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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S107-S111 (January 2021)
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Vol. 35. Issue S2.
The 3rd International Nursing and Health Sciences Students and Health Care Professionals Conference (INHSP)
Pages S107-S111 (January 2021)
Open Access
A linkage of personal, food, and environmental hygiene to presence of E. coli in Warmindo Food Stall
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Azham Umar Abidina,
Corresponding author
, Adelia Anju Asmaraa, Anja Asmaranyb, Luthfia Isna Ardhayantic, Dwita Subhi Ramadhanid, Reynaldi Demoane Iskandard
a Department of Environmental Engineering, Centre for Occupational Health Safety and Environment, Faculty of Civil Engineering and Planning, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
b Polytechnic of Marine and Fisheries, Sidoarjo, Indonesia
c Environmental Quality Laboratory, Faculty of Civil Engineering and Planning, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
d Alumnee Environmental Engineering, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
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Tables (3)
Table 1. Environmental sanitation: food and facilities hygiene (n=33).
Table 2. Analysis of E. coli presence in Warmindo Food (n=33).
Table 3. Analysis of bivariate using Chi-square between hygiene variable and the presence of E. coli.
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Abstract
Objective

This study aims to identify pathogenic microbes of foods served by Warmindo and to assess the relationship of environmental sanitation, which is facilities and food, also personal hygiene factors to presence of E. coli.

Methods

This study utilizes a cross section design, data sheet is provided consisting questionnaire and observation results. Chromocult Coliform Agar (CCA) is applied to know positive E. coli contamination.

Results

Based on the chi-square analysis, relationship between food sanitation and the presence of E. coli (p=0.03), facilities sanitation (p=0.077), and personal hygiene that there is a significant relationship between hygienic behavior and the presence of E. coli (p=0.046). The laboratory test results show 6 (9.1%) from 33 food samples from Warmindo positive contaminated with E. coli. No meaningful differences between re-heating and direct-cooking food.

Conclusions

There is a relationship between food sanitation, facilities sanitation, and hygienic behavior with Escherichia coli contamination in food sold at Warmindo.

Keywords:
E. coli
Environmental health
Personal hygiene
Sanitation
Full Text
Introduction

Inexpensive and convenient food stalls in developing countries such as Indonesia still become one of main issues rather than nutritious and hygiene food consumption. Warmindo is a food stall that proves various instant noodles menu as well as other menus, for example, egg rice, sardines rice, instant beverages, and so on. Firstly, initiated from West Java Province, recent Warmindo can be reached in big cities such as Jakarta, Yogyakarta, Semarang, Surakarta, etc. As fast food and simple-eating places, affordable prices, 24h operating time make Warmindo is ubiquitous food stall around college and workplaces.1

Warmindo reflects traditional cultures based on eating and gathering culture among dwellers. Special Region of Yogyakarta called Student City in Indonesia comprising thousands of students from many universities who live there. So that Warmindo is famed for having a meal, making small discussion groups, chit chat meetings with no time limit for students. According to Elvinstudy, along with not requiring high-skill expertise and low-funding establishment, Warmindo especially in Yogyakarta City in a decade has increased by around 100 units, from 1600 to 1700 Warmindo.2 The findings also addition facts that Warmindo is one of middle enterprises, named UMKM, which plays a significant role in the economic growth of Yogyakarta Government.3,4 Moreover, Warmindo is being a benchmark for basic necessities price in Yogyakarta area. Notwithstanding foods served by Warmindo is very popular, health safety of those foods and drinks is not guaranteed. Based on several observations, there are some Warmindo possessing poor sanitary conditions.

Most of the students or the lower incomes of many cities’ dwellers prefer that cheap and delicious meal is more important than food hygiene conditions. Its understanding leads to foodborne disease which is identified by the disorder of the digestive tract with symptoms of nausea, heartburn, vomiting, and diarrhea. Another developing country in South-east Asia, five thousand food poisoning cases in Malaysia faces foodborne diseases due to inappropriate clean handling during serving food.5 Supported by Lambrechts states that approximately 97% of foodborne disease is caused by a lack of personal hygiene.6

On the other hand, in Indonesia, the incidences of several diseases are transmitted through food is relatively high, for instance, typhoid, cholera, dysentery, diarrhea, and so on.7,8 Ministry of Health points out that diarrhea is a top ten disease identified by health facilities and generates rising high-mortality of children under five years old. As much as 10,086 cases were multiplied-increase compare the previous year occurred in all ages in Yogyakarta.9 Unhygienic food management and sanitation is able to trigger eat contaminated by pathogenic microorganisms, such as Escherichia coli. Research explains there is a relationship between cooking utensils and E. coli existence in Canteen of Semarang State University.10 Then, personal hygiene factors show the most dominant factor influencing E. coli contamination from food handlers.11 This study conducts to highlight the pathogenic microbes of foods served by Warmindo, in addition, an interview completing a questionnaire survey is undertaken to assess the linkage of environmental sanitation, which is facilities and food, also personal hygiene factors to presence of E. coli. By identifying the relationship, the results obtained are able to reduced diarrhea outbreaks, specifically in student circle area and to be utilized as evaluation material to improve hygiene food-serving.

Methods

Cross sectional method approached univariate and bivariate analysis. Those detailed parameters referred to the Indonesian Ministry of Health Rules, i.e. 1098/2003 concerning sanitation hygiene of restaurants. Interview data was interpreted by scoring and describing food stall hygiene conditions. The results were explained in percentages that have good, medium, and poor categories that explored previous study with modified the methods.11,12 Sampling was carried out randomly as many as 33 Warmindo located within a radius of 500m from a University in Sleman, Special Region of Yogyakarta.

Microbiological analysis

One gram of food samples was homogenized with 9mL of 85% salt solution. Next, the samples were mixed by 0.85% NaCl solution using a vortex mixer. After being homogeneous, the samples were diluted inside test tubes containing 9mL of 0.85% of NaCl. The dilution series was employed for 8 times, from 10−1 to 10−8. The only series of 10−2, 10−4, and 10−6 solution as much 0.1mL were taken and spread into a plate containing 10mL of Chromocult Coliform Agar (CCA) medium in sterile condition inside Laminar Air Flow (LAF). After inoculated, the media was going to be incubated for 24h in an incubator with a temperature of 37°C. The presence of E. coli is able to be indicated from purplish night blue colonies. To ensure the existence of E. coli, an Indol test was carried out using the Kovacs reagent. Indol testing only was applied specifically for positive on CCA media. The Kovacs reagent dropped directly on the suspected colony therefore it changed to cherry red color around the suspected colony.

ResultAnalysis of environmental sanitation

Fig. 1 explains environmental sanitation observing from facility and food sanitation variables. Overall, from 33 samples, 46% owns medium quality, and the rest up to 36% has low proper facilities. Thus, it can be said that there are still numerous Warmindo that have inappropriate facilities. Furthermore, all variables of facilities and food sanitation are analyzed by information collected from the questionnaire. Table 1 gives a summary each parameter in a percentage of frequency.

Fig. 1.

Environmental sanitation.

(0.25MB).
Table 1.

Environmental sanitation: food and facilities hygiene (n=33).

