IN FOCUS: 'Once you go viral it's a downfall' – tackling the food poisoning scourge in Singapore

SINGAPORE: Hours after Ms Gillian Lim ate tofu fries from a street food kiosk in Singapore, her stomach started churning "like a washing machine".

Then came the nausea, vomiting and diarrhoea in what she described as the worst episode of food poisoning in all of her 31 years. 

Nearly everyone would have experienced some form of gastroenteritis from consuming spoilt food and beverages, or coming into contact with contaminated surfaces or people. 

Despite strict regulations and enforcement in Singapore, outbreaks have persisted, with cases cutting across all types of food establishments.

In recent months, higher-end dining outlets have made headlines in this area, with outbreaks reported at Chinese eatery Peach Garden and Pan Pacific Hotel's Edge buffet restaurant. 

NUMBERS "LOW" - BUT NOT GOING AWAY

Statistics from the Singapore Food Agency (SFA) since its formation in 2019 showed that the number of major gastroenteritis incidents have fluctuated from year to year.

These are defined by the statutory board as "incidents with significant severity and impact".

SFA recorded 60 such cases in 2019, 48 in 2021, 57 in 2022 and 44 last year. There were only 12 in 2020 due to the COVID-19 pandemic putting a stop to dining in.

SFA also tracks the number of people affected in foodborne outbreaks involving 15 or more. This is presented as an average per 100,000 population.

There were 21.6 such cases in 2019, 25.6 in 2021, 21.2 in 2022 and 22.5 last year. Similarly, 2020 saw a lower than average number - 7.8 - due to the pandemic.

All 2023 figures are provisional as they include cases pending investigations.

"The number of foodborne illness cases related to foodborne outbreaks has been kept low," said SFA in response to CNA's queries. 

"In 2023, despite an increase in the number of both retail and non-retail food establishments, the number of foodborne illness cases and major gastroenteritis incidents were lower than in 2022."

Cases publicised by SFA in the last five years showed that gastroenteritis outbreaks often occur for reasons related to poor food handling, personal hygiene or housekeeping, manifested through filthy premises, ill-maintained equipment or pest infestations. 

SFA mandates that all food retail establishments be licensed for operation. Food handlers must be registered and attend a course on food safety and refreshers. 

One of the most notorious food poisoning cases in Singapore involved the Spize restaurant back in 2018, when 45 people were hospitalised after eating bento sets at a company event. One died of sepsis and multi-organ failure after acute gastroenteritis.

Strains of salmonella bacteria were found at Spize's now-defunct River Valley Road outlet, along with faecal matter on food and kitchen tools, suggesting poor hygiene practices.

Seven out of 34 food handlers there were also unregistered and had not attended the basic food hygiene course.

Last year, two Bedok outlets under Spize were fined for food safety lapses leading to another gastroenteritis outbreak. 

The restaurants did not properly separate raw and cooked food; and failed to provide hand soap for washing.

KITCHEN CREW SPILL THE BEANS

Industry insiders with more than 10 years of kitchen experience told CNA that sub-standard food safety practices were common at their past workplaces.

They declined to be fully named for fear of reprisal from former employers. 

One sous chef, Mr Lee, said that out of 10 eateries he's worked at, seven have had lapses that boiled down to a lack of manpower, time or funding.

For instance, in smaller businesses with tighter budgets, washing and cleaning duties sometimes fall to the chef.

This one person would have to prepare and cook the food as well as wash the dishes and kitchen, "with very little time to properly clean up", said Mr Lee, who's in his early 30s. 

"During busy periods, the chef will be rushed to (put) out the food faster, which might (result in) mistakes ... for example cutting ready-to-eat food on a raw food chopping board." 

He has also witnessed employees being asked to wash kitchens during operating hours, while food is being prepared or cooked at the same time.

"There might be cross contamination when chemicals or soap accidentally go into the food," said Mr Lee, who started out as kitchen assistant 15 years ago. 

Another sous chef, 38-year-old Ms Goh, said businesses sometimes mass-hire part-time service staff using social media platforms, and with no clear indication of whether these hires will be handing food directly.

As a result, those hired might not have undergone the mandated food safety course. 

The co-owner of a bistro, who only wanted to be known as Mr Singh, pointed out that "not everyone comes into Singapore with a food handling cert".

"Usually we get people from Malaysia. And to train them ... that's where you've got to keep being on the ground (and) hands-on most of the time for the first month or so, to switch them from how they used to do things back there to how we want to do things at my location," said the 37-year-old.

"Food hygiene is number one, Singapore is a small country, once you go viral on social media, it's a downfall."

Still, well-trained employees are no guarantee of high standards.

Mr Lee recalled how another chef - at an eatery he worked at years ago - would clean tables with the same cloth he used to wipe his shoes. 

"Once I saw that, I stopped eating the food he made." 

A WHOLE HYGIENE "CHAIN"

Some eateries, including the Burger & Lobster at Jewel Changi Airport, have also been taken to task over infrastructural issues such as cracked kitchen tiles or peeling wall paint. 

Paint chips or flakes can fall into preparation areas and potentially contaminate food, said the Singapore Institute of Technology's (SIT) capability development lead of food technology Mabel Wang.

Microbes can also hide in cracks and crevices; these are difficult to clean and lead to dirt, water and food debris accumulating, in turn fostering the growth of bacteria, mould or fungi, she added.

A former owner of a Thai casual dining eatery in Singapore's north told CNA how his business was plagued by pests, despite daily efforts to clean and wash the premises.

"We were opposite a forested area, which resulted in many rodents entering the shop. This was despite having an ongoing pest control plan mandated by SFA," said the man, who declined to be identified.

