Food Safety – Problems and Solutions | IntechOpen

Inadequate preparation and improper cooking practices, such as those involving cross-contamination, insufficient processing, poor hygiene and the re-use of ... SPECIALOFFER:30%OFF+FREESHIPPINGAppliestoallprintcopies|OfferendsJune30thHome>Books>Significance,PreventionandControlofFoodRelatedDiseasesOpenaccesspeer-reviewedchapterFoodSafety–ProblemsandSolutionsWrittenByAslıUçar,MustafaVolkanYilmazandFundaPınarÇakıroğluSubmitted:April29th,2015Reviewed:March17th,2016Published:April13th,2016DOI:10.5772/63176DOWNLOADFORFREEShareCiteCitethischapterTherearetwowaystocitethischapter:1.ChoosecitationstyleSelectstyleVancouverAPAHarvardIEEEMLAChicagoPlaceholderCopytoclipboard2.ChoosecitationstyleSelectformatBibtexRISDownloadcitationIntechOpenSignificance,PreventionandControlofFoodRelatedDiseasesEditedbyHussainiMakunFromtheEditedVolumeSignificance,PreventionandControlofFoodRelatedDiseasesEditedbyHussainiAnthonyMakunBookDetailsOrderPrintChaptermetricsoverview8,225ChapterDownloadsViewFullMetricsDOWNLOADFORFREEShareCiteCitethischapterTherearetwowaystocitethischapter:1.ChoosecitationstyleSelectstyleVancouverAPAHarvardIEEEMLAChicagoPlaceholderCopytoclipboard2.ChoosecitationstyleSelectformatBibtexRISDownloadcitationImpactofthischapterIntechOpenDownloads8,225TotalChapterDownloadsonintechopen.comAltmetricscoreOverallattentionforthischaptersCitationsCitations8CitationsAdvertisementAdvertisementAbstractWhencertaindisease-causingbacteria,virusesorparasitecontaminatefood,theycancausefood-relateddiseases.Anotherwordforsuchabacterium,virus,orparasiteis“pathogen”.Sincefood-relateddiseasescanbeserious,orevenfatal,itisimportanttoknowandpracticesafefood-handlingbehaviorstohelpreducetheriskofgettingsickfromcontaminatedfood.AccordingtotheCodexAlimentariusCommission(CAC),“foodsafetyistheassurancethatfoodwillnotcauseharmtotheconsumerwhenitispreparedand/oreatenaccordingtoitsintendeduse”.Foodbornediseasesarewidespreadthroughouttheworld.Theprocessbywhichafoodbornediseasespreadsbeginswiththefeaturesofthedisease,contaminatingthefood,whichinturnthreatensbothindividualandpublichealthbymeansofthefoods.Healthy,orwhatcanbetermedassafefood,isfoodthathasnotlostitsnutritionalvalue,thatisclean,inphysical,chemicalandmicrobiologicaltermsandthatisnotstale.Thefactorscausingthecontaminationofthefoodmaythreatenthesafeconsumptionofitandtherebymakethefoodsharmfultohumanhealth.Forthisreason,itisnecessarytoutilizevariousresourcestopreventthefoodfrombeingcontaminatedinallstagesofthefoodchain,fromharvesttoconsumption.Theaimofthischapteristodeterminethefactorsaffectingfoodsafetyandproffereffectiveinterventionstrategiesagainstfood-relateddiseases.KeywordsFoodsafetyfoodhygienefoodhandlershygienekitchenandequipmenthygienenutritionAuthorInformationShow+AslıUçar*AnkaraUniversityFacultyofHealthSciences,DepartmentofNutritionandDietetics,Ankara,TurkeyMustafaVolkanYilmazAnkaraUniversityFacultyofHealthSciences,DepartmentofNutritionandDietetics,Ankara,TurkeyFundaPınarÇakıroğluAnkaraUniversityFacultyofHealthSciences,DepartmentofNutritionandDietetics,Ankara,Turkey*Addressallcorrespondenceto:[email protected],orthefoodbornediseases,aredescribedastheillnesseswithwhichpeopleareinfectedbythefoodstheyeat[1].Thesediseasesareawidespreadpublichealthissueandareexpensivetotreat[2].Foodbornediseasesresultfromtheconsumptionofcontaminatedfoodsandproducts.Contaminationofthefoodatanystage,fromproductiontoconsumption,producesbacteria,viruses,parasites,chemicalagentsandtoxins,whicheventuallycausethefoodbornediseases[1].Thesediseasesareseenasapervasive,permanentproblemthatcanleadtomorbidityand,occasionally,tomortality.Foodbornediseasesareincreasingworldwide,particularlyinthedevelopingcountries,duetoneglectofpersonalhygieneandfoodhygiene[3].Foodborneillnessesposeathreattointernationalpublichealthsafetyandeconomicdevelopment.Withtheincreasingamountoftrade,travelandimmigration,therateatwhichdangerouscontaminantsandpathogenspassthroughthebordershasalsorisen.Everyyear,approximately2.2millionpeople,amajorityofwhomarechildrenlivingindevelopingcountries,dieasaresultoffoodandwatercontamination[1].Typhoidfeveroccursin16.6millionpeopleandcauses600,000deathseveryyeararoundtheworld.IntheUnitedStates,contaminatedfoodsareseenasbeingresponsiblefornearly76millioninfections,325,000hospitalcasesand5000deathseveryyear[4].Accordingto2011datafromtheCentersforDiseaseControlandPrevention(CDC),itwasestimatedthatintheUnitedStates,oneoutofeverysixpersonswasinfectedwithfoodborneillness(48millionpeople)andthatfoodborneillnessesresultedin128,000hospitalcasesand3000deaths[5].In2013,FoodNet,aCDC-establishedprogramthattracksfoodborneillnessesintheUnitedStates,foundthatfoodborneillnesseswereresponsiblefor19,056infections,4,200hospitalcasesand80deaths.Theincidenceofbacteriaresponsibleforcausingdiseasesinevery100.000peoplewasdeterminedtobe15.19forSalmonella,13.82forCampylobacter,4.82forShigella,2.48forCryptosporidium,1.15forSTECnon-O157,0.51forVibrio,0.36forYersinia,0.26forListeriaand0.03forCyclospora.IncidencesofCyclospora,ListeriaandVibriowerefoundtobethehighestamongtheelderly,aged65yearsandolder,whereasforalloftheotherpathogens,thehighestincidentrateswerefoundamongchildrenyoungerthan5yearsofage[6].ThediseasescausedbySalmonellaandCampylobacter,themainagentsresponsibleforfoodborneinfections,aredramaticallyincreasinginsomecountries,includingDenmark,Finland,Iceland,theNetherlands,Norway,Sweden,SwitzerlandandtheUnitedKingdom.In1999and2000,thenumberofreportedfoodbornediseasecaseswas84,340and77,515,respectivelyinTurkey.WhileSalmonellaisthemostfrequentlyencountereddiseaseagent,theactualfiguresonfoodborneinfectionsandtoxinsarenotreflected,asitisnotmandatorytoreportthesediseases[7].Theworld’sgrowingpopulationandtheconsumers'desiretobeprovidedwithawiderrangeoffoodshaveresultedinalongerandmorecomplexfoodchain.Today,foodsreachconsumersafterbeingcollectedfromfields,farmsandfactoriesandthenpassontomanycountries,travelingdistancesofthousandsofkilometers.Withthisglobalfooddistribution,aninfectionthatoccursatanypointwithinthefoodchainhasthepotentialofaffectinganygivenpopulationintheworld.Itisthereforeessential,giventhenumberofinteractionstakingplacebetweentheactorsinvolvedinthefoodchainandthelongdistancesbetweenthem,thatmulti-sectorialandinternationalcollaborationtakeplace.Asnocountrycanprovidefoodsafetyonitsown,safetymeasuresneedtobeenhancedinmanycountries[8].Whileexpertsonfoodsafetyandhealthhavedeterminedthatmillionsoffoodbornediseasecasesarereportedeveryyear,theactualnumbersarecloudedbyuncertainty,asmostcasesgounreported.Furthermore,foodbornediseasesaredifficulttodiagnose,sincetheyhavevarioussymptoms,includingfatigue,chills,mildfever,vertigo,upsetstomach,dehydrationcausedbydiarrhea,severecrampsand,insomecases,evendeath.Inmanyofthereportedcases,foodspreparedoutsideofthehomearetheprimarycauseoffoodbornediseases,thoughitisnotuncommonforhome-madefoodstoalsocausediseases[9].