Prerequisite Programs at Schools: Diagnosis and Economic Evaluation

Abstract

In this study, 20 Brazilian public schools have been assessed regarding good manufacturing practices and standard sanitation operating procedures implementation. We used a checklist comprised of 10 parts (facilities and installations, water supply, equipments and tools, pest control, waste management, personal hygiene, sanitation, storage, documentation, and training), making a total of 69 questions. The implementing modification cost to the found nonconformities was also determined so that it could work with technical data as a based decision-making prioritization. The average nonconformity percentage at schools concerning to prerequisite program was 36%, from which 66% of them own inadequate installations, 65% waste management, 44% regarding documentation, and 35% water supply and sanitation. The initial estimated cost for changing has been U.S.$24,438 and monthly investments of 1.55% on the currently needed invested values. This would result in U.S.$0.015 increase on each served meal cost over the investment replacement within a year. Thus, we have concluded that such modifications are economically feasible and will be considered on technical requirements when prerequisite program implementation priorities are established.

Introduction

S chool meals are a great opportunity for public authorities to implement actions that provide the population with nutritional and safe food. In Brazil, the School Feeding National Program (Programa Nacional de Alimentação Escolar) is the oldest program on food security comprising food supply for schools. In 2008, the program benefited about 36 million students, including those registered at indigenous, philanthropic, and public schools for children (preschool and daycare centers) and basic education (Anonymous, 2008). The program is currently intended to meet students' nutritional needs during their stay at school, which represents 15% of daily recommendations (350 kcal and 9 g of protein), contributing to their growth, development, and schooling, preventing them from school dropouts, and promoting their healthy eating habits to this priority social group (Santos et al., 2007; Anonymous, 2008).

School meal microbiological quality and safety have been studied in several countries such as Brazil, Spain, Argentina, and Chile (Tessi et al., 2002; Diaz et al., 2003; Reyes et al., 2007; Santana et al., 2009), as well as foodborne illness outbreak occurrence within schools have been also internationally reported (Richards et al., 1993; Kaku et al., 1995; Evans and Maguire, 1996; Daniels et al., 2002; Dominguez-Berjon et al., 2003; Drowkin et al., 2004; Morais, 2004; Morillo-García et al., 2005; Michelin et al., 2006; Wei and Chiou, 2002; Lima, 2008; Pakalniskiene et al., 2009; Unicomb et al., 2009). These outbreaks are mostly caused by inadequate storage, food preparation, and maintenance practices, as well as by poor raw material quality (DeBess et al., 2009; Jacob and Powell, 2009). Thus, the prerequisite program adoption (good manufacturing practices [GMP]) and standard sanitation operating procedures (SSOP) are important parts of food safety strategies to assure students' health. This is because prerequisite programs establish general basic hygiene standards on food handling from its preparation to its consumption. When properly developed, prerequisite programs may provide an organized, clean, and safe environment as well as a productivity increase; employees' motivations may provide good basic handling principle control, being used as the implementation basis of hazard analysis and critical control points (HACCP). Prerequisite programs may help to reduce the critical process points of making HACCP plan efficient, easier, and cheaper.

Despite food safety being a subject of increasing concern among consumers (Chen, 2008; Raspor, 2008), the matter of costs to adequate prerequisite programs is not usually focused on subject studies. For the well-succeeded prerequisite program (PRP) implementation, besides awareness campaigns with handlers' food, nonconformity changing prioritization should take into account an involved cost estimative. In this regard, this work is intended to evaluate PRP implementation level at schools and perform involved cost analysis to nonconformities. That information may be used not only for providing information to originate strategies for improving food safety, but also for taking into account the economic feasibility of corrective measures.

Materials and Methods

Definitions

To guide the PRP implementing evaluation and economic feasibility, the following terms were considered:

Good manufacturing practices

These include general requirements regarding maintenance and sanitation establishment, equipment, utensils, personal hygiene, environmental hygiene, incoming material, packaging control, water supply, integrated urban pest control, preventive maintenance, training programs, waste management, and operation control, aiming to ensure food safety.

