**1. Introduction**

Some individuals tend to eat out of the home, often at food service operations, such as cafeterias, canteens, fast food outlets, bars, and restaurants [1]. In recent years, the catering

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sector has been experiencing an increase in technological innovation in correspondence with changes in consumer habits of the population, transformed by numerous factors and changing lifestyles, demographic trends, and so on, which have increased consumer preferences for healthy, safe, and convenient foods.

Food service or catering industry defines those businesses, institutions, and companies responsible for any meal prepared outside home. These industries include restaurants, school and hospital cafeterias, catering operations, and some other small- and big-scale establish‐ ments. A catering food establishment also means an approved food establishment that is serving or preparing food at a location other than its permitted location for a contracted food service event. During these operations, foods are often transported, distributed, handled, and consumed in a short-time framework (often less than 1 week).

The catering sector can be divided into three groups based on the population they serve, the way of working, the technology used, or the food types served (Table 1): commercial (resi‐ dential and non-residential) catering sector, and non-commercial residential establishments.


**Table 1.** Types of catering establishments

The Hazard Analysis and Critical Control Points (HACCPs) system has been recognized as a useful tool to prevent food contamination in food service establishments. Control measures are mainly focused on training of food handlers in hygiene practices to improve safety of served meals.

Unquestionably, consumption outside home is linked to a fact of modern life that causes some concern among health professionals and food authorities because of the potential adverse effects that may entail for human health. Food poisoning poses a serious problem for public health worldwide, and the most vulnerable population (children, elderly, pregnant, and sick) counts among the most affected.

Data from the World Health Organization assert that about 2.2 million people become daily ill in the world for more than 200 foodborne diseases and about two-thirds of the outbreaks that occur originate in their homes and in catering establishments. Given the higher volume of meals prepared in the later ones together with meals exposure to handling and environ‐ mental factor, the risk of becoming ill is expected to be considerably higher [2]. In Europe, an increasing trend in foodborne diseases outbreaks has been attributed to catering businesses [3]. This fact highlights that the impact of prevention measures in the past few years has not been sufficiently effective as expected. Important aspects such as the size of establishments and heterogeneity of foods served justify the creation of specific regulations on food safety management, to reduce the risks of foodborne illness.

Moreover, it seems to be necessary to strengthen food hygiene and compliance with HACCP system to prevent food outbreaks. These outbreaks are mainly caused by foodborne pathogens and norovirus. Special attention should be paid to food services destined to susceptible population, such as hospitals, long-term care facilities, or school canteens, because people could be more susceptible to become ill when exposed to foodborne agents. Besides this, the large number of meals served per day could have an impact on public health if prepared foods are contaminated.

In food service environments, various factors may be related to foodborne diseases. According to the Food and Drug Administration (FDA), these factors are the food served coming from unsafe sources, poor personal hygiene, inadequate cooking, improper holding temperatures, or utilization of contaminated equipment. On the other hand, the World Health Organization (WHO) [4] suggested that drinking water could be an important factor related to foodborne diseases. It was already demonstrated that training of food handlers and knowledge acquisi‐ tion in hygienic food preparation, processing, and distribution of meals is crucial in the prevention of most types of foodborne diseases [5]. The use of normalized questionnaires on good manufacturing practices (GMPs) was achieved to evaluate training of food handlers. It was found that, after implemented, there is a substantial improvement in GMP [6–8]. However, it is recognized that these training activities should be repeated over time to minimize the reluctance of food handlers to apply the acquired knowledge [9].

Legislation in food hygiene at EU level prioritizes control measures to protect public health, making food operators responsible to assure product safety [10]. Implementation of HACCP system in food service operations may increase food safety management. However, given the complexity of the food chain and variety of menus and meals prepared, simplified and flexible self-control measures must be required in most cases to increase efficiency and homogeneity of implemented food safety management systems [7]. Evaluation of microbial risks is crucial to determine food safety of prepared meals [11].

In the present chapter, a review of the most significant risk factors influencing microbial contamination of foods in food service centers will be described with special focus on those establishments where susceptible population (i.e., children, elderly, immunocompromised people) is present. Besides, potential preventive measures to be considered in that establish‐ ments and correct implementation of food safety actions will be given to provide useful recommendations to food handlers, food operators, and risk managers.
