CHAPTER 1 INTRODUCTION

According to Abraham Maslows pyramid of human needs, it is the physiologic needs that comprise the base and biggest part of the pyramid. A big portion of these physiologic needs is represented by mans primary need which is food. It is the building block of nutrition and the fuel of human physical health. However, this main source of energy could also become mans source of destruction. Food set on the table could either be fuel for a longer life or a strike leading to death. More than !! known diseases are transmitted through food. "he causes of food borne illness include viruses, bacteria, parasites, to#ins, metals, and prions, and the symptoms of food borne illness range from mild gastroenteritis to life$threatening neurologic, hepatic, and renal syndromes. %ontaminated food contributes to &.' billion cases of diarrhea in children each year, resulting in more than three million premature deaths, according to the (orld Health )rgani*ation +(H),. "hose deaths and illnesses are shared by both developed and developing nations. For e#ample, in the -nited .tates, the %enters for /isease %ontrol and 0revention +%/%, estimates that food borne diseases cause appro#imately 12 million illnesses annually among the countrys 3! million residents, as well as 4 ',!!! hospitali*ations, and ',!!! deaths. In .outh 5ast Asia, appro#imately one million children under five years of age die each year from diarrheal diseases after consuming contaminated food and water.

In the 0hilippines, having cases of food poisoning has also been reported from the 3!s up to the present. For instance is the case of food poisoning outbreak during a wedding ban6uet at a %hinese restaurant in .an 7uan, Metro Manila last March &1, &332. Food handlers were interviewed and the kitchen facilities at the restaurant were inspected. Another was the cynaide$poisoning incident last !!' wherein &!! children were hospitali*ed after eating cassava snack at school. 8ecently, an alarming number of !! people were hospitali*ed due to 9food poisoning in %alumpit, :ulacan last 7une &4, !&&. Most of these outbreaks were caused by unsanitary food handling practices. All these ideas brought the researchers to conduct this study on, Compliance of Vicente Sotto Memorial Medical Center (VSMMC) Canteen on the Basic Guidelines for Food Safety to bring out awareness to the current status of the hospitals personnels compliance. As health care providers themselves, the researchers are also conducting this study to ensure the safety of the big population of patients being catered in the facility.

RESEARCH OBJECTIVES

General Objective /etermine the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen personnel on the basic guidelines for food safety in terms of personnel hygiene, sanitary facilities and control, and production and process control.

Speci ic Objective!" .pecifically, the study seeks to answer the following<

&. (hat is the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen on the basic guidelines for food safety in terms of personnel hygiene specifically on the following aspects< &.& &. &.4 &.= &.' &.2 pre$employment physical e#amination clean working garments effective hair restraints maintenance of gloves personal cleanliness hand washing

(hat is the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen on the basic guidelines for food safety in terms of sanitary facilities and control specifically on the following aspects< .& use of food service spaces

. .4 .=

vermin control toilet and washing facilities disposal management

4 (hat is the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen on the basic guidelines for food safety in terms of production and process control> 4.& 4. 4.4 4.= 4.' 4.2 4.1 4.? 4.3 6uality and protection of food e6uipment and utensils washing of utensils bactericidal treatment handling of washed utensils storage of washed utensils dry storage of non$perishable foods refrigerated storage of perishable foods food servicing operations

Si#ni icance $ t%e St&'( "he researchers plan to conduct a survey on this particular topic because they would like to find out the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen on the basic guidelines for food safety. "he

researchers believe that the study in the clinical setting it may be of immense benefit to the following< VS))C A'*ini!trati$n+ As the ones managing, and making and implementing the rules to be followed by ;icente .otto Memorial Medical %enter +;.MM%,, this study will help them be aware of the personnels compliance to the guidelines they have set for them to follow. .ince this study also aims to bring awareness to the respondents on their own compliance, then this will ensure safety to all the recipients of the food being prepared. "he feeling of safety this compliance brings to the recipients also reflects and brings good image to the administration and the hospital itself. VS))C Canteen S&pervi!$r+ .ince the supervisor will also be part of this study, awareness of the compliance of the people he@she is handling is also one of the e#pected results. In turn, since these personnel and the canteen itself are all under his@her responsibility, thus response action on whatever is lacking in their compliance is also one thing to look forward to after this study is completed. VS))C Canteen Per!$nnel+ :eing the main respondents of the survey, they are the number one targets when it comes to awareness. "his awareness will bring them the motivation to develop and improve their practices as personnel. "his study will also be an eye$opener and reminder for those who have forgotten that the life of the patients and customers who trustfully eat the food they prepare, lie on their hands. Patient!+ As recipients of the food being prepared by the canteen personnel, improvement of the patients health is also secured in this study.

:eing part of their daily consumption and daily needs, safety in the food they eat will also serve as ground on the betterment of their current health dilemma. C&!t$*er!+ 7ust like the patients, as recipients of the food being prepared by the canteen personnel, this study also ensures their safety as they trustfully buy and eat what is being offered in the canteen. "his will also make sure their health will not be compromised. Anowing that most of the customers of the canteen are mainly the professional health care providers and the significant others of the patients, it will be such a dilemma if the safety of the food they eat from the canteen is 6uestionable. How will they then take care of the patients who need them badly when they themselves become the patients due food poisoning and contaminated food> )e'ical Re!earc%er!+ As they continue to unfold the nature of health and all affecting factors that they may be inspired and be able to get ideas that may help them in their own study. "hat they may be guided and be able to make use of this research as basis for conducting a potential study in the field of evidence$ based practices.

