Food Protection Trends - November/December 2022 - 446

the most common violation. This violation and the serious
violation of certified food manager on site are potentially
correlated, meaning that when a certified food manager is on
site management and employees are more likely to use proper
food safety behaviors during an inspection. This hypothesis is
supported by the fact that one of the least frequent violations
over the 10-year period was the person in charge was present
and performing duties. The presence of a food safety certified
manager who is communicating and overseeing employees is
critical for ensuring proper food handling behaviors. Murphy
et al. (22) explored the relationship between mandatory
food safety training certification and inspection results at
restaurants (n = 907) in Orange County, Florida. Results
indicate that mandatory food safety certification training
may help to reduce violations during food safety inspections.
Arendt et al. (3) found that the manager's leadership and
effective communication were important for assuring safe
food handling practices.
This upward trend in critical food safety violations also
could be due to increased scrutiny by health inspectors
across the 10-year period. An understanding of how health
inspections and health inspectors evolve over time can help
to put this trend into context. Petran et al. (24) compared
routine food safety inspection data conducted at outbreak
restaurants with data from routine food safety inspections
conducted at nonoutbreak restaurants and found that
significantly more violations were recorded at restaurants that
had been associated with outbreaks. The majority of these
violations were related to contamination in the facility and
to food handling procedures. Thus, health inspectors need to
ensure proper knowledge levels.
Educational interventions can increase food safety
knowledge (8, 13, 20). Reviews of food safety training
topics from 2004 to 2009 (21) and 2013 to 2018 (27)
have revealed that the topics most commonly covered were
personal hygiene, food safety best practices, and hazard
analysis critical control points. In a recent study, school
foodservice employees reported barriers to following proper
food handling practices that were related to the need for
more time and adequate access to resources, equipment,
and facilities (1). Attention to an organization's food safety
culture, that is, the organizational and environmental aspects
affecting food safety, is also a critical step for improving food
safety practices. Da Cunha (10) highlighted how a proactive
food safety culture and behavior-based strategies can improve
food safety practices in foodservice facilities. Reynolds et
al. (29) found that a positive food safety culture, including
open communication and manager and coworker support,
directly affected foodservice employees' positive food safety
practices.
In the final phase of a 10-year study, the U.S. Food
and Drug Administration (FDA) a found a low level of
compliance with food safety practices in foodservice
establishments, including time and temperature abuse,
446 Food Protection Trends November/December
poor personal hygiene, and cross-contamination (37). In
the present study, two of the five most common critical
recurring violations were associated with improper
temperature controls: lack of facilities to maintain proper
storage temperatures and potentially hazardous food
exceeding acceptable temperatures during preparation.
In a previous study in which foodservice employees were
observed, participants followed the FDA Food Code
recommendations for temperature controls only 50% of the
time (2). Procedures for responding to vomit and diarrhea
were lacking in the present study, consistent with previous
research (28). Prior research on foodservice in childcare
settings revealed that improving written policies for food
preparation can prevent the spread of foodborne illnesses to
children (28).
Recurring serious violations identified during the 10-year
study period were associated with lack of cleaning equipment
(dish washing, outside waste, and toilet room supplies) and
evidence of rodent or insect infestations. These types of
violations create a potential health hazard when not corrected
in the timeframe specified by the CDPH. Serious violations
identified during an inspection and not immediately
corrected result in a failed inspection. Lee and Liu (18)
reported a similar lack of cleaning equipment identified
during Missouri school foodservice inspections.
The most commonly cited minor violations of the study
period were associated with lack of cleaning procedures
for walls, ceiling, ventilation, flooring, and food- and non
food-contact surfaces. Although minor violations are less
likely than critical or serious violations to contribute to food
contamination or illness, schools must not ignore these
violations because they can cause more serious problems if
neglected. Thomas et al. (34) highlighted the importance of
cleaning procedures in school foodservice for ensuring the
health and safety of the students.
Trends in violation patterns were also identified for the
least common violations during the 10-year period. The
five least common critical violations were associated with
proper personal hygiene habits, proper water sources and
temperatures, a manager on duty, and the presence of
contamination controls. However, these violations may be
underrepresented; due to the timing of inspections some
potential violations may not be observed. For example,
inspectors may not have the opportunity to observe
employees eating or drinking during the inspection. The
majority of least common serious and minor violations were
associated with food storage (disposal, labeling, and use
of original packaging), inspection reports on display, and
availability of thermometers. Thus, the majority of the least
common critical, serious, and minor violations were not
those associated with employee behavior. School foodservice
employees often are the cause of food safety violations. Thus,
updated and targeted training interventions are needed to
mitigate these improper employee food handling behaviors.
Food Protection Trends - November/December 2022

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