Parameters  Frequency, n (%)
  Yes  No 
Facilities sanitation
Kitchen location close to pollution sources  27 (75.8)  9 (24.2) 
Closed and water-proof material of trash bin  2 (6.1)  34 (20.9) 
Hand washing facility  0 (0.0)  100 (100.0) 
Building construction separated from the main house  8 (21.2)  28 (78.8) 
Building construction saved from animal carrier invention
Insect  8 (21.2)  28 (78.8) 
Rats  16 (45.5)  20 (54.5) 
Sufficient clean water  100 (100.0)  0 (0.0) 
Good quality of clean water  35 (97.0)  1 (3.0) 
Washing standard processing of kitchen stuffs  23 (63.6)  13 (36.4) 
Unbroken kitchen stuffs  33 (90.9)  3 (9.1) 
Periodically rubbish transported  31 (84.8)  5 (15.2) 
Rubbish basket  100 (100.0)  0 (0.0) 
Wastewater drainage system  34 (93.9)  2 (6.1) 
Sufficient of kitchen stuffs washing  25 (69.7)  11 (30.3) 
Clean toilet  22 (60.0)  14 (40) 
Toilet location near kitchen  18 (50.0)  18 (50.0) 
Permanent construction  36 (100.0)  0 (0.0) 
Food sanitation
Suitable temperature and moisture of food keeping condition  10 (27.3)  16 (72.7) 
Covered food keeping  14 (39.4)  22 (60.6) 
Covered food serving  1 (3.0)  35 (97.0) 
Good quality of raw material food  34 (93.9)  2 (6.1) 
Registered raw material  100 (100.0)  0 (0.0) 
Separation place between raw material and cooked-food  100 (100.0)  0 (0.0) 
Clean food keeping  15 (42.4)  21 (57.6) 
Food saving in a food rack  25 (69.7)  11 (30.3) 
Appropriate clothes for food buyers  34 (93.9)  2 (6.1) 
Tweezers using to take the foods  35 (97.0)  1 (3.0) 
Appropriate kitchen stuffs handled by food serving  34 (93.9)  2 (6.1) 
Suitable food condition  100 (100.0)  0 (0.0) 
Bacteria contamination  6 (9.1)  30 (90.9) 
Suitable temperature and time period of cooked-food keeping  100 (100.0)  0 (0.0) 
Freshly food serving  100 (100.0)  0 (0.0) 
Clean plating when food served  100 (100.0)  0 (0.0) 
Clean food container  34 (93.9)  2 (6.1) 
Source: Primary Data, 2018.
Analysis of personal hygiene condition

Fig. 2 explains personal hygiene of food handlers in Warmindo. The assessment results indicate that food handlers are good attitude peaked on 84.80% while two others, hygiene knowledge and behavior pointed on 57.60% and 54.60%, respectively. Contrary, no applying Personal Protective Equipment (PPE), such as mask, hair covering, and apron during cooking and serving food is the most dominance reached up 81.80%.

Fig. 2.

Personal hygiene.

(0.4MB).
Analysis of E. coli presence

By testing in laboratory, two samples of re-heating food are positive of E. coli in each Warmindo X and Y therefore totally 4 food samples (6.1%) are contaminated. In addition, Table 2 presents E. coli contamination also happened in direct-cooking food which is two samples (3.0%). Thus, the difference test employed by Kolmogorov–Smirnov Z method describes no meaningful differences between re-heating and direct-cooking food. All kind of foods possess equal potency to be contaminated. Positive test results are continued by confirmation test marked by the appearance of cherry red color on test medium that imagined in Fig. 3.

Table 2.

Analysis of E. coli presence in Warmindo Food (n=33).

Kind of foods  Most extreme differencesKolmogorov–Smirnov Z  Frequency n, %  p-value 
  Absolute  Positive  Negative       
Re-heating food  0.030−0.030.1234 (6.1)  0.077 
Direct-cooking food  2 (3.0)  0.030 
Total contamination  6 (9.1)  0.384 
Source: Primary Data, 2018.
Fig. 3.

(a) Positive test and (b) confirmation test of E. coli.

(0.05MB).
Analysis of bivariate between two variables

Table 3.

Table 3.

Analysis of bivariate using Chi-square between hygiene variable and the presence of E. coli.

Parameters  E. coli (n)α; 95% confidence interval  p-value 
  (+)  (−)  Total     
Facilities sanitation      33  0.1  0.1 
Good       
Medium  15       
Bad       
Food sanitation      33   
Good  22       
Medium  11       
Bad       
Knowledge worker      33    0.4 
Good       
Medium  18       
Bad       
Attitude worker      33    0.4 
Good  26       
Medium       
Bad       
Behavior worker      33   
Good       
Medium  18       
Bad       
Protective Personal Equipment (PPE)      33    0.5 
Good       
Medium  18       
Bad       
Covered food      33    0.6 
Good  16       
Medium       
Bad       

(*)Asymp. and exact Sig (two-tailed) mean 1.