Operati$nal De initi$n $ Ter*! CO)P,IANCE B "his refers to the ability of the Medical "echnologist to act according to accepted standards. VICENTE SOTTO )E)ORIA, )EDICA, CENTER B a general, tertiary and a teaching or training facility located in :. 8odrigue* .t., %ebu %ity. "his is where the proposed study will be conducted. It has a ?!!$bed

capacity and caters to different cases coming from different departments such as .urgery, 55C", Family Medicine, 0ediatrics, Internal Medicine, and ):$Dynecology. BASIC GUIDE,INES B "his refers to the set of rules to be followed from which compliance is measured and assessed -OODSA-ET. B "his refers to the condition which ensures that food will not cause harm to the consumer when prepared and@or eaten according to their intended use

CHAPTER / REVIE0 O- RE,ATED ,ITERATURE AND RE,ATED STUDIES

Food as it is produced, moved, stored, processed, distributed and served in public places is e#posed to ha*ards that pose risk to human health. "hese ha*ards could cause human illness, inEury or death +5llis, !&!,. "here have been millions of cases all over the world rooted from food poisoning each year. Moreover, in the 0hilippines, these cases has never ceased

in each passing year. 5ven if !& has Eust started, there were already reported cases of poisoning. An e#ample is the case of ten family members hospitali*ed in :arangay %alubawan, .an %arlos %ity, 0angasinan after eating spaghetti last 7anuray ', !& +Fa*aro, !& ,. "his case was followed by a report in DMA

Cews on at least ten employees of a restaurant at a mall in 0asay %ity rushed to a hospital on a "hursday night after eating food at the establishment last February =, !& +DMA Cews, !& ,. 8eports on these cases are the very reason why, according to the (orld Health )rgani*ation, food safety is an increasingly important public health issue. Dovernments all over the world are intensifying their efforts to improve food safety +(orld Health )rgani*ation, !!1,. "hese efforts are in response to an increasing number of food safety problems and rising consumer concerns. 8ecent updates in the 0hilippine laws and regulations imply that the 0hilippine government has not given much importance of this. As reported last year, .enator 5dgardo Angara has renewed his call for %ongress to pass the Food .afety Act which he said is long overdue. According to an interview, Angara has stated, G"he Food .afety Act is long overdue. It would the first time we will put together a comprehensive, regulatory regime that will coordinate different government agencies in charge of food safety and 6uality assurance.H +"orrego*a, !&&,.

-$$' B$rne Illne!!e! De ine'

According to the (orld Health )rgani*ation, food borne illnesses are defined as diseases, usually either infectious or to#ic in nature, caused by agents that enter the body through the ingestion of food. 5very person is at risk of food borne illness +(orld Health )rgani*ation, !!1,.

)a#nit&'e $ -$$' B$rne Illne!! Food borne diseases are a widespread and growing public health problem, both in developed and developing countries. "he global incidence of food borne disease is difficult to estimate, but it has been reported that in !!' alone &.? million people died from diarrheal

diseases. A great proportion of these cases can be attributed to contamination of food and drinking water. Additionally, diarrhea is a maEor cause of malnutrition in infants and young children +(orld Health )rgani*ation, !!1,. In industriali*ed countries, the percentage of the population suffering from food borne diseases each year has been reported to be up to 4!I. In the -nited .tates of America +-.A,, for e#ample, around 12 million cases of food borne diseases, resulting in 4 ',!!! hospitali*ations and ',!!! deaths, are estimated to occur each year +(orld Health )rgani*ation, !!1,. (hile less well documented, developing countries bear the brunt of the problem due to the presence of a wide range of food borne diseases, including those caused by parasites. "he high prevalence of diarrheal diseases in many developing countries suggests maEor underlying food safety problems +(orld Health )rgani*ation, !!1,.

(hile most food borne diseases are sporadic and often not reported, food borne disease outbreaks may take on massive proportions. For e#ample, in &33=, an outbreak of .almonella due to contaminated ice cream occurred in the -.A, affecting an estimated =,!!! persons. In &3??, an outbreak of hepatitis

A, resulting from the consumption of contaminated clams, affected some 4!!,!!! individuals in %hina +(orld Health )rgani*ation, !!1,.

)aj$r -$$' B$rne Di!ea!e! r$* )icr$$r#ani!*! Here are Eust a few maEor food borne diseases that humans can get from microorganisms. First is .almonellosis, a maEor problem in most countries. It is caused by the .almonella bacteria and symptoms are fever, headache, nausea, vomiting, abdominal pain and diarrhea. 5#amples of foods involved in outbreaks of .almonellosis are eggs, poultry and other meats, raw milk and chocolate +(orld Health )rgani*ation, !!1,. Ce#t is %ampylobacteriosis, a widespread infection. It is caused by certain species of %ampylobacter bacteria and in some countriesJ the reported number of cases surpasses the incidence of .almonellosis. Food borne cases are mainly caused by foods such as raw milk, raw or undercooked poultry and drinking water. Acute health effects of %ampylobacteriosis include severe abdominal pain, fever, nausea and diarrhea. In two to ten per cent of cases the infection may lead to chronic health problems, including reactive arthritis and neurological disorders +(orld Health )rgani*ation, !!1,.

