Bacterial Assessment among Traditional Food Handlers and Their

Behavior Related to Hygiene and Sanitation

Nenni Dwi Aprianti Lubis

, Sri Amelia

, Nurfida K. Arrasyid

and Muhammad Fakhrur Rozi

Nutrition Department; Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Microbiology Department; Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Parasitology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Bacterial, Contamination, Food-handlers.

Abstract: The foodborne disease still become significant health problems in the developing region. As the primary

school-age children were most affected, regulation to reduce its incidence is necessary. Food-handlers are

one of the sources of transmission, particularly in a school environment. Our study aimed to provide

bacterial assessment among traditional food-handlers in two different public primary schools, Public

Primary School 064024, Prona Satu St and Public Primary School 066656, Karya Sembada St, in Medan

Selayang sub-district, Medan, Indonesia. We conducted a descriptive study enrolled 22 traditional food-

handlers and evaluated their behavior related to hygiene and sanitation by using fundamental principles

rules released by the Ministry of Health of Republic of Indonesia No.942/MENKES/SK/VII/2003. We

found that all food-handlers did not perform basic principles rules and categorized as ineligible. While, 18

of 22 (81.8%) traditional food-handlers carried bacterial pathogen species including Escherichia coli (50%),

Staphylococcus aureus (22.72%), and Klebsiella spp (9.09%).

1 INTRODUCTION

Foodborne diseases are still becoming a

significant problem for a specific population,

especially school-aged children. School-aged

children are vulnerable acquire food-borne diseases

at school due to inappropriate behavior related to

sanitation and hygiene of people around the school

including food-handlers. World Health Organization

(WHO) defines foodborne disease as infectious or

toxic diseases and caused by agents entering the

body via ingested foods, whether caused by

microbes or other causes (viruses, parasites,

freshwater or seawater algae, bacterial and non-

bacterial toxins) (Scott, 2003). Generally,

Escherichia coli, Bacillus cereus, Salmonella,

Hepatitis, Shigella, Staphylococcus aureus,

Rotavirus, Brucella and other enteric bacteria are the

most common etiologic agent causing food-borne

disease (Rane, 2011).

Statistically, due to economic reasons, poverty,

and lack of adequate health care facilities, the

frequency of foodborne diseases and its outbreaks in

school still increases in Indonesia. In 2004, there

were 19 incidents of food poisoning noted by the

Department of Health with a total of 575 children

affected by the outbreaks. There was also a report

from National Agency of Drug and Food Control

(2011) in Samarinda, Indonesia, most cases of food-

borne diseases are caused by food and drink

contamination (39.92%). The increased prevalence

of food-borne diseases prevents certain nations from

achieving Millenium Development Goals (MDGs) 1,

4, 5, and 6 (Monney, 2013).

Therefore, the school circle starts from a teacher,

principal, the parents, food-handlers, and the

children should understand the quality of proper

sanitation and hygiene to reduce the incidence of the

foodborne diseases (Machado, 2014). The incidence

of foodborne diseases will increase related to

imperfect knowledge and behavior of people about

sanitation and hygiene, particularly food-handlers.

Food-handlers become potential sources in the chain

of bacterial transfer into food and causing the

disease. Consequently, by controlling the cleanliness

of food-handlers become a cornerstone in preventing

the transmission of foodborne disease (Unicomb,

2009). Nevertheless, only 6.6% food-handlers using

an apron while working and there was also evident

462

Lubis, N., Amelia, S., Arrasyid, N. and Rozi, M.

Bacterial Assessment among Traditional Food Handlers and Their Behavior Related to Hygiene and Sanitation.

DOI: 10.5220/0010073404620466

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

462-466

ISBN: 978-989-758-449-7

that 11.1% of food-handlers had poor behavior in the

specific part of Indonesia (Agustina, 2009). Several

policies related to control and improve hygiene and

sanitation has been established, for instances,

UNICEF (United Nations Children's Fund) has also

launched child-friendly school (CFS) model and also

Indonesia's government policy by releasing several

ground-rules related to hygiene and sanitation.

