1. Introduction

Food safety is crucial for public health, especially in hospital settings where vulnerable populations are at a higher risk of foodborne illnesses [1, 2]. Ensuring safe and hygienic food prevents health complications and promotes patient well-being. Food handlers play a vital role in maintaining food safety standards, as their knowledge, attitudes, and practices directly impact the quality and safety of food served [3]. To maintain quality healthcare services in Qatar, evaluating and improving the understanding of food safety among the food handlers in the hospitals should be prioritized. Hospitals assist people with weak immune systems; as such, they are likely to be infected by diseases resulting from contaminated food [4].

Food-associated infectious diseases may cause major adverse effects, including longer hospitalization, higher treatment expenses, and death [5]. Some studies have also revealed a lack of awareness regarding food safety and its implementation, indicating the need for further training and education. These include failure to wash hands effectively, poor storage of foods, and poor perception of the crosscontamination risks [6]. These challenges can be addressed by using proper training programs accompanied by evaluation and promotion of food safety culture.

According to statistics from the World Health Organization (WHO), 600 million individuals are affected by foodborne illnesses, and 420,000 people die from these diseases annually. At the same time, 33 million disability-adjusted life years are lost [7]. Stressing food safety and hygiene measures, many scientific papers have reported cases of foodborne diseases, emphasizing the need for proper implementation of standard food safety procedures [8, 9]. In particular, literature has documented foodborne outbreaks linked to inadequate kitchen hygiene practices and poorly managed disease outbreaks in hospital settings [10–14].

For instance, a retrospective review of 50 food poisoning outbreaks from hospitals in Scotland from 1973 to 1977 involving 1530 patients identified Clostridium perfringens as the most frequent causal organism, occurring in 31 outbreaks, while Salmonella was identified in 11 outbreaks and Staphylococcus aureus in three outbreaks, with unidentified etiology in five outbreaks. Noteworthy findings from this review indicated a higher frequency of involvement of psychiatric and geriatric units in these outbreaks [13].

A study examining 48 outbreaks between 1978 and 1987, involving 2287 individuals and 12 fatalities, found a significant decrease in Clostridium perfringens cases, but Salmonellosis persisted. The study highlighted the need for improved hospital kitchen protocols, particularly cooking food on the day of consumption, to mitigate outbreaks. Still, crosscontamination from poultry was considered a significant risk [10]. In a separate investigation, a Clostridium perfringens food poisoning outbreak affected 38.6% of patients in two hospital wards after consuming roast pork. The source was a local supplier with food safety deficiencies. The oversized meat cuts and lack of equipment for rapidly cooling cooked meat highlighted the hazards of using commercially prepared meats in hospital food service [12].

A review of hospital-acquired listeriosis cases found that 25% were hospital-acquired, with 75% being immunosuppressed. Eight outbreaks showed strong evidence of foodborne transmission within hospitals, linked to food items like sandwiches, butter, and Camembert cheese. The authors recommend hospital policies to enhance food safety, especially by avoiding higher-risk foods for immunocompromised patients [14]. Contamination risks in large-scale cooking operations are high due to multiple individuals involved, posing a significant threat to consumer health and financial implications [15, 16]. Hospital environments, particularly for immunosuppressed, elderly, children, and pregnant women, require strict adherence to hygiene practices, minimum internal cooking temperatures, and appropriate handling and storage of food, including segregation of raw and cooked items, to prevent foodborne illnesses and ensure safety.

Hamad Medical Corporation’s (HMC) catering division has obtained a Hazard Analysis Critical Control Point (HACCP) certification in adherence to the International Organization for Standardization 22000 (ISO 22000) food safety management standards. A contracted agency ensures that food handlers receive adequate training and a foundational food safety course. This study aimed to address a research gap in Qatar by assessing food safety knowledge among hospital food handlers. It is crucial as patients with compromised immune systems are at a higher risk of severe health complications from foodborne illnesses. The research, unique in its focus on food handlers in Qatari Hospitals, aims to identify gaps in knowledge and practices, enhancing patient safety and improving healthcare quality. The findings will inform targeted interventions, training programs, and policies in hospital settings.