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)n the other hand, infections due to 5nterohaemorrhagic +causing intestinal bleeding, 5. coli, e.g. 5.coli )&'1, and Fisteriosis are important food borne diseases which have emerged over the last decades. Although their incidence is relatively low, their severe and sometimes fatal health

conse6uences, particularly among infants, children and the elderly, make them among the most serious food borne infections +(orld Health )rgani*ation, !!1,. And lastly, %holera, a maEor public health problem in developing countries, also causing enormous economic losses. "he disease is caused by the bacterium ;ibrio cholerae. In addition to water, contaminated foods can be the vehicle of infection. /ifferent foods, including rice, vegetables, millet gruel and various types of seafood have been implicated in outbreaks of cholera. .ymptoms, including abdominal pain, vomiting and profuse watery diarrhea, may lead to severe dehydration and possibly death, unless fluid and salt are replaced +(orld Health )rgani*ation, !!1,.

Ot%er -$$' Sa et( Pr$ble*!" S$*e )aj$r E1a*ple! %ases of food of illnesses are not only limited to microorganisms. "here are also other possible sources which can cause poisoning. First, naturally occurring to#ins, such as mycoto#ins, marine bioto#ins, cyanogenic glycosides and to#ins occurring in poisonous mushrooms,

periodically cause severe into#ications. Mycoto#ins, such as aflato#in and ochrato#in A, are found at measurable levels in many staple foodsJ the health

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implications of long$term e#posure of such to#ins are poorly understood +(orld Health )rgani*ation, !!1,. Ce#t, unconventional agents such as the agent causing bovine spongiform encephalopathy +:.5, or Kmad cow diseaseK,, is associated with variant %reut*feldt$7akob +v%7/, /isease in humans. %onsumption of bovine products containing brain tissue is the most likely route for transmission of the agent to humans +(orld Health )rgani*ation, !!1,. Also included are 0ersistant )rganic 0ollutants +0)0s,, compounds that accumulate in the environment and the human body. Anown e#amples are /io#ins and 0%:s +polychlorinated biphenyls,. /io#ins are unwanted byproducts of some industrial processes and waste incineration. 5#posure to 0)0s may result in a wide variety of adverse effects in humans +(orld Health )rgani*ation, !!1,. Metals are also not e#ceptions. "hese include lead and mercury, cause neurological damage in infants and children. 5#posure to cadmium can also cause kidney damage, usually seen in the elderly. "hese +and 0)0s, may contaminate food through pollution of air, water and soil +(orld Health )rgani*ation, !!1,. (ith all these facts at hand, the 0hilippine government, though there was a delay of passing the Food .afety Act, has long been fighting this concern through implementing guidelines on food handling.

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As stated in 0residential /ecree Co. ?'2, also known as the .anitation %ode, there should be specific guidelines to be followed by all food handlers and be strictly implemented by supervisors and managers. "hese guidelines, to be followed food establishments are enlisted in details in the %hapter III of the %ode. "hese could be subdivided into three main categories including 0ersonnel Hygiene, .anitary Facilities and %ontrols, and 0roduction and 0rocess %ontrols. %lassified under the three guideline categories here are the contents of 0./. ?'2 +0residential /ecree Co. ?'2, &31' ,.

Per!$nnel H(#iene 0ersonnel hygiene is clearly stated under .ection &3 entitled, 9 Food Handlers. "hese include two main guidelines. First is the pre employment health assessment which states that no person shall be employed in any food establishment without a health certificate issued by the local health authority. "he second part applies during the employment period. "hese include the following guidelines. Food handlers shall at all time wear clean working garments +the cook shall wear prescribed caps and female employees caps or hairnets,, observe good personal hygiene, and wash their hands thoroughly with soap and water and dry them with a clean or disposable towel or a suitable hand$drying device immediately before working, or after visiting the toilet +0residential /ecree Co. ?'2, &31',.

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Sanitar( -acilitie! an' C$ntr$l! )n the other hand, sanitary facilities and controls guidelines are covered in .ection &? + se of Food!Ser"ice Spaces,, .ection Control,, .ection & +#oilet and $ashin% Facilities ,, and .ection 'efuse, +0residential /ecree Co. ?'2, &31',. In .ection &?, the following guidelines apply for the use of food service spaces< +a, food$service spaces shall not be used as living or sleeping 6uartersJ +b, clothing or personal effects shall be kept in lockers or in designated places away from food service spacesJ +c, no animal or live fowls shall be allowed in such spacesJ +d, persons not directly connected with food preparation and serving shall not be allowed to stay in food$serving spacesJ +e, foods in storage or in preparation must not be handled by anyone other than the preparation and serving staff +0residential /ecree Co. ?'2, &31' ,. -nder .ection !, vermin control is focused. It states the definition of a vermin which is a group of insects or small animals such as flies, mos6uitoes, cockroaches, fleas, lice, bedbugs, mice, and rats which are vectors of diseases. "he guidelines are as follows< +a, spaces where food and drinks are stored, prepared and served shall be so constructed and maintained as to e#clude verminJ +b, all opening which connects spaces to the outer air shall be effectively protected with screen of non$corrosive wire &2$mesh or finer. /oor screens shall be tight$fittingJ +c, a vermin abatement program shall be maintained in the establishments by their owners, operators, or administrators and if they fail, ! +Vermin +&isposal of

