S1335 Assessment of Knowledge of Gluten-Free Diet Amongst Food Handlers in Hospitals

Abstract

Introduction: Individuals with celiac disease (CD) and other gluten-related disorders require a strict gluten-free diet (GFD). If ever admitted to hospital, they rely on food handlers for provision of safe, uncontaminated gluten-free meals. Previous studies have assessed knowledge of CD and GFD in restaurant chefs, dietitians, and physicians. However, there is no such research on food service personnel in health care institutions such as hospitals. We aimed to assess the basic knowledge of GFD and food preparation practices amongst individuals involved in making meals for patients in hospital. Methods: A questionnaire was developed with 10 demographic items and 35 test items to assess knowledge of GFD including practical workplace scenarios encountered in food preparation. The questionnaire was developed by members of the research team, which included adult and pediatric gastroenterologists and dietitians with expertise in GFD. Further guidance was obtained from chefs, patients with CD and parents of children with CD. A score of 28 out of 35 (80%) was set as a Pass. Subjects were recruited from food handling services of two tertiary care, university-affiliated hospitals and included cooks, utility workers, dietary technicians and supervisors. Results: A total of 72 individuals completed the study, mean age 40.3 ± 1.6 years, 75% female. Only 42 (56.8%) scored a Pass. The average test score was 75.9 ± 13.4% (26.6 out of 35), range 25.7-100%. The supervisors (87.9 ± 11.4%) had significantly higher scores than utility workers (73.0 ± 11.4%, P = 0.01) and cooks (71.7 ± 14.5%; P = 0.01), but similar to scores of dietary technicians (87.1 ± 8.0%, P = 1.0). Cooks had the lowest scores and highest fail rate (80%). There was a significant difference in scores between male and female participants (68.8 vs 77.8%; P = 0.02). Conclusion: There are significant differences in gluten-free diet knowledge between various individuals involved in food preparation in hospitals. While supervisors and dietary technicians play important roles in the selection of gluten-free meals and accordingly have higher levels of formal education in nutrition, cooks and utility workers are at the frontline in meal preparation and these individuals must be adequately educated on GFD. We identified gaps in knowledge of gluten-free diets amongst food handlers, which has a potential of compromising the safety of patients with celiac disease. Targeted interventions to educate these individuals about gluten-free diet are required.