ATVRES Recurrent Critical Violations of the Food Code in Retail Food Service Fstablishments

Records of restaurant inspections by public healtb departments provide sequential "snapshots" of conditions in retail food service establishments that can be used to identil)' risk factors and evaluate the effectiveness of interventions. Data from a random 10 percent sample of restaurant inspection files from 31 counties in Oklahoma, including 4,044 inspections conducted during 19962000 in "medium-risk" and "bigh-risk" establishments, were analyzed to determine rates of critical violations and recurrent violations for different categories of estahlisbments. Repeat violations accounted for about half of all violations. Estahlisbments subjectively designated as high risk by healtb department personnel were in fact found to have higher violation rates than those described as medium-risk establishments. Outside Oklahoma County, regional cbain restaurants were significantly more likely than other restaurants to bave recurrent violations of critical items related to food-holding temperature, hygiene practices, sanitization, and hygiene facilities. Differences observed in violation rates among individual establishments were not primarily attributable to inconsistent enforcement by individual inspectors; rather, they appeared to be indicative of real differences in bygienic conditions and practices. Introduition Restaurant inspection is a public health activity intended lo prevent foodborne illness. In addition to its primary function as a public health intervention, the inspection process generates a written record of conditions observed in food service establishments. Inspection records have been used retrospectively in studies to assess the effect that increased inspection frequency and food handler training have on inspection scores (Campbell et al., 1998) and the effect that altered enforcement consequences have on inspection scores (Fielding, Aguirre, & Palaiologos, 2001). Inspection records have also been used in case-control studies of the antecedents of foodborne-illness outbreaks in restaurants in tbe United States and the United Kingdom. Studies in Seattle &r King County (Irwin, Baliard. Crendon, & Kobayashi, 1989) and Los Angeles County (Buchhoiz, Run. Kool, Fielding, &: Mascola, 2002) found a significant relationship between the occurrence of foodborne-illness outbreaks from food service establishments and violations, low inspection scores, or both; in contrast, a case-control study of Chinese restaurants in Scotland did not find a significant relationship between inspection scores and outbreaks of infection with two rare strains oi Salmonella enteritidifi (Mullen, Cowden, Cowden,& Wong, 2002). Although inspection reports present a rich source of information on operations at retail food service operations, the completeness and consistency of inspections are open to question. In addition, even the most thorough inspection by a public health agency represents only a "snapshot" of operations at a food service establishment. Day-to-day protection of public health relies upon the implementation of food safety practices by the food service establishments themselves. The study reported here was based on the premise that by viewing these "snapshots" sequentially, investigators could identify differences among establishments in routine food safety performance. Recurrent violations of selected Food Code items during a defined period were 24 \'{)kimt'68 • Number 10