Sanitization standard operating procedures

SSOP are procedures written in a clear way, establishing sequential instructions to perform daily and specific operations in production, storage, and food transportation (Anonymous, 2003). SSOP contain sequential and operational instructions, execution frequency, name specification, and position and function of those responsible for the activities. In Brazil, the considered SSOP are procedures for environmental sanitation, equipment and utensils, preventive maintenance and equipment calibration, integrated urban pest control, reservoir sanitation and water potability control, food handlers' hygiene and health, raw material selection, ingredients and packaging, waste management, and food recall program. The SSOP must be approved, dated and signed by the responsible person for the facility, where applicable, and listed the material necessary for the transactions as well as for personal protective equipment.

Sampling

Twenty part-time and full-time urban and rural schools were picked up randomly. These schools represent about 45% of the Municipal Schools of Basic Education in a municipality in Paraná, in southern Brazil, serving about 6700 meals daily. Forty workers are involved at preparation and handling of these meals.

School feeding program characterization

Part-time schools serve two meals daily (in the breakfast: comprised of milk or probiotics and wholemeal bread and crackers; and at lunch: sweet lunch, once a week—porridge or a drink with crackers or bread—and savory lunch, in the other days of the week—pasta or rice and beans, meat, salad, fruits, or drinks). Full-time schools serve breakfast, lunch, and snack. The breakfast is similar to the ones in part-time schools, but the lunch is comprised of savory food (also similar) and the snack is similar to the breakfast. The schools that have daycare centers serve breakfast, lunch, snack, and dinner. All the surveyed schools have cafeteria; the bakery supplies are delivered three times a week, whereas meat (frozen), yogurt, and groceries are delivered weekly (point-to-point). Other kinds of food, stable at room temperature, are delivered weekly; however, these products come from a concessionaire's distribution center (DC). Cleaning products for sanitation are delivered twice a month and also come from the DC.

The 20-school average budget includes expenditures of about 58% in groceries, 23% in labor (lunch ladies, stockers and their assistants, supervisors, and coordinators), 11.4% in hygiene and cleaning, 4.5% in miscellaneous expenditures (administrative material and DC rent), 2.3% in raw material transport, 0.58% in maintenance, 0.2% in pest control, and 0% in training.

PRP evaluation

To evaluate the adequacy concerning to GMP and SSOP, a checklist based on Brazilian legislation on GMP for food services (Anonymous, 2004) and also based on the SSOP regulation/GMP checklist for food processing/distributing facilities was prepared (Anonymous, 2003). Later, the checklist was sent by e-mail to nutritionists responsible for facility supervision, to check its applicability and acceptance. The final approved checklist (Tables 1 –3) was comprised of 10 parts (69 questions): (1) installations/structure, (2) waste management, (3) documentation, (4) water supply, (5) hygiene, (6) storage, (7) food handlers' hygiene, (8) equipments and tools, (9) pest control, (10) training/education. This structure makes possible the evaluation of the main factors that may contribute to food contamination through a single checklist. In addition, it makes easier the management of the results to generate information that can be used to make-up the points not addressed and then improve the overall rate of each facility evaluated. Briefly, the questions regarding the item “installations/structure” had the aim to (1) provide information about all the facilities to avoid vectors and pests' entrance and their establishment at the manufacturing area; (2) know if the schools had proper facilities to personal hygiene and if they were built to avoid contamination of the foods; and (3) know if the facilities provided risks of contamination of foods due to physical hazards (lamps breakdown) or biological hazards.

Table 1.