In our study, we identified the presence of

bacteria in traditional food-handlers hand and

evaluated their behavior related to hygiene and

sanitation around the primary school environment.

We also noted certain aspects that might interfere

with the food-handlers' hygiene behavior mainly

income and last education level.

2 METHODS

This study is our preliminary study for detecting

bacterial among traditional food-handlers, nutritional

status among primary school-aged children, their

knowledge about hygiene and sanitation, and its

relationship with several risk factors. Therefore, the

study is still ongoing while we were completing this

descriptive study. We enrolled 22 traditional food-

handlers with no history of training about hygiene

and sanitation. The study was conducted at two

different public primary schools, Public Primary

School 064024, Prona Satu St and Public Primary

School 066656, Karya Sembada St, in Medan

Selayang sub-district, Medan, Indonesia. We used

total sampling, all food-handlers around the school

should be included in this study without using any

inclusion criteria. Before sampling, we explained the

study and procedure then without coercion all

samples give their consent.

2.1 Traditional Food-handlers

Behavior

Based on the decision of the Minister of Health of

the Republic of Indonesia

No.942/MENKES/SK/VII/2003, there are several

basic principles used to assess whether food-

handlers behavior has met the requirements in the

principle of proper hygiene and sanitation. All the

principles established in the decision must be carried

out by food-handlers. If the food-handlers did not

perform only one principle, their behavior was

declared as ‘ineligible.'

All the principles were listed, for instance (a)

Hand washing properly, before and after handling

the food, (b) keep the nail always clean, (c) keep the

clothes clean, (d) there is no open wound on their

hands, (e) using apron, (f) using head cover, (g) all

equipment must be washed with soap and draining

water, (h) food-equipment must be dried by using

clean cloth, (i) equipment must be kept in sealed

container, (j) when selling food was not allowed to

smoke, (k) scratching the body, (l) no coughing and

sneezing without covering nose and mouth. The

interview was directly performed by a face-to-face

method using rules that we mentioned before and

observational checklist.

2.2 Swab Collection and Bacterial

Identification

The swab obtained from the finger of the traditional

food handlers by using cotton stick before meal

preparation, then we transported the samples by

using Brain Heart Infusion (BHI) media to our

laboratory. In the laboratory, we swabbed the cotton

stick on to McConkey and blood agar. Bacterial

identification was made by using several techniques

such as using agar and biochemical reaction after

culturing the bacteria in agar (Blood agar and

McConkey agar). Then, the output of the

examination was a positive or negative growth of

bacteria. After 24 hours of incubation, the bacterial

colonies would appear. Hereafter, the bacterial

identification was started by using gram staining and

biochemical reaction including indole production,

methyl red, Voges-Proskauer, Simmons citrate,

urease, motility test, using Triple Sugar iron (TSI),

gas and sulfur production, glucose, lactose, maltose,

mannitol, and sucrose fermentation. All the process

mentioned above was done in the Microbiology

Department, Faculty of Medicine, Universitas

Sumatera Utara, Medan, Indonesia from February

until May 2018.

2.3 Ethical Consideration and Data

Analysis

We also attained study approval from the Health

Research Ethical Committee of Medical School of

Universitas Sumatera Utara No. 265/TGL/KEPK FK

USU-RSUP HAM/2018 and fulfilled the ethical

principles of the Declaration of Helsinki (2008).

After collecting all the samples, the data were

presented using univariate fashion using a computer.

Bacterial Assessment among Traditional Food Handlers and Their Behavior Related to Hygiene and Sanitation

463

3 RESULTS AND DISCUSSION

We included 22 traditional food-handlers who all

sold traditional snacks such as fried-tofu with filling,

meatballs, sausage, and toast. All food-handlers

marketed is processed by the food handlers

themselves. Therefore, we also evaluated their

behavior related to hygiene and sanitation. We found

a significant result that all food-handlers were

categorized as ineligible to be called as proper food-

handlers. We questioned all food-handlers by using

ground-rules of hygiene and sanitation made of

Ministry of Health of Republic Indonesia. The

observation was also done in a short period, we

observed all the food-handlers using the similar food

storage container, plastic container or open

container. Hand washing before and after food-

handling, become one of the critical rules, was only

performed by six food-handlers. While two food

handlers did not keep the cleanliness of their nails.

