incidence of enteropathogenic bacterial and intestinal parasitic infections from the stools of beverage and food handlers at RSU canteens (
Types of intestinal organisms | Frequency | % of total |
---|---|---|
Enteropathogenic bacteria | ||
| 2 | 2.5 |
Intestinal parasites | 9 | 11.4 |
Nonpathogenic protozoa | 8 | 10.1 |
| 2 | 2.5 |
| 2 | 2.5 |
| 1 | 1.3 |
| ||
| 2 | 2.5 |
| ||
| 1 | 1.3 |
Pathogenic protozoa | 1 | 1.3 |
| 1 | 1.3 |
Total | 11 | 11.9 |
Of the total respondents, 64 (81.0%) used the correct handwashing method, 77 (97.5%) reported that they regularly washed their hands when preparing food, 76 (96.2%) used soap during handwashing, all regularly washed their hands after visiting the toilet, 63 (79.8%) had fingernail trimming, 76 (96.2%) used uniforms/gowns when working, 50 (63.3%) wore a cap, 42 (53.2%) had passed food sanitation training, 28 (35.4%) had food sanitation training certificates, 13 (16.5%) had food handling certificates, and 48 (60.8%) had medical checkups (Table
Personal hygiene among beverage and food handlers at RSU canteens (
Personal hygiene practice | Yes (%) | No (%) |
---|---|---|
Correct handwashing method | 64 (81.0) | 15 (19.0) |
Regular hand washing when preparing food | 77 (97.5) | 2 (2.5) |
Use of soap when washing hands | 76 (96.2) | 3 (3.8) |
Regular hand washing after visiting toilet | 79 (100.0) | 0 (0.0) |
Fingernail trimming | 63 (79.8) | 16 (20.3) |
Use of uniform/gown | 76 (96.2) | 3 (3.8) |
Wearing cap | 50 (63.3) | 29 (36.7) |
Food sanitation training | 42 (53.2) | 37 (46.8) |
Having certificate of food sanitation training | 28 (35.4) | 51 (64.6) |
Having certificate of food handlers | 13 (16.5) | 66 (83.5) |
Frequency of medical checkup | 31 (39.3) | |
Every 3-6 months | 11 (13.9) | |
Every 6-12 months | 35 (44.3) | |
Others | 2 (2.5) |
The two food handlers infected with
Among food handlers in Rangsit University canteens, the prevalence of enteropathogenic bacteria was 2.5%. Despite a parasitic intestinal infection rate of 11.4%, there was only one pathogenic protozoan infection (
Food handlers at RSU canteens showed good personal hygiene (≥80%), i.e., regular hand washing after visiting toilets, regular hand washing when preparing food, using soap when washing hands, using uniforms/gowns, performing the correct hand washing method, and having short fingernails. Notably, <50% of the food handlers had passed food sanitation training and had a medical checkup, which may be because many food handlers work for a short period and then leave. However, personal hygiene and food safety interventions still need to improve to reach acceptable hygiene standards for customer safety. To this end, our team arranged for the food handlers to be trained in correct hand washing techniques.
This study has some limitations: (a) Because of low sensitivity of conventional microscopy, the reported prevalence rates for enteric parasites may represent an underestimation of the true figures. This is enhanced by the fact that a single stool per participant was analyzed; however, the modified formalin ether concentration were performed to support the prevalence. (b) No specific techniques were used for certain parasitic pathogens including coccidian (e.g., Ziehl-Neelsed staining) and soil-transmitted helminths such as
Though we detected a low prevalence of enteropathogenic bacteria (2.5% of
The data used to support the findings of this study are included within the article.
The authors declare that they have no competing interests.
SK conceptualized the study, performed testing, analyzed and interpreted all the data, and contributed to the writing of the manuscript. BJ, US, and CA contributed to the conceptualization, collected data, and contributed to the data analyses. All authors read and approved the final manuscript.
The authors are grateful to Medical Technology students who participated in community medicine in 2019 for their assistance in processing and examining the stool samples collected from RSU food canteens. We would like to thank administrators of RSU canteens for arranging all meetings and helping recruit study participants.