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Loloh Cemcem, a traditional beverage containing Cemcem leaves of (Spondias pinnata (L.f.) Kurz) from the tourism area of Penglipuran, has been widely distributed across Bali. This study aims to examine the microbiological quality of Loloh Cemcem and its association with hygiene and the sanitation of its production processes. A cross-sectional study was conducted, involving all home industries that produce Loloh Cemcem and its handlers, four water depots, and three samples of water source in Penglipuran, Bali. Observations and interviews were conducted to obtain data on hygiene and sanitation. Samples were tested for microbiological qualities, including total plate count (TPC), most probable number (MPN) method for coliform, and Escherichia coli (E. coli) contamination. A polymerase chain reaction (PCR) examination was conducted to identify virulent genes. The water source was contaminated with enterotoxigenic E. coli (ETEC), and about 25% of water depots and 43.3% of Loloh Cemcem samples were also contaminated with E. coli. This indicates E. coli viability under an acidic medium (average pH of 2.8). Of the 30 home industries, 76.7% of sanitation facilities met the safety standards, while the conditions were considerably lower for instrument sanitation (60.0%), personal hygiene of the handlers (50.0%), and production site sanitation (43.3%). Poor personal hygiene of the handlers was associated with the microbiological quality of Loloh Cemcem with an adjusted odds ratio (AOR) of 15.02 (95%CI: 1.32-171.56, P = 0.029). Ongoing monitoring is warranted to improve personal hygiene and sanitation of the production processes. Microbiological research is essential to understand the nature of E. coli, including its viability in acidic environments.

Microbiological Quality, Hygiene, and Sanitation of the Production Processes of a Traditional Beverage at Tourism Areas in Bali