Process design strategies are important to prevent or reduce food safety risks in production systems. In this sense, the Codex Alimentarius presents a set of principles for good hygiene practices to guide food producers. However, studies in food safety often focus on analyzing and controlling implemented production processes without a policy of designing them with a preventive logic, leading to resource misallocation and noncompliance. This study aims to gather and analyze techniques, drivers, challenges, and research opportunities for food safety-driven process design. A systematic literature review was carried out following three steps: (i) Data collection, including 52 studies; (ii) Bibliometric analysis; and (iii) Content analysis, identifying techniques, drivers, challenges, and research opportunities. Three main themes in the subject were identified: process assessment models, risk assessment, and whole-chain traceability. Eleven design techniques were identified and compared according to their typology, structure, and coverage of themes addressed by the Codex Alimentarius. There is a gap in techniques addressing employee competence and personal hygiene. We suggest developing a tool encompassing the Codex Alimentarius good hygiene practices themes in process design to guide food safety-driven process development.