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neglect or refuse to maintain a vermin abatement programs, the local health agency will undertake the work at their e#penseJ +d, during deratting or disinfecting operations, all foodstuffs, utensils, food preparation and cleaning e6uipment shall be covered to protect them from to#ic chemical substancesJ +e, vermin control in public places shall be the responsibility of the provincial, city or municipal governments which have Eurisdiction over themJ +f, the procedure and fre6uency of vermin abatement program shall be determined and approved by the local health authority +0residential /ecree Co. ?'2, &31' ,. In .ection &, toilet ad washing facilities are the main subEects. "he

guidelines for these two include< +a, ade6uate and clean toilet facilities for male and female customers and personnel shall be provided in properly located areasJ +b, toilet rooms shall not open directly into spaces where food is prepared, stored or served. (here such toilets e#ist, the doors shall be tight fitting and self$ closingJ +c, ade6uate hand$washing facilities shall be provided within or adEacent to toilet roomJ +d, facilities shall include hot and cold running water, single$service paper or cloth towel dispenser or drying device and soap or detergent +0residential /ecree Co. ?'2, &31',. Fastly, under .ection , disposal guidelines are the main contents. "hey

are as follows< +a, refuse cans may be used in food$preparation areas for immediate use onlyJ +b, storage refuse cans, filled and empty, shall be in a designated space separate from food$handling operationsJ +c, these cans shall be constructed and maintained as to be vermin$proof and easily cleanedJ +d,

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cans containing refuse shall be tightly covered at all times, e#cept during actual use in food$handling areasJ +e, holding bins may likewise be used, provided they are constructed of impervious, readily$cleaned materials, and fitted with tight$ fitting coversJ +f, where refuse cans are used, a space separated from the food$ handling spaces and adEacent to the refuse$can storage space shall be provided for cleaning them. "his space shall be e6uipped with scrubbing$brushes, cleansing agents, steam or hot water under pressure, and a hose fitted with adEustable no**le +0residential /ecree Co. ?'2, &31',. Pr$'&cti$n Pr$ce!!e! an' C$ntr$l! "he last parameter to be covered is the production processes and controls. Duidelines for these are enumerated under .ection &2 + (uality and )rotection of Food,, .ection 4 +*+uipment and of tensils,, .ection tensils,, .ection = +$ashin% 2 +Handlin% of ? +&ry

' +Bactericidal #reatment,, .ection 1 +Stora%e of $ashed

$ashed

tensils,, .ection

tensils,, .ection

Stora%e of ,on!)erisha-le Foods,, .ection

3 +'efri%erated Stora%e of

)erisha-le Foods,, and .ection 4! +Food Ser"icin% .perations, +0residential /ecree Co. ?'2, &31',. "o begin with, .ection &2 covers 6uality and food protection. "he guidelines for which are stated as, all food must be obtained from sources approved by the local health authority. In this regard, the following re6uirements are applicable< +a, meats, meat products and fish shall be procured from sources under sanitary or veterinary supervisionJ +b, all meat and fish shall be properly

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cooked before servingJ +c, no meat products, fish, vegetables and other food sources shall be procured from sources or areas known to have been affected by radioactivity as for e#ample, areas contaminated with a very large amount of radioactive falloutJ +d, milk and fluid milk products shall be obtained from sources approved by the local health authority and milk obtained from other sources must be sterili*ed, pasteuri*ed or otherwise heatedJ +e, milk shall be stored in a refrigerator while canned or package milk, other than dry milk powders, shall be refrigerated after the container has been openedJ +f, all perishable and potentially ha*ardous foods shall be stored at ='LF +1L%, or below. %ooked food intended to be served hot shall be kept at a temperature not lower than &=!LF +2!L%,. 8aw fruits and vegetables shall be thoroughly washed before they are used +0residential /ecree Co. ?'2, &31',. In .ection 4, general guidelines for e6uipment and utensils are covered. "hese are the following< +a, e6uipments and utensils shall be so designed, fabricated and installed so that cleaning is easy and they do not pose health ha*ardsJ +b, lead$soldered containers and cadmium$lined piping and fi#tures shall not be usedJ +c, surfaces that come into contact with food or drinks shall be constructed of materials that are impervious, corrosion$resistant, non$to#ic, easily cleanable, durable and resistant to chippingJ +d, sliding doors on cabinets shall be easily cleanable and removable, runners shall be allotted at the ends to permit removal of dust and debris, and the bottom shelves of open$based fi#tures shall be removable to facilitate inspection, cleaning and maintenance +0residential /ecree Co. ?'2, &31',.

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-nder .ection =, guidelines specific during the washing of the utensils are listed. "hese include< +a, utensils shall be scraped and pre$rinsed to remove food articlesJ +b, they shall be thoroughly cleansed in warm water at & !LF +=3L%, with soap or detergentJ +c, if running water is not used, the wash$water shall be changed fre6uently +0residential /ecree Co. ?'2, &31',. )n the other hand, .ection ' mentions specific guidelines for bactericidal treatment. It states that eating and drinking utensils and e6uipment, after thoroughly cleaned, shall be subEected to one of the following bactericidal treatments< +a, immersion for at least half a minute in clean hot water at a temperature of at least &1!LF +11L%,J +b, immersion for at least one minute in a lukewarm chlorine solution '! ppmJ +c, e#posure in a steam cabinet at a temperature of at least &1!LF +11L%, for at least &' minutes at a temperature of !!LF +3!L%, for at least ' minutesJ +d, e#posure in an oven or hot$air cabinet at a temperature of at least &?!LF +? L%, for at least ! minutesJ or +e, any other method approved by the local health authority +0residential /ecree Co. ?'2, &31',. .ection 2 follows with the specifics on handling washed utensils. "hese include< +a, washed utensils shall be allowed to drain dry in wire racks without use of drying cloths, or shall be stored in a self$draining position to permit ready air$dryingJ +b, the drying cloth on which to store dishes and utensils temporarily after bactericidal treatment should be clean and changed fre6uently +0residential /ecree Co. ?'2, &31' ,.

