Foodborne illness remains a critical public safety issue. Scallan et al. (1) in a 2011 CDC report estimated that 48 million people contract a foodborne illness annually in the US.

However, during 2009-2010 the CDC reported only 1,527 foodborne illness outbreaks. This underreporting is obviously concerning to public health officials.

In 2013 Arendt, S. et al. (2) published a study “Reporting of Foodborne Illness by US Consumers and Healthcare Professionals” with the purpose of identifying why consumers and healthcare professionals do not report foodborne illnesses. In their study, they found that consumers cited reasons for not reporting foodborne illnesses which included not knowing who to contact, being too ill to seek care, being unsure of the cause, and believing that reporting would not be beneficial.

Healthcare professionals indicated that the amount of time between patients’ consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illnesses.

With the obvious difficulties among both consumers and healthcare professionals in reporting and diagnosing foodborne illnesses it becomes incumbent upon food service managers and owners to enact more stringent and more state of the art food safety measures at their establishments. It also becomes the responsibility of the FDA Food Code and associated agencies, that recommend improved food safety guidelines, and the food equipment manufacturers to advocate for these new innovative protective measures. It also follows that public health officials would then support, monitor and enforce any new measures that further protect the public’s overall health.

In the FDA Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Food Service, Restaurant and Retail Food Store Facility Types (2009) (3) it was determined that the same risk factors identified as problem areas in the 2000 and 2004 Reports remained in need of priority attention.

At full service restaurants 76% Out of Compliance values were associated with poor personal hygiene risks, mainly inadequate hand washing. 64% Out of Compliance values associated with improper cleaning and sanitizing of food contact surfaces including contaminated equipment were also found at full service restaurants.

Similar percentages of Out of Compliance values were found at fast food restaurants associated with poor personal hygiene, contaminated equipment/food contact surfaces and chemical contamination including improper identification, storage and use of cleaners and sanitizers.

This report cited that In Compliance percentages were higher with the presence of Certified Food Protection Managers at these establishments.

It is obvious from these FDA reports that employee compliance with risk factors involving poor personal hygiene, improper cleaning and sanitizing of food contact surfaces and equipment and improper identification, storage and use of cleaners and sanitizers should be a top priority at fast food establishments.

It was recommended from the 2000 and 2004 FDA reports that more innovative and effective strategies to improve food safety practices at food service establishments are needed.

An independent study published in 2015, “Motivators and Barriers to Safe Food Practices: Observations and Interview” by Arendt, S. et al.,(4) found many similarities to the FDA reports on food service operations.

Employees had low compliance with hand washing (35.8%), used gloves (63.1%), and changed gloves (33.3%). Compliance rates with recommended procedures for these actions were even lower (6.7%,6.0% and 1.9%) respectively. Cleaning and sanitizing procedures had compliance rates of only 30.6%.

In particular, improper cleaning and sanitizing procedures had the highest noncompliance rates. Opportunities for recontamination of cleaned and sanitized equipment as a result of poor personal hygiene were routinely presented in food services.

Employees cited the following as barriers to food safety compliance: 1) forgetfulness/no habits, 2) time pressure/too busy, 3) lack of knowledge, 4) lack of available resources, 5) damaged tools, and 6) ineffective culture of the workplace.

The study cited food safety culture (management support and communication) as playing a critical role for improving food safety with employees.

Similarly to the healthcare field, instituting an effective food safety culture will be dependent upon employee conscientiousness, good will, compliance, and competence. As cited in the 2004 FDA report, innovative strategies, i.e., more standardized, repeatable automated cleaning and sanitizing processes may be a more effective method of eliminating foodborne illness risk factors and thereby significantly decreasing the incidence of foodborne illnesses that are markedly under-reported by consumers and under diagnosed by healthcare professionals.

Gary Russotti, MD,MS

Idea Boxx – Director of Medical/Biochemical R&D and Regulatory Compliance

  1. Scallan et al., “Foodborne Illness Acquired in the US”, Emerg. Infect. Dis., Vol. 17, No. 1, 2011.
  1. Arendt, S, et al., “Reporting Foodborne Illness by US Consumers and Healthcare Professionals”, Int. J. Environ. Res. Public Health., 10(8): 3684-3714, 2013.
  1. FDA Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types (2009)
  1. Arendt, S. et al., “Motivators and Barriers to Safe Food Practices: Observations and Interview, Food Protection Trends, 35 (5): 365-376, 2015.