Implementation of food safety management systems helped reduce outbreaks in food catering in Singapore, according to a study.

However, reported food hygiene violations did not change after they were applied. HACCP-based food safety management systems (FSMS) were mandated in Singapore in June 2014 for all licensed catering services.

Researchers investigated the effects of FSMS implementation on foodborne disease outbreaks and reported hygiene violations linked to food caterers using a controlled interrupted time-series analysis. 

There were 42 foodborne outbreaks and 521 food hygiene violations associated with catering service establishments from 2012 to 2018. Eighteen months after FSMS implementation, researchers observed a 78.4 percent decrease in the average level of outbreaks at these sites but there was no significant effect on reported hygiene violations.

Impact on outbreaks
In 2018, there were 39,000 licensed food sites in Singapore. Of these, almost 400 were food catering service establishments. Firms licensed before June 2014 were given 12 months to implement FSMS while those licensed after June 2014 had to do so before they started food production operations. FSMS uptake did not reach its peak until December 2015.

Upon introduction, uptake of FSMS increased by an average of 4.1 percent per month from June 2014 to November 2015, after which it plateaued at an average of 93.8 percent from December 2015 to December 2018.

There were 42 foodborne outbreak notifications linked to catering service establishments and 754 from non-catering food establishments from 2012 to 2018.

Using the first model assessing the impact of FSMS that excluded the grace period and early period of implementation, researchers observed a 78.4 percent reduction in the average level of outbreaks from December 2015 to December 2018.

In the second model capturing effects of FSMS in the grace period and early phase of implementation, there was a 65.1 percent decrease in the average level of outbreaks from June 2014 to December 2018.

“This suggests that the early phase of FSMS implementation may have had less influence on foodborne outbreaks. This could be due to the low uptake during the 12-month grace period – FSMS uptake among legally obligated establishments was lower than 50 percent during the first 12 months of implementation,” said researchers.

There were no changes in reporting requirements for outbreaks, in food safety policies, or in trends reflected by non-food catering service establishments.

A look at hygiene
Over the study period, there were 521 reported food hygiene violations and 9,484 health inspections among food catering service establishments and 13,730 hygiene violations and 830,690 health inspections in non-catering food sites.

Scientists classified 72 violations as directly related to food hygiene. The top three violations were: failure to keep the licensed premises clean; failure to keep the premises free of infestation; and failure to register food handlers.

There was no evidence of a significant effect of FSMS on the average rate of reported food hygiene violations regardless of the model. This was inconsistent with other studies that reported improvements in food safety following FSMS implementation.

“Poor implementation of FSMS prerequisite programs in some food businesses may have contributed to the sustained trend of reported violations throughout the study duration,” according to the research report.” Although our finding was non-significant, we did observe that reported food hygiene violations in catering food service establishments reduced by almost a quarter after FSMS implementation.”

Researchers said the study provides evidence that legally mandated FSMS implementation is an effective food safety policy to reduce the risks of outbreaks associated with the sector.

“Health authorities seeking to reduce outbreaks in food catering operations should consider mandating FSMS. Given the substantial resources required to implement and sustain FSMS in food production, the expansion of FSMS implementation to different categories and sizes of food establishments must be tailored in order to maximize its effectiveness.”