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"hen .ection

1 follows$up with specifications on storage of washed

utensils. "hese are the following< +a, washed utensils shall be stored in a clean and dry place ade6uately protected against vermin and other sources of contaminationJ +b, cups, bowls, and glasses, shall be inverted for storageJ +c, when not stored in closed cupboards or lockers, utensils and containers shall be covered or inverted whenever practicable and utensils shall not be stored on the bottom shelves of open cabinets below the working top levelJ +d, racks, trays and shelves shall be made of materials that are impervious, corrosion$resistant, non$ to#ic, smooth, durable and resistant to chippingJ +e, drawers shall be made of the same materials and kept clean. Felt$line drawers are not acceptable, but the use of clean and removable towels for lining drawers is acceptable +0residential /ecree Co. ?'2, &31',. )n the other hand, .ection ? offers the guidelines for the dry storage of non$perishable foods. It states that non$perishable foods shall be stored in the following manner< +a, designated spaces, lockers, cupboards, racks, shelves and containers shall be used for storageJ +b, all spaces, lockers and cupboard shall be constructed of materials of the same 6uality as used for food$preparation and food$serving operations and containers shall be made of metal fitted with tight coversJ +c, the recommended temperature range for dry stores is '!$2!L% +&!$ &'L%, e#cept where dry foods for immediate use are stored in the preparation and servicing spaces +0residential /ecree Co. ?'2, &31',.

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"his is followed by the guidelines for refrigerated storage for perishable foods under .ection 3. It states that perishable foods shall be stored in the

following manner< +a, they shall be kept at or below ='LF +1L%, e#cept during preparation or when held for immediate serving after preparationJ +b, when such foods are to be stored for e#tended periods, a temperature of =!LF +=!L%, is recommendedJ +c, fruits and vegetables shall be stored in cool rooms. +d, recommended temperatures for perishable food storage +& $ Fro*en foodsJ not more than &!LF + L%,, $ Meat and fish< 4 $4?LF +!$4L%,, 4 $ Milk and milk

products< =!$='LF +'$1L%,, = $ Fruits and vegetables< ==$'!LF +1$&!L%,,J +e, all refrigerating compartments and refrigerators must be kept clean, in good repair and free from odors. "hey shall be provided with thermometers with scale divisions not larger than LF +&L%,. .ufficient shelving shall be provided to

prevent stocking and to permit ade6uate ventilation and cleaning +0residential /ecree Co. ?'2, &31',. Fastly, in .ection 4!, food servicing operations are covered. It specifically states that these operations should be in accordance with the following re6uirements< +a, hand contacts with food or drink shall be avoidedJ fingers shall not be used to serve butter, ice, or similar items of food and sugar shall be served in covered dispensers or containers, or in packages wrapped for single serviceJ +b, the surfaces of containers and utensils, including glasses and table wares, which come in contact with food and drink shall not be handledJ +c, disposable cups, plates, spoons and other single$service containers and utensils shall be purchased in sanitary cartons and stored in a clean, dry place until used

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and these articles shall be so handled on removal from the carton that the hand does not touch the surface which will be in contact with food or drinkJ +d, clean cloths, napkins, spoons, towels, and other cloth e6uipment shall be stored in clean places designated specifically for them and also soiled linens, including towels, aprons, and coats, shall be stored in a closed bin or locker, suitably markedJ +e, .poons, spatulas, dippers and scoops used intermittently for dispensing fro*en desserts shall be kept in running water or in water maintained at &1!LF +11L%, and fre6uently changed, or they may be washed and stored in a dry place after each use. %onstant$temperature bottles and other containers used for potable water and other beverages shall be kept clean and given effective bactericidal treatment before and after subse6uent use +0residential /ecree Co. ?'2, &31',. "hese guidelines are highly supported by former /epartment of Health .ecretary, Manuel /ayrit, in the Administrative )rder Co. &'4 last !!= +/ayrit, !&!,. .tudies all over the world were also already conducted. An e#ample would be the study conducted by 5llen 5stremera$%ea, a Master of Food .ervice Administration from the -niversity of the 0hilippines, /iliman, Mue*on %ity. It was entitled, G#he /pplication .f Ha0ard /nalysis /nd Critical Control )oints (Haccp) 1n #he )reparation .f Blenderi0ed Feedin% Formula 1n / Hospital2 According to this study, most of the studies done in the 0hilippines regarding food safety focused on commercial and educational food service institutions. A study has yet

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to deal with hospital food service operations, despite reports on microbiological contamination in hospital food service +%ea, !!2,.

CHAPTER 2 RESEARCH DESIGN AND )ETHODO,OG.

Re!earc% De!i#n "his study utili*es the descriptive survey type of research. "he researchers will gather their data by providing researcher$made 6uestionnaires that are based on the different related literature. "hese will be distributed to the randomly selected respondents from the canteen personnel of ;icente .otto Memorial Medical %enter +;.MM%,.

Re!earc% S&bject "he researchers specifically choose the canteen personnel of ;icente .otto Memorial Medical %enter +;.MM%, as the subEects of this study, because they believe that these people are the ones who are preparing the food and thus the safety of the food distributed throughout the entire facility is in their hands. "he subEects of the research are all the canteen personnel of ;.MM%. "he respondents will be asked to answer the survey 6uestions truthfully and honestly in order to gather the necessary data needed to be able to draw out a credible conclusion. Also part of the respondents is a representative from the supervisors and the administration. "his is to get three different point$of$views coming from

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the same establishment< one is the perception of the personnelJ two is the perception of the supervisorJ and lastly, the perception of the administration. "his will provide great comparison and may reveal either unity or inconsistency of their perceptions. "he researchers themselves will also be assessing the canteen using the same guidelines through direct observation.

