Food Protection Connection: Food Safety Trends in the U.S.

(reprinted from Dietary Manager, May 2011)

For the past 10 years the National Retail Food Team of the Food and Drug Administration (FDA) has been conducting a study to measure trends in the occurrence of employee behaviors and food preparation practices at the retail and foodservice level that are thought by the Centers for Disease Control and Prevention (CDC) to be most frequently linked with foodborne illness outbreaks in the U.S. The analysis of the data collected was to detect and report improvements or regression trends of foodborne illness risk factors over a 10 year span.

Released in late 2010, the Trend report shows some interesting food safety developments and suggests that “control of certain foodborne illness risk factors improved over the 10-year period in most facility types, but that compliance with important requirements in the FDA Food Code needs further improvement in order to adequately prevent foodborne illness outbreaks.”

Trend analysis was conducted by evaluating facility types during three separate studies in 1998, 2003 and 2008 using the 2007 FDA Model Retail Food Code. In each of these studies, nine facility types in three categories were evaluated: Institutional, to include hospitals, nursing homes, and elementary schools (K-5); Restaurants, to include fast food and full service; and Retail Food Service, to include deli, meat/poultry, seafood, and produce departments.

The 5 Foodborne Illness risk Factors include:

• food from unsafe sources,
• poor personal hygiene,
• inadequate cooking,
• improper holding/time and temperature, and
• contaminated equipment/protection from contamination.

We recognize these five items as being the most likely reasons why a foodborne illness occurs. Within the five major risk factors, 42 individual data items were evaluated.

As you will see from the Trend Analysis, which evaluates the three individual studies, in spite of considerable improvements in food safety over the 10 year time frame, three risk factors continue to be the most in need of concentration by both industry and regulators. These risk factors are: improper time/temperature, poor personal hygiene, and contaminated equipment/protection from contamination.

If you are a numbers person, you will love this report. If you are not, I still think you will find some very useful and interesting facts that may relate to the foodservice area you may be involved with. You can read all three of the individual studies and the final Trend Analysis at www.FDA.gov.

The overall Trend Analysis looked at several basic areas:

1. Overall in-compliance percentages (all 42 data items combined),
2. In-compliance percentages for the 5 foodborne illness risk factors, and
3. In-compliance percentages for each individual data item.

The study was done throughout the U.S. in randomly selected facilities. You can see in Table 1 the number of inspections that were conducted during each data collection period.

Table 1: Total Number of Establishments Included in the Study

FDA Trend Analysis Report 1998-2010 (Table 4), www.fda.gov

In an effort to summarize this lengthy report and provide you with some interesting information, I will simply give a brief overview of some of the findings in the Trend Analysis.

Percent Overall IN-Compliance
To begin, let’s look at the overall IN-compliance rate for all 42 data items combined. Which facility types showed statistically significant improvement in the In IN COMPLIANCE category for all 42 data items combined? Five stood out:

1. elementary schools,
2. fast food,
3. full service restaurants,
4. meat/poultry departments, and
5. produce departments.

In 1998, FDA set target improvement goals for each establishment type. Both meat/poultry and produce departments met that improvement goal (Table 2). The good news is that none of the nine facility types had percentages IN-Compliance that were lower than the original assessment in 1998.

Table 2: Percentage of Observations Found IN-Compliance for ALL Data Items

FDA Trend Analysis Report (Table 5), www.fda.gov

Risk Factor Trends
The next overall trend to review is this: Within each of the nine facility types, did any show significant improvements in any of the overall Risk Factors? The answer is yes (Table 3). FDA reports the following:

• Significant improvement for the poor personal hygiene risk factor in 7 of the 9 facility types.
• Significant improvement for the improper holding/time and temperature risk factor in 5 of the 9 facility types.
• None of the 9 facility types had a significant regression for any of the foodborne illness risk factors.

Table 3: Foodborne Illness Risk Factors with Statistically Significant Improvement, 1998-2008

FDA Trend Analysis Report (Table 6), www.fda.gov

FDA does, however, report that when looking at the improvement rates of risk factors in various facility types, that “although the scope of the improvement trends for poor personal hygiene and improper holding/time and temperature risk factor is encouraging, these risk factors generally had lower IN compliance percentages than the other risk factor areas.”

In an effort to simply draw attention to one type of foodservice facility for the purposes of this article, let’s focus on Institutional Food Service. Institutional food service consisted of hospitals, nursing homes, and elementary schools (K-5). These segments were specifically looked at due to the uniqueness of this food service as it relates to serving highly susceptible populations, i.e. those at higher risk of having a foodborne illness.

When the Trend Analysis looked at the In-compliance percentages for 5 Risk Factors within a hospital setting, generally compliance remained steady. There was neither significant improvement nor regression in any of the risk factors except a very slight statistically significant improvement in Inadequate Cooking (93.3% in 1998 to 97.7% in 2008). In the same review of nursing homes with relation to risk factor compliance, again, most compliance stayed static. In nursing homes, poor personal hygiene did improve, but the improvement was not significant (79.6% in 1998 to 84% in 2008). For elementary schools, although again relatively static, improper holding/time and temperature (60.1% in 1998 to 72.5% in 2008) and poor personal hygiene (74.7% in 1998 to 85.1% in 2008) both had significant improvements. FDA provides fantastic graphs and charts in their Trend Analysis report that can help you visualize the In-Compliance rates.

Individual Data Items
If you would like to explore the 42 individual data items that were observed during inspections, I urge you to review the Trend Analysis report in detail. The Individual Data Items will give you a more intimate idea of exactly what issues within a risk factor were in or out of compliance. You will definitely gain insight as to where deviations may be occurring in your own facility. The chart and tables provided in this report are full of useful information.

FDA’s Conclusions
At the end of this 10 year study, what did FDA conclude? The report “shows industry improvement in the occurrence of some risk factors, with eight of the nine facility types showing significant improvement in at least one of the foodborne illness risk factors.” FDA reports, however, that improvements are definitely needed, as evident by the fact that some facility types continue to show high percentages of OUT of compliance observations in critical food safety areas. Some of the most significant improvements in the occurrence of risk factors were in areas that had the lowest in-compliance observations when the study began. FDA suggests that proactive measures must be implemented to assure that risk factor violations are reduced if progress is to be made with improving food safety in the U.S.

This study will allow FDA to continue providing the food safety initiatives, programs, and intervention strategies that will best improve poor food safety practices. The goal is to enhance public health protection. By understanding trends and real life food safety practices, food safety programs around the nation can allocate resources that will make the largest impact in improving practices, and thus reduce the incidence of foodborne illness.

What are the root causes of poor food safety practices? What are the best intervention strategies that will effect change? Is there a better inspection process to enhance food safety? There are many more questions to answer in order to fully understand how to realistically control foodborne illness in various facility types.

I hope every reader will review this study and find information that may help you focus on your particular food industry and understand trends, so you may start taking measures to improve food safety in your world. As an inspector, this study was invaluable as it has allowed me to understand where strengths and weaknesses are in various facility types. During inspections I can give greater attention to reviewing specific data items of concern, focus my time and efforts better, and ultimately help the facility execute preventative measures to reduce their chances of a foodborne illness event.

Sources: www.fda.gov; FDA Trend Analysis Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types (1998-2008)

by Melissa Vaccaro, MS, CHO
Melissa Vaccaro, MS, CHO is a Food Program Specialist for the PA Department of Agriculture and an Executive Board Member for the Central Atlantic States Association of Food Drug Officials (CASA). Contact her at mvaccaro@state.pa.us.