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Industry Efforts Reduce Food-borne Illness: Vigilence is Key

When is comes to food safety, common qualifiers such as good trend or bad trend are meaningless and risky. To say that the existence of outbreaks of foodborne illnesses in the United States is a bad trend overlooks the undeniable fact that the number of such incidences in the past decade has actually decreased. On the other hand, to qualify this as a good trend is premature because the industry may inadvertently relax its awareness and preparedness to fight foodborne illness.

ID magazine has determined in its surveys that food safety is one of three major concerns confronting the foodservice industry. With consumers spending a greater percent of their food dollars on eating away from home, operators are more mindful of the drastic effects on their business and the industry of even one illness that has been caused by a foodborne pathogen that was ingested in their eatery.

Dr. Carolyn Manning, a professor of nutrition and dietetics at the University of Delaware, Newark, DE, and a food-safety expert, believes this concern is not misplaced. "The industry must guarantee the safety of its products to the consumer and the consumer is concerned about this, especially with the current food-safety education underway in the public sector," Manning says.

Having said that, let's look at the positive statistics. Food-safety experts concur that the American food supply is the safest in the world. Broad statistics state that there are 76 million reported illnesses in the United States per year, resulting in 325,000 hospitalizations and 1,800 deaths that are attributed to foodborne pathogens. However, with the U.S. population standing at 260 million and three meals being consumed every day, the chances of contracting a foodborne illness is extremely low in any given year for the general population.

Data collected by the Centers for Disease Control and Prevention, Atlanta, the government agency entrusted with monitoring the nation's health, demonstrate that cases of foodborne illness and deaths have been slightly decreasing in the past 10 years. Certainly, when reading government statistics, it is best to understand the terminology. First of all, the data is based on reported cases, those that are severe enough to be recognized by the consumer. Most foodborne illnesses are mild and the person may not seek medical attention to confirm the affliction. Those illnesses that do get reported, for the most part, are those that are major, interstate or restaurant related. A case of foodborne illness is defined as a sick individual. A foodborne outbreak is an incident in which two or more persons experience a similar illness after eating a common food and the epidemiological analysis implicates the food as the source of the illness. One of the exceptions is botulism - one case of botulism, which is the most potent toxin known to man, constitutes an outbreak.

In the most recent 10-year span for which data are available, from 1988 to 1997, the CDC's report called "Surveillance for Foodborne Disease Outbreaks" shows that cases of foodborne illnesses averaged 16,323 per year, with the highest number, 22,607, appearing in 1996, and the lowest, 11,015 and 11,940, occurring in 1992 and 1996. The number of deaths has been decreasing from 19 in 1988 to 2 in 1997.

Steven Grover, vice president of health and safety regulatory affairs for the National Restaurant Association, Washington, DC, sees the statistics as "a pretty steady decline." Grover says, "The CDC has done an enormous effort to capture all foodborne illnesses and still the actual number reported in the five-year summary shows that over the last decade the number of reported foodborne illnesses has gone down slightly. I think that's actually very good news."

Accurate reporting may be one aspect of the downward trend, but Grover also sees the industry's efforts as contributing factor. "We've spent so much time and effort at all parts of the industry, restaurants, distributors, processors, in trying to address these issues. The people who are doing the work everyday and handling the food everyday now have a higher sense of food safety than they did at any other time in our history. The industry efforts are bearing fruit. It's constant attention and focus. You can say the sky is falling but there has been over the past 10 years a greatly increased focus on food safety and it bears fruit at a lot of levels."

The foodservice distribution community should not be on the sidelines in this effort and should "play a vital role," Grover says. "Especially if you look at temperature controls and handling contamination and simply understanding food safety. DSR can play an important role by being an important player and an important advocate for food safety," he notes.

Cathy Kuethman, marketing assistant of Advance Tabco, Edgewood, NY, emphasizes that "the foodservice supply chain, manufacturers, distributors and operators can cooperate in eliminating this problem through continuous education, training, rewards for proper and consistent hand washing. Hand washing should be like breathing to the foodservice worker and it is our job to make sure that this happens."

