A study by the Food and Drug Administration (FDA) has identified improper holding time/temperature, poor personal hygiene, contaminated equipment, inadequate cooking and unsafe sources of food as the risk factors in retail food store deli departments in the United States.

The study was conducted to investigate the relationship between Food Safety Management Systems (FSMS), Certified Food Protection Manager (CFPM) and the occurrence of risk factors and food safety behaviors/practices commonly associated with foodborne illness in the United States in retail food store deli departments (delis) from 2015-2016.

The report indicated that the two most commonly occurring out-of-compliance risk factors in delis in the country were improper holding time/temperature (91.2%) and poor personal hygiene (71.5%). The FDA notes time/temperature control for safety (TCS) foods should be held under refrigeration at or below 41°F (5°C) to limit the growth of pathogens that may be present in the food.

Poor personal hygiene, which involves handwashing by employees, includes knowing both when to wash and how to wash properly. This is critical in reducing the spread of pathogens from employees’ hands to food, food contact surfaces, and equipment that lead to cross-contamination.

Of the foodborne illness risk factors investigated in this study, inadequate cooking was best controlled. Delis were found to thrive in cooking raw-animal derived foods, such as meat, poultry and eggs, to the requisite temperatures.

Functional FSMS critical

The study found that the presence of a functional Food Safety Management Systems (FSMS) was the strongest predictor of the compliance status in the sector, hence a promising tool in reducing foodborne illness risk factors. It noted that establishments with well-developed FSMS had significantly fewer out-of-compliance food safety practices than did those with less developed food safety management systems, resulting in a reduced occurrence of foodborne illness risk factors in those outlets.

FSMS refers to a specific set of actions used by food service establishments to help achieve Active Managerial Control (AMC). While FSMS may vary across the retail and food service industry, the consistent components include the purposeful implementation of procedures, training, and monitoring.

For the improper holding time/temperature risk factor, FSMS had the strongest impact on date marking and disposition, which is one of the primary controls in the FDA Food Code for growth of Listeria monocytogenes (Listeria), a pathogen of major concern in delis. Approximately 32% of delis had well-developed or well-developed and documented FSMS.

The National Retail Risk Factor Study categorized FSMS into four categories; non-existent, underdeveloped, well-developed, and well developed and documented. Well-developed and documented systems have the greatest impact on compliance and are vital to success as they are complete, consistent, and primarily written. These findings denote that well-developed and documented FSMS are an expedient tool in plummeting the occurrence of foodborne illness risk factors.

Analysis of the study data showed that deli departments had the best control over ensuring no bare-hand contact with ready-to-eat foods.

Leadership role

According to the FDA, either the presence of a Certified Food Protection Manager (CFPM) or the multiple-unit status of establishments were significant predictors of having out-of-compliance data items when all factors studied were taken into account.

Delis with a CFPM present had fewer primary data items out of compliance than those without a CFPM. The restaurants that had a CFPM who was the person in charge at the time of data collection, had significantly better food safety management scores than those that did not have a CFPM present or employed.

A CFPM is an individual who has shown proficiency in food safety information by passing a test that is part of an accredited program.

Foodborne diseases cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year.


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Table 1

Foodborne illness risk factor

Associated primary data item numbers and description

Poor personal Hygiene

#1 – Employees practice proper handwashing.

#2 – Employees do not contact ready-to-eat food with bare hands.

Contaminated Equipment/Protection from contamination

#3 – Food is protected from cross-contamination during storage, preparation and display.

#4 – Food contact surfaces are properly cleaned and sanitized.

Improper holding time/temperature

#5 – Foods requiring refrigeration are held at the proper temperature.

#6 – Foods displayed or stored hot are held at the proper temperature.

#7 – Foods are cooled properly.

#8 – Refrigerated, ready-to-eat foods are properly date marked and discarded within 7 days of preparation or opening.

Inadequate cooking

#9 – Raw animal foods are cooked to required temperatures.

#10 – Cooked foods are reheated to required temperatures.

 

Table 2

Characteristic

Number of Delis (N= 397)

Percentage

Certified Food Protection Manager

 

 

None

133

33.5%

Employed but not present

56

14.1%

Employed and Present

5

1.3%

Person in charge

203

51.1%

Food Safety Management System

 

 

Nonexistent

48

12.2%

Underdeveloped

220

56.1%

Well-developed

101

25.8%

Well-developed and documented

23

5.9%

Risk categorization

 

 

Risk category 2

192

48.4%

Risk category 3

185

46.6%

Risk category 4

20

5.0%

Multiple- Unit

 

 

Yes

294

74.1%

No

103

25.9%

 

Table 3

Risk Factors Out-of-Compliance

Foodborne illness Risk Factor

Delis out of compliance (OUT)

