Understanding the Relationships Between Inspection Results and Risk of Foodborne Illness in Restaurants

Foodborne disease is a common, but preventable, burden of illness worldwide. Almost one-half of every dollar spent on food in the United States is spent on food from restaurants. A growing body of data from foodborne disease outbreaks and studies of sporadic (non-outbreak-associated) gastrointestinal disease of various etiologies suggest that eating food prepared in restaurants is an important source of infection. These data suggest a critical need for action that is focused on preventing disease transmission within the food service industry. Clinicians should report all suspected foodborne disease to public health authorities to ensure appropriate epidemiologic investigation.

The Los Angeles County Department of Health Services revamped its retail food establishment inspection program in 1998 to include, among other novel provisions, the prominent posting of grades. The purpose of the present study is to examine results from the second year of the revamped program to determine the longer-term impact of the program. An analysis of program results for Year 1 led to several program refinements: stratification of risk categories, certification of food handlers, and an external fraud hotline. Outcome measures used included routine inspection scores; closure rates; scores from owner-initiated inspections and departmentally initiated inspections; inspection frequencies; compliance with food handler certification requirements; and frequency of use of the external fraud hotline. Inspection scores continued to increase in 1999, while the rate of closures decreased. The owner-initiated inspections also resulted in improved scores, generally maintained on subsequent inspections. Higher risk establishments were inspected more frequently than were lower risk establishments. Over 30,000 food handlers were certified. The external fraud hotline received 16 fraud complaints. Results indicate that retail food establishments are taking stronger action to assure compliance with food safety practices. Copyright 2001 American Health Foundation and Academic Press.

To analyze the association between the results of routine inspections and foodborne outbreaks in restaurants, we conducted a matched case-control study using available data from Seattle-King County, Washington. Case restaurants were facilities with a reported foodborne outbreak between January 1, 1986 and March 31, 1987 (N = 28). Two control restaurants with no reported outbreaks during this period were matched to each case restaurant on county health district and date of routine inspection (N = 56). Data from the routine inspection that preceded the outbreak (for case restaurants) or the date-matched routine inspection (for control restaurants) were abstracted from computerized inspection records. Case restaurants had a significantly lower mean inspection score (83.8 on a 0 to 100 point scale) than control restaurants (90.9). Restaurants with poor inspection scores and violations of proper temperature controls of potentially hazardous foods were, respectively, five and ten times more likely to have outbreaks than restaurants with better results. Although this study demonstrates that Seattle-King County's routine inspection form can successfully identify restaurants at increased risk of foodborne outbreaks, it also illustrates that more emphasis on regulation and education is needed to prevent outbreaks in restaurants with poor inspection results.