TOP REASONS
Food-safety experts have determined five principal reasons for foodborne illness. (See chart on page ABC) Dr. Michael Doyle, director of the Center for Food Quality and Safety Enhancement at the University of Georgia, Griffin, GA., and an internationally-recognized authority on foodborne pathogens, has been studying the causes for nearly a quarter of a century. "The reasons differ among outbreaks. Cross contamination is a major reason. Undercooking is another one. Poor practices in personal hygiene, hand washing, are also causes. There are certain organisms that are largely carried by humans. For example, if there is a shigellosis outbreak, it probably came from a food handler because only humans carry that particular pathogen," Doyle points out.

Doyle offers a couple of graphic case studies that demonstrate that employee negligence in handling food properly have contributed to foodborne illnesses. "A woman, who iced cakes in a major grocery store, had long finger nails, and she had diarrhea, and apparently she didn't wash her hands too well because she contaminated enough cakes to make almost 300 people sick. There have been several cases reported in at least one restaurant where meats or poultry were stored above salads and the drippings from the fresh meats dripped onto salads, which were ready to serve. There was no step in there to kill the pathogens."

Doyle believes there are "opportunities for contamination at restaurants at every step of the way. Some restaurants deal with these issues much better than others." Salad bars are a case in point. Doyle says that one restaurant's solution to salad bar hazards was to appoint monitors. "I know one chain that watches salad bars like a lifeguard watches a swimming pool. Monitors are out there actually watching to see how people are handling food at the salad bar. If somebody sticks a finger in the pudding, they remove it. If the food is out on a salad bar for a long period of time without being used up, it will be taken off and a fresh batch will be brought out. They don't replenish it. It's important to take out what's not been used and throw it out rather than put it in the refrigerator for use the next day," Doyle advises.

At McDonald's, the undercooking problem was solved with the introduction of foolproof cooking equipment. "When McDonald's had their old flat grills, they were at the mercy of the grill person to properly cook those hamburgers. That person was to follow a defined protocol and flip the burgers after a certain period of time and take them off the grill after a certain period of time. However, when it's rush hour that person might be under pressure to get those burgers off the grill faster because people are waiting. Sometimes they didn't always cook them, as they should. So McDonald's worked with an equipment manufacturer to develop what's called a clamshell grill and then worked out the protocol for cooking hamburgers at a specific temperature long enough to kill even high levels of e-coli. The grill person could not override this system. The hamburger was put on the grill, the top of the clamshell was brought down and it didn't open up until the hamburgers were cooked for the established amount of time," Doyle relates.

Eliminating or reducing human intervention in cooking is one practical answer to strict adherence to food preparation times. Awareness and education are equally important components of food-safety principles and the NRA's Grover is convinced they've helped to decrease the occurrences of foodborne illnesses. "The first component is education. The success story over the last decade is the NRA ServSafe program. A decade ago we certified about 25,000 people a year in ServSafe. Last year we certified 250,000 people," Grover says. All told, the NRA has certified some 1.5 million foodservice managers, who compose the front line in maintaining food-safety procedures in a restaurant. "We focus on managers. We know that they're the critical component here. We've got to get the managers, we've got to get them educated, they've got to know the principles and then they've got to enforce them and work with their staffs. We're also seeing great success in our employee programs but really it's management that sets the tone. That's been our focus for the past 25 years," Grover emphasizes.

In addition, advises Delaware's Manning, universal commitment ensures food safety. "Real commitment from management, not just in words but in actions. Make safe handling of food the No.1 priority and communicate this on a daily basis and in all activities," she says.

IT'S HANDWASHING, ...
Remember your Mother's admonition, "Wash your hands"? It's still wise advice. Poor or complete lack of personal hygiene on the part of restaurant employees is the third leading factor of foodborne illness and one which can be easily remedied by washing hands.

According to Grover, hand washing and personal hygiene have seen the greatest strides in food-safety awareness. Doyle says that statistics show that washing hands can substantially reduce transmission of pathogens. He has found that some restaurants have special hand-washing devices or gels for cleaning hands. "The operators may require that the worker washes his hands every hour. They may have a monitoring procedure to verify that workers have indeed washed their hands after visiting the restroom," Doyle says. "One company developed a system whereby the employee would have to insert his ID card in a device to indicate that he has washed his hands. We need these devices, so the equipment industry should come up with the ideas."

