Restaurants are important settings for foodborne disease outbreaks and consumers are increasingly using restaurant inspection results to guide decisions about where to eat. Although public posting of inspection results may lead to improved sanitary practices in the restaurant, the relationship between inspection results and risk of foodborne illness appears to be pathogen specific.
To further examine the relationship between inspection results and the risk of foodborne disease outbreaks, we evaluated results of routine inspections conducted in multiple restaurants in a chain (Chain A) that was associated with a large Salmonella outbreak in Illinois. Inspection results were collected from 106 Chain A establishments in eight counties. Forty-six outbreak-associated cases were linked to 23 of these Chain A restaurants. There were no significant differences between the outbreak and non-outbreak restaurants for overall demerit points or for the number of demerit points attributed to hand washing or cross-contamination. Our analyses strongly suggest that the outbreak resulted from consumption of a contaminated fresh produce item without further amplification within individual restaurants. Inspections at these facilities would be unlikely to detect or predict the foodborne illness outbreak because there are no Food Code items in place to stop the introduction of contaminated food from an otherwise approved commercial food source.
The results of our study suggest that the agent and food item pairing and route of transmission must be taken into consideration to improve our understanding of the relationship between inspection results and the risk of foodborne illness in restaurants.
Understanding the relationships between inspection results and risk of foodborne illness in restaurants
Foodborne Pathogens and Disease. September 2016, ahead of print. doi:10.1089/fpd.2016.2137.
Paula Wissel of KNKX reports the Washington Department of Health is still investigating this month’s E. coli outbreak that forced a Seattle restaurant to close temporarily. The Matador in Seattle’s Ballard neighborhood has now reopened, but the source of the E. coli that sickened several patrons remains a mystery. Meanwhile, food safety advocates say this latest scare underscores the need for a promised restaurant grading system to be implemented quickly by public health officials.
Back in 1993, Sarah Schacht, along with her mother and little brother, was sickened in the deadly E. coli outbreak linked to undercooked hamburgers at Jack in the Box. Then, a few years ago, she contracted the foodborne illness again.
“The experience of getting E. coli the second time was much worse. It was feeling like my stomach was being ripped open, I had extreme cramping and I was in and out of the hospital,” Schacht said.
She is one of the primary proponents of restaurants in King County being required to post placards showing what score they received from the health department. She sat on a stakeholders panel convened by the county to come up with a system. Although Public Health of Seattle and King County announced several years ago they were going to implement a system, it has yet to be put in place, which frustrates Schacht.
“They’ve continually rolled back deadlines for this program and so it’s been disappointing to see another outbreak and no posted signs,” Schacht said.
In response, county health officials says they want to make sure that when it launches, the grading system is consistent across eating establishments. The health department has conducted a series of studies to try and figure out how best to obtain that consistency. A grading system pilot program is scheduled to begin in January.
Here’s a couple of suggestions:
Filion, K. and Powell, D.A. 2009. The use of restaurant inspection disclosure systems as a means of communicating food safety information. Journal of Foodservice 20: 287-297.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.
I recycled an old op-ed in response, and still wondering why the same issues haven’t gained traction after 20 years of publicity in Australia.
The Advertiser editorial thingies wrote that irony can be really ironic, given that the government department charged with upholding and maintaining food standards in SA treats the public like mushrooms.
By keeping the public in the dark by refusing to release the names of the 621 food outlets in breach of hygiene rules last year, SA Health is denying consumers the right to make an informed choice.
While it is good enough for the NSW State Government to identify offending premises, those who water their gardens with human effluent, sell out of date food and have cockroach-infested kitchens in SA apparently deserve anonymity.
There is more than a whiff of double standards surrounding the secrecy of the data held by SA Health.
On one hand (who writes this crap?), the public is not allowed to know which of their local fast food outlets is cutting food hygiene corners by selling six-day-old schnitzels, and on the other, it wasted no time last week issuing a warning about NT- grown rockmelons being the apparent source of a food poisoning outbreak in SA.