Table 1: This caption has one line so it is centered.

Variables Bacterial culture result N (%) p-value

Positive N

(%)

Negative N

(%)

Gender

Male

Female

16 (84.2)

2 (66.7)

3 (15.8)

1 (33.3)

19 (86.4)

3 (13.6)

0.470

Age

≤ 50 yrs

> 50 yrs

10 (71.4)

8 (100.0)

4 (28.6)

0 (0.0)

14 (63.6)

8 (36.3)

0.254

Last education level

Primary school

Junior high school

Senior high school

No formal education

8 (80.0)

1 (33.3)

8 (100.0)

(

100.0

)

2 (20.0)

2 (66.7)

0 (0.0)

(

0.0

)

10 (45.5)

3 (13.6)

8 (36.4)

(

4.5

)

0.080

Income

≤ Rp 200.000,00

> R

200.000,00

10 (76.9)

(

88.9

)

3 (23.1)

(

11.1

)

13 (59.1)

(

40.9

)

0.616

Table 2: This caption has more than one line so it has to be set to justify.

Principles Bacteria culture result N (%)

Positive N

(

)

Negative

(

)

Handwashing before and after food-handling

Yes

5 (83.3)

13 (81.3)

1 (16.7)

3 (18.8)

6 (27.2)

16 (72.7)

Cleanliness of finger and cloths

Yes

17 (85.0)

1 (50.0)

3 (15.0)

1 (50.0)

20 (91.0)

2 (9.0)

Using apron and head cover

Yes

0 (0.0)

(

81.8

)

0 (0.0)

(

18.2

)

0 (0.0)

(

100.0

)

Food equipment washed and dried using draining

water

Yes

0 (0.0)

18 (81.8)

0 (0.0)

4 (18.2)

0 (0.0)

22 (100.0)

Smoke habit while handling

Yes

10 (83.3)

(

80.0

)

2 (16.7)

(

20.0

)

12 (54.5)

(

45.5

)

Access to clean water

Yes

0 (0.0)

(

81.8

)

0 (0.0)

(

18.2

)

0 (0.0)

(

100

)

A cough and sneezing while handling

Yes

1 (100.0)

(

81.0

)

0 (0.0)

(

19.0

)

1 (4.5)

(

95.5

)

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

464

and cloth. None of the food handlers used apron and

head cover. Moreover, 22 food-handlers had a

terrible habit of smoking while handling 18 of 22

(81.8%) traditional food-handlers are positively

evident of bacterial pathogen growth in agar. From

the identification process, we determined the

bacteria species including Escherichia coli (50%),

Staphylococcus aureus (22.72%), and Klebsiella spp

(9.09%). Three of the bacteria is categorized as the

agent of food-borne disease; therefore, we stated all

food-handlers who was confident with the pathogen

are at risk of becoming a source of transmission. We

commonly found Bacillus subtilis and

Staphylococcus epidermidis as normal flora among

food-handlers.

Food-handlers are one of the sources of

foodborne diseases transmission, their behavior

directly related to the incidence of foodborne

disease, we found 81.8% of food-handlers are

positive with bacterial pathogen growth. A study

conducted in Sari City, Iran (2017) showed more

than 60% food-handlers are positive for different

bacterial species including Staphylococcus aureus

(46%), Escherichia coli (29.2%), Coliforms

(18.2%), and Pseudomonas aeruginosa (6.6%) from

their fingernail. We also obtained a similar result

that Staphylococcus aureus, 40-50% found in the

skin of healthy people, and Escherichia coli are the

most common species found in our study. While

some literature emphasizes S.aureus causing food

poisoning and it is evident that its toxin is highly

associated with food poisoning (Loir, 2003),

(Møretrø and Langsrud, 2017). Moreover, by

coughing and sneezing S.aureus will transmit

rapidly during food-handling since S.aureus

colonized around the anterior nostril of the nose

(Hennekinne, 2012). In our study, we found one

participant who had coughing and sneezing habit

while handling and it was positive with bacterial

growth.