Mean Percentage of Unconformity in Installations, Waste Management, and Documentation

Installations
1. Do the facilities have self-closing doors?	90%
2. Do the facilities have restrooms with toilet paper, soap, and antiseptic lotion?	90%
3. Are the doors fitted with screens to avoid pest access?	90%
4. Do the facilities have a lavatory at the production area?	85%
5. Do the facilities have protection around the light fittings?	85%
6. Are the doors fitted with screens to avoid pest access?	85%
7. Do the facilities have a recipient to put the fat and drain?	45%
8. Does the place have adequate ventilation?	15%
9. Do the facilities sanitize all the installations?	10%
Food wastes and other residues
10. Do the facilities have collectors with plugs to avoid manual contact?	95%
11. Do the facilities have easy-to-clean and identified collectors?	55%
12. Are the residues periodically collected and stored away from the production area?	45%
Documentation
13. Are there provisions to record and register the temperature of incoming goods at the time of receival?	100%
14. Are records kept for at least 30 days?	70%
15. Do the facilities keep records on how and when are the stock room cleaned and sanitized?	55%
16. Does the place have standard operating procedures?	50%
17. Do the facilities have an up-to-date standard operating procedures (i.e., any changes implemented are documented and registered?	55%
18. Does the place have registers of unconformities at the time of delivery, for example, temperature above that established for an ingredient?	55%
19. Do the facilities control the hygiene and health conditions of food handlers? Are they recorded?	20%
20. Do the facilities keep records of the food handlers' health?	30%
21. Do the facilities have a manual of good hygiene practices?	20%
22. Do the facilities have register of a pest program control?	15%
23. Do the facilities keep record on the installations' sanitization?	10%

Table 2.

Mean Percentage of Unconformity in Water Supply, Hygiene, and Storage

Water supply
1. Do the facilities adopt hygienization of water tank every other 6 months?	100%
2. Are the water tanks kept covered and only those not broken and not cracked are used?	5%
3. Do the facilities have drinkable water?	0%
Hygiene and preparation practices
4. Do the facilities keep the prepared meals above 60°C for no longer than 6 hours?	75%
5. Do the facilities thaw adequately (using refrigerators to avoid microbial growth under inadequate time/temperature conditions) frozen foods?	75%
6. Do the facilities cool products before freezing?	75%
7. Do the facilities leave perishable products under room temperature for long periods (>2 hours)?	65%
8. Do the workers use a correct dilution for the sanitizers (i.e., according to manufacturers)? Do they leave the sanitizer act for the recommended time (i.e., according to manufacturers)?	45%
9. Do the workers cook foods at ≤70°C for a long time?	20%
10. Do the workers clean the package before opening?	15%
11. Is there a risk of cross-contamination (raw/semiprepared foods)?	15%
12. Is the cafeteria clean and organized?	0%
13. Does the place has established a schedule for cleaning and sanitizing processing facilities?	0%
14. Is there a hygienization procedure after the work time?	0%
Storage
15. Does the product tag contain designation, expiry date, and fractionation?	95%
16. Do the facilities monitor and register the temperatures of each equipment?	95%
17. Do the facilities contain washable and resistant shelves?	40%
18. Do the facilities have adequate space and ventilation?	30%
19. Do the workers store properly the ingredients that were not used?	10%
20. Do the workers clean the stock room?	0%
21. Do the workers follow the guideline “first in, first out”?	0%
22. Are the utensils and tools accordingly hygienized and stored?	0%

Table 3.

Mean Percentage of Unconformity in Food Handler's Hygiene, Equipments and Tools, Pest Control, and Education and Training

Food handler's hygiene
1. Do the visitors obey the same requisites as those followed by food handlers?	55%
2. Do the handlers wash their hands before working?	45%
3. Do the handlers wash and disinfect their hands and/or use disposable gloves during distribution of the prepared food?	45%
4. Do the workers use uniforms?	35%
5. Do workers keep the uniform clean and change it every day?	30%
6. Do the workers use adornments while working?	25%
7. Do the workers wear hairnets while working?	15%
8. Do the workers follow minimal personal cleanliness requirements (take bath)?	5%
9. Do the workers have their nails cut and unpolished?	0%
Equipments and tools
10. Are the equipments submitted to periodical maintenance and calibration?	35%
11. Do the equipments and tools have resistance to corrosion?	30%
12. Do the equipments have washable, impermeable, and smooth surfaces to make easier their sanitization and to avoid food accumulation?	25%
13. Are the equipments and tools in good working conditions (no corrosions)?	15%
14. Are the equipments and tools sanitized periodically?	0%
Pest control
15. Are the processing areas kept free of pests or vectors?	35%
16. Do the managers take continuous and effective actions to control pest access?	5%
17. Are there periodical pest and rats control programs?	0%
Education and training
18. Do the facilities keep records of workers' training and supervision?	50%
19. Do the facilities keep explanatory posters regarding hygiene practices?	20%
20. Do the facilities provide training on good manufacturing practices?	0%
21. Do the facilities provide training to the workers?	0%
22. Do the facilities provide training on food contaminants?	0%
23. Do the facilities provide training on foodborne diseases?	0%
24. Do the facilities provide training on hygienic handling of foods?	0%

