WHO Chapter 7

7/28/2019 WHO Chapter 7

1/6

The role of health workers in food safety

specific infections such ascampylobacteriosis, salmonellosis, or E.coli O157:H7 infection. Laboratorysurveillance involves the recording of

results of laboratory investigation ofspecimens (usually faecal samples) ob-tained from patients. The laboratory can

test for a range of pathogens.Outbreak detection takes several forms.Health workers should keep alert to thepossibility of a shared exposure among

patients with the same condition, or theymay routinely report selected conditionseither voluntarily or as required by law.

KEY POINTS

l Prevention is better than cure.

l Education in food safety is an important preventive measure.

l Educational programmes must be focused and relevant to the

target audience.

l Specific target groups for food safety education should beidentified and educational interventions aimed at them.

l Mothers and pregnant women are important target groups

for prevention of infant diarrhoea.

l In addition to education of food handlers in basic principles of

food hygiene, an HACCP-based approach can be applied to the

preparation of food in homes, in food service establishments or forstreet food vending operations in order to select behaviours which

are of particular importance to food safety.

l Surveillance of foodborne diseases is an important tool for

assessing the food safety situation and identifying factors leadingto foodborne diseases.


2/6

Basic Food Safety for Health Workers

themselves but also communicate theneed for food hygiene to their parents andother family members. The earlier thateducation in food safety starts, the bet-

ter it is. Even children in kindergartensand nurseries can be trained in some ba-sic rules of food hygiene. Teaching chil-dren about food safety has the doublybeneficial effect of helping to protect avulnerable group and of educating thenext generation.

In many places, existing school educationon food safety is limited to teachingabout hand-washing after defecation,protection from flies and rodents, latrine

use and safe storage of water. Althoughthis advice is important, it has not alwaysbeen enough to prevent foodborneillness, which more often results frominsufficient cooking, incorrect storage offood, re-use of leftovers, lack of hand-washing prior to food preparation, andother factors that favour contamination,survival and multiplication of pathogens,or production of toxins in food.

Teachers may themselves have noeducation in the subject, and may oftenlack teaching materials.Therefore, ifteaching about food safety is to beimproved, teachers should also receiveformal training in food safety. Where foodsafety is not on the school curriculum,this presents an opportunity for healthworkers to visit schools to educatechildren about the importance of foodhygiene.

Street food vendors and food serviceestablishments

A substantial amount of food handlingand processing occurs in street foodvending operations and food serviceestablishments. In many situations it isnot possible to control these operationscompletely through official inspection.Control must be exercised by the food

handlers themselves. The role of the

health worker in helping this to happenis to provide both the food handlers andthe consumers with information and edu-cation about food safety.

SurveillanceHealth workers should actively partici-pate in the surveillance of foodborne dis-eases. Epidemiological data are neededso that public health authorities can beaware of the kind of diseases that arecurrent in the population, can identifywhich population subgroups are most atrisk, can plan appropriate food safety pro-

grammes, and can target educational in-terventions in an appropriate way.Surveillance of diseases involves fivemethods:

n registration of deaths andhospital discharge diagnoses;

n disease notification;

n sentinel surveillance;

n laboratory surveillance;

n outbreak investigation.In most countries, physicians complete adeath certificate when a person in theircare dies. In many hospitals, and in allhospitals in some countries, hospitalrecords include data on the diagnosis ofall patients who are discharged.

Notification of diseases is often legallyrequired from physicians or other healthworkers, though this notification may

apply only to certain conditions. Thisinformation is usually analysed centrallyin order to identify trends in health andillness and also to detect outbreaks ofdisease.

In sentinel surveillance, selected healthworkers or facilities monitor selectedhealth events. For foodborne diseases,relevant health events might includesyndromes such as diarrhoea, dehydrationand haemolytic uraemic syndrome, or


3/6


made aware that the health consequencesof foodborne infections may be moreserious for them, and that they may bemore susceptible than other groups to

infections such as salmonellosis,enterohaemorrhagic E. coli infection andlisteriosis. Health workers in contact withthe elderly can encourage them to avoidhigh-risk foods such as meals made fromraw or undercooked animal products(eggs, meat, milk) or raw seafood.

The sick

Great care should be taken when prepar-ing food for hospital patients includ-ing the newborn if they are not breast-fed. Food handlers in hospital kitchensshould be trained in safe food handling.Nurses and dieticians should also receiveeducation in food safety. The higheststandards of hygiene will be required forfoods produced for the sick and elderly.