Studiesconductedonthedistributionoffoodbornediseasesacrosstheworldhavedemonstratedthatamajorityofthesediseasesoccurduringtheprocessingofthefoodinthepreparationstageathomeoratfoodproductionsites[10].Infact,mostfoodbornediseasescanbepreventediftheregulationsgoverningfoodsafetywerecompliedwith,fromproductionstagestoconsumption[11].Improperheatingofthefood,suchasundercooking,re-heatingandwaitingintheheat,orimpropercoolingofthefoodaccountfor44%ofthefoodborneillnesses.Inadequatepreparationandimpropercookingpractices,suchasthoseinvolvingcross-contamination,insufficientprocessing,poorhygieneandthere-useofleftovers,areresponsibleforcausing14%ofthesediseases[7].Asindicatedbythesefigures,foodbornediseasesarewidespreadthroughouttheworld.Theprocessbywhichafoodbornediseasespreadsbeginswiththefeaturesofthediseasecontaminatingthefood,whichinturnthreatenbothindividualandpublichealthbymeansofthefoods.Healthy,orwhatcanbetermedassafe,foodisfoodthathasnotlostitsnutritionalvalue,thatisclean,inphysical,chemicalandmicrobiologicaltermsandthatisnotstale.Thefactorscausingthecontaminationofthefoodmaythreatenthesafeconsumptionofitandtherebymakethefoodsharmfultohumanhealth.Forthisreason,itisnecessarytoutilizevariousresourcestopreventthefoodfrombeingcontaminatedatallstagesofthefoodchain,fromharvesttoconsumption[12].Thisstudyconductsananalysisofthefactorsresponsibleforjeopardizingfoodsafetyandfoodsafetypoliciesthroughouttheworld.Advertisement2.ThefactorsthataffectfoodsafetyFoodsarethebasicbuildingblocksoflivingthings,yettheymayposeathreatandbecomeharmfultohumanhealthinsomesituations[13].Manypeoplethroughouttheworldbecomeillbecauseofthefoodtheyeat.Thesediseasesassociatedwithfoodconsumptionarereferredtoasfoodbornediseases,andtheymayresultfromdangerousmicroorganisms[14].Foodscanbecomeharmfultohumanhealthorevenfatalwhencombinedwithbacteria,mold,viruses,parasitesandchemicaltoxins[13].Therefore,itisabsolutelynecessarythatconsumersbeprovidedwithasafefoodsupply.Thefactorsinvolvedinthepotentialthreatcausedbyfoodsareinappropriateagriculturalpractices,poorhygieneatanystageofthefoodchain,lackofpreventivecontrolsduringprocessingandpreparationofthefood,incorrectuseofthechemicalmaterials,contaminatedrawmaterials,foodandwaterandinappropriatestorage[15].Theseissueswereclassifiedintothreecategories:foodhygiene,personalhygieneoffoodhandlersandkitchensanitation.2.1.FoodhygieneManyfactorsservetounderminefoodhygiene.Thehygienicqualityofthefoodsisnegativelyinfluencedbypurchasinglow-qualityorstalefoods,storingfoodininappropriateconditions,cookinglargeamountsoffood,morethanisnecessary,andlettingitsitininappropriateenvironments,storingrawandcookedfoodstogetherandpreparing,cookingandstoringfoodusingincorrectmethods[13].Iffoodsarecontaminatedatanystage,fromproductiontoconsumption,thehygieneofthefoodiscompromised,dependingonthetemperature,humidityandpHvaluesoftheenvironmentitisstoredin,andthefoodthenbecomespotentiallyharmfultohumanhealth.Aninfectionorintoxicationcausedbytheconsumptionofacontaminatedfoodordrinkiscalledfoodpoisoning[16].Thecausesoffoodpoisoningareclassifiedasmicroorganisms,parasites,chemicals,naturallycreatedfoodtoxins,naturallycreatedfishtoxins,metabolicdisorders,allergicreactionsandradioactivesubstances[17].Salmonella,CampylobacterandEnterohemorrhagicEscherichiacoli(EHEC)arefoodbornepathogensthataffectmillionsofpeopleeveryyear.Symptomsoffoodpoisoningcausedbythesepathogensincludefever,headache,upsetstomach,vomiting,abdominalpainanddiarrhea.Althoughfoodpoisoningismostlycausedbybacteria,someparasitesandvirusescanalsobefactors.ParasitessuchasTrichinellaspiralisandToxoplasmagondiicanremainalivebyusingthenutritionalelementsinthecarrier.VirusessuchasHepatitisAcanbehavelikeparasitesandinfectpeopleaswellastheentirefoodchain[9,18].Staphylococcusaureus,Clostridiumperfringens,Salmonella,Streptococcus,Shigella,Clostridiumbotulinum,E.coli0157:H7,CampylobacterandBacilluscereusarethemicroorganismsthatmostfrequentlycausefoodpoisoning[9,13,18,19].S.aureusisagram-positivecoccalbacteriumabout0.5–1.0μmindiameter.Theoptimumgrowthtemperatureis37°C.ThenormalecologicalhabitatofS.aureusishumanbody[16].S.aureuscanbeculturedfrommultiplesitesoftheskinandmucosalsurfacesofcarriers;theprimaryreservoirofstaphylococciisthoughttobethenostrilsofthenose.SpreadofSaureusgenerallyisthroughhuman-to-humancontact.CarriageofS.aureusinthenoseappearstoplayakeyroleintheepidemiologyandpathogenesisofinfection.Inthegeneralpopulation,ameancarriagerateof37.2%wasfound[20].S.aureusisconveyedtothefoodbythepersonhandlingit.Personswithskin,noseorthroatinfectionsorinflammatorywoundspassthismicroorganismontothefood.ThefoodsposingaparticularriskforcontainingStaphylococcusincludecookedmeat,potatosalad,dessertswithmilk,suchascustard,andchicken,fishandothermeatsalads[9,13,21].Itcausesfoodpoisoningbyreleasingenterotoxinsintofood.After3–6hoursofconsumingcontaminatedfood,symptomsbegin.Themostmarkedandseveresymptomsarenauseaandvomiting.Theothersarestomachacheanddiarrhea[16].Thisbacteriumcannotbeeliminatedbycooking.Therefore,itisnecessarytokeepfoodsrefrigerated;theuseofapronsandglovesbystaffreducesskin-to-skincontactand,therefore,thestaffshouldfurtherfollowtherulesofhygieneandminimizephysicalcontactwithfood[9,13,21].Forstaphylococcalfoodpoisoning,phagetypingcanbeperformedtodeterminewhetherthestaphylococcirecoveredfromthefoodwerethesourceofinfection.Dependingonthetypeofinfectionpresentanappropriatespecimenisobtainedaccordinglyandsenttothelaboratoryfordefinitiveidentificationusingbiochemicalorenzyme-basedtests.Furthermore,fordifferentiationonthespecieslevel,catalase,coagulase,DNAse,lipaseandphosphatasetestsarealldone[19].C.perfringensisagram-positive,rod-shapedanaerobic,spore-formingpathogenicbacterium[19].C.perfringensisverycommoninnature.Especially,itisfoundinthedigestivesystemofhumansaswellasofanimalsandinsoil[13].ThisbacteriumisthethirdmostcommoncauseoffoodborneillnessesintheUnitedKingdomandUnitedStates.Accordingtosomeestimates,thistypeofbacteriacausesnearlyamillionillnesseseachyear.Poisoningoccursaftercontaminationoffoods.CookingkillsthegrowingC.perfringenscellsthatcausefoodpoisoning,butnotnecessarilythesporesthatcangrowintonewcells.Ifcookedfoodisnotpromptlyservedorrefrigerated,thesporescangrowandproducenewcells[22].Becausethesporesofsomestrainsareresistanttotemperaturesashighas100°Cformorethanlh,theirpresenceinfoodsmaybeunavoidable.Furthermore,theoxygenlevelmaybesufficientlyreducedduringcookingtopermitgrowthoftheclostridia.Sporesthatsurvivecookingmaygerminateandgrowrapidlyinfoodsthatareinadequatelyrefrigeratedaftercooking[23].Iteasilyreproducesinmeatthathasbeensittingatroomtemperatureforalongtimeafterbeingcooked,inundercookedandrepeatedlyre-heatedmeatandinmeatservedcold[13,19].C.perfringenscellslosetheirviabilitywhenfoodsarefrozenorheldunderprolongedrefrigerationunlessspecialprecautionsaretaken.SuchlossesmaymakeitdifficulttoestablishC.perfringensasthespecificcauseofafoodpoisoningoutbreak.Itisrecommendedthatsamplesthatcannotbeexaminedimmediatelybetreatedwithbufferedglycerinsaltsolutionandstoredorshippedfrozentothelaboratory[23].Itcanbedetectedincontaminatedfood[ifnotheatedproperly)andfeces.Incubationtimeisbetween6and24hoursafterconsumingofcontaminatedfood[24].Usualsymptomstypicallyincludeabdominalcramping,diarrhea;vomitingandfever.Veryrare,fatalcasesofclostridialnecrotizingenteritis(alsoknownaspigbel)havebeenknowntoinvolve"TypeC"strainsoftheorganism,whichproduceapotentlyulcerativeβ-toxin.ManycasesofC.perfringensfoodpoisoninglikelyremainsubclinical,asantibodiestothetoxinarecommonamongthepopulation.ThishasledtotheconclusionthatmostofthepopulationhasexperiencedfoodpoisoningduetoC.perfringens.Despiteitspotentialdangers,C.perfringensisusedastheleaveningagentinsaltrisingbread.Thebakingprocessisthoughttoreducethebacterialcontamination,precludingnegativeeffects[25].Thismicroorganismcanbepreventedfromharmingthefoodbycoolingthecookedfoodrapidly,savingleftoverfoodinshallowcontainersandstoringfoodinappropriateconditions[13,19].Salmonellaisarodshapedbacteriaandcanliveinavarietyofhabitats.SomestrainsofSalmonellaliveinwater,soil,foodplantsandfecesofcontaminatedhumans.Generallythebacteriumisabletoaccessthoseplacesthroughcross-contaminationofalready-infectedorganismsorfeces.Whenpresentinwater,Salmonellacanliveforseveralweeks;insoilthebacteriacanliveuptoseveralyears,whileinfecesthebacteriamayonlysurviveafewdays.Thebacteriacansurviveinsaltwaterandcoolerenvironments,butatoohotofanenvironmentmaykillthebacteria[19,26].Salmonellosisinhumansisgenerallycontractedthroughtheconsumptionofcontaminatedfoodofanimalorigin(mainlyeggs,meat,poultryandmilk),althoughotherfoods,includinggreenvegetablescontaminatedbymanure,havebeenimplicatedinitstransmission.Person-to-persontransmissionthroughthefecal–oralroutecanalsooccur.Humancasesalsooccurwhereindividualshavecontactwithinfectedanimals,includingpets[27].Usually,symptomsstart12–72hoursafteringestionofbacteria.Itisusuallycharacterizedbyacuteonsetofdiarrhea,fever,abdominalcramps,nauseaandvomiting.Inmostcases,theillnesslastsfor4–7days,andmostpeoplerecoverwithouttreatment.But,Salmonellacancausemoreseriousillnessinolderadults,infantsandpersonswithchronicdiseases[26].Salmonellafoodpoisoninghaslongbeen,andcontinuestobe,animportantglobalpublichealthproblem.InmuchofEuropeandNorthAmerica,Salmonellaismostlyfoundinraworundercookedchicken,meat,eggsandfishandinunpasteurizedmilk.Itisveryeasytocontrolandcanbekilledbycookingfoodsatsufficientlyhightemperatures.TopreventSalmonellacontamination,thefoodshouldbestoredatappropriatetemperatures,sanitationandhygienerulesshouldbefollowedandrodentsandfliesshouldberemovedfromtheworkenvironment[9,13,27].Streptococcusisagram-positiveandnonmotilebacteriumandthenamereferstothebacterium’scharacteristicsofgroupinginchainsthatresembleastringofbeads.Thenaturalhabitatofthebacteriaarepharynx,rectumandskin[19].CertainStreptococcusspeciesareresponsibleformanycasesofpinkeye,meningitis,bacterialpneumonia,endocarditis,erysipelasandnecrotizingfasciitis[18].Streptococcusisfoundinsidethehumanmouth,onhandsandinnosesecretionsandcanbeconveyedtofoodsthroughcontactwiththesesecretions.Forthisreason,infectedpersonsshouldnotpreparefood,andthefoodshouldbekeptinappropriateconditionsafterbeingcooledrapidly[19,21].Shigellaisanonmotile,gram-negative,facultativeanaerobic,non–spore-forming,rodshapedbacterium.Itisoneoftheleadingbacterialcausesofdiarrheaworldwide[28].TheprimaryhostandnaturalreservoirknownatthispointforShigellaisthehumangastrointestinaltract.Shigellacansurviveinfecal-contaminatedmaterialbuthasalowsurvivalratewithouttheoptimalacidicenvironmentintheintestinaltract[29,30].Theycaneasilymultiplybetween10and48°C[16].Theoptimumgrowthtemperatureforthisbacteriumis37°C[30].Therearetwodifferentmechanismsforpathogenicity.Firstly,bacterialnumberincreasesveryfastinintestineandthensettlesintomucosalentryandcolon.Becausetheymaycauseleakageofbloodintothelumen,bloodydiarrheaoccurs.Secondly,theproductionofendogenoustoxin,whichisknownasShigatoxin,resultsindiarrhea[16].Shigellainfectiontypicallyoccursbyingestion(fecal–oralcontamination);dependingonageandconditionofthehost,fewerthan100bacterialcellscanbeenoughtocauseaninfection.FoodpreparedbythecontaminatedpersonmayeasilybecomecontaminatedwithShigellabacteria[30].Symptomsofshigellosisincludemildtoseverediarrhea,bloodydiarrhea,fever,dehydration,nausea,vomitingandstomachcramps.Theyusuallyappearbetween1and7daysaftercontractingthebacteria[31].Thediagnosisofshigellosisismadebyisolatingtheorganismfromdiarrhealfecalsamplecultures.Itcaninfectthefoodinanyenvironmentwherehygienerulesarenotfollowed.ThemostimportantprotectivefactoragainstShigellaistofollowproperpersonalhygienerules[13,18,21].Handwashingbeforehandlingfoodandthoroughlycookingallfoodbeforeeatingdecreasetheriskofgettingshigellosis[32].Cbotulinumisagram-positive,rod-shaped,anaerobic,spore-forming,motilebacteriumwiththeabilitytoproducetheneurotoxinbotulinum[33,34].ThenaturalhabitatsoftheC.botulinumaresoilsandmarinesedimentsthroughoutoftheworld.Sinceitisfoundinthesoil,itmaycontaminatevegetablescultivatedinoronthesoil.Italsocolonizesthegastrointestinaltractoffishes,birdsandmammals[35].C.botulinumisnotaverycommonbacterium,yetitisverydangerouswhenitdoesinfectaperson[9,18].Foodbornebotulismgenerallyoccurs18to36hoursafterexposure[range6hoursto8days].Initialsymptomscanincludenausea,vomiting,abdominalcrampsordiarrhea.Aftertheonsetofneurologicalsymptoms,constipationistypical.Drymouth,blurredvisionanddiplopiaareusuallytheearliestneurologicalsymptoms.Theyarefollowedbydysphonia,dysarthria,dysphagiaandperipheralmuscleweakness.Symmetricdescendingparalysisischaracteristicofbotulism[35].Therearenofeverandnolossofconsciousness.Thesymptomsarenotcausedbythebacteriumitself,butbythetoxinproducedbythebacterium.Incidenceofbotulismislow,butthemortalityrateishighifpromptdiagnosisandappropriate,immediatetreatment(earlyadministrationofantitoxinandintensiverespiratorycare)arenotgiven.Thediseasecanbefatalin5to10%ofcases[36].Becauseitisananaerobicbacterium,itcanonlygrowintheabsenceofoxygen.FoodbornebotulismoccurswhenC.botulinumgrowsandproducestoxinsinfoodpriortoconsumption.Thegrowthofthebacteriaandtheformationoftoxinoccurinproductswithlowoxygencontentandcertaincombinationsofstoragetemperatureandpreservativeparameters.Cannedfoodsimproperlypreparedandheatedandparticularlylow-acidfoods,suchasgreenbeans,spinach,mushrooms,meatandvegetables,areveryriskyinregardtoC.botulinumcontamination[9,18].Occasionally,commerciallypreparedfoodsareinvolved.ThoughsporesofC.botulinumareheatresistant,thetoxinproducedbybacteriagrowingoutofthesporesunderanaerobicconditionsisdestroyedbyboiling(forexample,atinternaltemperature>85°Cfor5minutesorlonger).Therefore,ready-to-eatfoodsinlow-oxygenpackagingaremorefrequentlyinvolvedinbotulism[36].Foodinsidecansthataredeformedorwarpedshouldundernocircumstancesbeconsumed[9,18].Preventionoffoodbornebotulismisbasedongoodpracticeinfoodpreparation,particularlypreservationandhygiene.Botulismmaybepreventedbytheinactivationofthebacterialsporesinheat-sterilizedorcannedproductsorbyinhibitingbacterialgrowthinotherproducts.Commercialheatpasteurizationmaynotbesufficienttokillallspores,andthereforethesafetyoftheseproductsmustbebasedonpreventingbacterialgrowthandtoxinproduction.Refrigerationtemperaturescombinedwithsaltcontentand/oracidicconditionswillpreventthegrowthofthebacteriaandformationoftoxin[18,35,36].E.coliisagram-negative,facultativeanaerobic,rod-shapedbacterium[18].E.Coli0157:H7isaverycommonbacteriumfoundinthehumanintestines[9].Providedresourceavailabilityandkeyabioticconditions(availabilityofenergyandnutrientsources,pH,moistureandtemperature)arepropitious,E.colipopulationscansurviveandevengrowinopenenvironmentssuchassoil,manureandwater.Therearealsopossibilitiesformigrationbetweenthesehabitats[37].Whetherfoodispreparedathome,inarestaurantorinagrocerystore,unsafehandlingandpreparationcancausecontamination.Commoncausesoffoodpoisoningincludefailingtowashhandscompletelybeforepreparingoreatingfood,usingutensils,cuttingboardsorservingdishesthatarenotclean,causingcross-contamination,consumingdairyproductsorfoodcontainingmayonnaisethathavebeenleftouttoolong,consumingfoodsthathavenotbeenstored/cookedattherighttemperature,especiallymeatsandpoultry,consumingrawseafoodproducts,drinkingunpasteurizedmilkandconsumingrawproducethathasnotbeenproperlywashed[38].Fecalcontaminationofwaterorfoodsisresponsibleforcausingtheinfection[39].Itcanbeconveyedthroughraworundercookedmincedmeatorunpasteurizedmilk.Infectionbythisbacteriumcancausehemolytic–uremicsyndrome,whichcancausebloodycolitiswithsevereabdominalpain,bloodydiarrhea,nauseaandvomiting,andthesyndromecanleadtorenalfailure,braindamage,heartattack,paralysisandevendeath[9].Peoplewithweakenedimmunesystems,pregnantwomen,youngchildren,andolderadultsareatincreasedriskfordevelopingthesecomplications[38].Person-to-personcontactisanimportantmodeoftransmissionthroughtheoral-fecalroute.ThedurationofexcretionofEHECisabout1weekorlessinadults,butcanbelongerinchildren.VisitingfarmsandothervenueswherethegeneralpublicmightcomeintodirectcontactwithfarmanimalshasalsobeenidentifiedasanimportantriskfactorforEHECinfection[39].Toprotectagainstcontamination,themeatshouldbecookedverywellandfoodsthatincludemeatshouldbepreparedinperfectlyhygienicconditions[9].Thepreventionofinfectionrequirescontrolmeasuresatallstagesofthefoodchain,fromagriculturalproductiononthefarmtoprocessing,manufacturingandpreparationoffoodsinbothcommercialestablishmentsandhouseholdkitchens[39].Campylobacterisagram-negative,microaerophilic,non-fermentativebacterium.Itgrowsbestinhabitatswithanoxygenlevellowerthan5%,anditistypicallyfoundintheintestinaltractofanimals.Theyareabletomoveviaflagella.Theoptimumgrowthtemperatureis42–45°Candtheycannotproliferateinroomtemperature[16].Campylobacterisoneofthebacteriamostfrequentlyresponsibleforcausinggastroenteritis.Whileitsactualincidenceisnotknownexactly,inhigh-incomecountries,itsincidencerangesbetween4.4and9.3inevery1000peopleeachyear[27].Theinfectioncanpassthroughanimal-sourcedfood,particularlythoseofflyingbirdspecies,domesticanimals,suchascatsanddogs,contaminatedsurfacestreams,unpasteurizedmilkanddirectphysicalcontactwithinfectedanimals.Infectionfromthisbacteriumleadstofoodbornediseasesusuallythroughuncookedmeatandotherproductsandraworunpasteurizedmilk.Contaminatedwaterandicearealsosourcesofinfection[39].Campylobacterjejunicanbefoundinbothfreshwaterandseawaterandcanlivefor5weeksinthisenvironment.Wildbirds,farmanimals,farmareasandsurfacesofstillwaterscreateanidealecologicalsystemfordifferenttypesofCampylobacter.Thepresenceofthismicroorganisminnatureindicatesthatfecalcontaminationhasoccurredinthatarea.Thesemicroorganismsareunabletosurviveandreproduceanywhereexceptforintheirhosts,andtheydieinsunlight.Contaminationoccursintheenvironmentandonotheranimalsparticularlythroughthedroppingsofwildbirds,suchasducks,geeseandseagulls[21].ThemostfrequentsymptomsassociatedwiththisinfectionareGuillain-Barresyndrome(GBS),reactivearthritis(ReA)andirritablebowelsyndrome(IBS)[27].Topreventitsinfection,itisnecessarytotakeprotectivemeasuresinallstagesofthefoodchain,fromproductiontoconsumption,andtoapplytheseprotectivemeasuresinbothindustrialanddomesticenvironments[39].B.cereusisagram-positive,rod-shaped,soil-dwelling,facultativeanaerobicbacterium.Itcangrowbetween10and50°C,buttheoptimumgrowthtemperatureis28–37°C.Itcanbedestroyedattheboilingtemperaturein5–30minutes[16].B.cereusispresentindustandsoilandcancausecontaminationincereals,particularlythosemadeofrice,infoodthatsitsoutforalongtimeandinmeatproducts[19,21].Themicrobeisabletogroweitherinthepresenceorintheabsenceofoxygen.Itssporesaresufficientlyheatresistanttosurvivepasteurizationtreatmentofmilkandstandardcookingtemperaturesreachedindomestickitchens.Itcannotsurvivethehigh-temperaturetreatmentusedtoprocesscannedfoods.Thesymptomsstartafter30minutesofingestion.Firstly,nauseaandvomitingcanbeseenandthendiarrheticsyndromegenerallystarts[40].Incaseoffoodborneillness,thediagnosisofB.cereuscanbeconfirmedbytheisolationofmorethan105B.cereusorganismspergramfromepidemiologicallyimplicatedfood,butsuchtestingisoftennotdonebecausetheillnessisrelativelyharmlessandusuallyself-limiting[41].Topreventinfection,foodsshouldbewashedthoroughly,notleftatroomtemperatureforalongtimeafterbeingcookedandnotleftinanopencontaineronthekitchenfloor[19,21].Giardiaduodenalis,Cryptosporidiumparvum,CyclosporacayetanensisandT.gondiiaretheparasitesthatposethebiggestthreattofoodsafety.G.duodenalis,previouslycalledGiardialamblia,andnowcommonlyknownas"intestinalis",isamicroscopicparasite,whichlivesinhumanandanimalintestines.Itusuallyinfectspeoplethroughcontaminatedwateranduncookedmeat.Theparasiteattachestotheepitheliumbyaventraladhesivediscandreproducesviabinaryfission.Themostfrequentsymptomsassociatedwiththisparasitearediarrhea,abdominalcramps,gasandnausea.Giardialambliaisdifficulttodetect,whichoftenleadstoadelayindiagnosisormisdiagnosis;severaltestsshouldbeconductedovera1-weekperiod.Giardiasisisaglobaldiseasethatinfectsnearly33%ofpeopleindevelopingcountriesand2%ofadultsand6–8%ofchildrenindevelopedcountriesworldwide.Itisespeciallyimportantthatproperhandhygienebepracticedforprotectionagainstthisparasite[42].C.parvumisaunicellularmicroscopicparasiteprotectedbyashell.Itisresponsibleforcausingthediseasecryptosporidiosis,alsoknownas"Crypto",anditisthemaincauseofworldwidediseasesoriginatingfromwaterandfood.Generally,itinfectspeoplethroughsoil,foods,waterandinfectedanimalpartsthathadcontactwithfeces.Itsmostwidespreadsymptomsarediarrhea,abdominalcramps,upsetstomachandmildfever.Somecases,however,maynotcauseanysymptoms.Inordertoprotectagainstthisparasite,properpersonalhygieneshouldbeperformed,onlycleanwatershouldbeusedfordrinkingandvegetablesorfruitsthathavebeenfertilizedwithunprocessedfertilizershouldnotbeconsumed[42].Thisparasiteistransmittedbyinfectedfoodhandlersorprocessors’contacttothefoodorbyfoodsproducedwithusinganimalfecesasafertilizer.Whentheparasiteisinvolved,waterydiarrheaiscommonlyseenasthemainsymptom.Thereisnoknowneffectivetreatmentmethod.