Implementation of Hazard Analysis Critical Control Point

Nutrition Service at The Regional Public Hospital Toto

Kabila, Bone Bolango

Sunarto Kadir Commented [A1]: Sebaiknya penelitian merupakan tim

…tambahkan nama anggota tim terkait

Faculty of Sports and Health, Universitas Negeri Gorontalo

Correspondence Address:
Jl. Jenderal Sudirman No.6 Gorontalo, Indonesia
Email : [email protected]

Abstract. Hazard Analysis Critical Control Point (henceforth called HACCP) is a control system to prevent issues based on Commented [A2]: Sertakan abstrak dalam bahasa Indonesia
the identification of critical points in the management and production of food as a way to ensure the food safety. The Dalam abstrak metode lebih di deatilkan lagi, teknik penentuan
informan, analisis data dengan metode apa…..
objective of this study is to identify the implementation of the principles of HACCP in the nutritional and dietetic service of
the regional public hospital (henceforth called RSUD) Toto Kabila, Bone Bolango. This qualitative research employed
descriptive survey method. HACCP, as contamination prevention system on food, functions as the research variable. The
informants consist of eight people; three among them serves as the key informants. Furthermore, the data were analyzed by
interpreting the interview into a narration resulting in information that describes the obtained result. The result reveals that
the department of nutrition and dietetics of RSUD Toto Kabila Bone Bolango is yet to implement the principle of HACCP
according to the national standard. Instead, the department applies it manually without documentation. This issue blames the
lack of facilities and human resources at the department. It is suggested that the hospital implement HACCP according to the
Indonesian National Standard (henceforth called SNI) along with providing supporting facilities.
Keywords: HACCP, Critical Points, Food Management

Introductions
According to WHO (2006), Hazard Analysis Critical Control Point (henceforth called
HACCP) is defined as a scientific, rational, and systemic approach to identify, assess, and
control hazards. SNI (1998) defines the term as a device to assess hazards and to establish a
control system focusing on the prevention rather than the test of a final product. Every system
of HACCP is able to accommodate changes, i.e., advancement in equipment design,
processing procedures, or the development of technology. Furthermore, SNI divides the
system into 12 steps, namely, establishment of HACCP team, product description,
identification of usage objectives, preparation of flow chart, confirmation of flowchart in the
field, recording of all potential hazards, determining critical control points (henceforth called
TKK), determining critical limits, preparation of monitoring systems for each TKK,
determining corrective actions, determining verification procedures, and determining
documentation.
 In HACCP, the standard operating procedure (SOP) has a common goal, i.e., to attain
an efficient, effective, consistent, and secure routine procedure. This also functions to
improve the quality of service by fulfilling the established standard (Reni, 2012).
The regulation of the minister of health of the Republic of Indonesia number
147/Menkes/Per/I/2010 defines the tern hospital as an institution that provides complete
health services for individuals; these encompass services, e.g., inpatient, outpatient, and
emergency care. In addition, the Department of Health Affairs of the Republic of Indonesia
(2009) defines nutrition and dietetics department as a hospital unit that is responsible for
providing nutrient care based on the condition of a patient, such as the clinical condition,
nutritional status, and metabolism status. The scope of this department involves 1) Outpatient
nutrition care, 2) inpatients nutrition care, 3) food management, and 4) Nutrition research and
development.
The management of food in a hospital is a set of activities ranging from planning
menus to the distribution of the food to patients. Thisis aimed at achieving optimal health
status by providing an appropriate diet. The processes of food management also involve
steps, such as keeping a record, reporting, and evaluation. Furthermore, the objective of food
management in a hospital is to provide good quality food and services based on the needs of
the patients. The steps of providing food are divided into five, namely: selection of
ingredients, food storing, preparation of the ingredient, management of the ingredient, and the
distribution of food. These steps are prone to contamination from the environment that can
impact food safety and quality (Department of Health Affairs of the Republic of Indonesia,
2009).
Since food safety is central to one’s health and life, it goes without saying that this
aspect is considered as the rights of the consumers (Winarno & Surono, 2004).
Implementation of the policy of food quality and food safety and qualified human resources
that can monitor the processes of food management in preventing contamination is essential
in ensuring the aspect of food safety in a hospital (Damanik, 2012).

