Model Food Code Research Articles

Assessing Employee Health Policies and Practices in Foodservice Establishments

The aim of this study was to investigate current practices in the food industry regarding the development and implementation of food safety management systems, with a focus on employee health policies. Specifically, this study assessed written employee health policies and practices that retail food establishments used to mitigate the risk of foodborne illnesses. Surveys were distributed, and 14% (76/538) of the surveys were returned by senior food safety leaders, representing 336,268 restaurant, grocery, and convenience store outlets. The majority of participants represented larger franchises or chains. Results showed most participants (98.4%) reported having written employee health policies, with most policies based on the U.S. Food and Drug Administration’s Model Food Code and Annex. Most participants (98.3%) agreed that their employee health policy stipulated exclusions and restrictions for food employees based on their health and activities as they relate to diseases transmitted through food; however, fewer (87.7%) policies had provisions for removing such exclusions and restrictions. The survey also revealed the use of novel approaches to promote handwashing and the frequency with which conditional employees are made aware of reporting requirements. Taken as a whole, the survey highlights opportunities to improve employee health policies and increase awareness of reporting requirements for employees in the retail food industry.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

Validation of a Simple Two-Point Method To Assess Restaurant Compliance with Food Code Cooling Rates

Outbreaks from improperly cooled foods continue to occur despite clearly described Food Code cooling guidelines. It is difficult for regulators to enforce these guidelines because they are typically in an establishment for less than the 6 h needed to document proper cooling. Prior research proposed using a novel method to estimate cooling rates based on two time-temperature points, but this method has not yet been validated. Time-temperature profiles of 29 different foods were collected in 25 different restaurants during cooling. Cooling curves were divided into two categories: typical (21 foods) and atypical (eight foods) prior to further analysis. Analysis of the typical cooling curves used simple linear regression to calculate cooling rates. The atypical cooling profiles were studied using Monte Carlo simulations of the cooling rate. Almost all linearized typical cooling curves had high (>0.90) R2 values. Six foods with typical cooling profiles that did not pass Food Code cooling times were correctly identified by the two-point model as having slow cooling rates. Three foods that did not pass Food Code cooling times were identified by the two-point model as having marginal cooling rates. Ten of 12 foods identified by the two-point model as having acceptable cooling rates met Food Code cooling times. Most (six of eight) foods that were considered to have atypical cooling curves failed to meet the Food Code cooling times. The two-point model was also able to determine whether these foods would fail based on Food Code guidelines depending upon the simulation criteria used. Our data show that food depth has a strong influence on cooling rate. Containers with a food depth ≥7.6 cm (3 in.) were more likely to have cooling rates slower than the U.S. Food and Drug Administration Model Food Code cooling rate. This analysis shows that the two-point method can be a useful screening tool to identify potential cooling rate problems during a routine restaurant inspection visit.

Good Worker Health and Hygiene Practices: Training Manual for Produce Handlers

The goal of this first Edition of Good Worker Health and Hygiene Practices: Training Manual for Produce Handlers is to provide owners, managers, and/or supervisors in Florida's produce industry a training tool for their workers. Drawn from many sources in the subject area including the FDA-GAPs, FDA-GMPs, FDA Model Food Code, recommendations from the American College of Occupational and Environmental Medicine, and other publications from federal government agencies, this manual is designed to be a reference to accompany the other educational materials included in the UF/IFAS Worker Health and Hygiene Training Program. This document is FCS8769, one of a series of the Family, Youth and Community Sciences Department, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Original publication date May 9, 2005.

Assessment of Risk Communication about Undercooked Hamburgers by Restaurant Servers

According to the U.S. Food and Drug Administration 2013 Model Food Code, it is the duty of a food establishment to disclose and remind consumers of risk when ordering undercooked food such as ground beef. The purpose of this study was to explore actual risk communication behaviors of food establishment servers. Secret shoppers visited 265 restaurants in seven geographic locations across the United States, ordered medium rare burgers, and collected and coded risk information from chain and independent restaurant menus and from server responses. The majority of servers reported an unreliable method of doneness (77%) or other incorrect information (66%) related to burger doneness and safety. These results indicate major gaps in server knowledge and risk communication, and the current risk communication language in the Model Food Code does not sufficiently fill these gaps. The question is "should servers even be acting as risk communicators?" There are numerous challenges associated with this practice, including high turnover rates, limited education, and the high stress environment based on pleasing a customer. If servers are designated as risk communicators, food establishment staff should be adequately trained and provided with consumer advisory messages that are accurate, audience appropriate, and delivered in a professional manner so that customers can make informed food safety decisions.