However, hand washing is not as simple as running water over dirty hands. Advance Tabco's Kuethman cautions that "washing your hands after visiting the lavatory doesn't constitute safe hand washing."

"There are several factors that contribute to the lack of safe hand washing and not being educated on the consequences of not washing hands is one of them. Employees aren't always aware of the consequences of not washing their hands. They know that the manager said that they should wash them but they don't know or understand that someone can get sick even die if they don't. Educating the foodservice employees on the proper techniques and consequences is very important," advises Kuethman.

Advance Tabco and six other industry suppliers are sponsors of the Handwashing Leadership Forum, a Washington, DC-based civic group whose goal is to raise awareness of the risks associated with infrequent hand washing and poor gloving practices in the industry.

Proper hand-washing techniques are composed of three steps, one of which is education and the remaining two are accessibility to hand sinks and elimination of language barriers. Kuethman points out that "hand sinks aren't always readily accessible in a kitchen. When you have customers lined out the door, you don't have the time to walk to the back of the kitchen to wash your hands. Hand sinks located at the front line, in open view of the manager or supervisor and in each food prep area, will assist in promoting safe hand washing."

With growth of non-English-speaking workers in the foodservice industry, Kuethman advises operators to post bilingual English-Spanish signs on mirrors, near the hand sinks that would inform the employees of the crucial need for maintaining clean hands. The Handwashing Leadership Forum also created a silent educational video, which trains employees about the importance of washing their hands and the consequences of not washing their hands.

Kuethman realizes that even an educated employee may not abide by hand-washing procedures so she recommends not only monitoring their behavior but also making the process fun. "During your monthly company meeting have a hand-washing contest. Base it on proper hand washing techniques and put them into action. The winner, who successfully washes their hands, passes the clean-hands test wins free meals for the week," she suggests.

WHAT ELSE IS THERE?
With incidences decreasing and awareness increasing, what's left for the industry to do? To be sure, not sit on its laurels. Grover says that maintaining the high level of awareness is a permanent task. Every Marine readily recognizes the Corps' sacred motto: "Semper Fi!". The foodservice industry would do well to adopt its own motto: "Semper Vi!" or ever vigilant.

"When you're dealing with food safety, the crisis will never be over. One foodborne illness is too many and we have to continue vigilance. There's never a point that we can clap our hands together, go home and say that we've now cured food safety. That isn't going to happen," Grover warns. "We would advocate that vigilance needs to exist permanently. When you're dealing with food safety, the people that can affect the greatest change are those who are growing the food, preparing the food, processing the food, distributing the food and delivering it to the tables, and that includes restaurant staffs and homemakers. From a food safety perspective, those are all the groups that directly impact it."

Grover adds that it is a mistake to evaluate food-safety compliance merely in terms of dollars and cents. He says the cost of implementing food-safety principles is negligible in comparison with the losses. "Cost of noncompliance with food-safety principles could be your business. The restaurant industry is littered with businesses that have been closed by the health department or closed because of a foodborne outbreak. One foodborne outbreak associated with your business, in many cases, is too many. It puts the restaurant out of business. We try not to say what compliance is going to cost you, we say noncompliance is going to cost you your livelihood and the livelihood of everyone who works there," he explains.

Doyle also offers some common sense advise for operators. "We know some foods commonly carry harmful bacteria because it occurs during the processing of the meat. Somehow the harmful content of the intestinal tract contaminates the meat, and usually on the surface. We just have to take it for granted that if it's raw food from animal origin, raw milk, there could be pathogens present," he says. Doyle's other pet peeve is a restaurant that is still willing to cook a hamburger that's red or pink in the middle, which, he explains, constitutes a health hazard, especially for young kids. "Young kids are particularly susceptible. This segment of the population tends to develop kidney failure and these kids will have to go on dialysis and have blood transfusions, some of them will go into a coma and die." But despite all of the warnings about not eating certain types of food, the CDC found that 20-30 percent of consumers still like to eat hamburgers that are red or pink inside.

"The starting point is to tell people what to do. There is always going to be that issue of compliance. However, once people are educated, they actually start putting the procedures into practice," the NRA's Grover urges. "I don't believe education is the end, I believe it's the beginning. I believe that vigilance over the past decade has increased, that people are more focused on food safety than at any other time in our history and we need to continue that."
Semper Vi!

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