Besides, proper hand washing is one of the best

ways to prevent foodborne diseases, and this small

action is related to significant implication since our

study found 13 participants (81.3%) without hand

washing are positive for bacterial culture result.

Hand washing is mandatory because of its

association with the bacterial transmission,

particularly among food-handlers. (Lambrechts,

2014) conducted a study to determine bacterial

contamination among food-handlers, it showed only

18% of food-handlers had no detectable bacteria on

their hands and they risk becoming a source of

infections. It happened when most food-handlers did

not perform proper hand washing technique. Hand

washing is very crucial since it removes all viable

pathogen and resident microorganism, by using

antimicrobial soap it can add to the antimicrobial

effect of hand washing (Burton, 2011).

Using protection from outer garment while

handling is also one of the principles of hygiene and

sanitation released by the Ministry of Health. In our

study, there were no food-handlers using apron and

head cover. Meanwhile, (Assefa, 2015) found a

significant association between bacterial hand

contamination and cleanliness of outer garments

=7.653, p=0.006). Besides, WHO also released

international code of practice general principles of

food hygiene, it recommends food-handlers using

protection while handling such as head cover, apron,

or equipment tools so that they do not touch the food

directly using their hands (Codex Alimentarius,

2003).

(Allam, 2016) obtained positive result that by

using interventional health education session,

reduction in hand contamination was achieved.

Therefore, several interventions to increase

awareness of the foodborne disease among food-

handlers are already implicated by specific

organization and government. Indonesia’s policy

related to food safety has been ratified and released

in 2011 consisted of several ground rules about food

safety and quality. While the regulations came from

the Ministry of Health No.1096 Year 2011 also

stated basic principles hygiene and sanitation for

food-handlers in improving food safety that we used

to evaluate food-handlers behavior.

While UNICEF also launched the CFS program

to regulate school in improving quality of hygiene

and sanitation and it must become an implemented

program worldwide. In this approach, a school will

focus on providing proper sanitation and hygiene.

One of the strategic approach to achieve the

condition by using ‘WASH’ (Water, Sanitation, and

Hygiene education) for all people around the school

environment. Poor sanitation, water insufficient, bad

water quality, and lousy hygiene behavior are a

significant cause of mortality and morbidity for

children. School-aged children who spend long

hours in school should become the most affected

group whether the condition did not improve in their

school environment (Godfrey, 2012).

4 CONCLUSIONS

Our descriptive study showed several bad behaviors

related to hygiene and sanitation among traditional

food-handlers in two different public primary

Bacterial Assessment among Traditional Food Handlers and Their Behavior Related to Hygiene and Sanitation

465

schools in Medan, Indonesia. All stakeholder must

understand the state of quality of hygiene and

sanitation because primary school-aged children are

the most affected population with this unaware

behavior. From our evaluation, none of the

traditional food-handlers categorized as eligible

based on fundamental principles rules released by

the Ministry of Health of the Republic of Indonesia.

Our study is still ongoing and resulting from several

variables that we do not mention here. Moreover,

this study did not escape the limitation. Therefore,

after completing our study, we attempt to determine

the related risk factor and correlated them with

bacterial hand contamination.

ACKNOWLEDGEMENTS

This descriptive study was conducted at our

preliminary study to identify risk factors for

foodborne disease in Public Primary School at

Medan Selayang sub-district. Our study also granted

by Non-PNBP USU of the Year 2018 – following

the contract of TALENTA research implementation

No. 2590/UN5.1.R/PPM/2017.

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