1. Introduction
Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was first reported in Wuhan, China in December 2019, with the illness then spreading rapidly across many regions [
1]. The World Health Organization (WHO) proclaimed COVID-19 to be a pandemic on 12 March 2020 [
2]. Up until now, the WHO has reported approximately 476.4 million confirmed cases of COVID-19, with more than 6.1 million deaths worldwide [
3]. In Jordan, the total number of positive cases has reached 1.7 million, with 14,000 COVID-19 deaths [
3]. Person-to-person contact and respiratory droplets dispersed by coughing or sneezing have been identified as the virus’s primary modes of transmission [
2]. Although SARS-CoV-2 is airborne, can remain suspended in air for lengthy periods, and is spread through saliva, there are still no reports describing its transmission through food products. However, food could serve as an indirect vehicle for transmission of this virus via its contamination of food packaging materials [
4]. SARS-CoV-2 may survive for up to 72 h on surfaces such steel and plastic [
5]. SARS-CoV-2 has been found to be stable at temperatures as low as -20 °C for 3 weeks on salmon filets, chicken, and pork [
6]. On the other hand, it was reported that the contamination of a food product by SARS-CoV-2 was reduced by 4 log colony forming units (CFU)/g when the food was cooked at 63 °C for 4 min [
7].
The practices employed during the production and trading of food products may have an impact on sustainable development. Furthermore, the sustainability of food systems becomes an important issue during large-scale pandemics such as COVID-19 to prevent crises in the food sector. Food systems play a major role in accomplishing some of the sustainable development strategies that were adopted by the United Nations (UN) Agenda for implementation by 2030. For example, the achievement of food security, the enhancement of nutrition among communities, and the implementation of food safety are crucial factors to end poverty in all its forms across the globe, to ensure sustainable consumption and production patterns, and to ensure healthy lives and promote well-being for communities. Therefore, the definition of sustainability focuses on human health as well as the protection of the environment. Thus, the implementation of safety and hygiene programs during all stages of food production is a challenge for the food industry since the transmission of pathogenic microorganisms may occur at any stage from farm to table. This has also become more urgent during the COVID-19 pandemic [
8,
9].
COVID-19 outbreaks have caused health and behavior problems for both consumers and producers as well as for owners of food processing facilities and foodservice companies [
10]. Food safety programs were modified during the present pandemic to minimize the impact of foodborne illnesses, in addition to COVID-19. Further, many countries including China have suspended the import of food items from countries that experienced COVID-19 outbreaks among workers in food facilities [
11]. While food establishments have been required to implement social distancing guidelines, most organizations went further and cancelled food safety training classes for food workers in response to restrictions on the size of public gatherings. As might be expected, this has had a negative impact on the implementation of food safety measures [
12]. Although COVID-19 vaccines have been developed and been approved by the WHO for emergency use, they do not provide perfect (100%) protection. However, those vaccinated are more likely to have less severe symptoms if they become ill [
13]. Even in the presence of vaccines, good hygienic practices, minimal interactions with others, and avoidance of physical contact are the major strategies used to prevent viral transmission by those in the food industry. Before the pandemic, about 59% of food workers in the military hospital in Jordan were found to be incorrectly applying food hygiene practices [
14]. In contrast, Osaili et al. [
15] showed that the COVID-19 pandemic resulted in significant beneficial behavioral shifts amongst university students in Jordan, with the majority adopting more hygienic behaviors.
Food safety guidelines are commonly used by many industries including foodservice businesses according to the Codex Alimentarius. However, food safety standards are mandatory (such as the implementation of HACCP) according to Codex rules and regulations. Both the WHO and U.S. Food and Drug Administration (FDA) implemented extra rules and regulations intended to further protect consumers during or after COVID-19. Among these regulations, food retail shops were to provide customers with hand sanitizer and sanitation wipes, shopping baskets were to be disinfected after every use, physical distancing was to be maintained, and overcrowding was to be prevented by regulating the number of customers that entered the store. Food advertising campaigns and promotions were to be discouraged, while the frequent washing and sanitizing of utensils, catering tools, and surfaces was encouraged. Furthermore, delivery drivers were to be alone in vehicles during work; the use of face masks and gloves was to be strictly implemented within the work environment; disposable containers were to be used; and, in addition, drivers were to place delivered food items in designated pick-up zones to avoid physical contact with clients [
16,
17].
