Two recent studies have provided insight into restaurant inspection practices that may reduce the occurrence of foodborne illness outbreaks. The studies, which were funded through a cooperative agreement between the U.S. Centers for Disease Control and Prevention (CDC) and the National Environmental Health Association (NEHA), found that posting health department restaurant inspection scores at restaurants and using letter grades for restaurant inspection results are linked with fewer foodborne illness outbreaks.

The first study involved a survey of health departments about their inspection practices. Then, in the second study, the survey data was compared against data from the national Foodborne Disease Outbreak Surveillance System (FDOSS) to assess the reproducibility of the survey results.

From January 7–April 6, 2020, the 36-question survey was administered to 790 government-run food establishment inspection programs at state and local levels. Of the 149 survey respondents, 127 (85 percent) represented local food establishment inspection agencies.

In comparison to agencies that only disclosed food establishments’ inspection reports online, agencies that disclosed at the point-of-service (POS) reported fewer mean numbers of reinspections by 15 percent, foodborne illness complaints by 38 percent, outbreaks by 55 percent, and cases of Salmonella infection by 12 percent. Additionally, in comparison to agencies that did not grade inspections, the survey found that agencies that used some type of grading method for inspection results reported fewer mean numbers of reinspections by 37 percent, complaints by 22 percent, outbreaks by 61 percent, and Salmonella cases by 25 percent.

The second study used results from the previously conducted survey as a baseline for an analysis of foodborne illness outbreak data from FDOSS spanning January 1, 2016–December 31, 2018. During 2016 to 2018, there were 2,608 single-state foodborne illness outbreaks reported to FDOSS, with 1,638 attributed to food prepared in a restaurant setting. Of the outbreaks included in the study data, those that occurred in jurisdictions of the survey respondents accounted for 23 percent, and all other jurisdictions accounted for the remaining 77 percent.

The findings of the second study were consistent with the survey results, as the disclosure of graded inspection results at the POS was associated with fewer outbreaks reported to FDOSS. Additionally, FDOSS data revealed that agencies that used a grading system had lower mean numbers of restaurant outbreaks per 1,000 establishments, and agencies that used letter grades had the lowest mean and median numbers of restaurant outbreaks per 1,000 licensed restaurants. However, the study acknowledges its limited ability to distinguish among the grading methods used.

The second study also found a positive correlation between the number of complaints received per 1,000 licensed restaurants and the number of restaurant outbreaks reported to FDOSS, meaning that jurisdictions with higher rates of foodborne illness complaints also had higher rates of outbreaks linked to restaurants. This suggests that the ability to receive and investigate foodborne illness complaints may be an important predictor of the ability of an agency to detect foodborne illness outbreaks. The researchers emphasize the importance of agencies having a mechanism to receive foodborne illness complaints.