Prevalence of food thermometers usage and temperature control in restaurants in Dammam, Saudi Arabia

Abstract The Saudi Ministry of Municipal and Rural Affairs is planning to initiate a hazard analysis critical control point (HACCP) system in restaurants and cafeterias to manage issues of food safety in Saudi Arabia. One of the most important elements in the HACCP system is the monitoring temperature of cooked and stored food. The present study aimed to investigate the prevalence and use of refrigerators/freezers and food thermometers among food handlers in local and international restaurants in Dammam, Saudi Arabia. A cross‐sectional study was conducted in municipality‐licensed restaurants. The temperatures of refrigerator and freezer were checked, and the survey form was completed by the researcher according to logbook entries. We then checked for the presence of a food thermometer, and if a functional thermometer was present, the chef was asked to complete an online questionnaire using Survey Monkey website on a tablet. The response rate of the survey was 68% (238/350 restaurants). We found that 88.1% of restaurants used a thermometer to check the temperature of their refrigerators and freezers. Thirty‐one restaurants (13.0%) had a regular temperature‐monitoring record available for both the refrigerator and freezer. International restaurants had significantly greater temperature‐monitoring data than local restaurants (88.1% vs 63.3%; p = .0001). The prevalence of food thermometers in restaurants was 53.4% (127/238 restaurants), with significantly higher prevalence in international restaurants than in local restaurants (96.6% vs 10.8%; p = .0001). The practice of using food thermometer “always” when meat turned brown was significantly associated with the chef's age and education level. The study results showed poor monitoring and documentation of refrigerator and freezer temperatures along with a low prevalence of food thermometer use. The study result provides an insight into one of the barriers to the implementation of the HACCP system in Dammam.


| INTRODUC TI ON
Foodborne diseases (FBDs) are a major public health issue worldwide, and Saudi Arabia is no exception. A study conducted in Qassim, Saudi Arabia, reported that 68.9% of FBDs were due to consuming food prepared in food service establishments such as restaurants, canteens, and fast food outlets (Al-Goblan & Jahan, 2010). Another study used the information available from the Ministry of Health in Saudi Arabia Statistics and reported that FBD outbreaks increased from 2010 to 2011 and that food service establishments were responsible for 62% of these outbreaks (Al-Mutairi et al., 2015). Studies from Saudi Arabia reported foodborne outbreaks to be linked with Salmonella spp., nontyphoidal Salmonella spp., Staphylococcus aureus (S. aureus), Shigella spp., Camphylobacter jejuni (C. jejuni), Bacillus cereus (B.cereus), Clostridium perfringens (C. perfringens) (Al-Goblan & Jahan, 2010;Al-Joudi, 2007;AlMaghderi & AlMazroa, 2003;Al-Saydalani, 2011;Alsayeqh, 2015a).
Salmonella spp., Escherichia coli (E. coli), and S. aureus, which are not able to multiple at temperatures below 5°C, may benefit from inadequate control of refrigeration temperature and start multiplying causing FBDs if consumed. Some bacterial species, including Clostridium botulinum (C. botulinum), B. cereus, C. perfringens, and Campylobacter spp. may not grow at temperatures below 5°C but may survive at these temperatures, and when the refrigerator temperature exceeds 10°C, it can start multiplying (Kassianenko et al., 2005). According to Centers for Disease Control and Prevention (CDC), the four steps to food safety include cleaning, separating, cooking, and chilling. Bacteria can multiply rapidly in food if left in the "Danger Zone" between 4°C and 60°C and the CDC recommends to keep the temperature below 4°C for refrigerator and below −18°C for freezer (CDC, n.d.) (https://www.cdc.gov/foodsafety/keep-food-safe.html). US Department of Agriculture (USDA) reports that foodborne illness caused by C. perfringens and S. aureus can be prevented by storing hot food hot and cold food cold [below 4°C] (USDA, n.d.) (https:// www.fsis.usda.gov/food-safet y/foodb orne-illne ss-and-disease).
The increase in the refrigerator temperature can result in an increase in bacterial growth, especially in time temperature control safety (TCS) food such as cheese, yogurt, meat, salad dressings, and dishes containing eggs.
Studies have reported that undercooked meat is also responsible for FBDs due to pathogens such as Salmonella serotypes, E.
coli, and C. jejuni (Al-Mutairi et al., 2015;Boore et al., 2010;USDA, n.d., https://www.fsis.usda.gov/food-safet y/foodb orne-illne ssand-disease). Consumers and chefs usually use a number of ways to determine whether food is adequately cooked, such as the color of meat, which is often used as an indicator of appropriate cooking (Lin, 2018). However, studies have reported that color of meat is not a reliable indicator of internal temperature and destruction of bacteria (Bergsma et al., 2007;Hague et al., 1994). Other methods that are used to confirm that meat is cooked include testing firmness, the color of juices, and loose joints, although most of these methods are not correlated with microbiological safety (Berry et al., 2001).  ; USDA, n.d., https://www.fsis.usda.gov/food-safet y/ foodb orne-illne ss-and-disease).
In Saudi Arabia, two government organizations, Ministry of To date, there is a lack of information regarding the use of refrigerators and food thermometers in restaurants, which is important in implementation of the HACCP system in Saudi Arabia. Therefore, the present study aims to investigate refrigerator and food thermometer' prevalence and its practice among food handlers in local and international restaurants of Dammam.