According to the knowledge, attitude, and practices (KAP) model, knowledge positively influences an individual’s attitude, which in turn influences their practices. In other words, food workers’ knowledge influences their attitudes and practices, and, as a result, their personal hygiene, kitchen cleanliness, and disease mitigation. Several studies have attempted to apply the KAP model to explore food workers’ knowledge, attitudes, and practices in various situations throughout the years [
18]. Olaimat et al. [
19], reported that 80% of students in Jordanian universities had adequate general knowledge about the symptoms, complications, and transmission of COVID-19. It would be expected that informed individuals such as restaurant owners and workers would have more knowledge, better attitudes, and would use acceptable practices toward COVID-19 due to them being more receptive to restrictive policies and precautions, that they would be more likely to understand the associated benefits, and that they would be aware that the adoption of proposed rules would minimize inconvenience and health risk. To the best of our knowledge, there are no data that highlight COVID-19 KAP among food workers in Jordan and examine the effect of precautions on food safety. Therefore, the main objectives of the current study were to assess the knowledge, attitudes, and behaviors regarding COVID-19 of restaurant owners and workers and investigate the effect of COVID-19 precautions on food safety implementation at foodservice establishments in Jordan.
4. Discussion
In this study, the knowledge, attitude, and behavior regarding COVID-19 of workers in foodservice establishments and the effect of COVID-19 preventive actions on the implementation of food safety measures were assessed through a cross-sectional study. In general, the results showed that workers in foodservice establishments in Jordan exhibited appropriate attitudes, used acceptable practices, and had adequate total KAP scores regarding COVID-19, but their levels of knowledge could be improved. Overall, the knowledge of food workers regarding COVID-19 in different foodservice establishments such as cafeterias in hospitals was rated at 61%, in other cafeterias it was 66%, and in restaurants it was 60%, while the overall KAP score for COVID-19 in the case of hospital workers was 68%, was 73% in cafeterias, and was 67% in restaurants. However, 13–18% of workers had poor knowledge, attitudes, practices and total KAP scores toward COVID-19. A study conducted by Almohammed et al. [
23] among healthcare workers in Saudi Arabian Hospitals showed higher levels of KAP toward COVID-19, where two-thirds of the participants (68%) had good knowledge, positive attitudes (72%), and good practices (80%) toward COVID-19. This is due to differences in terms of population and occupation, with healthcare workers being more knowledgeable and familiar with good practices. Similarly, 31% of the waiters working in food and drink establishments in Southwest Ethiopia had poor knowledge about COVID-19, while only 28% had strong knowledge [
24]. Quality control officers had the highest practices score (81%), which is likely because they are responsible for maintaining the quality and safety of foodservice establishments. Cleaners, meanwhile, had the highest knowledge, attitude, and total KAP scores, and this is because they are trained regarding the importance of maintaining the cleanliness of an establishment and the effectiveness of sanitizing. Qanche et al. [
24] also found that only 21% of waiters and bartenders working in restaurants and bars in Southwest Ethiopia had good preventive behaviors towards COVID-19.
Habiballah et al. [
25] assessed restaurant employees’ food handling practices in Irbid City, Jordan, and they found that females were significantly more committed to proper food handling practices than males; older employees also reported significantly better food handling practices than younger employees. Restaurant employees aged 45 years and older had higher average scores in food handling than those aged 35–44 years, those aged 24–34 years, and the 16–24-year-old group. These results were consistent with the findings of the present study where age, education level, work experience, and marital status had an impact on workplace knowledge. Females had higher KAP scores, as it was likely that they were more engaged in preparing meals at home, with them having a greater motivation to pay more attention to COVID-19, especially if they were raising children [
26]. Furthermore, Grewal et al. [
27] found that older age groups and higher education levels were associated with better knowledge scores. Cough etiquette and hygiene practices had a significant correlation with increased age and education level, whereas washing hands had a statistically significant correlation with age, education, and job rank. This study showed that the more experience a person had, the more knowledge they possessed. It was also seen that older workers were more likely to adhere to the attitudes required by COVID-19 regulations at their workplace. Those with higher experience levels (>15 years) also showed a higher attitude level. Furthermore, the youngest respondents had the lowest total KAP scores, while the oldest respondents had the highest KAP scores. Workers with more than 15 years of experience had high KAP scores. Liu et al. [
28] found that there was a significant association between differences in age and KAP scores. In this study, the respondents with more experience had better attitudes, knowledge, and practices regarding COVID-19 precautions. Similar results were obtained by Lee et al. [
29], who found that food handlers in Malaysia with greater experience in the foodservice business had better overall food safety knowledge (more than 6 years > 5–6 years > 2–4 years > 2 years) than those with less experience.