2. Materials and Methods

3. Results

3.8. Total Knowledge Score and Associated Factors

Statistically significant differences were observed in the distribution of total knowledge scores across various job positions (p = 0.002, H = 30.393). Post hoc pairwise comparisons revealed significant disparities in scores between kitchen aides (mean rank = 246.92, median = 11 (IQR 10-12), n = 33) and receptionists (mean rank = 119.27, median = 9 (IQR 8-10), n = 11, adj.p = 0.033), as well as between kitchen aides and food servers (mean rank = 169.97, median = 10 (IQR 8-11), n = 130, adj.p = 0.011), favouring kitchen aides over the other two groups.

Additionally, a statistically significant difference in knowledge scores was noted based on marital status (p = 0.043, H = 8.139). Pairwise comparison indicated an important difference between married individuals with a median score of 10.5 (IQR 8-11) and those categorized as “other” with a median score of 6 (adj.p = 0.045).

However, the distribution of total knowledge scores did not exhibit significant differences across age categories (p = 0.103), gender (p = 0.611), level of education (p = 0.055), or work experience (p = 0.145). Furthermore, Spearman’s correlation analysis revealed no significant association between knowledge scores and either age (rho = 0.052, p = 0.325) or years of experience (rho = 0.013, p = 0.808). Table 4 summarizes the Kruskal–Wallis test results and Table 5 outlines the Mann–Whitney U test results, comparing knowledge scores based on gender and work experience.

Table 4. Kruskal–Wallis results of association between the sociodemographic factors and the total knowledge score.

Sociodemographic factor	Frequency	H statistic	Degrees of freedom	p value
Age	366	6.183	3	0.103
Level of education	365	7.586	3	0.055
Job position	366	30.393	12	0.002
Marital status	366	8.139	3	0.043

• Note: p values that are bold indicate that the results are statistically significant (below 0.05).

Table 5. Mann–Whitney U results of association between sociodemographic factors and the total knowledge score.

Sociodemographic factor	Sample 1	Mean rank	Median (IQR)	Sample 2	Mean rank	Median (IQR)	p value
Gender	Male (n = 223)	185.71	10 (8–11)	Female (n = 143)	180.05	10 (8–11)	0.611
Work experience	10 years or more (n = 49)	203.67	11 (9–11)	Less than 10 years (n = 317)	180.38	10 (8–11)	0.145

Figure 1 illustrates the distribution of food safety knowledge scores among study participants. Out of 366 participants, 223 (60.9%) achieved a “good” knowledge score, 110 (30.1%) attained a “satisfactory” score, and 33 (9.0%) had an “inadequate” knowledge score. The calculation of 60.9% was derived by dividing 223 (participants with good knowledge) by the total study population of 366 and then multiplying by 100 ((223/366) × 100 = 60.9%).

3.9. Total Score for Awareness About Safe Food Handling Practices and Associated Factors

A statistically significant difference was observed in the total score for awareness about safe food handling practices between participants with 10 or more years of work experience (mean rank = 157.49, median = 6 (IQR 5-6), n = 49) and those with less than 10 years of work experience (mean rank = 187.52, median = 6 (IQR 6-6), n = 317) (U = 9041, z = 2.608, p = 0.009, r = 0.1363).

Although a statistically significant difference was initially noted in the scores across job position categories (p = 0.016, H = 24.68), this significance was lost after adjusting for multiple comparisons using the Bonferroni method. Furthermore, no significant differences were found in total scores for awareness about safe food handling practices across marital status (p = 0.311), education level (p = 0.301), age (p = 0.65), or gender (p = 0.26). Moreover, Spearman’s correlation analysis revealed no significant association between awareness scores and either age (rho = −0.036; p = 0.492) or years of work experience (rho = −0.084; p = 0.114). Tables 6 and 7 outline the statistical analysis of total awareness scores for safe food handling practices. Table 6 presents the Mann–Whitney U test results based on gender and work experience, and Table 7 summarizes the Kruskal-Wallis results.