Re!earc% Envir$n*ent "his study will be conducted at ;icente .otto Memorial Medical %enter +;.MM%,, :. 8odrigue* .t., %ebu %ity. It is a general, tertiary and a teaching or training facility with ?!!$bed capacity and caters to different cases coming from different departments such as .urgery, 55C", Family Medicine, 0ediatrics, Internal Medicine, and ):$Dynecology. .pecifically, the study will be conducted in the ;.MM% canteen. It has &4 tables with ?$seat capacity each. It has a washing area. It has 4 doors. It is e6uipped with eight ceiling fans and three stand fans. It is usually operated by 2$ ? personnel per day.

Re!earc% In!tr&*ent! As a descriptive survey type of research, the use of 6uestionnaires is very important. "he researchers, themselves, construct the 6uestionnaire and include 6uestions that are brief, direct but at the same time relevant to the topic. "hese 6uestionnaires will be answered by three different respondents to bring up a great comparison of their point$of$views. "he 6uestionnaire is mainly composed

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of three parts namely< personnel hygiene, sanitary facilities and control, and production and process control. All the 6uestions are based on the guidelines specified in the related literature. An informed consent will also be signed by the respondents before they will be asked to answer the 6uestionnaires to make sure they are well aware of what the 6uestionnaires are for.

24

Re!earc% Pr$ce'&re Brainstorming of the topic Selection of the case and the hospital/ facility ppro!al of the research title c"#isition of the re"#est letter S#$mission of the transmittal letter to the administration and the canteen s#per!isor Sched#ling of the cond#ction of the s#r!ey ct#al s#r!ey

%istri$#tion of the "#estionnaires to the &S''( canteen s#per!isor

%istri$#tion of the "#estionnaires to the &S''( canteen personnel

nalysis and interpretation

(ollection and ta$#lation of the data

)orm#lating of recommendation

RE-ERENCES

25

J$&rnal 5llis, Abigail M.0. + !&!,. H: 431 Food .afety Act of !&!. /%ham.

G$vern*ent D$c&*ent! 0hilippines. 0residential /ecree Co. ?'2< %ode on .anitation. 0hilippine %onstitution. 0hilippines< Dovernment 0rinting )ffice, &3?1. /ayrit, Manuel M. + !&!,. 8evised Duidelines on %urrent Dood Manufacturing 0ractice Manual. /dministrati"e .rder ,o2 3452 S.

Ne3!paper! Fa*aro, Freddie D. KFood 0oisoning,K "empo !' 7anuary !& , 8egional Cews< D& "orrego*a, Hannah F. KFood .afety Act NFong )verdueN,K Manila :ulletin ? August !&&, Frontpage< A&

TV Pr$#ra* KFood 0oisoning /owns &! in 0asay,K DMA Cews. DMA. M5"8) MACIFA, 0hilippines. = February. !& .

Internet

26

KFood .afety and Food :orne Illness,K !!1 (orld Health )rgani*ation, March !!1 Owww.who.int@mediacentre@factsheets@fs 41@en@P

Ot%er St&'ie! %ea, 5llen 5. + !!2,. #he /pplication .f Ha0ard /nalysis /nd Critical Control )oints (Haccp) 1n #he )reparation .f Blenderi0ed Feedin% Formula 1n / Hospital2 8etrieved from Cutritionist$/ietitiansN Association of the 0hilippines.

APPENDI4 A TRANS)ITTA, ,ETTER

27

April !& /r. D58A8/) M. AM-IC)., 7r., M/.,MHA, %.55 Medical %enter %hief ;icente .otto Memorial Medical %enter :. 8odri6ue* .t. %ebu %ity /ear /r. A6uino< In compliance with the fulfillment of the re6uirements for the degree in :achelor of .cience in Medical "echnology, the proponents would like to present the proposal entitled G Compliance of Vicente Sotto Memorial Medical Center (VSMMC) Canteen on the Basic Guidelines for Food SafetyH. "he main purpose of the study is to determine the compliance of ;icente .otto Memorial Medical %enter +;.MM%, canteen personnel on the basic guidelines for food safety in terms of personnel hygiene, sanitary facilities and control, and production and process control. "his mainly aims for awareness not only for the personnel but also for the management and to the administration. "his will help ensure that patients, customers, and even the medical professionals who eat at the canteen get the utmost protection and safety with regard to their food. "o get the necessary data, the respondents will be asked to answer research$made 6uestionnaires. "here will also be a separate 6uestionnaire to be answered by the supervisors. (e will be more than happy to give you any feedback or report with regard to the results of this study. (e are hoping that this proposal will meet your approval.

8especfully yours, Hanilyn ). 8amas :.M"$4A Coted :y< Ms. Merafe ). "erregosa , 8M" M.M" %linical %oordinator %ollege of Medical "echnology Approved by< Marvi /ulnuan M./. F.0...0 /ean, %ollege of Medical "echnology

APPENDI4 B 5UESTIONNAIRE COVER ,ETTER March !& /ear 0articipant<

28

(e are third year students from .outhwestern -niversity taking up :achelor of .cience Medical "echnology. As a re6uirement for .Q !&&$ !& , we will be conducting a study entitled, GCompliance of Vicente Sotto Memorial Medical Center (VSMMC) Canteen on the Basic Guidelines for Food Safety2 :ecause you are part of the personnel from the said facility, we are inviting you to participate in this research study by completing the attached surveys. "he following 6uestionnaire will re6uire appro#imately '$&' minutes to complete. "here is no compensation for responding nor is there any known risk. In order to ensure that all information will remain confidential, please do not include your name. %opies of the proEect will be provided to our instructor and to the panelists who will approve this study. 0lease return the completed 6uestionnaires promptly. "hank you for taking the time to assist us in our educational endeavors. "he data collected will provide useful information. %ompletion and return of the 6uestionnaire will indicate your willingness to participate in this study. If you re6uire additional information or have 6uestions, please contact us at this number< 4&'=1?! and look for Mr. 7aimes "allo.