During the COVID-19 pandemic, research conducted in Iran looked at the impact of health and food safety training on restaurant food handlers and it showed that before training, 18% of participants had low total knowledge scores, 35% had moderate scores, and 47% had good ones. However, after training, 5% were low, 24% were moderate, and 71% were good. With regard to the attitudes among food handlers prior to training, 1% held strongly negative views, 77% were negative, 18% were positive, and 4% were highly positive. These positions were altered to 0% (strongly negative), 49% (negative), 33% (positive), and 18% (highly positive). Participants’ self-reported practice scores before training were 1, 56, and 43 for weak, acceptable, and preferred practices, respectively, while after the intervention of training, the scores improved to 0, 26, and 74%, respectively [
26]. This demonstrated the importance of food safety training in improving the KAP scores of employees and enhancing the application of food safety standards in order to reduce foodborne illnesses and food waste and facilitate the establishment of sustainable food systems.
The present work showed that only 20% of workers had a good level of knowledge (scores above 75%), 56% had positive attitudes, and 55% had good practices; however, 17, 13, and 18% of respondents showed poor knowledge, negative attitudes, and poor practices, respectively, with scores of ≤50%. In another study, food workers at food factories in Jordan had a mean knowledge score of 5.8/10 for prospective SARS-CoV-2 viral sources, which was considered to be a low level. In general, the mean knowledge score of participants’ attitudes and hygienic practice among food handlers was 7.2/10, which was regarded as good, while the mean knowledge score for the participants’ understanding of the basic requirements to manage COVID-19 was 6.1/10. This research found that although food workers had a fair understanding of food safety, this did not always reflect their positive attitude. This study reported an overall score of 79% [
25]. COVID-19 is not a foodborne virus; however, it can be spread through the improper handling of foods where inadequate hygiene and COVID-19 transmission precautions such as covering the mouth during coughing or sneezing are not followed [
2]. Various stages in the food supply chain, from production to consumption, may involve risks with respect to the transmission of microorganisms including viruses. Therefore, the management of safe food production and respecting the health of workers and consumers during food distribution have been significant challenges during the pandemic due to mandated changes in shopping behaviors [
30].
Studies show that SARS-CoV-2 is an airborne virus that remains viable in aerosols for a long time and can also spread through fluids (saliva) and droplets generated by coughing and sneezing. Therefore, this organism can spread from an infected person to someone else if no social distancing occurs, particularly when infected individuals do not wear face masks [
31]. For this reason, foodservice workers are at a higher risk of being infected with COVID-19, as they communicate directly with clients and with each other. Therefore, workers should be properly trained in the correct ways to prevent the spread of this virus. Although experiments have shown that the coronavirus can remain viable up to 72 h on hard surfaces such as steel and plastic, there is still not enough evidence to conclude that contaminated packaging material can transmit the virus [
5]. That is because packages are subject to different conditions and temperatures that may cause the virus to become more sensitive. On the other hand, when the virus is found on human skin, it can be transferred to the respiratory system by an individual touching their face or sneezing [
32]. However, according to the results of the current study, only 35% of workers understand that the duration of hand washing should be at least 20 s. It has been indicated that hand hygiene is more important than cleaning and disinfecting food surfaces in terms of controlling the spread of pathogens. That is because hands are considered the main vehicle for spreading pathogenic microorganisms and intestinal parasites to foods [
32]. Some studies have shown that SARS-CoV-2 is stable at lower temperatures up to −20 °C [
2]. On the contrary, when food is cooked for 4 min at 63 °C, the contamination of a food product by SARS-CoV-2 is reduced by 4 log CFU/g [
7]. However, this reduction might not be sufficient for full inactivation. Nonetheless, this represents strong evidence that it is more likely that workers in food establishments may spread the virus through person-to-person interaction rather than through contaminated food or packaging material [
33]. About 75% of the workers followed COVID-19 restrictions in their workplace and 74% avoided direct personal contact at work.