Table 6. Mann–Whitney U results of association between sociodemographic factors and the total score for awareness about safe food handling practices.

Sociodemographic factor	Sample 1	Mean rank	Median (IQR)	Sample 2	Mean rank	Median (IQR)	p value
Gender	Male (n = 223)	179.96	6 (6–6)	Female (n=143)	189.02	6 (6–6)	0.260
Work experience	10 years or more (n = 49)	157.49	6 (5–6)	Less than 10 years (n = 317)	187.52	6 (6–6)	0.009

• Note: p values that are bold indicate that the results are statistically significant (below 0.05).

Table 7. Kruskal–Wallis results of association between the sociodemographic factors and the total score for awareness about safe food handling practices.

Sociodemographic factor	Frequency	H statistic	Degrees of freedom	p value
Age	366	1.641	3	0.650
Level of education	365	3.653	3	0.301
Job position	366	24.68	12	0.016
Marital status	366	3.579	3	0.311

• Note: p values that are bold indicate that the results are statistically significant (below 0.05).

Figure 2 illustrates that most participants, 351 out of 366 (95.9%), achieved a good score in awareness about safe food handling practices. In comparison, 11 out of 366 (3%) attained a satisfactory score, and only 4 out of 366 (1.1%) received an inadequate score. These findings suggest that while awareness is generally high among hospital food handlers, targeted interventions may be necessary for specific subgroups to enhance food safety compliance further.

4. Discussion

This study revealed a notable male predominance among participants, contrary to findings in several studies where females typically constitute the majority of food handlers in healthcare and other institutional settings [15, 17, 18, 22]. All food handlers surveyed were non-Qatari, reflecting Qatar’s reliance on a diverse migrant workforce in the service industry. This highlights the importance of culturally and linguistically tailored food safety training programs to ensure effective communication and adherence to best practices. Additionally, it is crucial to implement standardized training that accommodates varying levels of prior knowledge and experience among food handlers.

While almost all participants (99.7%) had completed a food safety course, demonstrating a strong commitment to food safety training within Qatar’s healthcare food service sector, there remains a need for continuous refresher training. Regular refresher courses, ideally conducted every 6 months to a year, can help reinforce critical food safety principles, update food handlers on new regulations, and correct any misconceptions that may persist.

Regarding specific knowledge areas, our findings highlight strengths and gaps in food safety awareness. For instance, 71.9% of participants correctly identified the appropriate temperature for accepting and storing perishable foods as less than 5°C. While this is an improvement compared to some international studies, it still suggests the need for targeted interventions to improve temperature control practices [22, 24]. Hands-on training and real-time monitoring can be effective strategies to reinforce proper temperature management.

The current study revealed that most participants (70.8%) identified 3 days as the maximum storage duration for ready-to-eat perishable food, which aligns with the official guideline in Qatar and was considered the correct response. In contrast, Teffo and Tabit [22] reported a lower agreement (8.1%) in South Africa, where the official maximum storage duration is 7 days. This discrepancy suggests regional differences in food safety awareness and regulatory standards. While both studies showed a predominant preference for the 3-day limit, our study aligned with official guidelines, whereas the South African study highlighted inconsistencies in public perception [22].

The findings of this study revealed that 65% of participants correctly identified the refrigerator as the appropriate method for thawing frozen meat, indicating a higher level of awareness compared to studies by Elsherbiny et al. [25] in Egypt and Abdelhakeem et al. [17] in Jordan, where only 60.6% and 54.7% of respondents, respectively, recognized this practice. This improvement suggests better access to food safety education or stricter food handling regulations. Additionally, the present study significantly outperformed results from Teffo and Tabit [22] in South Africa and Guennouni et al. [18] in Morocco, where only 31.9% and 28% of participants, respectively, answered correctly, likely reflecting differences in food safety training, socioeconomic factors, or cultural practices. However, 22.7% of participants believed that thawing at room temperature was acceptable, highlighting a persistent knowledge gap. While this percentage is much lower than the 72.8% reported by Bou-Mitri et al. [20] in Lebanon, it still underscores the need for targeted interventions such as practical demonstrations and routine audits to reinforce proper thawing practices and reduce the risk of foodborne illnesses.