!3

.incerely, Hanilyn ). 8amas :.M"$4A Coted :y< Ms. Merafe ). "erregosa , 8M" M.M" %linical %oordinator %ollege of Medical "echnology

Approved by< Marvi /ulnuan M./. F.0...0 /ean, %ollege of Medical "echnology

APPENDI4 C 5UESTIONNAIRE A 6-$r Per!$nnel Re!p$n'ent!7 I+ PERSONNE, H.GIENE Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item.

29

CRITERIA /id you undergo a physical e#amination before you were hired in this Eob> /o you wear clean working garments while working> /o you wear effective hair restraints while working> /o you use gloves in handling food> /o you maintain personal cleanliness before and during work> /o you perform hand washing< at start of shift> after using the toilet> when entering the kitchen area> before and after coffee, food, and cigarette breaks> after snee*ing or coughing> after handling raw food> after touching any body part> at anytime hands become visibly soiled>

Alway s +=,

)ften +4,

.ome$ times + ,

8arely +&,

C@A +!,

II+

SANITAR. -ACI,ITIES AND CONTRO,S Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item. CRITERIA Always +=, )ften +4, .ome$ times + , 8arely +&, C@A +!,

/o you avoid using your service spaces as living or sleeping 6uarters>

30

/o you strictly not allow any animal or fowls in the facility> /o you strictly follow no hanging clothing or any personal belongings kept in the facility> Are the spaces where food and drinks are stored, prepared and served, constructed to e#clude vermin> /o the facilitys windows have a &2$mesh protective screen /o you have any vermin abatement program> /oes the facility have ade6uate and clean toilet facilities> Is there a toilet for both male and female> Is the toilet for personnel separate from those for the customers> /o the toilets have tight$fit doors> /o the toilets have adEacent hand$washing facilities> /o the toilets offer hot and cold running water> /o the toilets at least offer a single service paper or cloth towel dispenser or drying device> /o the toilets have soap or detergent or hand saniti*ers> /oes the canteen have garbage cans> Are the trash cans properly labeled as biodegradable, non biodegradable, and ha*ardous> Are the garbage cans separated from food preparation areas> Are the cans vermin$proof and easy to clean> /o the cans have tight covers> /o the cans have adEacent cleaning kit +scrubbing$brushes, cleansing agents, steam or hot water under pressure, and a hose fitted with adEustable no**le,> /uring deratting or disinfecting operations, are all foodstuffs, utensils, food preparation and cleaning e6uipment covered> Is the procedure and fre6uency of vermin abatement program determined and approved by the local health authority>

III+

PRODUCTION AND PROCESS CONTRO,S Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item. Alway s +=, .ome$ times + ,

CRITERIA

)ften +4,

8arely +&,

C@A +!,

31

Is the procurement of sources +meats, meat products and fish, under sanitary or veterinary supervision> Are the food served properly cooked> /o the milk and fluid milk products from approved sources> Is milk stored in the refrigerator> Are perishable and potentially ha*ardous foods stored at ='LF +1L%, or below> Are cooked food served hot not lower than &=!LF +2!L%,>
Are the e6uipments designed, fabricated and installed for easy cleaning and ha*ard free> /o you strictly not use lead$soldered containers and cadmium$lined piping and fi#tures> /o the e6uipments have impervious, corrosion$resistant, non$to#ic, easily cleanable, durable and resistant to chipping surfaces> /o the cabinets have easily cleanable and removable sliding doors> /uring the washing of utensils, are they< scraped and pre$rinsed> thoroughly cleansed in warm water at & !LF +=3L%, with soap or detergent> immersed for at least half a minute in clean hot water at a temperature of at least &1!LF +11L%,> immersed for at least one minute in a lukewarm chlorine solution> e#posed in a steam cabinet at a temperature of at least &1!LF +11L%, for at least &' minutes or !!LF +3!L%, for at least ' minutes> e#posed in an oven or hot$air cabinet at a temperature of at least &?!LF +? L%, for at least ! minutes>
disinfected through any other method approved by the local health authority> In handling washed utensils, are they< drained and dried in wire racks without use of drying cloths> stored in a self$draining position to permit ready air$drying> In storing washed utensils, are they< clean and dry> protected against vermin and other

32

sources of contamination> inverted especially cups, bowls, and glasses> not stored on the bottom shelves of open cabinets below the working top level> stored in impervious, corrosion$resistant, non$to#ic, smooth, durable and resistant to chipping racks, trays and shelves> /o the dry storage of non$perishable foods< have designated spaces, lockers, cupboards, racks, shelves and containers> have '!$2!L% +&!$&'L%, temperature range> /oes the refrigerated storage of perishable foods have a temperature of =!LF +=L%,> Are fruits and vegetables stored in cool rooms> Are the refrigerators kept clean, in good repair and free from odors> /o the refrigerators have sufficient shelving> /uring food service, do you avoid hand contacts with foods and drinks> Are the sugars in covered dispensers or in packages wrapped for single service sugars> Are the disposable cups, plates, spoons and other single$service containers and utensils purchased in sanitary cartons and stored in a clean, dry place until used> Are the clean cloths, napkins, spoons, towels, and other cloth e6uipment stored in designated area> Are the soiled linens, including towels, aprons, and coats stored in close bins and lockers> Are the spoons, spatulas, dippers and scoops used intermittently for dispensing fro*en desserts kept in running water>