[17].C.cayetanensisisaunicellularmicroscopicparasitethatcausescyclosporiasis.Althoughtheincidenceofcyclosporiasisisreportedtobeincreasinginmanycountries,thisorganismisnotverywellknown.Intheincubationstageoftheparasite,C.cayetanensisoocystsinfectpeoplethroughtheconsumptionofwatercontaminatedwiththisparasiteorbyeatinganythingthathascomeintocontactwiththefecesofananimalwithcyclosporiasisdisease.Thediseasemaycausesymptomssuchasdiarrhea,lossofappetite,abdominalventricosity,nauseaandvomiting.Toprotectagainstinfectionfromthisparasite,itisnecessarytoperformproperpersonalhygieneandtowashorpeelvegetablesandfruitsbeforeeatingthem[43].T.gondiiisaunicellularmicroscopicparasitethatcausestoxoplasmosisdisease,anditexistsallovertheworld.Itisamongthetopthreecausesofdeathfromfoodbornediseasesworldwide.Itcaninfectpeoplethroughtheconsumptionofuncookedmeatorbydrinkingfromfreshwatersources,suchaslakesorstreams.Thisparasitecanalsoinfectthefetusthroughthemother.Moreover,ascatsaremajorhostsforT.gondii,domesticcatsshouldreceivepropercleaningandhandsmustbewashedafterhandlingthem.Symptomsassociatedwithinfectionfromthisparasiteincludediarrhea,upsetstomach,vomitingandabdominalpain[44].Infood-causedtoxoplasmosiscases,T.gondiiinfectspeoplethroughconsumptionofuncookedorundercookedmeats.Especially,thisparasitespreadsfasterbyproductsthatarecontaminatedwithcatfeces.Withthehigherconsumptionofrawmeats,itshowsincreasedprevalenceinEuropeandSouthAfrica.Toxoplasmainfectionscanbediagnosedbyresponseofantibodieswithserologicapplications[17].Infectionscausedbymicroorganismsarelargelytheresultofthepoorhygieneofthepersonresponsibleforpreparingthefood.Thesemicroorganismscanrapidlyreproduceintemperaturesoutsidethesaferangesspecifiedbyfoodsafetyregulations[1].Cookedfoodsshouldnotbelefttositinroomtemperatureforlongerthantwohours.Thesefoodsshouldbecooledrapidlyandkeptrefrigerated,preferablyatatemperatureunder5°C.Microorganismscanreproduceveryrapidlyatroomtemperature.Temperaturesbelow5°Candabove60°Ccausethereproductionofmicroorganismstoslowdownorstop.Table1presentsthemeasuresthatshouldbefollowedtoensurefoodsafety[1].StepDangerMeasureSupply/PurchaseContaminationofrawfoodsPurchasefoodsfromreliablesuppliers.Makesurethathygienicconditionsareprovidedandmaintainedduringsupplyandtransportation.Contaminationofready-to-eatfoodsPurchasefoodsfromreliablesuppliers.PurchasefoodsfromcompaniesthatapplyHACCP*system.StorageContaminationKeepfoodsinwrappedorclosedcontainers.Performpestcontrol.ReproductionofbacteriaMonitorthetimeandtemperatureofstorage.FollowtheFIFO**principle.PreparationContaminationresultingfrompersonalhygieneWashhandsbeforetouchingthefood.Preventcross-contaminationbysurfacesandcontainers.Separatecookedfoodsfromrawfoods.Useboilingwater,especiallyifthefoodwillnotundergoadditionallycooking.ReproductionofbacteriaPaycloseattentiontotheamountoftimefoodsremainatroomtemperature.CookingSurvivalofthepathogenMakesurethatthefoodiscookedwell(thefoodinitsentiretyshouldhaveatemperatureof70°C)CoolingandkeepingatcooltemperaturesReproductionofthebacteriaandsporeswhichdidnotdieinhightemperature;toxinproductionMakesurethatthetemperatureofthefooddropsbelow5°Cassoonaspossiblewhencoolingit.Donotletfoodsremainatroomtemperaturelongerthantwohours.Avoidstoringtoomuchfoodintherefrigeratororinthecoolspacesinit.Bewareofthethermalagitationsinlong-termcoldstorage.ContaminationbyvarioussourcesWrapthefoodsappropriatelyandpreventtheirdirectorindirectcontactwithrawfoodsMakesurethatthefoodcontainersarecleanwhenstoringthecookedfoods.WaitinginhightemperatureReproductionofthebacteriaandsporeswhichdidnotdieinhightemperature;toxinproductionKeeptemperatureofthefoodabove60°C.Re-heatingSurvivalofthebacteriaRe-heatthefoodproperly.ServiceReproductionofbacteria,productionofspores,andtoxinsRe-heatthefoodproperly.ContaminationDonottouchthefoodwithhands.Servethefoodhot.Preventcontactbetweenuncookedfoodsanduncleancontainers.*HACCP:HazardAnalysisCriticalControlPoint**FIFO:FirstInFirstOutMethodTable1.MeasurestoBeFollowedtoEnsuretheProvisionofFoodSafety[45]2.2.PersonalHygieneofFoodHandlersThefoodprocessingstageisoneofthemostimportantstagesinthefoodchain,andthoseresponsibleforperformingthedutiesinvolvedinthisstageassumemajorresponsibilitiesinthepreventionoffoodpoisoningcases[46,47].Thefoodprocessingstaffshouldincludehealthyindividualswhodonothaveanydiseases,andtheyshouldundergoregularmedicalcheck-ups.Inadditiontobeinghealthy,itisalsoimportantthattheworkerstakeparticularcarefortheirpersonalhygieneandexecuteproperfoodhandlingbehavior.Thisisespeciallyimportantbecausefoodhandlerscancausecross-contaminationbetweenrawandcookedfoods,andtheymayjeopardizefoodhygienebyimproperpreparation,cookingandstorageoffoods[47].AstudyconfirmedbytheFoodandDrugAdministration(FDA)determinedthat81foodbornediseaseswerecausedbyfoodscontaminatedviafoodprocessingworkers[48].Itshouldbenotedthatfoodworkershavethepowertomakearemarkableimpactonpublichealth.Inreducingthefoodbornediseasesorfoodpoisoning,thepersonalhygienepracticesofworkersatfoodproductionsitesareakeyfactor[49].Itiswellknownthatproperpersonalhygieneisthebestwaytomitigatetherisksassociatedwithcontaminationbymostofthebacteriagenerallyseenasbeingresponsibleforfoodbornediseases(Table2)[40].PathogenFoodsinvolved/sourcesPreventionCampylobacterUnpasteurizeddairy,poultryandmeats,infectedfoodhandlerCookallfoodsthoroughly.Useonlypasteurizeddairyproducts.Washhandsproperly.HepatitisAWater,ice,shellfish,salads,coldcuts,sandwiches,fruits,fruitjuices,milk,milkproducts,vegetables,anyfoodthatwillnotundergofurtherheattreatmentPurchaseshellfishfromapprovedsuppliers.Preventcross–contaminationthroughhands.Ensurefoodhandlerspracticeproperhandwashing,andpreventbarehandcontactwithfood.NorovirusRawfruit,rawvegetables,preparedsalads,rawshellfishCookfoodsthoroughly.Washhands.Usecertifiedshellfish.Nobarehandcontactwithfood.