Development of a quantitative health inspection instrument in food and nutrition services, Brazil

Viterbo, Lilian Monteiro Ferrari; Dinis, Maria Alzira Pimenta; Sá, Katia Nunes; Marques, Cynara Araújo Santos de Castrothor; Navarro, Marcus Vinícius Teixeira; Leite, Handerson Jorge Dourado

doi:10.1590/1413-81232020253.16372018

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ARTICLE • Ciênc. saúde coletiva 25 (3) • Mar 2020 • https://doi.org/10.1590/1413-81232020253.16372018 copy

Development of a quantitative health inspection instrument in food and nutrition services, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The study aimed to develop a Quantitative Health Inspection Instrument (IQIS) large-sized Brazilian food and nutrition services. The inspection technology based on the Potential Risk Assessment Model (MARP) and the Brazilian Health Legislation was used. Twelve dimensions, 41 modules, and 57 risk control (critical/non-critical) indicators were structured on a scale of 0-5, totalling 1,512 indices with closed-ended response coding. The IQIS was validated with the Kappa Coefficient, with excellent agreement for the attributes of clarity and relevance (k = 0.82 and k = 0.92) and good agreement for applicability (k = 0.78). The Kruskal-Wallis test showed no statistically significant difference between the assessments (p = 0.423), the Intraclass Correlation Coefficient was satisfactory (ICC = 0.53), and Cronbach’s Alpha (α = 0.71) was acceptable. The final result made it possible to classify the service as having an unacceptable health risk. IQIS is considered to have validated content, be reliable and reproducible to assess the hygienic-sanitary conditions, being a technological innovation for food and nutrition services and sanitary, allowing a detailed and rigorous inspection.

Key words
Sanitary Inspection; Sanitary Risk; Food Services; Validation Studies

Realm	Module	Risk Control Indicator	Indexes
Food handlers	Cooking	Hand hygiene	0	Handling workers do not perform hand washing and antisepsis (hygienization) or do not have exclusive lavatory, strategically placed against the food preparation flow.
			1	Handling workers do not use antiseptic odorless liquid soap or odorless liquid soap and antiseptic or non-recycled paper towels or other hygienic and safe hand drying system or dispose of in a paper collector without rational odoon or does not perform frequent, adequate hygiene.
			2	Proper hand hygiene, but no poster is available for guidance on hand washing and antisepsis.
			3	Performing hand hygiene in an exclusive washbasin, strategically placed against the food preparation flow, with adequate frequency (when arriving at work, before and after handling food, after service interruption, after touching contaminated materials, after using restrooms), and when necessary, with antiseptic odorless liquid soap or odorless liquid soap and antiseptic product, using non-recycled paper towels or other hygienic and safe hand drying system, and disposing of in a non-hand-activA A posteror. Poster is affixed and available for guidance on hand washing and antisepsis.
			4	Same previous condition without hand-activations (faucet and paper towel holder).
			5	Same previous condition, with frequent, systematized hand washing every 60 minutes.

Realms	Total of items	Applicability		Clarity		Relevance
Realms	Total of items	N1	Kappa	N2	Kappa	N3	Kappa
I. Building, facilities, equipment, furniture and utensils	150	120	0.80	138	0.92	141	0.94
II. Hygiene of facilities, equipment, furniture and utensils	354	269	0.76	280	0.79	326	0.92
III. Integrated vector and urban pest control	06	04	0.67	04	0.67	06	1.00
IV. Water supply	24	14	0.56	22	0.94	24	1.00
V. Waste management	90	85	0.94	89	0.99	86	0.95
VI. Food handlers	186	166	0.89	167	0.90	180	0.97
VII. Raw mingredients gredients and packaging	276	204	0.74	237	0.86	229	0.83
VIII. Food preparation	78	65	0.83	64	0.82	78	1.00
XI. Storage and transport of prepared food	42	38	0.9	38	0.9	42	1.00
X. Exposure to the consumption of prepared food	102	64	0.63	79	0.77	84	0.82
XI. Documentation and registration	24	14	0.60	20	0.83	23	0.97
XII. Accountability	12	04	0.33	05	0.44	07	0.61
Total Items	1,344	1,047		1,143		1,226
Mean			0.72		0.82		0.92
%		78%		85%		91%

Blocs	Nutritionists							p-value
	1	2	3	4	5	6	7
	(%)	(%)	(%)	(%)	(%)	(%)	(%)
I. Building, facilities, equipment, furniture and utensils	27.10	21.30	23.50	23.20	26.60	25.70	22.80	0.423
II. Hygiene of facilities, equipment, furniture and utensils	33.30	29.90	26.00	31.60	33.30	33.90	27.40	0.423
III. Integrated vector and urban pest control	0.00	0.00	0.00	0.00	100.00	0.00	0.00	0.423
IV. Water supply	41.70	41.70	41.70	50.00	16.70	41.70	41.70	0.423
V. Waste management	40.20	37.30	41.20	36.30	40.60	41.10	40.20	0.423
VI. Food handlers	33.30	32.50	31.70	38.90	38.10	30.20	31.00	0.423
VII. Raw ingredients, ingredients and packaging	35.80	35.40	28.00	32.70	36.70	39.30	28.70	0.423
VIII. Food preparation	34.30	38.60	27.20	39.50	32.50	33.30	30.60	0.423
IX. Storage and transport of prepared food	40.50	38.10	40.50	40.50	40.50	40.50	40.50	0.423
X. Exposure to the consumption of prepared food	42.20	38.60	42.20	42.20	43.10	44.10	42.20	0.423
XI. Documentation and registration	33.30	33.30	33.30	33.30	33.30	33.30	33.30	1
XII. Accountability	50.00	50.00	50.00	50.00	50.00	50.00	50.00	1
Mean	34.31	33.06	32.11	34.85	40.95	34.43	32.37	3

Blocs	Nº of items	Nº of risk indicators	Nº of critical risk indicators	% of compliance	Classification of potential risk
I. Building, facilities, equipment, furniture and utensils	57	9	1	27	Tolerable
II. Hygiene of facilities, equipment, furniture and utensils	59	4	3	30	Unacceptable
III. Integrated vector and urban pest control	1	0	1	14	Unacceptable
IV. Water supply	6	1	5	38	Acceptable
V. Waste management	17	1	1	67	Acceptable
VI. Food handlers	23	0	3	64	Unacceptable
VII. Raw ingredients, ingredients and packaging	27	2	4	61	Unacceptable
VIII. Food preparation	20	1	5	57	Unacceptable
IX. Storage and transport of prepared food	7	3	2	69	Acceptable
X. Exposure to the consumption of prepared food	21	3	3	65	Unacceptable
XI. Documentation and registration	3	2	1	33	Acceptable
XII. Accountability	2	1	1	100	Acceptable
Total		27	30	35	Unacceptable

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

LMF Viterbo: worked in the conception, research, methology and final writing. KN Sá: worked in the conception, research, methology and final writing. MVT Navarro: worked in the conception and final writing. CASC Marques: worked in the research. HJD Leite: worked in the conception, research, methology and final writing.