| Recruitment and data collection
A list of total of 350 registered/licensed restaurants was provided by the municipality of Dammam. All the restaurants were visited after obtaining approval from the MOMRA. The researcher showed the permission letter issued by the Ministry to the restaurant supervisor, and if he agreed to participate, the researcher reviewed the temperature of the refrigerator and freezer (if the restaurant had multiple refrigerators or freezers, we randomly selected one of each for review) using his thermometer and completed the survey according to the restaurant's refrigerator and freezer maintenance practice based on the logbook entries (checklist is available in Appendix S1). We then looked for the presence of a food thermometer and provided the chef with the online questionnaire using Survey Monkey on a tablet for self-administration under the supervision of the researcher. The questionnaire had two sections: the first one had four questions on demographics, and the second section had five questions on the use of food thermometers. The questionnaire was finalized by external experts in the field before being used, and the questionnaire used is available in Appendix S1.
The visits were without notification to the restaurant supervisors.

| Data analysis
The statistical package software for social sciences (IBM SPSS Statistics Version 24) was used for the analysis. Descriptive analysis was conducted for all the variables (independent and dependent) and is reported as frequency and percentage. The comparison was performed between the refrigerators/freezers with built-in thermometer (independent variable) and the monitoring of refrigerators/freezers temperature (dependent variable), followed by the comparison of type of restaurant (independent variable) with the presence of built-in thermometer refrigerators/freezers and its monitoring practices (dependent variable). Furthermore, a comparison was performed between the independent variables (type of restaurant and age, education, and work experience of chef) and dependent variables (responses of chefs to food thermometer practice questions). The chi-squared test was used for comparison, and a p-value of <.05 was considered significant.

| Ethical considerations
The study protocol was reviewed and approved by the Institutional  emphasize that these systems play a significant role in building a restaurant culture that is economically, socially, and environmentally more sustainable.

| Prevalence of food thermometer in restaurants
The prevalence of food thermometers in restaurants was found to be 53.4% (

| Practice of food thermometer usage among the 127 chef participants
The chefs' demographic profile is shown in Table 3 and their re- were in the 21-35 age group, and education level of high school and above [102 (83.3%)]. Ninety (70.9%) chefs reported the use of a barbecue fork "sometimes" to confirm that food was cooked. All chefs responded that they "never" used hands to check whether food was cooked. The practice followed by chefs in international and local restaurants is shown in Table 4. The practice of "always" checking the internal temperature of cooked food was significantly higher for chefs working in international restaurants than for those in local restaurants (90.4% vs. 53.8%, p = .0001). Although the practice of using a food thermometer "always" to check the internal temperature of cooked food in international restaurants was high (90.4%), the recording and documentation of the temperature of cooked food were poor (32.5%). Similar findings were reported by the studies conducted in different countries (Henroid, & Sneed, 2004;Mustaffa et al., 2017;Youn & Sneed, 2003;Walker & Jones, 2002).
Our previous study conducted with restaurant managers revealed that they had a fair-to-good level of knowledge about the internal temperature of cooked meat and the best method to check for safe cooking temperature, that is, using a thermometer and a cold food storage temperature (Al-Mohaithef et al., 2021). Therefore, the employment of a well-qualified manager in the restaurant can help in effective TA B L E 2 Comparison of presence of inbuilt thermometer in refrigerator and freezer and monitoring practices based on type of restaurants (n = 238 restaurants). TA B L E 3 Demographic details of the participated chefs (n = 127 chefs).

Chef (n = 127) Percentage
Age ( A significantly higher percentage of chefs in the 21-35 age group and education level high school and above "always" used a food thermometer to check the food temperature when meat turned brown, compared to their counterparts (28.4% vs. 8.7%, p = .007 and 22.6% vs. 16.0%, respectively) ( Table 5 and Table 6). Moreover, chef's education level also showed significant association with the practice of using barbecue forks to confirm that food is cooked (p = .010) ( Saudi Arabia, 1 and by 2013, staff of 171 restaurants out of 440 restaurants were trained and designated as "qualified" (Lin, 2018).
However, the effect of this training program has not been assessed to date.

| Strength and limitation
To the best of our knowledge, this is the first study conducted in Saudi Arabia to assess and validate the practice of refrigerator thermometers. In our study, we measured the temperature of refrigerators and freezers, validated the monitoring practice followed in the restaurant by reviewing the logbook, and also confirmed the presence of a food thermometer in the restaurant before providing the survey link to the chef for its completion.

| CON CLUS ION
The study results showed poor monitoring and documentation of refrigerator and freezer temperatures along with a low prevalence of food thermometer use. The study results provide insight into one of the barriers to the implementation of the HACCP system in Dammam.

TA B L E 6
Comparison of food thermometers usage among chefs based on education (n = 127 chefs).

ACK N OWLED G M ENTS
The authors of this study would like to express their gratitude to the Municipality of Dammam and MOMRA to support us by providing the list of registered restaurants and permission for visiting the restaurants. Further, the authors express their gratitude to restaurant managers and chefs who agreed to participate in the survey.

FU N D I N G I N FO R M ATI O N
None.

CO N FLI C T O F I NTE R E S T S TATE M E NT
We have no conflict of interest to declare.

DATA AVA I L A B I L I T Y S TAT E M E N T
Data are available from the corresponding author and can be obtained upon request.