Surely the public is allowed to know the identity of a food retailer that has been found guilty of a major breach of food standards that could potentially have the same impact as eating the dodgy rockmelon.
For a food outlet to be warned several times about using effluent to water gardens simply beggars belief.
SA Health’s repeated warnings to the business owner were akin to being slapped with a wet lettuce leaf.
If such a practice can continue for such an extended period of time, the public can only wonder just what sort of heinous breach of food safety regulations a business must commit to be jumped on immediately.
My response was:
I coach little kids’ (ice) hockey in Brisbane.
For that voluntary pleasure, I had to complete 16 hours of certification training, in addition to the 40 hours of training I completed in Canada to coach a travel team.
To produce or serve food in Australia requires … nothing.
Restaurants and food service establishments are a significant source of the foodborne illness that strikes up to 20 per cent of citizens in so-called developed countries each and every year.
After helping develop and watching the mish-mash of federal, state and local approaches to restaurant inspection and disclosure in a number of western countries for the past 15 years, I can draw two broad conclusions:
Anyone who serves, prepares or handles food, in a restaurant, nursing home, day care center, supermarket or local market needs some basic food safety training; and,
the results of restaurant and other food service inspections must be made public.
There should be mandatory food handler training, for say, three hours, that could happen in school, on the job, whatever. But training is only a beginning. Just because you tell someone to wash the poop off their hands before they prepare salad for 100 people doesn’t mean it is going to happen; weekly outbreaks of hepatitis A confirm this. There are a number of additional carrots and sticks that can be used to create a culture that values microbiologically safe food and a work environment that rewards hygienic behavior. But mandating basic training is a start.
Next is to verify that training is being translated into safe food handling practices through inspection. And those inspection results should be publicly available.
A philosophy of transparency and openness underlies the efforts of many local health units across North America in seeking to make available the results of restaurant inspections. In the absence of regular media exposes, or a reality TV show where camera crews follow an inspector into a restaurant unannounced, how do consumers — diners — know which of their favorite restaurants are safe?
Cities, counties and states are using a blend of web sites, letter or numerical grades on doors, and providing disclosure upon request. In Denmark, smiley or sad faces are affixed to restaurant windows.
Publicly available grading systems rapidly communicate to diners the potential risk in dining at a particular establishment and restaurants given a lower grade may be more likely to comply with health regulations in the future to prevent lost business.
More importantly, such public displays of information help bolster overall awareness of food safety amongst staff and the public — people routinely talk about this stuff. The interested public can handle more, not less, information about food safety.
Even in New South Wales and Queensland, results are only posted voluntarily.
So if an outlet sucks at food safety, they don’t have to tell anyone.
Toronto, Los Angeles and New York have had mandatory disclosure, on the doors for years.
Adelaide can figure it out.
And instead of waiting for politicians to take the lead, the best restaurants, those with nothing to hide and everything to be proud of, will go ahead and make their inspection scores available — today.
Matt Rocheleau of the Boston Globe reports that Boston Mayor Martin J. Walsh is asking the City Council for approval to fine restaurants $300 per day if they fail to post their food safety inspection letter grades in their storefronts.
Restaurants and food trucks would have a year to comply after the launch of the letter-grade system being developed for restaurants citywide, though the grades would be available on the city’s website.
The city’s Inspectional Services Department has been developing the program. Officials there have said restaurants would receive either an A, B, or C grade.
The program would resemble rating systems that New York, Los Angeles, and other cities have been using since as early as the late 1990s. Locally, Newton launched a similar program in the fall that requires numerical ratings to be displayed inside restaurants.
Boston officials have previously told the Globe that letter grades will be issued to all of the city’s roughly 3,000 food establishments, including restaurants, food trucks, cafeterias, and other food vendors.
When an establishment gets a low grade, inspectors will return within 30 days to reinspect, city officials have said. If the violations are corrected, the city would bump up the grade accordingly. If the issues remain, the grade would stand until the next routine inspection, officials have said.
