The U.S. Food and Drug Administration (FDA) has published a report on the occurrence of foodborne illness risk factors in fast food and full-service restaurants from 2017–2018. The report reflects the second of three data collection periods for the sector, as part of FDA’s ongoing 10-year study to identify trends in foodborne illness risk factors and food safety behaviors in foodservice facilities.

The data collected in 2017-2018 will be compared to baseline data collected in 2013, which will then be used to assess trends in the occurrence of risk factors during a future third data collection. The study was observational, in which trained data collectors observed and recorded the food safety practices of retail food management and staff using a standardized data collection tool during normal business hours.

Specifically, the objectives of this study are to identify the least and most often occurring foodborne illness risk factors and food safety behaviors/practices in retail food establishments in the U.S., to determine the extent to which a food safety management system (FSMS) and the presence of a certified food protection manager (CFPM) impacts the occurrence of foodborne illness risk factors and food safety behaviors/practices, and to determine whether the occurrence of foodborne illness risk factors and food safety behaviors/practices in retail food establishments differ based on an establishment’s risk categorization and status as a single-unit or multiple-unit operation.

A total of 421 fast food restaurants and 430 full-service restaurants were included in the study. Approximately 70 percent of the restaurants in the study operated in jurisdictions that required a CFPM, and most restaurants (66 percent of fast food and 57 percent of full-service) were found to have a CFPM employed, present, and in charge at the time of data collection.

Of the foodborne illness risk factors investigated in the study, restaurants had the best control over inadequate cooking. Data collectors observed a need to gain better control over improper holding/time and temperature and personal hygiene. Additionally, regarding food safety behaviors/practices, restaurants displayed the best control over ensuring no bare-hand contact with ready-to-eat (RTE) foods and cooking raw animal foods to required temperatures. Still, there remains a need to gain better control over employee handwashing, cold-holding refrigerated foods, and cooling foods properly.

The study found FSMS to be the strongest predictor of compliance, with well-developed FSMSs associated with fewer out-of-compliance food safety behaviors/practice than those underdeveloped or non-existent FSMS.

Restaurants with a CFPM present and in charge at the time of data collection were associated with fewer out-of-compliance food safety behaviors/practices than those whose CFPM was not present and in charge, based upon univariate examination. However, upon multivariate examination, the correlations between CFPM and out-of-compliance became non-significant, indicating that both FSMSs and not the presence of a certified food protection manager predicts compliance with food safety behaviors/practices.

Additionally, restaurants that had a CFPM who was in charge at the time of data collection had significantly better FSMS scores than those restaurants that did not have a CFPM present or employed. In fast-food restaurants with a CFPM who was in charge at the time of data collection, the average FSMS score much higher than those with no CFPM suggesting that having a CFPM present at all hours of operation may enhance FSMSs and reduce the number of out-of-compliance food safety behaviors/practices.

Areas of future study may include identifying antecedents and root causes associated with poor food safety behaviors/practices in restaurants and to determine cost-effective, evidence-based intervention strategies and inspection approaches for improving retail food protection. Further study to understand the relationship between the number and type of employee health policy components and FSMS is also needed. Additionally, the adoption of the Food Code employee health policy recommendations as regulatory requirements in retail food programs may be explored, along with identifying barriers associated with the development and implementation of such policies.