Further to this metric, the CDC estimates that 70 percent of the “illnesses” occur due to failures in food service operations.  Probably, the two most memorable events were the 1993 Washington state Jack-in-the-Box contamination event that killed four children and sickened at least 700 due to E. coli-tainted meat coupled with improper burger cooking to kill the bacteria and then in 2006, when 71 people became ill with E. coli after eating at Taco Bell restaurants in four states that had served contaminated lettuce.

These two events were major, but CDC figures suggest that there are thousands or millions on a much smaller scale that do not hit our radar screen.  Most recently, a new report from the Hollin’s University (Roanoke, Virginia) found 48 percent of machine beverages tested contained coliform bacteria … begging the question as to how and how often are these machines cleaned?

The FDA has issued several guidelines for food service personnel that are aimed at reducing consumer bacterial contamination.  While a variety of publications have occurred since 1934, the FDA began publishing a “Food Code” in 1993 that was recommended by the U.S. Public Health Services for regulatory operations providing food directly to the consumer.  One can view this 698 page document on the internet or purchase it from the FDA for $69.  The 2009 full version (the seventh since 1993) was recently published. There have been numerous supplemental updates between the full versions.

The “Code” covers the following areas:  Food handling and preparation–sources, receiving, storage, display, service, and transportation; personnel–health, personal cleanliness, clothing, hygiene practices; equipment and utensils–facilities and equipment; utilities and services–water, sewage, plumbing, restrooms, waste disposal, integrated pest management; construction and maintenance–floors, walls, ceilings, lighting, ventilation, dressing rooms, locker areas, storage areas; foodservice units–mobile and temporarily units, and compliances procedures–foodservice inspections and enforcement actions.

As of April 2009, the Association of Food and Drug Officials reports that 48 of the 50 States (96 percent) have adopted codes patterned after the 1993, 1995, 1997, 1999, 2001 or 2005 versions of the Food Code and represent 95.7 percent of the U.S. population. Of the remaining two States, North Carolina and Kentucky are actively pursuing Food Code adoption Rulemaking.   

While almost all of the 50 States have adopted at least one version of the Food Code, only 43 states (84 percent of the U.S. population) have adopted a Code more recent than 1999.

Fourteen have adopted the 1999 Food Code, representing 15.2 percent of the U.S. population. Twenty have adopted the 2001 Food Code, representing 57.7 percent of the U.S. population. Nine have adopted the 2005 Food Code, representing 11.0 percent of the U.S. population. Five have adopted an earlier version of the Food Code.

Since the Code is intended to help state health departments develop regulations for their food service inspection program, there is a variance in the enforcement, penalties and infraction severity from state-to-state.  Many states and communities, as well as independent companies, offer training that can include individual “certification” for best food handling services, but what is the incentive to become certified?

Local and state communities conduct near annual inspections of restaurants in most cities.  I am sure that most of you have seen in some restaurant windows a prominent A, B, or C card in the window where the “Grade” reflects how well a restaurant complies with the local health and state sanitary code.  I always thought these “grades” were made on a consistent set of criteria, but this is not the case, so a grade of an “A” in a restaurant in New York City may not mean the same as an “A” grade in Los Angeles.   Specifically, to maintain an “A” Grade in Manhattan, the restaurant may not receive more than 14 demerits. A severe violation has a score of 7, a critical violation a score of five and a general violation a score of two.   In LA, an “A” rating is achieved with a score of 90 to 100 points. Major violations receive a six point reduction, minor violations a four point reduction and general violations a one point reduction.  The definitions for each category vary, but in both cases, a restaurant can attain an “A” rating with one infraction in their highest category and one in their next highest category.  Does this sound like an “A” to you?

In NYC, if the restaurant does not attain an “A”, it has 30 days to correct the infractions and in the interim does not have to put the “B” or “C” card on display.

Summarizing, foodservice contamination accounts for about 70 percent of food-related illnesses.  The FDA has published a massive Food Code document since 1993 to help states improve food safety, yet less than 20 percent of the states have adopted the latest code and 2 states, after 17 years are still “in process.” I wonder how many people have actually read the entire 698 page document?

States or local statues, regulations, and ordinances vary from state-to-state, and the restaurant rating system is not consistent between states or localities–and an “A” rating allows at least one severe infraction without penalty–either financially or in immediate loss of the rating.

In today’s economy every business is trying to reduce costs to remain profitable and in some cases, just to stay in business.  This is no different in the foodservice industry.  The restaurant owner desires to provide the consumer with a pleasant food experience and make money.  Given the foodservice inspection process, one can easily see that the restaurant owner may not be giving food safety his/her number one priority, but if there was a direct monetary incentive to pay more attention to food safety, would this change the food service owner’s priorities?  

Some tempting incentives might be a 10 to 20 percent federal and/or state tax credit for a 100 percent report card–no infractions during an inspection; a five to 10 percent federal and/or state tax credit for having all personnel “certified” food servers; or a guarantee to serve local and state functions for a year … these could be all levels of foodservice for a variety of events.

While incentives may not be the silver bullet to significantly improve food safety, maybe a new method is in order to raise the priority of food safety on every food server’s menu. 