Restaurants would be subject to the $300 fines if they fail to post their letter grades “immediately after receipt, unobstructed, at eye-level, facing outward on an exterior-facing wall or window within five feet of the main entrance in the interior of the restaurant,” according to Walsh’s proposal to the council, which was previously reported on by the Universal Hub website.
The council is due to take up the matter at a meeting in City Hall on Wednesday.
The new rating system would not cost the city any extra money, city officials have said, because it would calculate grades based on the existing system used to inspect restaurants.
The decals — which include green stickers for “Inspected and Permitted” facilities; yellow “Consumer Alert” stickers for when conditions may pose a health risk; and red “Closed” stickers for facilities shut down for serious health code violations until fixes are made — also have been redesigned in an easier-to-read format.
“The updated placards will provide county residents with a clear and easy-to-read status of the facilities they’re considering when making dining choices, while also providing easy access to the reports,” health department director Karen Hacker said in a statement.
Restaurant inspection reports have been available for residents to view online using a search engine on the health department’s website since 2007. The QR codes will provide a direct link to the search page.
“Eatsafe is designed to protect and reassure the public by providing more transparency around food safety and suitability in Auckland,” says Bylaws and Regulatory Committee Chair, Councillor Calum Penrose.
The new Food Act 2014 promotes food safety by focusing on the processes of food production and not the premises where the food is made.
“Our industry-leading system recognizes that every one of the more than 8,000 food businesses in Auckland is different, with differing levels of measurement required, depending on the type of food premises,” he says.
The new grading system assesses each business based on food safety, looking at cleaning, cooking, chilling of food and operator conduct, as well as food suitability issues such as food composition and labelling.
“With the increasing number and diversity of food outlets, and the rising popularity of eating out in Auckland, more people will be looking for the Eatsafe “A – Excellent” rating on the wall. Of course, under the new system, a “B” or “C” rating will also be a passing grade and quite appropriate for some types of outlets,” says Councillor Penrose.
Auckland Council’s current blue food safety certificates will be phased out over the three years and food operators serving alcohol have until June 2017 to switch.
Toronto, Los Angeles and New York City, along with hundreds of jurisdictions have figured this out: public health should disclose public health ratings, at the door, when people make up their mind about entering an establishment to spend their money.
But the UK and several Australian states go through this convulsed process where they have scores on doors, but restaurants only have to post them if they want to, and who knows about food in school or hospital cafeterias.
The Brits were never ones for public disclosure (see Mad Cows and Mother’s Milk, 1997, or Yes, Minister).
Australian newspapers are reporting that customers are demanding voluntary food hygiene ratings become mandatory across New South Wales restaurants.
Same in the UK.
As someone who has been involved in these public disclosure efforts, including NSW’s back in the day, and advocated mandatory public disclosure from the beginning, it’s painful to watch the contortions.
According to The Border Mail, “Some retail food businesses in NSW display their rating in the window, but only if their council signs up to the program and only if the business is happy with its rating.
Councils and industry groups are calling on the NSW Food Authority initiative, Scores on Doors, which issues certificates with three, four and five-star ratings during routine health inspections, to be made mandatory to standardise food safety across NSW and give customers more consistent information about hygiene at food establishments.
Since the program was launched in 2010, only about one-third of local governments in NSW have adopted the system.
North Sydney Council is the latest to announce that from July 1, following annual food safety inspections, it will begin issuing certificates that eateries can then choose to display.
“If a restaurant is displaying the purple and green poster, it has met minimum hygiene and food safety standards during the last food inspection. If it’s not displaying one, they can ask why,” North Sydney mayor Jilly Gibson said.
Wok On Inn at The Rocks, which scored five stars, has been displaying the certificate since the end of last year, and waiter Sunny Dongdang said he thinks that all businesses should be required to do so.