Methods Commented [A3]: Metode perlu lebih di detailkan

Focus penelitian, teknik penentuan informan, dan analisis data
menggunakan metode apa…
This research was conducted in the department of nutrition and dietetics, Regional
Public Hospital Toto Kabila, Bone Bolango. This qualitative research employed descriptive
survey method; it was done by exploring the sources of information. HACCP, as
contamination prevention system on food, functions as the research variable. The informants
consist of eight people; three among them serve as the key informants. Furthermore, the data
were analyzed by interpreting the interview into a narration resulting in information that
describes the obtained result.

Results and Discussions

The observation focuses on the food management in the department of nutrition and
dietetics of RSUD Toto Kabila, Bone Bolango. Furthermore, the observation emphasizes the
food processing and distribution as these processes are susceptible to contamination from the
environment by which it impacts on the food safety and quality. The data from the
observation were backed up by the result of an interview with key informants.
The results of the observation on the feasibility of hygiene and processing sanitation
and distribution of food management in the research site are provided in Table 1 and Table 2
as follows.

Table 1. Observation of Sanitation Hygiene Feasibility of Food Processing in Nutrition and

Dietetics Department of RSUD Toto Kabila Bone Bolango in 2015
No. Standard Components Yes No
Food Processing
1. Clean working attire √
2. Wearing gloves √
3. Wearing an apron √
4. Wearing a mask √
5. Covering mouth when coughing or sneezing √
6. Removing jewelry during food processing √
7. Not talking during food processing √
8. Not mixing the appliances √
9. Washing hands before food processing √
Food Processing room
1. The floor and walls are clean √
2. The room is separated from the bedroom or administration room √
3. The room is insects free √
4. The room has well-functioned ventilation √
5. The room has sufficient lighting √
6. The room has a washbasin √
components with (yes) response
% of feasibility = number of questions
x 100
10
= x 100 = 55% (Below the standard)
16
 According to the principle of HACCP, the ideal steps of food processing comprise:
1) Identification of hazardous potential: cracks on the appliance, worker’s saliva, nail, and
hair.
2) Control: wearing work equipment, cleanliness of processing venue, and worker’s
hygiene.
3) Critical limits: temperature and duration of food processing.
4) Observation: observing food processing in the site by the employees of the nutrition
department.
5) Corrective action: ensuring that food processing is in accordance with the standard.
6) Verification: controlling that the food processing is in accordance with the standard.
7) Documentation: taking notes if things go wrong and recording corrective actions

Table 2. Observation Results of Sanitation Hygiene Feasibility of Food Distribution at

Nutrition and Dietetics department RSUD Toto Kabila Bone Bolango in 2015
No. Standard Components Yes No
1. Hospital food trolleys are water-proof √
2. Hospital food trolleys have fine textures √
3. Hospital food trolleys are easy to clean and have its cover √
4. Food trolleys are anti-rust and leak-proof √
5. Food trolleys have a temperature-control device √
6. Food trolleys have different food compartments √
7. The area for food trolleys remains clean √
8. The area for food trolleys are dust free √
9. The trolleys are not contaminated by hazardous material, such as √
pesticides, etc.
10. Food trolleys are not used for distributing materials except food √
11. Food trolleys are used according to its capacity √
12. The food distribution routes are short √
13. The food remains closed prior to serving to the patients √
14. Employees wear all the necessary attires √
15. The trolleys are cleaned regularly √
components with (yes) response
% of feasibility = number of questions
x 100
9
= x 100 = 60% (Below the standard)
15

According to the principle of HACCP, the ideal steps of food processing comprise
1) Identification of potential hazards: small rocks, soil, and insects.
2) Control: trolleys must remain covered and clean.
3) Critical limits: the duration and distance for transporting or distributing food to the
patients.
4) Monitoring: employees in the nutrition department monitor the food management prior
to distributing the food.
5) Improvement: trolleys maintenance, e.g., washing the trolleys and ensuring the density of
trolley’s door.
6) Verification: re-checking the cleanliness and controlling the duration and distant while
distributing the food.
7) Documentation: monitoring notes and checking during food distribution.