In addition, the present study found that 88.3% of participants correctly identified the minimum internal cooking temperature for meats, poultry, and seafood, highlighting strong awareness but a need for reinforcement through visual aids and exercises persists. In contrast, awareness was much lower in South Africa (9.05%), Egypt (35.6%), and Saudi Arabia (49.8%), as reported by previous studies [19, 22, 25]. These variations may arise from differences in food safety education, cultural practices, and resource availability. The findings emphasize the importance of targeted interventions like educational campaigns and hands-on training. Access to temperature measurement tools can improve food safety awareness and reduce health risks.

Regarding foodborne disease awareness, 87.2% of participants identified Salmonella as the leading cause of foodborne illness, 79.5% recognized that bacteria double rapidly at 37°C, and 88% knew diarrhoea is the most common symptom of food poisoning. In contrast, the South African study by Teffo and Tabit [22] reported much lower awareness, with only 47.1% recognizing Salmonella and 38.1% understanding bacterial growth at 37°C. However, 91.9% of participants in the South African study correctly identified diarrhoea as a key symptom, slightly higher than the 88% in the present study. These differences indicate a stronger overall food safety awareness in the present study, except for symptom recognition, where both studies showed similar knowledge. The findings highlight the need for region-specific food safety education to address varying knowledge gaps [22].

Regarding high-risk populations, 67.2% of participants correctly identified preschool children as high-risk due to their immunocompromised status. In comparison, 82.5% accurately recognized vulnerable populations prone to foodborne illnesses, highlighting a strong awareness of at-risk groups. However, further emphasis is needed on pregnant women and the elderly to ensure comprehensive understanding among food handlers. In comparison, the South African study by Teffo and Tabit [22] reported slightly lower awareness, with 66.7% recognizing preschool children as at-risk and 71.4% correctly identifying high-risk groups for foodborne illnesses. Additionally, Al Banna et al. [24] found that 76.4% of Bangladeshi participants had poor knowledge of the issue, with many incorrectly assuming all people, including children, elderly, and pregnant women, were equally vulnerable. These findings indicate that the present study’s participants demonstrated greater awareness of foodborne illness risks compared to other studies.

The distribution of total food safety knowledge scores differed across the various job positions which is consistent with the findings from the Egyptian study by Elsherbiny et al. [25], and the Turkish research by Ulusoy and Çolakoğlu [26] but inconsistent with the South African study by Teffo and Tabit [22]. This was expected as the people with more responsibilities would show higher scores because of their daily practice.

The “other” and married groups had significantly different distributions of overall food safety knowledge ratings, with the latter scoring higher. While statistically significant, caution should be taken in interpreting this difference due to the small sample size (three in the “other” group), which may not accurately represent the population. More research in studies with a wider subgroup sampling is needed to corroborate these findings.

In the present study and the study done by Teffo and Tabit [22], no effect was demonstrated between the level of educational attainment and the overall score of total food safety knowledge, as we had expected. This is contrary to the results obtained from other research conducted by Abdelhakeem et al. [17] and Akabanda et al. [15].

Our study found no significant associations between total food safety knowledge scores and age or work experience, emphasizing the need for structured learning interventions like competency-based assessments, mentorship programs, and interactive workshops to bridge knowledge gaps. In contrast, Elsherbiny et al. [25] in Egypt reported that longer work experience and older age were linked to higher knowledge scores, suggesting that expertise enhances food safety knowledge. Similarly, Bou-Mitri et al. [20] in Lebanon found that participants with 21 or more years of work experience demonstrated superior knowledge. These findings indicate that while work experience may play a role in knowledge acquisition, structured training remains essential for all demographics.