(Staph)S.aureusReady-to-eatfoods,i.e.,sandwiches,salads,hamandothermeats,potatosalads,custards,warmed-upfoods;foodhandlers'infectedcuts,throat,noseandacnePracticeproperhandwashingandhygiene.Avoidcross-contamination.Keepbarehandcontactwithfoodstoaminimum.Prohibitworkerswhohavecutsandlesionsfromhandlingthefood.Coolfoodsrapidly.SalmonellaUndercookedorrawmeats,poultry&shelleggs,poultryandeggsalads,eggcustardsandsauces,protein-containingfoods,petsandinfectedfoodhandlersAvoidcross-contamination.Coolandrefrigeratefoodsimmediately.Cookmeats/poultrythoroughly.Practiceproperhandwashing.ShigellaReady-to-eatfoodsassociatedwithbarehandcontact(salads,sandwiches,etc.),source:humanfecesandfliesPracticeproperhandwashingafterusingthebathroom.UseonlyapprovedwaterandfoodsControlflies.NobarehandContactwithfood.Table2.Pathogensthatthreatenfoodhygiene,thefoodstheyinfectandpreventivemeasuresIntheCodexAlimentarius[50],thetopicsinvolvingworkersatfoodprocessingsitesandfoodhygienewereclassifiedunderthefollowingtitles:Healthstatus,Illnessandinjuries,PersonalcleanlinessandPersonalbehavior.Personswhohaveanydiseasethatmaycausefoodinfectionorpersonswhoaresuspectedtobehostsshouldnotbeallowedintothefoodprocessingsite.Workersatfoodprocessingsiteswhohaveanysymptomsassociatedwithinfectionsshouldbereportedtotheadministration,andtheymustbeexaminedbyaphysician[50].Accordingly,thelawthatenteredintoforceinTurkeyin1996includestheprovision:“Thestafftobehiredtoworkintheprocessingoffoodsandfoodadditivescannotbeemployedwithoutfirstprovidingamedicalreport.Thosewhoaredeterminedtobecarriersshouldimmediatelybetreated.Thosewhodonotobtainacleanbillofhealthaftercompletingtheirtreatmentshoulddefinitelynotbeemployed.Theowneroradministratoroftheworkplaceisresponsibleforensuringthattheworkplaceisincompliancewithallofthesepractices”[51].Similarly,itisreportedthatincertainregionsintheUnitedStates,workersatfoodprocessingsitesarerequiredtoshowahealthcardtotheiremployers[52]].IntheWHOconsultationreport,routinemedicalandmicrobiologicalexaminationsoffoodhandlersarenotgenerallyrecommended,butiffoodhandlersaresufferingfromanillnessthatincludessymptomssuchasjaundice,diarrhea,vomiting,fever,sorethroat,skinrashorskinlesions,likeboilsorcuts,theyshouldreportthistotheirsupervisorbeforestartingwork[53].Ifworkershaveasorethroatorfever,opencutsorinfectedwounds,Norovirus,diarrhea,vomitingorjaundiceoriftheyhavehadcontactwithsomeonewhohasSalmonellatyphi,E.coli0157:H7,HepatitisAorShigella,theyshouldimmediatelyberemovedfromthefoodproductionsites.Theemployermusttakethenecessaryprecautionswithin24hoursandreporttheseworkerstotherelevantinstitutions.Manystudieshaverecommendedthatfoodproductionsitesincludehealthserviceunitsandthatitwasimportantthatworkersreporttheirdiseases[54–57].Thehygienepracticesthatshouldbeperformedbyfoodprocessingworkersincludepreciseadherencetopersonalhygieneregulationsandthewearingofspecial,protectiveattiresuchasbonnetsandglovestohelpsecuretheirhygiene.Itisimportantthattheseclothesberegularlycleanedandcaredfor[50].Reportshaveshownthatthelackofpersonalhygieneamongworkersatfoodprocessingsiteswasamongoneofthepracticesthatcontributedtofoodbornediseasesandthatproperhandwashingwasthemostcommonlyneglectedpractice.Thepracticeofimproperhandwashingmaybeanimportantfactorinthespreadingoffoodbornediseasesbycross-contamination.Itwasreportedthatofthestaffworkinginfoodproductionsites,60%didnotwashtheirhandscorrectly,andofthefoodbornediseases,25to40%werelinkedtostaffworkinginfoodprocessingandfoodservicesindustries[58,59].Itwasalsoreportedthatfoodprocessingandfoodserviceworkersweretheasymptomaticcarriersofthepathogenswhichcausedfoodpoisoning,duetotheirfailuretowashtheirhandsproperlyafterusingtherestroom[60].Anotherstudydeterminedthatthefoodsbecameinfectedduetoimpropercleaningofcontaminatedhandsafterusingtherestroom[61].Aycicek[62]tooksamplesfrombarehandsandhandswithglovesduringthefoodpreparationstage(180intotal)andfoundthatthebacterialoadonbarehandswassignificantlyhigherthanthatoftheglovedhands(p<0.05).ThemostcommonbacteriafoundwereS.aureus(126/180),Bacillusspp.(19/180)andE.coli(14/180).Inaddition,manystudieshavereportedthatworkersinthefoodprocessingindustrydidnotshowenoughcareinwashingtheirhandsproperlywhennecessaryandinusingprotectiveattire(e.g.,gloves,bonnet)[63–66].Thesituationswhenworkersshouldwashtheirhandsaresummarizedbelow.BeforestartingtopreparefoodBeforetouchingunpackedfoodsandcleanequipmentBeforeservingthefoodsandtouchingthecleanutensilsandequipmentBeforechangingtasksfromrawmeattoready-to-consumefoodsinordertopreventcross-contaminationduringfoodpreparationpracticesAftertouchinganypartofthebodyAfterusingtherestroomAftercoughing,sneezingorusingahandkerchiefAftersmokingAftereatingordrinkingsomethingAftertouchinguncleanequipmentandtoolsAfterleavingthekitchenandbeforeenteringagainAfterwashingthedishesAftertouchingthehandleoftherefrigerator,doororanyotherplacecommonlyusedbypeopleduringfoodpreparationpracticesAftertouchingworkingclothesBeforeandafterenteringareaswherefoodsarekeptandstoredAfterhandlingcashBeforewearingglovesandaftertakingthemoff,handsshouldbeproperlywashedaccordingtohygienerules[67]Thestepsforproperhygienichandwashingare:washhandsandwristswithsoapundercleanrunningwater,beingsuretorubbetweenthefingers;useanailbrushtocleannails;rubarmsandwristswithsoapandwater;soapandrubhandstogetherfor10to15seconds;dryhandswithhotairorpapertowelanduseapapertoweltoturnoffthetap[63,68].Itisnowknownthathand-dryingmethodsareasimportantashand-washingmethodsinthepreventionofcontaminationbymicroorganisms[69].Studieshavedemonstratedthatamongallformsofdryingmethods,handdryersposedthegreatestthreatofcontamination.Itwasfoundthathanddryingmachinesarelessthananidealalternativefordryinghandsaftertheyhavebeenwashed,asthesemachinesallowthebacteriatobeabletospreadasfarasonemeteraway;therefore,theuseofpapertowelsshouldbeencouraged[70,71].Ingeneral,humansaretheprimarysourceoffoodcontamination,posingarisktofoodsafetyascarriers.Alongwiththemanyextraneousfactors,suchashands,clothes,accessories,hairandmustache,internallyderivedfactors,suchasthebreath,spitandwounds,canbesourcesofcontamination.Itwasreportedthatfoodprocessingworkerswerecapableofspreading10,000to100,000microorganismseveryminute[72,73].Thus,workersshouldavoidcertainbehaviorsattheproductionsite,suchassmoking,coughing,sneezing,chewingandeating.Theyalsoshouldnotwearaccessories,watchesorhairpins[50].2.3.KitchensanitationAnotherimportantissueintheprovisionoffoodsafetyiskitchensanitation.AstudyconductedinchildcarecentersinthestatesofNorthCarolinaandSouthCarolinaintheUnitedStatesfoundthatmostkitchenswerenotincompliancewiththeFDA’s2009FoodCode[74].Inordertominimizetheriskoffoodborneillnessesintheproductionandprocessingoffoods,itisnecessarytominimizetheriskofcontaminationintheplacement,arrangementanddeckingofkitchenutensils,tosetuptheareasothatitisequippedtoperformmaintenance,repair,cleaninganddisinfectionandtoensurethatsurfacesandmaterialsinthekitchenareanti-toxic,thatthekitchenhascontrolmechanismsfortemperatureandhumidity,ifpossible,andthateffectivemeasuresaretakenagainstpests[50].2.3.1.KitchenhygieneIssuesrelatedtokitchenhygieneshouldbeaddressedpriortoevencompletingtheconstructionofthekitchen.Theplanandinteriordesignofthekitchenshouldbearrangedinsuchawayastofacilitateproperhygienepractices(e.g.,protectionagainstcross-contamination)[50].Thekitchenshouldbeconstructedwithdurablematerialsthatareeasytocareforandclean.Thesematerialsshouldbefreeofanysubstancesthatcanpotentiallyrenderthefoodunsuitableforconsumption,suchasparasites,pathogenicmicroorganismsandtoxins,orrawmaterials,foodcomponentsandotherssubstancesusedintheproductionofprocessedproductsthathavebeeninfectedbyforeignsubstances[75].Thesurfacesshouldbedesignedinsuchawayastonotaccumulatedirt,topreventforeignsubstancesfrominfectingfoodsandtonotallowthecreationofdenseliquidsormold.Pestsshouldalsobepreventedfromenteringtheworkplace.Drainagesshouldbeeasytocleanandpreventpestssuchasrodentsfromenteringandwasteliquidsfromre-enteringbackintothekitchenenvironment[76].Thereshouldbewarningswrittenandhungonthewallsoftheworkplaceabouttherulesthestaffshouldobeyandthebesthygienepracticestobeperformed.Thestaffshouldbeprovidedwithchangingroomsthatincludeasufficientnumberoflockerstoholdbothworkandcivilianclothes.Thestaffshouldnotkeepanyfoodintheselockers[75].Ventilationsystemsshouldbecapableofeliminatingsmoke,odors,sootandevaporation,keepingheatinsideandpreventingdust,dirtandpestsfromentering.Filtersandotherpartsofthesystemsshouldbeeasilyaccessibleforcleaningorchanging.Thekitchenshouldhavenaturalorartificiallightsthatareequaltothenaturallightoftheday,andtheintensityandcolorofthelightsshouldnotimpacttheproductionorthequalityofthefoodsinanegativeway.Thereshouldbecontinuouscontrolonhumidityandtemperatureinthefoodstoragesites[76].Tomaintainahygienickitchen,thecontinuityofcleaninganddisinfectionproceduresisasimportantasthelayoutplanofthekitchen.Therefore,acleaninganddisinfectionplanshouldbedevelopedforthekitchen,andallcleaninganddisinfectionpracticesshouldbedoneaccordingtothisplanandrecorded.Thestaffshouldbetrainedonthesanitationanddisinfectionofthekitchen[75].2.4.EquipmenthygieneEquipmentthatcomesintoregularcontactwithfoodsshouldbemadeofmaterialabletobecleanedanddisinfected,resistanttocorrosionandnon-toxic.Theequipmentshouldbearrangedinawayastoenableitandtheareaaroundittobecleanedsufficiently.Whenitisnecessarythatchemicalsbeusedtocleantheequipment,theinstructionsgoverningtheuseofthosechemicalsshouldbefollowed.Calibrationchecksoftheequipmentandtoolsshouldbemaderegularly,andthesechecksshouldberecorded[76].Advertisement3.FoodsafetysystemsEffectivefoodcontrolsystemsareneededtoimprovetheapplicabilityandcontroloffoodsafety[77].Currently,theHACCP,ISO22000andPAS220arethemostcommonlyusedinternationallyapprovedfoodsafetysystems.3.1.Hazardanalysisandcriticalcontrolpoints(HACCP)HACCPwasfirstusedinthe1960sbytheAmericanPillsburycompanyforthepurposeofproducing"zerodefect"productsfortheUSArmyandNASA.Later,startinginthe1970s,itbegantobeusedasareferencebytheFoodandDrugAdministration(FDA)inofficialsupervisions.ItwasadoptedbytheCodexAlimentariusCommissionin1992andpublishedastheHACCPinternationalstandardforthefirsttime.Sincethen,thefoodindustryandofficialauthoritieshavebeenusingittoprotectagainstandcontroltherisksofpotentialdangersthatcouldthreatenfoodsafety[78].Initially,HAACCPhadthreeprinciples:IdentificationandassessmentofhazardsassociatedwithfoodproductsDeterminationofcriticalcontrolpointstocontrolidentifiedhazardsEstablishmentofasystemtomonitorthecriticalcontrolpointsTheHACCP,asitisappliedtoday,hasfivestartingstepsandisgovernedbysevenprinciples.ThestartingstepswerecreatedbyCodex,andtheyshouldbecompletedpriortoimplementingthesevenHACCPprinciples.ThestartingstepshelptoensurethattheHACCPsystemisimplementedandmanagedinthemosteffectivewaypossible[79].TheHAACPsystemisapplicableforanycompanyoperatingwithinthefoodchain,regardlessoftheirsize.Intheimplementationstage,theHACCPsystemshouldbesupportedbycertainpreliminaryconditionprograms.Acompanyinterestedinimplementingthissystemshouldalreadybefollowingtherequirementsofthispreliminaryconditionprogram.Preliminaryconditionprogramsincludenationalregulations,codesofpracticeorotherfoodsafetyprerequisites.Ingeneral,preliminaryconditionprogramsinvolvefactoriesandequipment,stafftraining,cleaningandsanitation,maintenancechemicalcontrol,wastemanagement,storageandtransportation[78].FivestartingstepsThesevenprinciplesoftheHACCPsystem1.AssembleHACCPteam1.Conductahazardanalysis2.Describetheproduct2.DetermineCriticalControlPoints3.Identifyintendeduse3.EstablishcriticallimitsforeachCCP4.Constructflowdiagram4.EstablishamonitoringsystemforeachCCP5.Conducton-siteconfirmationofflowdiagram5.Establishcorrectiveactions6.Establishverificationprocedures7.EstablishdocumentationandrecordkeepingTable3.HACCPImplementationin12StepsHACCPisaninternationallyacceptedsystemandinmostcountries,itisrequiredthatcompanieswithinthefoodindustryimplementthissystem.3.2.ISO22000In2005,TheInternationalOrganizationforStandardization(ISO)publishedastandardfortheFoodSafetyManagementSystemknownasISO22000.TheISO22000systemisacombinationofpreliminaryconditionprograms,HACCPprinciplesandimplementationstepsdefinedbytheCodexAlimentariusCommissionandISO9001:2000standardcomponents.Afteritwasdefined,itbegantobeusedinmorethan50countrieswithin2years[80].ThebasicapproachoftheISO22000standardistoimplementapreventivesystemthatservestoprotectconsumersfromfoodbornediseases.Thisstandardcontrolsalltheprocessesinthefoodchain,includinginfrastructure,staffandequipment.Inbusinessestablishments,theFoodSafetyManagementSystemimplementationsincludeproductioncontrol,productcontrol,equipmentcontrol,maintenance,generalhygienepractices,staffandvisitorhygiene,transportation,storage,productinformation,training,theselectionandevaluationofsuppliers,communicationandothersimilarissues[81].Themaingoalofthisstandardistohaveasysteminplacethatdeterminestheunacceptablerisksthatmayresultfromprocesserrorsandtosecureproductsafetyandconsumerhealth.Foodsafetysupervisionoverproduct,design,productionandqualitycontroldeterminesandeliminatesthepotentialdangers.ThefundamentalroleofISO22000isnotonlytoprovidefoodsafetybutalsotoimprovethesensoryandnutritionalqualityoffood,anditalsoplaysaprimaryroleinthequalityassuranceofservicepracticesinindustrialproduction.Lastly,thisstandardhelpstoreduceoperationallossesbyinstitutingamoreeffectiveuseofresourcestoincreaseproductivity,andthereby,directstheestablishmenttoasystemoftotalquality[80].3.3.PAS220(publiclyavailablespecification)ThisstandardwascreatedbythemajorglobalfoodproducersincooperationwiththeConfederationofFoodandDrinkIndustries(CIAA)withthepurposeofeliminatingtheweaknessesoftheISO22000foodsafetysystemstandard.Nestle,Unilever,DanoneandKraft,thesectorleadersgenerallyknownas"G4",collectivelypublishedthePAS220standard,whichrefinesthepreliminaryconditionsprograms.ThePAS220standardisapplicableforalltypesofcompaniesandwasmadeavailablein2008.ItwasintendedthatthePAS220standardbeusedtogetherwiththeinternationallyacceptedISO22000standard[82].ThecontentandtopicsofPAS220elaborateonthe10sub-titlesintheISO22000standardandadds5ofitsown,resultinginthefollowing15items[82]:StructureandplacementofbuildingsPlacementofworksite,buildingsandtheirwingsSupportingplants(air,water,energy)Supportingservices,includingwastesandsewageAdequacyoftheequipment,cleaningandpreventivecareManagementofpurchasedmaterialsMeasuresagainstcross-contaminationCleaningandsanitationPestcontrolStaffhygieneandworkers'lodgingsRe-processingProductrecallproceduresStorageInformingconsumersaboutproductsFooddefense,biodefenseandbioterrorismAdvertisement4.GoodagriculturalpracticesToday,increasingattentionisfocusedupontheimpactfarmingpracticesarehavingontheenvironment,andthereisanincreasingemphasisonmoresustainablemethodsofcropproduction.Systemsneedtobeadoptedthataremoresensitivetoenvironmentalissues,geneticdiversity,wildlifeandtheirhabitatsandinsomecasesthesocialstructuresofruralcommunities.Furthermore,consumersaroundtheworldaremoresophisticatedandcriticalthaninthepast,demandingtoknowhowandwhathasbeenusedtoproducetheiragriculturallyderivedproducts.GoodAgriculturalPractices(GAP)aredefined"practicesthataddressenvironmental,economicandsocialsustainabilityforon-farmprocesses,andresultinsafeandqualityfoodandnon-foodagriculturalproducts''bytheFAO.TheaimsoftheGAPareasfollows:Ensuringagriculturalproductionharmlesstoenvironment,humanandanimalhealthSafetyofnaturalresources,Ensuringtraceabilityandsustainabilityinagriculture,Improvingworkershealthandworkingconditions,Ensuringsafetyandqualityofproduceinthefoodchain.GeneralprinciplesforGAPwerefirstpresentedtotheFAOCommitteeonAgriculture(COAG)in2003inthepaper“DevelopmentofaFrameworkforGoodAgriculturalPractices”theannexofwhichbroadlyoutlinedfarm-levelGAPrecommendationsin10fields;whichare“soil”,“water”,“cropandfodderproduction”,“cropprotection”,“animalprotection”,“animalhealthandwelfare”,“harvestandon-farmprocessingandstorage”,“energyandwastemanagement”,“humanwelfare,health,andsafety”and“wildlifeandlandscape”.AlthoughtherearesomeGAPusedbydifferentorganizationstosucceeddifferentpurposesandgoals,GLOBALGAP(EUREPGAP)isthewidespreadcertificateinagriculturalproduceworldwide.GLOBALGAPdocumentsconsistsof;ISO9001:2000QualityManagementSystem,ISO14000Environmentalmanagementsystem,OHSAS18001WorkHealthandSafetyManagementSystemandISO22000FoodSafetyManagementSystemprinciples[83].Advertisement5.ConclusionFoodsafetyultimatelydealswiththeconsumptionstage,wheretheexistenceandlevelofthedangerscausedbyfoodsareofchiefconcerns.Theobservanceofrigorouscontrolproceduresthroughoutthecourseofthefoodchainisafundamentalnecessity,giventhatriskstofoodsafetycansurfaceinanystageofthechain.Therefore,allpartiesinvolvedinthefoodchainsharetheresponsibilityforensuringfoodsafety.Thedesignofafoodsafetysysteminvolvesnumerousfactors.Tobeginwith,minimumhygienestandardsshouldbedeterminedbylawsandregulations,foodproducersmustapplyfoodsafetymeasuresandproceduresandofficialbodiesmustsuperviseandinspectfoodindustrycompaniestoconfirmthattheyareconductingtheiroperationsinamannerconsistentwiththeregulationsinforce.Foodpoisoningcasesthatthreatenpublichealthgloballyoccurasaresultofthecontaminationoffoodsinanystage,fromproductiontoconsumption.Althoughthefactorsjeopardizingfoodsafetyseemtobeeasytocontrolintheory,studiesandcurrentpracticesindicatethatthereisstillalongwaytogoinpractice.References1.WHO,2008.WHOinitiativetoestimatetheglobalburdenfoodbornediseases.Geneva.AlsoAvailableathttp://www.who.int/foodsafety/publications/foodborne_disease/burden_nov08/enFoodsafetyfactsheet[Internet].Geneva:WorldHealthOrganization;2014.2.CDC,2015.CDCandFoodSafety.http://www.cdc.gov/foodsafety(accessed:22.06.2015).3.SADAOC,2002.FoodHygieneandtheProblemofStreetFoodinWestAfrica.SixMonthlyBulletinonFoodSecurityPoliciesandStrategiesinWestAfrica.6(1).Availableat:http://www.sadaoc.bf/anglais/sadaocinfo6.htm.4.WHO,2007.Foodsafetyandfoodborneillness.FactsheetNo:237,http://www.who.int/mediacentre/factsheets/fs237/en/index.html,Accessed:10.07.2008.5.CDC,2011.CDCEstimatesoffoodborneillnessintheUnitedStates.http://www.cdc.gov/foodborneburden01.07.2015.6.CDC,2014.IncidenceandTrendsofInfectionwithPathogensTransmittedCommonlyThroughFood–FoodborneDiseasesActiveSurveillanceNetwork,10U.S.Sites,2006–2013.MorbidityandMortalityWeeklyReport.63(15):328–332.7.WHO,2004.FoodandHealthinEurope:anewbasisforaction.WHOregionalpublicationsEuropeanSeries,No.968.Fukuda,K.2015.Foodsafetyinaglobalizedworld.BulletinoftheWorldHealthOrganization.93:212.9.Duyff,R.L.2002.AmericanDieteticAssociationcompletefoodandnutritionguide(2ndEdition).JohnWileyandSonsInc.,NewJersey.10.WHO,2000.Foodbornedisease:Afocusforhealtheducation,Geneva.11.Medeiros,L.,V.Hillers,P.Kendall,andA.Mason.2001.Evaluationoffoodsafetyeducationforconsumers.JournalofNutritionEducationandBehavior.33(S1):S27–S34.12.Bilici,S.,F.Uyar,etal.2006."FoodSafety(inTurkish)"RepublicofTurkey,MinistryofHealth,BasicHealthServicesHeadOffice,NutritionandPhysicalActivitiesDepartment,NutritionEducationSeries,Ankara,Turkey.13.Yiğit,V.&Duran,T.1997.InstitutionalNutritionTechnologyI(inTurkish).EkinPublishing,Istanbul,Turkey.14.WHO,2012.Fivekeystogrowingsaferfruitsandvegetables:promotinghealthbydecreasingmicrobialcontamination,Geneva.15.WHO,2003.Assuringfoodsafetyandquality:guidelinesforstrengtheningnationalfoodcontrolsystems.FoodandAgricultureOrganizationoftheUnitedNations.16.Bas,M.2004.FoodHygieneSafetyandHACCP(inTurkish).502p.,SimPublishing.,Ankara,Turkey.17.Tayfur,M.2009.FoodHygiene,foodrelatedinfectionsandpoisonings(inTurkish).337p.KubanPublishing,Ankara,Turkey.18.Jay,J.M.1998.ModernFoodMicrobiology.FifthEdition,AspenPublishers,Maryland.19.Adams,M.R.,Moss,M.O.2008.FoodMicrobiology.ThirdEdition,pp463,RoyalSocietyofChemistryPublishing,UK.20.KluytmansJ,vanBelkumA,VerbrughH;VanBelkum;Verbrugh(1997)."NasalcarriageofStaphylococcusaureus:epidemiology,underlyingmechanisms,andassociatedrisks".ClinicalMicrobiologyReview.10(3):505–20.21.Hayes,P.R.1995.FoodMicrobiologyandHygiene.SecondEdition,Springer-Science+BusinessMedia,UK.22.Anon,2015.Clostridiumperfringens.http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/cperfringens/(accessed:04.11.2015).23.Rhodehamel,E.J.HarmonandS.M.1998.Clostridiumperfringens,BacteriologicalAnalyticalManual,8thEdition,RevisionA,Chapter16.http://www.fda.gov/Fodd/FoddScienceResearch/LaboratoryMethods/ucm070878.htmAccessed:04.11.2015.24.Murray;etal.2009.MedicalMicrobiology(6thed.).MosbyElsevier.ISBN978-0-323-05470-6.25.Juckett,Gregory;etal.November2008."TheMicrobiologyofSaltRisingBread"(PDF).WestVirginiaMedicalJournal(22).Retrieved22July2015.26.Anon,2015b.Salmonella.http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/cperfringens/(accessed:04.11.2015).27.WHO,2013.Salmonella(non-typhoidal).FactsheetNo:139.http://www.who.int/mediacentre/factsheets/fs139/en/Accessed:17.06.2015.28.Mims,Cedric;Dockrell,Hazel;Goering,Richard;Roitt,Ivan;Wakelin,Derek;Zuckerman,Mark,eds.(2004).MedicalMicrobiology(3rded.).Mosby.p.287.ISBN978-0-7234-3259-3.29.Niyogi,SK.2005.Shigellosis.JournalofMicrobiology.43(2):133–143.30.Warren,BR.,H.G.Yuk,andK.R.Schneider.(2007)SurvivalofShigellasonneionsmoothtomatosurfaces,inpotatosaladandinrawgroundbeef.InternationalJournalofFoodMicrobiology.116,400–404.31.Anon,2011“Shigellosis.”http://www.health.ny.gov/diseases/communicable/shigellosis/fact_sheet.htmaccessedon04/11/2015.32.Ram,P.K.;Crump,J.A.;Gupta,S.K.;Miller,M.A.;Mintz,E.D.(2008)."P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