The questions about “food waste and other residues” aimed at knowing how well the waste management was conducted to avoid recontamination or cross-contamination at the manufacturing area. Further, these questions aimed at knowing how the collectors were identified at the manufacturing area and also the frequency that wastes and other residues were discarded to avoid the attraction of pests.

The “documentation” questions had as main objectives to obtain information about registers regarding important parameters (sanitization of equipments and facilities, temperature of equipments, food handlers' health, GMP training, GMP manual, pest control, etc.) that may affect the food safety. Regarding “water supply,” the objective was to guarantee the actions that are adopted to avoid the use of water that may be a source of contamination of food products and equipments. It also had as purpose to avoid that the water tanks were an attraction of pests (e.g., if tanks are kept close). The objective of the questions included in the item “hygiene and preparation practices” was to obtain information about the practices adopted to prepare food products, aiming to avoid food contamination/recontamination and multiplication and survival of microorganisms. Another objective was to know if the sanitization procedures were being satisfactorily followed (e.g., correct use of detergents and sanitizers).

Regarding the “storage” block, the objective was to know if the identification of the ingredients was being satisfactorily performed to avoid inadequate use of ingredients with expired date. Another aspect evaluated was the cleaning of the stock rooms. The item “food handlers' hygiene” had as main objectives to know how the food handlers' health was managed and how they were trained to adopt GMP. These items included information about use and cleanliness of uniforms, use of adornments, etc.

In the item “equipments and tools,” the question was aimed at verifying the conditions of equipments (calibration, maintenance, if the material is easy to clean, and sanitization) and if there is a program to sanitize equipments and tools periodically. “Pest control” questions looked for evidences that there were no pests at the processing area. The objective of using those questions was to know if there was a program of pest control and to know if the managers took continuous and effective actions to control pests. Finally, the item “education and training” focused on the questions related to food handlers' training about many topics related to food contaminants and practices to avoid contamination. Moreover, the questions aimed to know if some actions were taken to emphasize the importance of food handlers' hygiene practices (e.g., placards).

During the application of the questionnaire, the items that were in conformance and nonconformance for each question were appropriately registered. Finally, nonconformity percentage was determined for each evaluated block and was used with the economic analysis to provide a nonconformity equalizing prioritization basis.

Economic analysis

The reported price for several items was obtained by consultation and visual inspections at several business establishments where they are sold. We used the average values quoted in national currency (real), which was later converted into American dollars (U.S.$1.00 = R$1.926). To perform the conversion, we used the average U.S. dollar exchange rate from the last 3 years (2007–2009). The estimated expenditure calculations and the percentage were based on the 9-month full billing, because it was considered that there is a great student absenteeism from December to February (reducing served meal quantity) (school holidays).

Results and Discussion

Figure 1 shows nonconformity percentage concerning prerequisite program implementation at schools. We have observed that installations and waste management reached higher nonconformity rates (>60%), whereas integrated pest control and training had a higher conformity percentage (>90%). Critical items for food safety such as water quality, environmental hygiene, and personal hygiene had a nonconformity average of about 30%.

FIG. 1.

Average prerequiste program nonconformity percentage according to 10 assessed blocks.