Validation of Mathematical Models for Salmonella Growth in Raw Ground Beef under Dynamic Temperature Conditions Representing Loss of Refrigeration

Temperature is a primary factor in controlling the growth of microorganisms in food. The current U.S. Food and Drug Administration Model Food Code guidelines state that food can be kept out of temperature control for up to 4 h without qualifiers, or up to 6 h, if the food product starts at an initial 41°F (5°C) temperature and does not exceed 70°F (21°C) at 6 h. This project validates existing ComBase computer models for Salmonella growth under changing temperature conditions modeling scenarios using raw ground beef as a model system. A cocktail of Salmonella serovars isolated from different meat products (Salmonella Copenhagen, Salmonella Montevideo, Salmonella Typhimurium, Salmonella Saintpaul, and Salmonella Heidelberg) was made rifampin resistant and used for all experiments. Inoculated samples were held in a programmable water bath at 4.4°C (40°F) and subjected to linear temperature changes to different final temperatures over various lengths of time and then returned to 4.4°C (40°F). Maximum temperatures reached were 15.6, 26.7, or 37.8°C (60, 80, or 100°F), and the temperature increases took place over 4, 6, and 8 h, with varying cooling times. Our experiments show that when maximum temperatures were lower (15.6 or 26.7°C), there was generally good agreement between the ComBase models and experiments: when temperature increases of 15.6 or 26.7°C occurred over 8 h, experimental data were within 0.13 log CFU of the model predictions. When maximum temperatures were 37°C, predictive models were fail-safe. Overall bias of the models was 1.11. and accuracy was 2.11. Our experiments show the U.S. Food and Drug Administration Model Food Code guidelines for holding food out of temperature control are quite conservative. Our research also shows that the ComBase models for Salmonella growth are accurate or fail-safe for dynamic temperature conditions as might be observed due to power loss from natural disasters or during transport out of temperature control.

Utilization of Mathematical Models To Manage Risk of Holding Cold Food without Temperature Control

This document describes the development of a tool to manage the risk of the transportation of cold food without temperature control. The tool uses predictions from ComBase predictor and builds on the 2009 U.S. Food and Drug Administration Model Food Code and supporting scientific data in the Food Code annex. I selected Salmonella spp. and Listeria monocytogenes as the organisms for risk management. Salmonella spp. were selected because they are associated with a wide variety of foods and grow rapidly at temperatures >17°C. L. monocytogenes was selected because it is frequently present in the food processing environment, it was used in the original analysis contained in the Food Code Annex, and it grows relatively rapidly at temperatures <17°C. The suitability of a variety of growth models under changing temperature conditions is largely supported by the published literature. The ComBase predictions under static temperature conditions were validated using 148 ComBase database observations for Salmonella spp. and L. monocytogenes in real foods. The times and temperature changes encompassed by ComBase Predictor models for Salmonella spp. and L. monocytogenes are consistent with published data on consumer food transport to the home from the grocery store and on representative foods from a wholesale cash and carry food service supplier collected as part of this project. The resulting model-based tool will be a useful aid to risk managers and customers of wholesale cash and carry food service suppliers, as well as to anyone interested in assessing and managing the risks posed by holding cold foods out of temperature control in supermarkets, delis, restaurants, cafeterias, and homes.

Using a theoretical predictive tool for the analysis of recent health department inspections at outbreak restaurants and relation of this information to foodborne illness likelihood.