It is revealed that the sanitation hygiene in RSUD Toto Kabila Bone Bolango in 2015
did not meet the standard. This blames the lack of infrastructure of the nutrition and dietetics
department. Such an issue is also due to the behavior of food handler that does not meet the
standard of hygiene sanitation, such as talking during work and do not wear gloves or mask.
Similarly, the issue of the food handler is also the contributing factor to the issue of food
management in the research site. The distribution of food in the research site is also below
the standard since some improvements are needed, e.g., the use of trolley and the distribution
of food (the food compartment is mostly from the patients). This phenomenon may lead to
food being contaminated.

Food Security and Quality Policy

The result of interview and observation on documents signifies that RSUD Toto
Kabila, Bone Bolango has established a policy regulating quality that ensures food security.
Thisis regulated in the Standard Operating Procedure (SOP), the Guidelines for Nutritional
Management in Hospitals, 1990. For the HACCP, the nutrition department in RSUD Toto
Kabila has a guidebook, i.e., Guideline for the Management of Food in Institution and the
report of internship students that incorporate HACCP in the research site.

Human Resources
The department of nutrition and dietetics in RSUD Toto Kabila, Bone Bolango has 12
employees with different educational backgrounds. The recruitment is done by the
management of the hospital based on the needs of human resources and the capacity of the
hospital. According to the result of the interview, the human resources in the department
emphasize providing nutrition care, involving planning menus and designing a diet for
patients according to the standard. However, the principles of HACCP to monitor the service
are yet to be established. The human resources in the department consider that they are
incapable of handling such works since they have yet participated in workshops or seminars
on HACCP. In fact, seven principles of HACCP have been conceptualized by the staffs, but
they are yet to interpret it in documentation; this, however, is done manually without any
record.

Standard Operating Procedure (SOP)

The department of nutrition and dietetics in RSUD Toto Kabila, Bone Bolango has
designed its SOP and has been implemented from the very first operation of the department.
The SOP has regulated all the food management processes to ensure the food safety for the
patients in RSUD Toto Kabila, Bone Bolango. Furthermore, the SOP has been well-
implemented by all the staffs in the department under the supervision of a head of the
nutrition department. The department also gives sanction to those who violate the SOP. Still,
none of the employees has failed to comply with the regulations.

Problem Identification
Problem identification is among the processes attempted by the nutrition department
of RSUD Toto Kabila, Bone Bolango which aims at coping with issues in the department,
especially food management. The department held a meeting once a week to evaluate the
management of food in a week and to find out whether there have been some issues or not. In
identifying the issues or hazard, the department has monitored all of the processes as it is
among the steps of HACCP in food management. However, official documentation regarding
the monitoring by the department has yet to be implemented.

Conclusions
Generally, the department of nutrition and dietetics in RSUD Toto Kabila, Bone
Bolango has implemented the principles of HACCP although it is not in accordance with the
Indonesian National Standard. However, the internal of the department is the one who notices
the implementation of HACCP while the management of the hospital prioritizes the
implementation of SOP as a policy for food quality and security. It is suggested that the
hospital implement HACCP according to the Indonesian National Standard (henceforth called
SNI) along with providing supporting facilities.
Acknowledgments
We would like to thank The Regional Public Hospital Toto Kabila, Bone Bolango
(RSUD Toto Kabila) who funded my research.

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