The distribution of total food safety knowledge scores did not differ by gender in our study, consistent with the Turkish research by Ulusoy and Çolakoğlu [26]. This aligns with expectations considering the mandatory nature of food safety courses for all participants.

Participants in our study demonstrated better awareness of food safety practices than those in the South African study by Teffo and Tabit [22]. For instance, a higher proportion of participants in our study (98.1%) emphasized the importance of keeping raw and cooked food separate, contrasting with rates of 40.9%, 80.6%, 87.6%, 90%, and 92.7% in the Egyptian study by Elsherbiny et al. [25], Sri Lankan study by Adikari et al. [27], South African study by Teffo and Tabit [22], Moroccan study by Guennouni et al. [18], and Bangladeshi study by Al Banna et al. [24], respectively.

However, concerning food handling during episodes of diarrhoea, our study revealed that 8.7% of participants did not agree with avoiding food preparation for others, with an additional 3% expressing uncertainty on the matter. This highlights a critical area requiring attention, as outlined in the Food Safety Code of Practice for Food Services, emphasizing the importance of food handlers’ awareness of health and hygiene obligations, including reporting any health conditions to supervisors and abstaining from food handling when a contamination risk exists [23]. Such discrepancies may stem from concerns about reporting illness due to potential consequences, particularly as food handlers are contracted through a third-party employer. Furthermore, additional training is warranted to ensure correct practices when experiencing diarrhoea.

The current study revealed that the comparatively young employees with experience of not more than 10 years had a better attitude towards safe food handling practices than their older employees with 10 years or more experience. This could be attributable to training that was still recent and, therefore, the “novelty effect” regarding routine tasks and the workplace environment. Besides that, different generations’ working motivations and various learning styles can define this difference where new employees are motivated to apply their knowledge and be promoted.

Our findings indicate that while food safety knowledge among healthcare food handlers in Qatar is relatively strong, there is room for improvement in specific areas. Regular refresher training, hands-on demonstrations, and continuous monitoring should be integrated into food safety programs to enhance compliance with food safety protocols. In addition, employing multilingual training materials and practical assessments will ensure all food handlers, regardless of educational or cultural background, can fully grasp and apply critical food safety principles.

5. Strengths and Limitations

The study marks the inaugural investigation into hospital food handlers’ understanding of food safety in Qatar, emphasizing HMC personnel. A “do not know” option has been added to the questionnaire to reduce speculative answers and potential response bias. Limitations include the questionnaire’s self-administered format as participants are unlikely to seek clarifications for questions they do not understand.

6. Conclusion

The study found that hospital food handlers strongly understand safe food handling practices, including proper cooking temperatures and crosscontamination risks in Qatar. However, there are variations in knowledge based on job roles and marital status, as well as variations in safe food handling practices based on work experience. The study suggests that while overall food safety awareness is high, there are areas where training and consistency could be enhanced. The study indicates that a comprehensive and standardized food safety training program provided by HMC as a precondition for employment would ensure up-to-date knowledge of best practices. This program should include detailed modules on hazard analysis, hygiene protocols, and emergency response measures. It should be recurrent, tied to contract renewals, and continually revised to align with the latest Food Safety Code of Practice for Food Services. Future research should explore the effectiveness of such training programs in improving compliance and reducing foodborne illness incidents. Additionally, studies could investigate the role of cultural and demographic factors in shaping food safety behaviours among hospital food handlers to tailor interventions more effectively.

Ethics Statement

This study has received clinical governance and HMC corporate approval (protocol number MRC-01-23-613).

Consent

Informed consent has been taken from all the participants.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

N.A.—conceptualization, methodology, data analysis, writing of the original draft, and editing. M.A.—conceptualization, review, and editing. L.A.—methodology and monitored data collection. I.B.—methodology and supervision. All authors read and approved the final manuscript.

Funding

Open Access funding was provided by the Qatar National Library.