Because U.S. restaurants are inspected at least annually against criteria in the U.S. Food and Drug Administration Model Food Code, large amounts of data are generated and should be systematically reviewed. The purpose of this study was to determine the relationships among the data obtained through health department inspections, the contributing factors to foodborne illness identified by the Centers for Disease Control and Prevention, and the risks of outbreaks of norovirus, Salmonella, and Clostridium perfringens infection associated with a specific restaurant. These agents were chosen for the analysis because they cause the majority of foodborne illnesses. A theoretical predictive assessment tool was built that extracts data from routine health department inspection reports for specific restaurants to establish a risk profile for each restaurant and identify the likelihood of a norovirus, Salmonella, or C. perfringens outbreak at that restaurant. The tool was used to examine inspection reports from restaurants known to have had confirmed norovirus, Salmonella, and C. perfringens outbreaks. Although evaluation of an extensive data set revealed lack of an overall association between outbreak inspection scores and routine inspection scores obtained at outbreak restaurant locations, certain specific violations were significantly more likely to be recorded. Significant differences in types of violations recorded during outbreak and routine inspections were determined. When risks based on violation type can be identified, targeted actions may be able to be prioritized and implemented to help decrease illnesses.

Identifying baseline food safety training practices for retail delis using the Delphi expert consensus method

With the seriousness of foodborne illness risk in the deli industry, more emphasis is being placed on food safety training for deli employees. It is critical to identify the minimal, baseline training that must be given to every new employee in order to keep the public safe from foodborne illnesses. Food safety objectives (286) were obtained based on the 2009 United States Food and Drug Administration Food Code and four online food safety training platforms, and were screened by expert Beta panelists to 75. These were presented to 15 experts currently working in or managing retail delis in a three round modified Delphi technique by means of Qualtrics survey software. Delphi is a unique method to develop group consensus for what should be included in subject matter where precise information is not readily available. In the first Delphi round none of the objectives, including those from the FDA Model Food Code, reached the consensus level. A 5-point Likert scale was used to identify the relevance of each deli specific, food safety objective. The results of our statistical analysis were presented to the expert panel before each subsequent Delphi round, so that by the third iteration, 53% of the panelists agreed with the inclusion of particular deli specific training objectives. Fifty-eight of the 75 training objectives achieved at least a 70% consensus rate. None of the current online food safety training materials addresses deli specific content. The results of this research could serve as a guideline when food safety instructors in deli operations develop their own training materials or to identify key concepts in existing training platforms.

Observational study of food safety practices in retail deli departments.

In order to improve the safety of refrigerated ready-to-eat food products prepared at retail deli departments, a better understanding of current practices in these establishments is needed. Food employees in deli departments at six chain and three independent retail establishments in Maryland and Virginia were observed, using notational analysis, as they prepared deli products for sale. The frequency of contact with objects and deli products before sale, hand washing and glove changing during preparation, and equipment, utensil, and surface cleaning and sanitizing was determined. Compliance with the U.S. Food and Drug Administration's 2005 model Food Code recommendations, which must be adopted by the individual state and local jurisdictions that are responsible for directly regulating retail establishments, was also assessed. Observations indicated there were a large number of actions for which hand washing was recommended at independent and chain stores (273 recommended of 1,098 total actions and 439 recommended of 3,073 total actions, respectively). Moreover, 67% (295 of 439) of the actions for which hand washing was recommended at the chain stores and 86% (235 of 273) of those at the independent stores resulted from employees touching non-food contact surfaces prior to handling ready-to-eat food. Compliance with hand washing recommendations was generally low and varied depending on store type with independent stores exhibiting lower compliance than chain stores (5 instances of compliance for 273 recommended actions and 73 instances of compliance for 439 recommended actions, respectively). Potential risk mitigation measures that may reduce the frequency of hand washing actions needed during ready-to-eat food preparation in retail deli departments are discussed. More research is needed to determine the impact of such measures on food safety.