Nonconformity types within each block have directly affected costs related to corrective measures to be taken. Therefore, these nonconformities must be clearly presented when PRP and adequacy costs are associated. Tables 1 –3 show nonconformity average within each evaluated block at initial PRP implementation analysis. The overall nonconformity average was about 35%, whereas the expenditures with initial investment were estimated to be over U.S.$24,438 (Table 4), including all the considered items. The monthly maintenance program cost is U.S.$8438 (12.31% of billing; 1.54% higher than the current expenditure) for the 20 surveyed schools. PRP implementation cost will represent an increase of U.S.$0.015 at meal cost. However, these costs are supposed to return in about a year. Thus, despite high costs to adequate nonconformity, the monthly resource using dilution would result in about 1.5% increased costs. However, such increased costs are justified because of benefits into served meal safety at schools.

Table 4.

Average Costs for Prerequisite Program's Adaptation

Items	Costs (U.S.$)
Installations	7445.58
Waste management	3557.89
Documentation	219.53
Water supply	471.17
Hygiene and preparation practices	6766.45
Storage	263.44
Food handlers' hygiene	323.47
Equipments and tools	3998.44
Pest control	111.32
Training/education	1318.02

Regarding installation nonconformity, more than 80% of them can be modified with small and medium investments. However, most of the resources would be for changing room and toilet installation adjustment. The total estimated cost to adequate installations was U.S.$7444. For the waste management block, i.e., collector adequacy and stocked waste isolation, there was an estimated investment of U.S.$3557. To make this calculation, we took into account the plastic collectors with 60 L capacity preventing manual contact and a 2-m² covered area construction with aluminum doors (which represented 59.1% of the cost).

Costs with documentation are low and need an initial investment of U.S.$219 (0.9% of total investment), whereas U.S.$30 are needed to maintain monthly records. The adequacy of such items is fundamental to assure information on implementation and actions related to PRP and they are filed and available for further assessment and/or auditing.

Regarding the water supply, all facilities had drinking water; however, none of them had their reservoirs cleaned twice a year, and 5% had covered water tanks, or they got cracked or broken. The cost for adequate water supply is U.S.$471 (1.9% of investment needed). In this study, we have taken into account a 1000-L fiberglass water tank purchase and sanitizers and manpower cost (transport and payment proportional to 3 hours/tank) to clean the 20 facilities. The biannual sanitation costs would be about U.S.$264, whereas the costs for purchasing the water tanks would represent 43.97% of this item adequacy total cost. Despite the low nonconformity adequacy cost regarding water quality and supply, they can positively affect school meal safety. It is known that water may be a means of several microbial diseases (Woodall, 2009).

Environmental hygiene improvement requires efforts concerning training and/or purchasing and equipment maintenance. These costs were included at the respective blocks. Expenditures on production hygiene are related to detergents, distributors, sanitizers, disinfectants, disposable products, garbage bags, cloths, and hygienic paper towels. The estimated cost for this item changing was U.S.$7.371, representing an increase of 7.57% when compared with the current expenditure.

Storage, when inadequately carried out, may serve as pest's attraction or shelter. In this study, we have observed that nonconformities regarding this item are of low severity for food safety. For adequate food storage facilities, an initial investment of U.S.$263 (1.1% of the implementation cost) would be needed. This investment would include sterile bag acquisition to collect samples, shelf-life labels, and plastic containers; the monthly cost to maintain such actions would be U.S.$217.

Inadequate personal hygiene is one of PRP items that mostly negatively affect food safety. Handlers' role or their behavior as contributing factors for foodborne illness outbreak occurrence have been reported in literature (Kennedy et al., 2005; Shojaei et al., 2006; Todd et al., 2008, 2009; Campos et al., 2009; DeDonder et al., 2009; Jevšnik et al., 2009). In this study, the initial diagnosis has shown that food handlers had their nails trimmed and unpolished and were not used to wear ornaments at 75% of facilities. However, 15% of school handlers did not wear hairnets, 45% reported lack of asepsis while handling food, and 45% of school handlers did not perform their own proper hand asepsis. In 35% of cases, handlers were not properly dressed, and in 30%, daily cloth changing and/or washing were not adequate. Visitors have not met the same hygiene requirements as food handlers at 55% of school meal facilities. Because of its importance, cost–benefit of this investment is well justified and must be enhanced by periodic training. The estimated cost of this item was related to complete uniform purchase (aprons, pants, shoes, sleeved shirts, and caps). Its total value was U.S.$323.