• In 2006, E. coli contamination was found in packaged spinach that made 300 people sick in 26 states and caused 3 deaths.

• In 2007, Tyson recalled 40,000 pounds of beef in 12 states due to E. coli contamination

• In 2008, Topps Meats recalled 21 million pounds of beef due to E. coli contamination that resulted in the closing of that company.  Also, this year, there were recalls of lettuce and spinach produce due to Salmonella contamination.

• In early 2009, King Nut had a massive recall for Salmonella-contaminated peanuts that recorded 399 cases in 42 states.

Over the past three months, several incidents were reported.  Between November 2009 and January 2010, over 2.8 million pounds of meat products were recalled due to contamination by E. coli or Salmonella and in February 2010, 225 people in 44 states were determined to have been sickened by Salmonella in imported black pepper used in the preparation of salami and other types of Italian sausage made by a company in Rhode Island.

In 1999, the Centers for Disease Control and Prevention claimed that 76 million people are infected with bacterial contamination annually, resulting in 325,000 hospitalizations and 5,000 deaths!  (At that time, the pathogens most responsible for contamination were Camylobacter jejuni, E. coli O157:H7, Listeria monocytogenes and Cyclospora cayetanensis).

Most authorities contend that there is significant under-reporting and the statistics have increased dramatically as the only major contamination event reported prior to the CDC report was the Sara Lee incident.  Also, almost all recent contamination events are attributed to either E. coli, Salmonella, and Listeria.

Most people believe the growth in the number and magnitude of contamination events is attributed to a combination of several factors that include: (1) the increased globalization of food sources, (2) the lack of federal regulations regarding food quality, and (3) the desire for food processors to increase revenue and profits, thereby reducing quality controls to ensure the consumer obtains “safe food.”  To add to the dilemma, a report recently released by a former U.S. Food and Drug Administration (FDA) economist indicated that food-related illnesses are estimated to cost the United States $152 billion annually in health care and other losses.

Our government is taking some actions, but probably not enough to make a significant difference.  President Obama has requested a 30 percent increase in funding in 2011 for the FDA food safety programs.  According to the agency, the budget will invest approximately $1.37 billion to strengthen food safety efforts, up $318.3 million from 2010 while FSIS (U.S. Department of Agriculture’s Food Safety and Inspection Service), on the other hand, would receive a less than 2 percent increase of $18 million to $1.046 billion for 2011, compared to $1.028 billion in 2010. 

The increase in contamination events prompts the questions, how can it be prevented and how is testing done today.  Researches are constantly investigating treatment methods that would kill bacteria before the food product is shipped to the consumer, but thus far none have been successful without adversely affecting the taste or structure of the food product.  So, inspection is the only viable method today. 

About 80 percent of the testing is done the way most of us learned in high school biology.  A meat sample is shipped to a test lab where a “scraping” is cultured in accordance with established methods in a Petri dish.  In roughly 24-72 hours, if bacteria are present in the sample it will appear in the Petri dish.  A trained microbiologist will take a sample, place it on a glass slide, examine it under a microscope, and determine the number and identification of the bacteria present.  Considering transportation time and test lab queues, results may not be available for a week or more and even if a contamination event is recorded, a confirmation test is done before any action is taken.  Since food processors do not “hold” inventory, a confirmed contamination results in recall. Coupling this to the fact that only small samples are taken for examination, it is quite possible a contaminated product could elude the inspection process.

Several companies have developed quicker methods, the most popular being the DNA testing otherwise known as Polymerase Chain Reaction (PCR) diagnostic systems. PCR systems entered the market over 10 years ago, but in a conservative, cost-conscious industry, acceptance is slow.  According to an industry consulting firm, rapid microbial identification processes only make up about 20 percent of all testing done.  In 2007, this represented over 630 million tests that is growing at a rate of about 10 percent per year.  PCR systems typically perform an ID in 36 to 48 hours with greater than 90 percent accuracy at a cost per test of about $10.  Some new systems can complete the whole process in 10 hours but at a cost of as high as $45 per test and a capital cost exceeding $40,000.  The test cost is driven mostly by the specific reagents or chemicals and the sample equipment needed to perform an ID.  A novel test method uses the principles of multi angle laser light scattering combined with proprietary algorithms to perform an ID.  The entire ID process takes less than 10 minutes and since no chemicals or reagents are used, the cost per test is about 10 cents.  The capital cost of the System is significantly cheaper than the lowest priced PCR System.  Other rapid methods exist with a cost per test as low as $2, but are compromised in either accuracy or specificity. 

Most rapid test methods are validated by independent agencies.  AOAC Research Institute (RI) is probably the one most respected in the industry.  They create a test protocol that rigorously tests the “method” for accuracy and robustness.  The accuracy testing is done by two different sources. If an inconsistency in the test results occurs, the testing is either redone or a “referee” within the AOAC RI organization together with inputs from the two test sources decides if the “method” should be certified. 

Cost effective, reduced time inspection systems are highly desired with the goal of preventing contaminated food from ever reaching the consumer.  Improved food test methods won’t solve all the problems, but they will certainly reduce the amount of annual illnesses and thereby reduce health care costs.