As a postscript to our recent trip to France, friend of the barfblog.com Albert Amgar, who we had the extraordinary pleasure of meeting, forwarded a note from a French colleague who argued that “I think that too much information on (food safety) problems creates uselessly an alarming climate of insecurity.”
I have a vague understanding of this class-based approach to disclosure.
In 1994, as a graduate student, I was invited to a pre-G7 summit in Naples, Italy. The idea was to bring in a scientist and a journalist from each of the G7 countries to discuss medical conditions and whether patients should be told.
I was the scientist and journalist from Canada.
There was a lot of posturing from the Italian hosts, a lot of drinking and eating, and very little work.
It was a lovely weekend.
The Americans, the Brits and me (the Canadians) agreed on full disclosure.
The other countries, including France, said their patients couldn’t handle it.
Guess things haven’t changed much.
According to The Times Paris on July 20, 2016, government wants to tell diners the truth by publishing results of health and safety inspections on the agricultural ministry’s website – chefs are aghast.
They are even more appalled at a proposal to stick a label in the window of their restaurants that will say whether hygiene is ‘very satisfactory’ ‘satisfactory’ , to improve’ or ‘to be corrected urgently’. Given that only a few restaurants are likely to be deemed ‘very satisfactory’ , the profession fears for its reputation.
Restaurateurs are campaigning to prevent the plan from being implemented next month. Hubert Jan, chairman of the Union of Hotel Trades and Industries, said that his members were already losing money because of France’s poor economic performance and terrorism fears. ‘The profession, which was badly hit by a fall in custom after the terror attacks, does not need to be thrown to the lions and stigmatised.’
The scheme was drawn up amid increasing concern over restaurant hygiene. In summer 2013, health inspectors ordered the closure of 252 establishments. In Paris, 321 were shut last year. Among the concerns of inspectors were sushi leƞ in the sun, broken fridges and food past sell-by date. The agriculture ministry tried out its ‘transparency of food hygiene’ programme in the capital, testing 367 restaurants. 34% were deemed to have a good level of hygiene, 54% were ‘acceptable’ and 8% were told they had to improve. The figures alarmed restaurateurs, who say that the ratings could be posted on internet guides and remain there even after failings have been rectified. They also fear diners will shun establishments with a label on their doors, unless it says ‘very satisfactory’.
Emery Cowan of the Arizona Daily Sun writes that if a restaurant has print out a calorie count for most meals on the menu, why not a letter grade for how safely it prepared its food?
That’s one of the reactions to our story earlier this month reviewing the Coconino County’s food inspection procedures and listing some of the more serious offenders. We found that although most eating establishments were being inspected twice a year and some even forced to close temporarily, diners were kept largely in the dark. A closed restaurant must post a notice but is not required to give a reason, and the public health department’s bimonthly report usually comes out well after any violations – large or small — have occurred.
Most restaurants never come close to being closed and their violations are relatively minor and fixed almost immediately. What benefit is it to diners to have outdated information about infractions that don’t rise to the level of a health threat?
We suppose that if a letter grade was the only information available to diners, it could be misleading. But in the age of the Internet, the Health Department can post a lot more information if diners are interested. They just have to know where to look.
But unfortunately, Coconino County’s website has no portal through which citizens can obtain information about the results of a restaurant’s inspection or even lodge a complaint. Even when a restaurant like China Star, which has been forced to close twice in the past five years, posts a notice of closure, there is no way for diners to find the 16 complaints it received since 2009 or the multiple critical violations it accumulated.
A brief tour of the Internet turns up dozens of cities with web sites containing interactive public databases of restaurant inspections and enforcement actions. Many have explanations of the scoring and ranking methods, the most commonly cited critical and noncritical violations and the risk associated with different types of violations.
We urge county health officials to put a restaurant inspection public database on the fast track.
We had lunch, hung out in his family’s apartment, toured old Paris and found out there really are other people in the world who have to have a couple of hours on the internet just to talk about food safety stuff.
Amy said the similarities were somewhat overwhelming.
I thought it was great.
Albert said France was terrible at public disclosure.