In order to prevent COVID-19 infection, it is essential that food workers follow the best hygiene practices possible, especially during a pandemic scenario, since poor hygiene can increase the risk of illness [
34]. Moreover, poor hygiene can cause the transmission of a number of diseases that may affect the respiratory system and cause pneumonia or even gastrointestinal infections. Thus, maintaining high standards for cleaning and hygiene levels is essential for employees and their work environment [
35]. In the current study, most workers were committed to wearing masks and gloves even when they were not at work. It was encouraging that the number of correct actions associated with wearing masks in the present survey was significantly higher than in India [
27] and Iran [
36], despite them being lower than in China [
37].
The CDC [
38] suggests that restaurant operators should consider how to limit risk for employees, customers, and communities and slow the spread of COVID-19 by applying preventive measures. These include wearing masks when not eating or drinking and when social distancing (6 feet) measures are difficult to maintain. The more individuals interact with others and the longer the interaction, the higher the chance of COVID-19 spreading. Employees who have tested positive for COVID-19 or who are showing COVID-19 symptoms should stay at home and monitor their health. Employees who have recently had close contact with a person who is infected with COVID-19 should also stay at home and monitor their health. In the present study, most employees agreed that if they had symptoms of COVID-19, the appropriate procedure would be to conduct a COVID-19 test, inform the company, and follow home isolation guidelines. When masks are worn, employees should not touch them and if masks are touched, employees should wash their hands with soap and water for at least 20 s. Proper handwashing is also required in other situations such as before, during, and after preparing meals and after touching rubbish. Employees should wear gloves when performing tasks such as removing garbage bags or handling and disposing of trash, cleaning, and disinfecting surfaces. The manufacturer’s guidelines on the disinfectant’s label should be consulted and followed to ensure its safe and effective use [
38].
The COVID-19 pandemic created many complications beyond the spread of viruses and food-borne illnesses that have affected physical health. Thus, it is very important for governments to control the spread of the virus by implementing strict rules regarding public gatherings, especially in restaurants and other foodservice establishments [
39]. It is notable that the current study showed that a significant proportion of employees at foodservice establishments did not believe that these restrictions and regulations improved food safety conditions and they had not noticed any improvements regarding food safety in their establishments since the pandemic began. However, consumers expect foods that they purchase to be safe to eat. Despite this, foodborne illness outbreaks and recalls continue, and efforts must be continuously exerted to ensure the required standards are applied to minimize product loss through recalls and illnesses from contaminated food. Therefore, the safety of food is an integral part of the food security equation.
All COVID-19 vaccines that have been licensed by the World Health Organization for emergency use have undergone randomized clinical trials to ensure their quality, safety, and efficacy. Vaccines must have an efficacy rate of ≥50% in order to be authorized. After they have been approved, they are monitored continuously to ensure that they are safe and effective. Vaccination protects not only the vaccinated person, but also those in the community who are unable to be vaccinated [
2]. In the current study, only about 47% of the respondents had received the COVID-19 vaccine or were willing to take it. In the United Kingdom, 72% of the population were willing to be vaccinated, 17% were extremely unsure, and 12% were very afraid [
40].
To improve the commitment to COVID-19 precautions and food safety standards, institutions should improve the food safety culture of workers. The most important component of food safety culture is the personnel. Employee behaviors and activities, from farm production procedures to customer service, all contribute to food safety and can reduce or increase the risk of disease transmission. The knowledge generated by educating personnel and promoting good behavior as well as establishing proper governance and metrics are major factors in this regard. It is critical that all employees should be aware of the procedures, methods, and behaviors that serve as preventative controls. Workers in food establishments should be educated on the importance of proper health and safety standards on a regular basis; all employees are consumers with families, and they should feel the sense of responsibility that comes with working in the food industry. As a result, they should be involved in decision-making and have the authority to apply solutions to reduce health and safety concerns. This should be reflected at all levels of the organization’s communications. Food safety must go beyond rules and regulations and exist within a company’s culture in order to be successful and sustainable [
41].
A potential limitation of this study is that it was based on a self-reported questionnaire regarding knowledge, attitude, and behaviors in the workplace. Thus, the results cannot be generalized in terms of all food handlers across Jordan or other countries. Another limitation may be that this survey was limited to online responses and some face-to-face interviews, which might decrease its accuracy. In addition, the questionnaire was long, and therefore, some respondents may have randomly answered the questions without reading their answers. Moreover, studying the effect of gender may have been another limitation, as females are fewer in number than males in the foodservice industry. Another very substantial limitation includes the restrictions imposed during the pandemic, where some employees were hesitant to fill out the questionnaire, thinking that it was tied to the government and regulations during the lockdowns.