It should be remembered that the stand-ard of cleanliness and hygienic practicein health centres sets an example for visi-

tors. A poor standard of hygiene in theseplaces will have a negative effect whilegood hygienic practices will encouragevisitors to emulate them.

The undernourished

Undernourished persons are especiallysusceptible to foodborne diseases andshould therefore also be seen as animportant target group for educationalinterventions.

The community

The whole community should participatein health education in food safety. In theirdealings with members of high-risk targetgroups and with the community membersin general, health workers should ensurethat all understand theTen Golden Rulesfor SafeFood Preparationrecommended byWHO.

Refugees

When disaster strikes, the safety of thefood supply may be affected, leading toa greater risk of foodborne disease. At

the same time, people may flee theirhomes and the situation of refugees anddisplaced persons requires special careand attention. Conditions in refugeecamps are prone to outbreaks offoodborne disease. Environmentalcontamination and improper foodhandling increase the risk of epidemicssuch as cholera. While education of thepublic in food safety is important at all

times, in disasters and emergencies it isan absolute necessity. When there is a riskof epidemics, families should bereminded of the rules of safe foodhandling.

Mass feeding in refugee camps has manyadvantages. It ensures, for instance thatfood is available to everyone. However,there are also disadvantages in that itincreases the risk of large scale outbreaksof foodborne illness. In refugee centres,food handlers who are responsible forpreparing the food, and their supervisors,need training in safe food handling andin the HACCP concept. Health workerscan give them clear instructions abouttheir responsibilities and may even putup posters with the rules for safe foodhandling. Health workers should makesure that those responsible for the refugeecentre understand the important need for

adequate clean water and sanitation, andfor proper disposal of unused food andother waste.

Schoolchildren

Schoolchildren are both a target group foreducation on food safety and a channelfor this education as well. Educatingschool children is a very effective strategyfor preventing foodborne diseases as thechildren not only learn about food safety


4/6


how to protect their breast milk fromchemical or other hazards (e.g. by mini-mizing contact with pesticides, by avoid-ing consumption of foods containing

unsafe levels of contaminants).Mothers of older infants and youngchildren

While public health authorities have rec-ognized the importance of breast-feed-ing in preventing foodborne diseases, al-most no attention has been paid to safefood handling during the preparation ofcomplementary foods. The education ofmothers and care-givers in food safety

principles is vital if there is to be asubstantial improvement in prevention ofdiarrhoeal diseases in infants andchildren. In this area, health workersclearly have the leading role. Most healthcentres already advise mothers on breast-feeding, infant feeding and nutrition, aswell as other aspects of the care of infantsand children. It would be important thatthese centres extend their informationand education to include information onsafe food handling practices. WHO hasissued a leaflet entitledBasic principles forpreparation of safefood for infants and youngchildren that health workers can use foradvising mothers in food safety.

Professional food handlers

Professional food handlers should ideallyreceive training and education in twoaspects of food safety:

a) principles of good hygienicpractice;

b) application of theHACCP conceptto food preparation.

Where food handlers are receiving formaltraining and education in foodpreparation, the above two aspects offood safety should be included in theircurricula. Training in principles of goodhygienic practice equip food handlerswith the rudiments of food safety whereastraining in HACCP helps them to learn

to adopt a critical thought process andeventually learn to:

n identify potential hazards and controlmeasures that are relevant, effective

and specific to the operation in ques-tion and to the work situation;

n prioritize control measures, ensure thatthe critical ones are applied correctlyand that they meet the necessaryconditions; and

n to take appropriate action whenconditions are not met.

When food handlers lack professional

training and qualifications, its may bedifficult to train them in HACCP. In suchcases, it is nevertheless important toimpress on them the value of thistechnique. Health authorities or healthworkers could assist in conductingHACCP studies by identifying hazards,appropriate control measures, criticalcontrol points, critical limits andcorrective measures and train foodhandlers in the outcome of the studies.

High-risk groups and people

preparing food for them

Travellers

Travellers will require advice on safe andunsafe foods in a particular area. If aregion has a reputation for unsafe food,income from tourism could be affected.

Travellers often consult physicians or

clinics for vaccination and otherprophylactic or therapeutic treatment.Advice on prevailing foodborne diseasesand on food and drink likely to becontaminated in certain countries couldbe provided to travellers at vaccinationcentres. WHO has issued a guide on safefood for travellers that is intended to helpmeet this need (see bibliography).

