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Highest Rates of Foodborne Illness Associated with Restaurants: The Causes and Cures

With more than half of all estimated foodborne illness outbreaks in the U.S. associated with food from restaurants, the FDA has been conducting studies to attempt to determine root causes and risk factors. Most recently, the agency issued a Report on the Occurrence of Foodborne Illness Risk Factors in Fast Food and Full-Service Restaurants. The June 20 release was part of FDA’s 10-year (2013-2022) study to measure the occurrence of practices and behaviors commonly identified by the CDC as contributing risk factors. Along similar lines, USDA FSIS has published a Best Practices Guidance for Controlling Listeria monocytogenes (Lm) in Retail Delicatessens discussing key causes of contamination and actions to help prevent or reduce the likelihood of contamination.

The FDA study included data from 851 randomly selected fast food (421) and full-service (430) restaurants across the U.S., with data collected by FDA’s Regional Retail Food Specialists. Specialists observed practices in the restaurants to assess employee handwashing, bare hand RTE food contact, cross-contamination, food contact surface cleaning and sanitizing, cold and hot holding and cooling of foods, refrigerated RTE food date marking, raw meat cooking, and cooked food reheating.

Of these, the two most commonly occurring risk factors found to be out of compliance in both types of restaurants (fast food and full service) were poor personal hygiene and improper holding and cooling of foods. Surprisingly, full-service restaurants fared worse than fast-food restaurants in these, and many other risk categories.

  • Fast Food
    • 61% poor personal hygiene
    • 77 % improper holding of foods, primarily due to:
      • 62% refrigerated foods at improper temperature
      • 59% foods not cooled properly
  • Full-Service Restaurants
    • 77% poor personal hygiene
    • 94% improper holding of foods, primarily due to:
      • 80% refrigerated foods at improper temperature
      • 69% foods not cooled properly
      • 64% refrigerated RTE foods not properly date marked or discarded within seven days of preparation or opening

Continuing our focus this week on risks at retail and food service operations, the FSIS guidance referenced above was developed to assist retail deli operators in the prevention and control of Listeria monocytogenes (Lm); however, similar to the FDA study, FSIS notes both lack of proper employee practices (focused primarily on hand hygiene) and improper food handling and holding as being key sources of contamination in delis.

Additionally, the recommendations from both FDA and FSIS focus on having active managerial controls as part of a well managed Food Safety Management System, which can help reduce contamination and the occurrence of foodborne illness risk factors. In fact, the FDA study specifically found that “Having well-developed Food Safety Management Systems (FSMS) were the strongest predictor that risk factors would be minimized.”

As detailed in both the FDA and FSIS documents, “Active managerial control means the purposeful incorporation of specific actions or procedures by industry management into the operation of their business to attain control over foodborne illness risk factors.” Particularly, this means having a preventive rather than reactive approach to food safety through a continuous system of monitoring and verification, with the implementation of consistent procedures, training, and monitoring. The FDA study also showed that establishments with well-developed FSMSs had significantly fewer food safety behaviors/practices out-of-compliance than did those with underdeveloped and non-existent FSMS.

Additionally, FSIS notes that HACCP principles contain many key elements for establishing active managerial control and effective food safety management system by identifying, evaluating, and controlling food safety hazards that are likely to cause illness if not properly controlled.

From the FDA study, which is reinforced, not only by the FSIS documentation, but also by what TAG itself has seen in retail/foodservice establishments, it is evident that there remains a need for better control over employee hygiene focused primarily on handwashing (both when and how to wash properly) and on cold handling and cooling of food requiring refrigeration. And following the guidance and recommendations from FDA and FSIS and developing and/or assessing your Food Safety Management System and active managerial controls are two key elements of mitigating contamination and foodborne illness disease factors.

Historically, regulatory agencies have not focused on risks at retail and food service to nearly the same extent as they have on manufacturing and processing. One of the major challenges around overseeing food safety at retail and food service is that there are so many more establishments than in manufacturing and processing. Personnel turnover is much higher, and resources and expertise are often much less. 

However, the consequences to a restaurant or a retailer for a food safety error can be catastrophic in terms of lost sales and reputation in the local market in which it operates. Impact can be even greater if it is a brand that operates in multiple locations. So, these risks clearly should not be taken lightly, and assessing your level of control of these risks and looking for solutions is important to protect your brand.

If you have systems that could benefit from an assessment or would like assistance in developing your systems, give TAG a call. We have the experts and expertise to help.


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