"We had several sauces which contained fermented ingredients like fish sauce, and these attracted cockroaches as well."

He shuttered his restaurant earlier in 2024, after three years of operations. 

Bistro co-owner Mr Singh also pointed to the importance of picking certified food suppliers.

"Food hygiene for me, it's a whole supply chain from your supplier to how you store to how you prepare; it's the entire process." 

CATERING MORE SUSCEPTIBLE

A study published this year found that caterers, restaurants and in-house kitchens topped the list for gastroenteritis outbreaks in Singapore between 2018 and 2021. 

In that period, 51 foodborne outbreaks were from caterers, 18 from restaurants and 15 from in-house kitchens. Food courts and hawker centres only recorded one and two outbreaks respectively.

In 2021, Singapore had around 4,800 restaurants and about 750 caterers, according to figures by the Department of Statistics. 

The study - conducted jointly by the SFA, the Ministry of Health, National University of Singapore and Nanyang Technological University -  defined an outbreak as two or more cases of gastroenteritis symptoms linked to a food establishment.

The way caterers operate can be directly linked to their higher number of gastroenteritis outbreaks, according to the study.

This includes undercooking due to cooking in bulk and prolonged storage of food at ambient temperatures, it said, advising that food be cooked in smaller batches instead.

Restaurants, on the other hand, typically have better access to resources and can invest in quality ingredients, modern equipment, and professional staff.

But such larger operations can also lead to oversight on intricate processes, said SIT's Dr Wang. 

They handle big volumes of food preparation and service simultaneously, increasing the risk of contamination if protocols are not followed. They may also prepare and hold food in advance, unlike hawker and coffee shop stalls. 

These smaller businesses, meanwhile, may lack the resources to carry out regular hygiene maintenance, said Dr Wang.

But the sous chef Ms Goh pointed out that hawkers have a better overview.

"They clean (the equipment) themselves, they know where to put it and maintain," she said. "The hawker or the owner is a cook, a chef, a steward. He plays four, five roles by himself."

In contrast, a restaurant chef would not know if the knife he was using was washed by the person who used it the day before.

Hawkers also work in spaces visible to the public, which could encourage them to maintain hygiene standards, while restaurants typically have kitchens behind closed doors, Ms Goh noted. 

HEAVY-DUTY CHECKS AND MEASURES

One business, How's Catering, shared with CNA the extent of measures it takes to ensure food safety.

According to managing director Lyor Loh Chee Hua, among other steps, it designates kitchen spaces for specific functions; gets staff to ensure that delivered food is consumed within four hours of cooking; and sends samples to a lab to check for pathogens monthly. Samples will be from food, water, ice and surface and hand swabs.

Weekly in-house hygiene refresher sessions are also held for kitchen staff.

But the job is becoming increasingly challenging for the caterer, which was founded in 1991.

Excessive heat in increasingly hot weather, for example, has in turn upped the risk of bacteria growth on food.

Training employees also requires significant investment, but retaining them is not a given when faced with competitors offering more attractive salaries and perks, said Mr Loh, who also pointed to quota limitations on hiring.

The Association of Catering Professionals Singapore said the same. "The shortage of skilled labour and reliance on part-time food handlers, who may not have a vested interest in compliance, can contribute to food safety risks," a spokesperson said. 

Other businesses, like Mr Singh's bistro, pointed to how they engage companies to do deep cleaning at least every six months.

Professional deep cleaning requires training as it involves using specialised equipment and detergent on top of identifying areas that need particular cleaning like degreasing. 

Director of One Heart Cleaning firm Lim Tze Wei described deep cleaning as going beyond superficial cleaning to reach neglected areas not visible to the human eye.

His company counts local coffee franchises, Michelin-starred restaurants and hawker stalls among its clients. 

One particular restaurant, decorated with tall bamboo poles, takes eight hours to clean, said Mr Lim.

Some businesses avoid the downtime needed for deep cleaning as it can be viewed as an opportunity cost, Mr Lim added. 

"Ultimately, it boils down to whether they are open to spending the additional cost," he said. 

"Let's say they don't want to do it during operating hours, they also have to station (an employee on standby) there, so the cost is on their hands."

One Heart Cleaning's services cost anywhere from S$300 to more than S$3,000 per session, depending on the scale of the cleaning. 

NO END TO FOOD POISONING?

In addition to cleaning, training and other food safety measures, businesses could also offer employees rewards or recognition for compliance, SIT's Dr Wang suggested. 

On a regulatory level, the government can continuously update and enforce food safety regulations, while conducting regular inspections and audits.

The authorities can also facilitate collaboration between agencies, industry experts and academia to address emerging risks, and keep educating both consumers and businesses about food safety, Dr Wang said. 

But she concluded that it would be challenging to completely eradicate food poisoning in a country where food is a "way of life".

For all the training and protocols put in place, human error can never be entirely eliminated, and mistakes leading to contamination can still be made, Dr Wang noted. 

Business owners agreed.

"At the end of the day, no matter how much you try your best ... sometimes there are certain things that are unseen," said Mr Singh, adding that diners' stomachs also have different thresholds for what they can handle. 

The veteran kitchen insiders shared with CNA some red flags, which they too look out for when dining out themselves.

To Ms Goh, mould or dust in a restaurant's premises signal an area not well-maintained. A chef with stained attire also indicates poor housekeeping or hygiene.

To Mr Lee, one or two cockroaches in a dining area is enough of a turn-off. "There's a high chance the kitchen is already full of it." 

For patrons who still end up with food poisoning, the course of action is clear, according to Ms Lim.

"It was just pure misery," she said of her episode with the tarnished tofu fries.

"After that, I never ate from there ever again."