Restaurant Industry Preparedness Against Intentional Food Contamination

Food safety and food defense are both responsibilities of public health agencies. Food safety practices within restaurants are regulated by state and local public health laws based on the US Food and Drug Administration Model Food Code. However, little is known about preemptive practices against intentional food-borne outbreaks within restaurants. The researchers administered a survey to a 50 percent random sample of South Carolina's restaurants, a state that relies heavily on tourism and the restaurant industry for its economic well-being. The survey received a response rate of 15 percent. The food defense practice items fall under three functional categories: employee management and training practices; vendor and delivery-related practices; and physical facilities and operational security practices. This study presents the results, classified by geographic region. Findings indicate some key areas of vulnerability that need attention to protect the public from mass food outbreaks due to intentional contamination. Of concern, there is much variation in practices by geographic region. On the basis of the survey, recommendations are made to improve restaurant preparedness against food-borne outbreaks from terrorism and malevolent contamination.

Preventing Allergic Reactions to Foods: The Development and Evaluation of a Fact Sheet for Food Service Operations

P-087 Abstract: Food allergies are a common, serious—and sometimes fatal–problem. Nearly 7 million Americans have food allergies. Among children under the age of 6, 1 in 12 has a food allergy. Fortunately, most have mild allergies and may experience a runny nose, sneezing, itching skin, hives, or digestive upset. But, for those who are severely allergic, exposure to a ‘trigger’ food may cause life-threatening reactions, such as an asthma attack or swelling of the tongue, lips or throat. In fact, severe allergic reactions (known as anaphylaxis) to nuts cause 100 deaths annually. Those with food allergies must avoid allergen-containing food. Eating away from home can make this avoidance difficult, especially if food service personnel do not know how to safely serve customers with food allergies. Little research has addressed baseline food allergy knowledge and practices of food service personnel and few educational materials are available. Therefore, the purpose of this study was to describe the importance food service personnel place on serving allergen-free orders and the information food service personnel need to prevent triggering food allergic reactions in their customers. Trained interviewers conducted key informant interviews with food service managers (N=33) in operations including quick service, fine dining, and school lunch using a guided interview protocol. During the ∼30-minute interview, managers rated the importance of food service personnel knowing how to handle allergen-free orders, described information most important for food service personnel to know about handling allergen-free orders, and described the desired format of related educational materials. Managers rated knowing how to handle allergen-free orders as very important (mean= 4.6±0.8 on 5-point Likert-scale). Qualitative analysis revealed the most important educational messages were: food allergies are a serious health issue; food allergens can be almost any food (including identification of common food allergens and their possible presence as “hidden ingredients”); and steps to ensure allergen-free orders. Managers indicated educational materials should be serious in tone, use photographs, be reproducible, durable, and in at least English and Spanish. Interview findings were used to create a factsheet for food service personnel. Factsheet drafts were evaluated by food service managers and physicians, then refined. The final factsheet complies with the 2005 Model Food Code published by the Food and Drug Administration. In addition, the factsheet has been legislatively mandated to be distributed to all food service operations in the state of New Jersey to help food service personnel avoid triggering food allergic reactions.

Strategies to control Salmonella and Campylobacter in raw poultry products.

Foodborne illness is a major public health concern. The largest number of foodborne illness cases attributed to poultry and poultry products are caused by paratyphoid serotypes of Salmonella and by Campylobacter jejuni. The effective prevention of foodborne disease requires an understanding that contamination can be introduced into foods at numerous points along the food chain. Since multiple entry points exist for foodborne pathogens, multifaceted intervention approaches are required to successfully control contamination of poultry during the various phases of the growth period and processing procedure of broiler chickens. Strategies during the grow-out period (the period during which day-old chicks are raised to six- to seven-week-old broiler chickens) include sanitation, biosecurity, vaccine and drug therapy, and biological control procedures, such as those aimed at preventing colonisation. There are also many critical control points identified in the processing plant which reduce contamination. These include temperature controls (washer and product), chemical interventions, water replacements and counter-flow technology in the scalder and chiller, and equipment maintenance. Transportation and food handling at retail outlets and by the consumer (i.e., storage at the proper temperature and adequate cooking) are the final critical control points in the farm-to-table continuum. It is important to apply risk reduction strategies throughout the food chain. These include: easing the development and implementation of voluntary animal production 'best management practices', implementing in-plant hazard analysis and critical control point systems, developing effective transportation and refrigeration standards, working to facilitate adoption of the model Food Code in all States and providing educational materials and support for public health activities nationwide.