Assessment of Knowledge and Attitudes Related to Food Hygiene Among Food Business Operators in Attica, Greece.

Food safety is a key public health function, as the catering sector is a frequently cited source of outbreaks. This study evaluated the knowledge and attitudes of food business operators (FBOs) in Attica, Greece, regarding food hygiene. A cross-sectional study was carried out in 522 mass catering establishments located in Attica. Knowledge and attitudes were assessed using a 25-item questionnaire. Statistical analysis included the chi-square test and multiple logistic regression to identify factors associated with adequate knowledge and positive attitudes in the study population. Questions related to hand hygiene (98.9%, n=516) and pathogen identification (Salmonella: 98.1%, n=512) received high scores. However, significant gaps in knowledge were identified regarding the transmission of typhoid fever through food (27.6%, n=144) and the risks associated with raw beef (31%, n=162). Overall, 47.9% (n=250) of participants demonstrated "good knowledge" (score ≥ 18/25), while 52.1% (n=272) had insufficient knowledge. In terms of attitudes, 59.8% (n=312) showed a satisfactory level. Multivariate analysis revealed that good knowledge was significantly associated with larger company size (≥51 employees: OR=2.68, p=0.020), high educational level (Master's/Doctorate: OR=5.04, p=0.006), and familiarity with Hazard Analysis and Critical Control Points (HACCP)-based systems (OR=0.15 for those who were not familiar, p=0.002). In contrast, participants with the role of owner within the company (OR=0.38, p=0.018) and managers (OR=0.36, p=0.021) were less likely to have good knowledge compared to head chefs. Positive attitudes were strongly associated with previous experience in the food industry (OR=12.96, p=0.018) and official inspections in the last five years (OR=1.75, p=0.022). Although basic awareness of food hygiene issues is widespread, specific technical knowledge remains inadequate among half of all FBOs. Specific training programs, especially for personnel performing the roles of owner and manager, as well as consistent official controls, are important factors in strengthening food safety culture and protecting public health.