Food Protection Trends - December 2009 - 846

lower than the City of Toronto average of 1.4 for 2001–2005; 0.4 for the NPC and 0.9 for the RSPs, respectively (Table 2). In the case of the NPC, it was 1.97 times less likely to receive notice of infractions during inspections (Table 3). Therefore, the low ratio of infractions/inspection observed for the NPC is consistent with this odds ratio. These ratios (infractions/ inspection) were used to compare the two study groups because the number of inspections per year was not the same for all study groups. Thus, the ratio served as the method of standardization for comparison. Type of infractions The RSPs had more infractions in the top three categories than the NPC (Table 4). Results similiar to these were also seen with inspection reports examined from the Toledo Health Department, 1998–1999. In restaurants without certified food handlers, more infractions were noted for food safety and hygiene, compared with restaurants with certified food handlers (14). In fact, 97% of premises without certified food handlers had one or more critical violations, in comparison to only 3% of restaurants with certified food handlers (14). The NPC had a lower frequency of infractions in all of the top three infraction categories: maintenance and sanitation of non-food contact surfaces; employee hygiene and handwashing; and maintenance and sanitation of washrooms. These categories are topics that are covered extensively in the NPC Food Handler Certification Program. Perhaps the NPC were able to achieve better inspection scores because their staff were trained in these areas. Harris et al. conducted a study comparing the training materials provided in Food Handler Certification to food safety inspection results and found that the amount of information included in the Food Handler Certification training manual impacted on inspection scores (10). In fact, it was suggested that the Food Handler Certification course should cover the main areas highlighted during an inspection. In Harris’ study, critical infractions were observed in areas that were excluded from the training materials. In this study, the NPC’s Food Handler Certification Program was, in fact, modelled after the inspection categories in the Toronto Public Health Food Safety Inspection Report. As Harris suggests, infraction categories that are highlighted on the inspection form can be used to guide training for food handlers (10). Therefore, if the RSPs had certified food handlers, it may have been possible to reduce the frequency of infractions. The maintenance and sanitation of non-food contact surfaces/equipment category was the most common infraction category; this is consistent with Toronto Public Health findings that indicated that this category accounted for the highest percentage of infractions for all food premise types from 2001– 2004 (26). The employee hygiene and handwashing category, the second most common infraction category, includes infractions such as “employee failed to wear headgear while working with food” and “employee failed to wash hands when required.” This is important because it relates directly to the safety of food and is emphasized in the NPC Food Handler Certification course because employees may be a source of infection during food preparation and thus cause foodborne illness (24). The maintenance and sanitation of washrooms category, the third most common infraction category, included infractions defined as minor such as “operator failed to clean toilets as often as necessary” and “operator failed to provide washroom supplies.” These infractions are defined as minor because they may impact on the overall condition of the premise, but they do not directly impact on food safety. Another infraction category, although not in the top three, that warrants discussion is the “food protected from contamination” category. This category includes infractions such as “operator failed to ensure that food is not contaminated and adulterated.” Infractions in this category may be defined as crucial or significant. Protecting food from contamination is a key topic in the NPC Food Handler Certification course. The concept of preventing cross-contamination during food preparation is taught in the course, including the use of separate utensils for raw and cooked foods, hand washing and washing/sanitizing of utensils. This is important because cross-contamination is a risk factor for foodborne illness (5). The NPC results in the “food protected from contamination” category are interesting; even though all their food handlers were certified they still had infractions in this category. This suggests that the transfer of training did not occur; perhaps food handlers did not put their knowledge into practice even though they were trained. Clayton et al. conducted a study on food-handler beliefs and self-reported practices and found that, despite being aware, food handlers did not practice safe food handling methods because of constraints on time, staff and resources (4). In fact, 85% of respondents who received certification training admitted that they were not putting into practice what they had learned (4). Another category with results that suggest that the transfer of training may not have occurred is the food temperature and control category. This is the only category in which, although the differences were not statistically significant, the NPC had more infractions than the RSPs during inspections (12 vs. 10) (Table 4). In theory, the NPC should have received better inspection scores, since food temperature control is a key concept taught in Food Handler Certification (24). However, the assumption that the transfer of training did not take place cannot be substantiated, because the Food Safety Inspection Report detailing the specific infraction details (e.g., observed food handlers storing chicken in the danger zone) was not examined in this study. Although “no deficiency found” is not an official category, it was included for comparison to the other categories. Most of the inspections conducted for both NPC and the RSPs fell into this category. These results may be attributed to the city of Toronto’s Food Premises Inspection and Disclosure Program, as a result of which the number of infractions per inspection decreased after 2001(23) and there was a reduction in the number of crucial infractions for all types of premises (23). Therefore, the impact of this public disclosure program on the results of this study cannot be overlooked. One establishment from the NPC group was ordered closed by Toronto Public Health because of a pest infestation; pest control is a component of Food Handler Certification. The Food 846 FOOD PROTECTION TRENDS | DECEMBER 2009

Food Protection Trends - December 2009

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