The elderlyThe elderly constitute an increasing pro-portion of the population. They must be


5/6


care-giver who brings a child for treat-ment can be given information abouthow to avoid foodborne hazards by cor-rect food preparation. A group of cases

of diarrhoeal disease would be an oppor-tunity to give educational messages tothe whole community. In this way thehealth worker plays not only a reactive(curative) role but also a proactive(preventive) one. The situation variesfrom country to country and it is notpossible to prescribe one approach toprevention that will work equally welleverywhere. However, some suggestionsare given here that may be adapted to

different situations.

Food safety education programmesshould aim to improve the knowledgeand practice of an entire population (in-cluding policy-makers, food producers,food processors, professional food han-dlers and consumers), as all have a roleto play in food safety. However, certaingroups, either because of their direct rolein food preparation and/or increased

vulnerability to foodborne diseases needto receive greater emphasis in the pro-gramme. These groups are:

n domesticfood handlerswho prepare food

for the family, particularly expectant

mothers and mothers with small chil-

dren who are especially vulnerable;

n professional food handlerssuch as streetfood vendors, catering personnel and

those working in the food processing

industry (in feeding large numbers of

people their impact on overall food

safety is considerable);

n high-risk groups and peoplepreparingfood

for them, particularly small children,

travellers, pregnant women, theimmunocompromised and the elderly.

Domestic food handlers

Domestic food handlers are persons whoprepare food for consumption by theirfamilies. Experience has shown that a largeproportion of foodborne disease outbreaksoccur in the home as a result ofmishandling of food. Education of thistarget group will help domestic foodhandlers to protect themselves and theirfamily members. Particular attentionshould be given to WHOsTen Golden Rulesfor SafeFood Preparation(Appendix 2).

Expectant mothers

There are a number of foodborne infec-tions, notably listeriosis and toxoplasmo-sis, which may adversely affect the foe-tus. Chemical contaminants such as leador methyl mercury, depending on theirlevel of intake, may also have negativeeffect on the health of the foetus. Preg-nant women are often motivated to doall they can for the health of their baby.Health workers particularly those inmaternal and child health centres and pri-

mary health care centres have the re-sponsibility of informing women on thetype of food/ practices which maypresent greater risks. Education of ex-pectant mothers in food safety shouldinclude information on breast-feeding. AWHO brochure providing advice on foodsafety issues of importance to pregnantwomen is also under preparation.

Lactating women

Breast milk is the ideal source of nour-ishment and the safest food for infantsduring the first 46 months of life. It pro-tects them against foodborne diarrhoeathrough its anti-infective properties andby minimizing exposure to foodbornepathogens. Major efforts are being madeat national and international levels to pro-mote breast-feeding, and a great deal ofeducational material is available for ad-

vising mothers on this subject. Healthworkers can also advise lactating women


6/6


Chapter 7

The role of

health workersin food safety

The first six chapters describe the basicsof foodborne illness: what it is, thefactors that lead to it, the problemsassociated with specific foods and foodprocessing, and how these factors mightbe controlled. We now consider what thehealth worker can do to alleviate theproblem of foodborne illness, particularly

with regard to children.

The health worker has essentially threeroles: curative, preventive andsurveillance.

The curative roleIn many cases the immediate problemfaced by the health worker is how to deal

with a sick patient. The foodborne originof an illness may not be immediatelyapparent for, although many foodborneillnesses have diarrhoea as a principalsymptom, others can have a variety ofpresentations. It is not the intention ofthis book to provide a manual on thetreatment of foodborne illness. Much ofthis should already be a key part of ahealth workers training and there are anumber of other publications that deal

specifically with this aspect (see bibliog-raphy).

Reliance on treatment, however success-ful, has its limitations. Treatment of aninfected individual does not remove thecause of illness from the environment oreliminate behaviours that lead tofoodborne illness. It does not, therefore,prevent other people from becoming illby the same route. Nor does infection

necessarily confer protection and reducethe risk of a patient succumbing to an-other episode soon after recovery. Sowhile treatment remains an essential taskfor the health worker, recognition of itslimitations has led to greater emphasisbeing placed on preventive measures toreduce the overall incidence of illness.

The preventive role:controlling foodbornehazards

The health worker can intervene toreduce the incidence of foodborne illnessthrough food safety educationprogrammes. Cases of diarrhoeal disease,for instance, should prompt the health

worker to consider whether food is beingprepared correctly. The mother or other

WHO Chapter 7

Documents

Transcript of WHO Chapter 7