Source: Primary Data, 2018.
Discussion

It can be seen from Table 1, there are five factors of facilities hygiene that drive on an increase of food contamination by bacteria. The first variable is the kitchen location. Twenty-six kitchens of Warmindo equal to 75.8% are beside the pollution sources, such as toilet, trash basket, main road, waste treatment plant, and so on. The fact is made worse by using a poor quality of trash basket in the second position. The majority of Warmindo utilize a rubbish basket that unclosed and non-waterproof material. Approximately 93.9% of vendors apply reusable plastic bags or cardboard as a trash basket. Applying those media indicates unsaved and non-standard solid waste collecting facilities. Unclosed trash bin excites pathogen animal carriers, for instance, insects and rats that are possible to spread germs through the food. Equally important, unsafe leachate produced by the organic waste decomposition process that spilled from non-waterproof material of trash basket generates soil pollution. As third factors, unfortunately, none of Warmindo (0%) facilitates handwashing places for food buyers. Even though, hand hygiene owns a pivotal role that prevents the movement of pathogenic bacteria causing food-borne disease.5

On the other hand, in food sanitation, the first factor is temperature and humidity of food keeping pointed to only 27.3% that is fit the basic hygiene standard. Then, other observations, the variables of food storage and food serving have bad scores, 39.4%, and 3%, respectively. Low percentages are reflected in the food containers that are not protected from disease-vector carryings, such as flies and rats. Many Warmindo do not apply food storage cabinets, closing curtains, and yet only placed on the table, openly. In the same way, Romanda investigated that opened food container is going to double rising E. coli contamination.11 This fact is proven by the presence of E. coli (9.1%) on the Warmindo food in Table 1. Other food sanitation aspects depict well enough conditions so that the frequencies show values mostly above 70%.

On personal hygiene aspects, limited food handlers who use PPE during food processing show the awareness of Warmindo vendors are inadequate. In some countries, the condition equally occurrs, complementary to this, in Uganda, the Aerobic Plate Count (APC) exhibits a high number of bacteria exceeding the permitted standard quality because of no applying PPE during food serving process.12 In Indonesia, the Ministry of Health through PERMENKES RI 1096/2011 already has regulated and recommended implementing PPE as personal hygiene terms. More than 50% of food serving knows how important to use PPE but it is not implemented in their behavior.13,14 Conversely, the bivariate test notes that applying PPE correlate to the presence of E. coli. The impression of data is indicated by another reason, as an example, many food handlers who use gloves to avoid food contamination, actually have the amount of Coliform that exceeds the minimum standard. In case, the dirty gloves however increasing of risk contamination.5

Subsequently, Table 3 explains the absence of a relationship between facilities sanitation and the presence of E. coli is in line with research by Rahman who states the difference between statistical test and the observation findings owing to slight and indirect correlation among those variables.15 As educational background also gives unconnected relations. Food handlers who are knowledgeable regarding hygiene exactly are still contaminated with E. coli. Several factors are probable to affect someone's knowledge, such as education level, age, experience, and workplace atmosphere. Although most of Warmindo food sellers graduated from junior to senior high school, it is thinkable that they have good knowledge through their experience.16 Additionally, Zulkifly said that lack of knowledge about food safety does not affect attitudes and practices to prevent food from germs contamination.17

Differences from previous explanations, food sanitation, and behavior aspect contribute straightway to effects. Food storage and food quality are able to affect E. coli contamination supported by data in Table 1.16 Then, by comparing attitude, the behavior is a long period and stable of accustomed attitude therefore it is not easily changed by the environment. Thus, the unpleasant behavior of food handlers automatically strikes up food-borne diseases. More than 70% of food handlers habitually did not wash their hands and cooking stuff properly with soap and sufficient water. Furthermore, during cooking the meal they often make conversation with each other without masks and freely smoking too. Those behavior conduct extremely susceptible to bacterial contamination and food poisoning.18–20

Conclusion

To conclude, a strong linkage between third factors, food sanitation, facilities sanitation, behavior hygiene, and the presence of E. coli compared to other variables. Along with the findings, 3 out of 33 Warmindo food samples are identified as positive contaminated by pathogen microorganisms, E. coli. No meaningful differences between re-heating and direct-cooking food.

Conflicts of interests

The authors declare that they have no conflict of interest.

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