Restaurant inspection and public health

Do restaurant inspections improve public health? Do inspections reduce the incidence of foodborne illness associated with restaurants? Can inspection data be used to predict problem restaurants?

Previous research has been largely inconclusive, but researchers at the University of Minnesota attempted to parse inspection data and make it more useful for future inspections. The goal in all this is fewer sick people.

I agree when the researchers conclude, “Inspections provide feedback to the operator concerning the effectiveness of the establishment’s process controls, thus enabling the operator to focus on interventions and programs that can have the greatest impact. Despite their limitations, restaurant inspections are a valuable tool that can be used to verify the existence of appropriate preventative controls and an active managerial control system.”

But inspections are only one tool.

The abstracts for the two papers are below.

Health department inspection criteria more likely to be associated with outbreak restaurants in Minnesota

Petran, Ruth L.; White, Bruce W.; Hedberg, Craig W.

Journal of Food Protection®, Volume 75, Number 11, November 2012 , pp. 2007-2015(9)

Millions of routine restaurant inspections are performed each year in the United States, and the Centers for Disease Control and Prevention has reported that a majority of foodborne illness outbreaks occur in restaurant settings. In an attempt to relate the data collected during inspections in Minnesota to illness likelihood, data from routine inspections conducted at outbreak restaurants were compared with data from routine inspections conducted at nonoutbreak restaurants. The goal was to identify differences in recorded violations. Significantly more violations were recorded at restaurants that had outbreaks. The majority of these violations were related to contamination in the facility and environment and to food handling procedures. Relative risks also were calculated for violations significantly more likely to occur at locations that had outbreaks of norovirus infection, Clostridium perfringensinfection or toxin-type illness, and Salmonella infection. These three pathogens are estimated to cause the majority of foodborne illnesses in the United States. Meta-analysis of composited data for the three pathogens revealed 11 violations significantly more likely (α < 0.05) to be identified during routine inspections at outbreak restaurants than during inspections at nonoutbreak restaurants. Application of this information permits assessment of health department inspection data in a consistent fashion. This approach can help identify criteria more likely to be associated with outbreak locations and allow operators to focus on interventions that will have the most significant impact in higher risk establishments.

Using a theoretical predictive tool for the analysis of recent health department inspections at outbreak restaurants and relation of this information to foodborne illness likelihood

02.nov.12Journal of Food Protection®, Volume 75, Number 11, November 2012 , pp. 2016-2027(12)

Petran, Ruth L.; White, Bruce W.; Hedberg, Craig W.

Because U.S. restaurants are inspected at least annually against criteria in the U.S. Food and Drug Administration Model Food Code, large amounts of data are generated and
should be systematically reviewed. The purpose of this study was to determine the relationships among the data obtained through health department inspections, the contributing factors to foodborne illness identified by the Centers for Disease Control and Prevention, and the risks of outbreaks of norovirus, Salmonella, and Clostridium perfringens infection associated with a specific restaurant. These agents were chosen for the analysis because they cause the majority of foodborne illnesses. A theoretical predictive assessment tool was built that extracts data from routine health department inspection reports for specific restaurants to establish a risk profile for each restaurant and identify the likelihood of a norovirus, Salmonella, or C. perfringens outbreak at that restaurant. The tool was used to examine inspection reports from restaurants known to have had confirmed norovirus, Salmonella, and C. perfringens outbreaks. Although evaluation of an extensive data set revealed lack of an overall association between outbreak inspection scores and routine inspection scores obtained at outbreak restaurant locations, certain specific violations were significantly more likely to be recorded. Significant differences in types of violations recorded during outbreak and routine inspections were determined. When risks based on violation type can be identified, targeted actions may be able to be prioritized and implemented to help decrease illnesses.