Food Protection Trends - December 2009 - 841

INTRODUCTION According to the Canadian Restaurant and Food Association (CRFA), the average Canadian household patronizes a restaurant for a meal or snack 536 times per year (8). In the United States, 44% of adults eat out at a restaurant daily, and more than 40% of foodborne illness outbreaks reported from 1993–1997 were linked to public food establishments (14). A United Kingdom government report indicated that “eating out is a very important source of food poisoning” (5). Therefore, ensuring the safety of food consumed outside the home should be a priority. The potential economic impact of foodborne illness is indeed substantial in both Canada and the United States. In Canada, it is estimated that approximately 11–13 million cases of foodborne illness occur annually (11). Toronto Public Health reported over 16,700 cases of enteric foodborne illness between 2000 and 2004 (25). In the US, foodborne illness causes approximately 76 million illnesses each year (17). The costs associated with foodborne illness in the US are an estimated $7.7–23 billion per year to consumers, the food industry and the economy (7). Some of the risk factors that contribute to foodborne illness include improper reheating and heating, inadequate hot-holding, and cross-contamination (5). According to Taylor, most food poisonings result from food handler error, which may be mitigated with food safety training (22). These factors may be directly controlled and influenced by food handlers. Therefore, Food Handler Certification courses are beneficial because they provide participants with the knowledge to identify and mitigate the risks that may contribute to foodborne illness (18). The Ontario Ministry of Health and Long Term Care (MOHLTC) has identified the benefits of food handler training to include a reduction in foodborne illness; prevention of hazards during food preparation; early identification of potential hazards; and a decrease in consumer complaints (18). The Ontario MOHLTC Programs & Services Guidelines require the local Public Health Unit to provide a food handler training course or to refer members of the public to a resource that pro- vides training. In Ontario, the minimum food-handler training course requirements must include these components: The Role of the Local Health Department, Public Health Legislation, Safe Handling, Preparation and Storage of Food, Food Handler Hygiene and Food Premises Sanitation (18). Since 1999, the Ontario MOHLTC has examined proposals for mandatory Food Handler Certification, but to date these proposals have not been implemented. Despite this, a number of provinces in Canada, including British Columbia, Saskatchewan, Nova Scotia and Alberta, have mandatory Food Handler Certification. As an alternative, Food Handler Certification programs may also be implemented at the municipal level. This is the case in Brantford, Winnipeg and Toronto, where mandatory Food Handler Certification was implemented in September 2006. The by-law (City of Toronto, Municipal Code, Chapter 545) requires that “every owner or keeper of an eating and drinking establishment shall ensure that there is, at all times when the establishment is operating, at least one certified food handler working in a supervisory capacity in each area of the premises where food is prepared, processed, served, packaged or stored”(2). In the US, most states rely on local public health departments to provide training for food handlers. Training programs sponsored by the health department are made available, but, in most cases, the training is the left in the hands of the operators/owners of food service establishments (1). As of 2004, seventeen states, including California, Washington, D.C., Florida, Pennsylvania and Washington State, had introduced mandatory Food Handler Certification in the US. Other states are in the process of developing programs (1). Research has been conducted in an attempt to determine if there is a correlation between certified food handlers and inspection scores (Table 1). For example, Riben et al. (20) conducted a critical appraisal of literature pertaining to the effectiveness of food handler training and routine restaurant inspections. As a result of this literature appraisal, the following recommendations were made; more research should be conducted to prove the effectiveness and efficiency for both routine inspections and training, and training should continue because, although weak, there is evidence that suggests a positive correlation between Food Handler Certification of managers and staff and inspection scores (20). Since this appraisal of the literature, a number of studies have concluded that food-handler training may have a significant impact on inspection scores (6, 12, 14, 15, 21, 23). In contrast, studies such as those of Frash et al. (9) and Powell et al. (19) have determined that training has no substantial impact on inspection scores (Table 1). In Canada, Mathias (15) conducted one of the largest studies of its kind with 630 restaurants across three provinces and twenty-one health unit jurisdictions. The formal education and level of food safety training and certification of food handlers were surveyed. It was determined that the restaurants with certified food handlers had better inspection scores than restaurants with staff that were uncertified (15). Similarly, another Canadian study completed by Thompson et al. (23), analyzed data from the Toronto Healthy Environments Information System (THEIS) to determine the impact of Food Handler Certification on inspection results. Analysis of 8,498 inspection records found an association between having at least one certified food handler and obtaining a pass notice during an inspection; premises with at least one certified food handler were 2.2 times more likely to receive a pass notice that those without (23). In fact, 93% of premises with at least one certified food handler received a pass notice on initial inspection, in comparison to 85.7% of those without at least one certified food handler (23). In another study conducted by Hedburg et al. (12) and the Environmental Health Specialists Network working group, a comparison was made between food-handling practices and characteristics in outbreak and non-outbreak restaurants. Differences that impacted food safety were noted (12). Data collected included food-handler training and certification. The presence of certified kitchen managers was associated with decreased risk for an outbreak; 71% of non-outbreak restaurants had certified kitchen managers, in comparison to 32% of outbreak restaurants (12). DECEMBER 2009 | FOOD PROTECTION TRENDS

Food Protection Trends - December 2009

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