Total Observations (IN $ OUT)

% OUT

Poor personal hygiene

284

397

71.5%

Contaminated equipment

248

397

62.5%

Improper holding time/temperature

362

397

91.2%

Inadequate cooking

31

270

11.5%

 

Table 4

Total Number and percentage of Delis Out-of-Compliance for each Data Item

Data Item

Description

Delis (#OUT)

Total Observations (IN & OUT)

% OUT

1

Employees practice proper handwashing

284

394

72.1%

2

Employees do not contact ready-to-eat foods with bare hands

22

397

5.5%

3

Food is protected from cross contamination during storage preparation and display

171

397

43.1%

4

Food contact surfaces are properly cleaned and sanitized

190

397

47.9%

5

Foods requiring refrigeration are held at proper temperatures

278

397

70.0%

6

Foods displayed or stored hot are held at proper temperature

177

334

53.0%

7

Foods are cooled properly

117

186

62.9%

8

Refrigerated, ready-to-eat foods are properly date marked and discarded within 7 days of preparation or opening

203

389

52.2%

9

Raw animal foods are cooked to required temperatures

12

249

4.8%

10

Cooked foods are reheated to required temperatures.

21

122

17.2%

 

Study History

In 1998, the FDA National Retail Food Team initiated a three-phase, 10-year study to measure the occurrence of practices and behaviors commonly identified by the Centers for Disease Control and Prevention as contributing factors in foodborne illness outbreaks.

In 2013, the team commenced a new, 10-year study to measure the occurrence of practices and behaviors commonly identified by the Centers for Disease Control and Prevention as contributing factors in foodborne illness outbreaks. Initial data collections began in 2013 for select restaurant facility types, followed by data collection for select institutional foodservice facility types in 2014 and select retail food store facility types in 2015.

The results of the initial data collection for each of the facility types will serve as the baseline measurement from which trends will be analyzed. Two additional data collection periods for each of the facility types are planned at 3-year intervals after the initial data collection for the purposes of analyzing trends.

As part of the ten-year study, data was collected from 2015-2016 on the occurrence of foodborne illness risk factors and food safety behaviors in retail food store delis. The data will be used as baseline measurement upon which to assess trends in the occurrence of foodborne illness risk factors in retail food store delis over the ten-year period of 2013-2023.

Foodborne illnesses statistics

Foodborne diseases cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year.

The annual economic burden from health losses due to foodborne illness is estimated at US$ 77.7 billion. Food safety practices in retail food establishments continue to play a critical role in preventing foodborne illness.

The Centers for Disease Control and Prevention (CDC) estimates Listeria as the 3rd leading cause of death from foodborne illness with about 1,600 infections, 1500 hospitalizations and 260 deaths. The most vulnerable people include pregnant women and their newborns, adults aged 65 or older, and those with weakened immune systems.

Listeria is pervasive in the environment and can be found in moist environments, soil and decaying vegetation. It is persistent in retail food environments and can grow in refrigeration temperatures below 1°C (33.8°F), which brands this organism as a menace for the food industry. This makes date marking and disposition the primary prevention factor for Listeria in the retail environment.

The Food Code stipulates that ready-to-eat TCS food, prepared in a food establishment and held longer than a 24-hour period, should be marked to indicate the date or day by which the food is to be consumed on the premises, sold, or discarded when held at a temperature of 5°C (41°F) or less for a maximum of 7 days.

According to the CDC, when considering incidents in 2015 and 2016, retail food stores accounted for 23 outbreaks (3%), and 15 outbreaks (2%), respectively, and 572 illnesses (5%), and 239 illnesses (2%), respectively.

Studies such as this serve as a source of information to aid decision makers in taking steps that will diminish the occurrence of risk factors responsible for causing foodborne illness. This study will also help inform the FDA’s upcoming activities on modernizing traditional retail food safety approaches.

The FDA is exploring ways to further modernize and help ensure the safety of foods sold at restaurants and other retail establishments as part of their work on the New Era of Smarter Food Safety initiative. The New Era blueprint outlines goals that include strengthening food safety protections, through the use of FSMS and risk‑based inspectional approaches, as well as exploring the use of new digital tools and smart kitchen equipment that could help minimize risks.

These outcomes also help the FDA prioritize development of educational resources to inform, engage, and empower local retail food industry, state, local, territorial, and tribal authorities, and other government agencies. The regulator will continue to collect data on the occurrence of foodborne illness risk factors and use the results to aid decision makers in minimizing the occurrence of risk factors responsible for causing foodborne illness.

Retail food establishments should take action to develop, implement, and strengthen their procedures, training, and monitoring within their establishment to create well-developed and documented FSMS.

This feature appeared in the July/August 2021 issue of Food Safety Africa. You can read the magazine HERE