In the equipment and utensil block, new equipment purchase and maintenance of those already in use, such as six-burner industrial stoves (without oven), 430-L refrigerators, and thermometers, would result into an approximate cost of U.S.$3997 (16.3% of the total to be invested). From this cost, 62% would be used to purchase equipment, 30% for maintenance, and 8% to purchase tools. For integrated pest control block, the monthly expenditure of all facilities is U.S.$111 (0.5% of the implementation cost). Despite this, 35% of the facilities were not pest free. However, measures to prevent from pests accessing production facility were planned and their costs were included at facility evaluation.

Training can be considered as a planned and systematic effort to modify or develop knowledge, skills, and attitudes (Buckley and Caple, 1990). Although food handlers may be very competent, they may not really understand why they undertake certain activities. Because of this, theoretical training may be required to encourage and motivate them to adopt safe practices and to support improvements in their attitude (Seaman, 2010). Despite half of the facilities did not have records on capacity and training, all of them claim at training necessities based on GMP, foodborne illnesses, contaminants, and hygienic handling. However, there were no educational posters concerning hygiene within the handling area in 20% of the facilities. Although the checklist items on training have shown high conformity, many other checklist nonconformity inquiries related to handlers' practices were included in the training course contents. This shows the importance of modifying it and its effect on the other PRP items and, consequently, on food safety. The training cost was U.S.$1318 (5.4% of the total to be invested) and was calculated from the specialized professional average hour value, multiplied by 48 hours (16 hours to prepare courseware, 16 hours to train lunch ladies, divided into 8 class hours, and 16 hours to train supervision and coordination team), courseware, and equipment for presentations. Expenditures on physical structure and productivity loss were not calculated, because handlers' school meal training are usually held at schools during school holiday period, not affecting its productivity.

Thus, we could verify that the cost to adequate installations, hygiene, and cleaning, equipment purchase, and maintenance have presented a greater impact concerning PRP implementation. The joint implementation of the three items corresponds to about 74.4% of the budget. According to a study by Bata et al. (2006) on the cost to implement HACCP in a catering company, a significant part of investments to adequate prerequisite programs were used on infrastructure (floor, walls, ceiling, and lighting). This fact importance is that installation of readaptation was mostly the fourth reason mentioned by companies for not having implemented GMP (Buchweitz et al., 2003). It is clear that the lack of actions or their delay to adequate nonconformity may clearly show the low company commitment to implement PRP. This perception, on the other hand, may complicate attitude adoption and maintenance depending on employees' motivation and training.

Although the surveyed schools have trained technical personnel and enough manpower to perform monitoring and recording (without affecting productivity), many legal requirements are not met. The barrier to changing, in this case, seems to be related to economic factors (such as investment in infrastructure, equipment, and training) and motivators, regarding employees' compliance with the standards. Although personnel's turnover was not verified, it may be one of the causes of low proper asepsis adoption, because training and time are needed to change food handlers' behavior (Bata, 2006; Yapp and Fairman, 2006). Expenditures in training and turnover have seemed to be important in large companies (Buchweitz et al., 2003). Although training is currently held by company's technical staff (supervisors and coordinator), in this study we have surveyed the expert's cost, because besides the content of courses, teaching and motivators are fundamental for group learning and stimulation, for their practical knowledge application.

Conclusions

The present study results show that there is a high unconformity index regarding prerequisite program implementation at surveyed schools. This is probably due to the initial adequacy nonconformity cost, considering that most part of the resources were used on installations, hygiene, cleaning, maintenance, and equipment purchase. However, these changes and improvements are economically feasible, even though it has been verified that they could increase about 1.5% monthly company costs. However, such improvements are extremely relevant for school meal safety. Each technical school staff must set deadlines and goals along with their managers to modify nonconformities and to not only consider the risks to consumers' health but also verify prioritization implementing costs.

Footnotes

Disclosure Statement

No competing financial interests exist.

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