04055254760J Environ HealthJ Environ HealthJournal of environmental health0022-0892291167095708856HHSPA898230ArticleImproving Food Safety Through Prevention: CDC’s Food Safety Prevention Status ReportLipcseiLaurenOak Ridge Institute for Science and Education (ORISE) research fellow in EHSB’s Division of Emergency and Environmental Health Services at the National Center for Environmental HealthKambhampatiAnitaORISE research fellow in the Division of Viral Diseases at the National Center for Immunization and Respiratory DiseasesCorresponding Author: Lauren Lipcsei, Division of Emergency and Environmental Health Services/National Center for Environmental Health, 4770 Buford Highway, MS F-58, Atlanta, GA 30341. yus0@cdc.gov88201792016301120177924648
In February 2016, the Centers for Disease Control and Prevention (CDC) released its second set of Prevention Status Reports (PSRs). These reports highlight—for all 50 states and the District of Columbia—the status of public health policies and practices designed to address 10 important public health issues: excessive alcohol use; food safety; motor vehicle injuries; nutrition, physical activity, and obesity; healthcare-associated infections; prescription drug overdose; heart disease and stroke; teen pregnancy; HIV; and tobacco use.
The PSR process identifies policies and practices that, if implemented, would reduce the health and economic impact of these 10 public health issues. The PSRs consolidate information about each state’s policies and practices in a simple format that stakeholders can use to examine their state’s status and identify areas for improvement. A three-level rating system (green, yellow, or red) is used to provide a practical rating of the status of policies or practices related to each of the 10 issues in each state (Figure 1).
Food Safety
As September is National Food Safety Month, we would like to highlight the food safety PSR. The food safety PSR measures the status of select practices and policies that can help states prevent or reduce foodborne illness risk. The food safety PSR focuses on three indicators.
The speed of DNA fingerprinting using pulse-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli 0157,
the completeness of PFGE testing of Salmonella, and
The adoption of select Food and Drug Administration (FDA) Food Code provisions.
In the 2013 PSRs, food safety only included the first two indicators listed above. This year’s PSR, however, introduced the third indicator, which measures state adoption of critical FDA Food Code provisions designed to prevent foodborne illness and outbreaks associated with restaurants and other retail food service establishments. Local, state, tribal, and federal regulators use the FDA Food Code as a model for their own food safety rules and to be consistent with national food regulatory policy.
Specifically, the new indicator assesses whether states have adopted the following four provisions from the 2013 FDA Food Code.
Excluding ill food service staff from working until at least 24 hours after symptoms of vomiting and diarrhea have ended,
prohibiting bare hand contact with ready-to-eat foods,
requiring food service employees to wash their hands, and
requiring at least one employee in a food service establishment to be a certified food protection manager (Food and Drug Administration, 2013).
Ill Workers
Preventing ill workers from working is especially important as certain foodborne illnesses, such as norovirus, can be transmitted even after symptoms have ended. Ill and recently ill food service employees who transmit their illness to others through the food they prepare play a role in almost half (46%) of restaurant-associated outbreaks (Gould, Rosenblum, Nicholas, Phan, & Jones, 2013). Furthermore, infected food workers cause about 70% of reported norovirus outbreaks from contaminated food (Centers for Disease Control and Prevention, 2014).
Bare Hand Contact and Hand Washing
One of the most effective ways to prevent the contamination of ready-to-eat foods (foods that will not be cooked) is through proper hand hygiene practices. Food service employees’ bare hand contact with ready-to-eat foods plays a role in almost a third (30%) of restaurant-associated outbreaks (Gould et al., 2013). And only a third of restaurant workers wash their hands when they should (Green et al., 2006).
Food Protection Manager Certification
In addition to hand hygiene and exclusion of ill food workers, food protection manager certification is important to retail food safety. An accumulating body of evidence indicates that manager certification is related to
increased manager food safety knowledge (Brown et al., 2014),
safer restaurant food preparation practices (Brown et al., 2014),
better inspection scores (Cates et al., 2009), and
fewer foodborne illness outbreaks (Hedberg et al., 2006).
A new CDC infographic illustrates the importance of having a certified food protection manager and provides an overview of certification benefits, including potential cost effectiveness (Figure 2).
PSR Ratings
Analysis of the PSR rating data for this Food Code indicator shows that as of September 2014, 33% of states have a rating of green (full), 31% have a rating of yellow (partial), and 35% have a rating of red (absent) (Figure 3). Further analysis indicates that all states have a provision requiring handwashing, yet
37% do not have a provision excluding ill food service employees from working until at least 24 hours after symptoms have ended,
20% do not have a provision preventing bare hand contact with ready-to-eat foods, and
47% do not have a provision requiring manager certification (Figure 4).
These data suggest that, while all states are showing some progress, there is room for improvement.
The inclusion of this Food Code indicator in the PSR highlights the important role of state food safety rules and regulations. We invite you to review your state’s PSR status and to pay particular attention to the Food Code indicator. Consider working with stakeholders and decision makers to improve your state’s use of the 2013 FDA Food Code by adopting the provisions your state is lacking. Together, we can improve our nation’s food handling practices, which will in turn improve our health.
Reprinted with permission from NEHA
BrownLGLeBWongMRReimannDNicholasDFawBDavisESelmanCA2014Restaurant manager and worker food safety certification and knowledgeFoodborne Pathogens and Disease111183584325361386CatesSCMuthMKKarnsSAPenneMAStoneCNHarrisonJERadkeVJ2009Certified kitchen managers: Do they improve restaurant inspection outcomes?Journal of Food Protection72238439119350984Centers for Disease Control and Prevention2014Preventing norovirus outbreaksRetrieved from http://www.cdc.gov/vitalsigns/norovirus/index.html?s_cid=ostltsdyk_cs_500Food and Drug Administration2013Food codeRetrieved from http://www.fda.gov/downloads/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/UCM374510.pdfGouldLHRosenblumINicholasDPhanQJonesTF2013Contributing factors in restaurant-associated food-borne disease outbreaks, FoodNet Sites, 2006 and 2007Journal of Food Protection76111824182824215683GreenLRSelmanCARadkeVRipleyDMackJCReimannDWStiggerTMotsingerMBushnellL2006Food worker hand washing practices: An observation studyJournal of Food Protection69102417242317066921HedbergCWSmithSJKirklandERadkeVJonesTFSelmanCAthe EHS-Net Working Group2006Systematic environmental evaluations to identify food safety differences between outbreak and nonoutbreak restaurantsJournal of Food Protection69112697270217133814
Three-Level Rating System Used to Rate the Status of State Policies or Practices for Each Prevention Status Report Indicator
Cost Effectiveness Section of the New Centers for Disease Control and Prevention Infographic on Kitchen Manager Certification
State Adoption of the Four Food and Drug Administration Food Code Provisions
State Adoption Status Based on Specific Food and Drug Administration <italic>Food Code</italic> Provisions
Note. Green = state adoption of provision.
Learn More
Learn more about the Centers for Disease Control and Prevention (CDC) Prevention Status Reports (PSRs) and food safety resources and the Food and Drug Administration (FDA) Food Code.