APPENDI4 D 5UESTIONNAIRE B 6-$r S&pervi!$r!7 I+ PERSONNE, H.GIENE Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item. Alway s +=, .ome$ times + ,

CRITERIA

)ften +4,

8arely +&,

C@A +!,

33

/o employees undergo a physical e#amination before being hired in their Eob> /o personnel wear clean working garments while working> /o they wear effective hair restraints while working> /o they use gloves in handling food> /o they maintain personal cleanliness before and during work> /o they perform hand washing< at start of shift> after using the toilet> when entering the kitchen area> before and after coffee, food, and cigarette breaks> after snee*ing or coughing> after handling raw food> after touching any body part> at anytime hands become visibly soiled>

II+

SANITAR. -ACI,ITIES AND CONTRO,S Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item. CRITERIA Always +=, )ften +4, .ome$ times + , 8arely +&, C@A +!,

/o personnel avoid using your service spaces as living or sleeping 6uarters> /o they strictly not allow any animal or fowls in the facility> /o they strictly follow no hanging clothing or any personal belongings kept in the facility> Are the spaces where food and drinks are stored, prepared and served, constructed to e#clude

34

vermin> /o the facilitys windows have a &2$mesh protective screen /o you have any vermin abatement program> /oes the facility have ade6uate and clean toilet facilities> Is there a toilet for both male and female> Is the toilet for personnel separate from those for the customers> /o the toilets have tight$fit doors> /o the toilets have adEacent hand$washing facilities> /o the toilets offer hot and cold running water> /o the toilets at least offer a single service paper or cloth towel dispenser or drying device> /o the toilets have soap or detergent or hand saniti*ers> /oes the canteen have garbage cans> Are the trash cans properly labeled as biodegradable, non biodegradable, and ha*ardous> Are the garbage cans separated from food preparation areas> Are the cans vermin$proof and easy to clean> /o the cans have tight covers> /o the cans have adEacent cleaning kit +scrubbing$brushes, cleansing agents, steam or hot water under pressure, and a hose fitted with adEustable no**le,> /uring deratting or disinfecting operations, are all foodstuffs, utensils, food preparation and cleaning e6uipment covered> Is the procedure and fre6uency of vermin abatement program determined and approved by the local health authority>

III+

PRODUCTION AND PROCESS CONTRO,S Aindly place a check +, mark in the space that corresponds to your answer. 0lease choose only one response per item. Alway s +=, .ome$ times + ,

CRITERIA Is the procurement of sources +meats, meat products and fish, under sanitary or veterinary supervision> Are the food served properly cooked> /o the milk and fluid milk products from

)ften +4,

8arely +&,

C@A +!,

35

approved sources> Is milk stored in the refrigerator> Are perishable and potentially ha*ardous foods stored at ='LF +1L%, or below> Are cooked food served hot not lower than &=!LF +2!L%,>
Are the e6uipments designed, fabricated and installed for easy cleaning and ha*ard free> /o you strictly not use lead$soldered containers and cadmium$lined piping and fi#tures> /o the e6uipments have impervious, corrosion$resistant, non$to#ic, easily cleanable, durable and resistant to chipping surfaces> /o the cabinets have easily cleanable and removable sliding doors> /uring the washing of utensils, are they< scraped and pre$rinsed> thoroughly cleansed in warm water at & !LF +=3L%, with soap or detergent> immersed for at least half a minute in clean hot water at a temperature of at least &1!LF +11L%,> immersed for at least one minute in a lukewarm chlorine solution> e#posed in a steam cabinet at a temperature of at least &1!LF +11L%, for at least &' minutes or !!LF +3!L%, for at least ' minutes> e#posed in an oven or hot$air cabinet at a temperature of at least &?!LF +? L%, for at least ! minutes>
disinfected through any other method approved by the local health authority>

In handling washed utensils, are they< drained and dried in wire racks without use of drying cloths> stored in a self$draining position to permit ready air$drying> In storing washed utensils, are they< clean and dry> protected against vermin and other sources of contamination> inverted especially cups, bowls, and glasses> not stored on the bottom shelves of open cabinets below the working top level>

36

stored in impervious, corrosion$resistant, non$to#ic, smooth, durable and resistant to chipping racks, trays and shelves> /o the dry storage of non$perishable foods< have designated spaces, lockers, cupboards, racks, shelves and containers> have '!$2!L% +&!$&'L%, temperature range> /oes the refrigerated storage of perishable foods have a temperature of =!LF +=L%,> Are fruits and vegetables stored in cool rooms> Are the refrigerators kept clean, in good repair and free from odors> /o the refrigerators have sufficient shelving> /uring food service, do you avoid hand contacts with foods and drinks> Are the sugars in covered dispensers or in packages wrapped for single service sugars> Are the disposable cups, plates, spoons and other single$service containers and utensils purchased in sanitary cartons and stored in a clean, dry place until used> Are the clean cloths, napkins, spoons, towels, and other cloth e6uipment stored in designated area> Are the soiled linens, including towels, aprons, and coats stored in close bins and lockers> Are the spoons, spatulas, dippers and scoops used intermittently for dispensing fro*en desserts kept in running water>

37