In the U.S., a significant source of foodborne illness comes from food prepared outside the home. Annually, there are estimated to be 76 million cases of foodborne illnesses in the U.S., which include 325,000 hospitalizations and 5,000 deaths (Mead et al., 1999). Sixty-five percent of foodborne illness outbreaks in U.S. restaurants were linked to infected restaurant employees, who can directly transmit pathogens that cause foodborne illness in consumers (Mead et al., 1999). Several factors have an impact on food safety in food service establishments: a) inspections conducted by local or state inspectors, b) knowledge of the Food and Drug Administration (FDA) Food Code, and c) proper training of managers and food workers (Bryan, 2002; FDA, 2009).
In the U.S., regulatory agencies such as local, county, and state health departments conduct health inspections of food handling facilities. The primary objective of health inspections is the prevention of foodborne illness. This objective is accomplished by control measures such as demonstrating knowledge (e.g., compliance with code, presence of a certified food safety manager [CFSM], food safety questions answered correctly), implementing employee health policies, identifying vehicles of contamination, monitoring of time/temperature relationships, and issuing consumer advisories (U.S. Department of Health and Human Services, 2009).
Health inspectors perform inspections at restaurants to ensure that restaurants are in compliance with health and sanitation regulations designed to ensure consumer and food employee safety; however, food safety inspections alone have not been effective in decreasing critical violations (Cruz, Katz, & Suarez, 2001; Jones, Pavlin, LaFleur, Ingram, & Schaffner, 2004; Newbold, McKeary, Hart, & Hall, 2008; Phillips, Elledge, Basara, Lynch, & Boatright, 2006). Food service workers are taught how to safely prepare and handle food; not being properly trained on food safety can lead to food being mishandled, which can increase risk factors of foodborne illness (Wotecki & Kineman, 2003).
Proper training in food safety of managers and food workers is significant because the costs associated with foodborne illness result in an estimated $7.7--$23 billion impact annually for consumers, the food industry, and the economy (Council for Agricultural Science and Technology, 1994). Managers who have positive attitudes and view food safety practices as important are more likely to promote food safety practices among workers (Mortlock, Peters, & Griffith, 2000). Restaurants face many challenges in trying to prevent foodborne illness outbreaks, such as employees not being adequately trained in food handling and high turnover rates (Jones & Angulo, 2006). Therefore, CFSMs play a significant role and have the essential duty to ensure that food workers are properly trained in food safety practices that reduce the risk of foodborne illness (Cates et al., 2009).
Using the FDA Food Code as a reference, Georgia implemented rules and regulations on food safety and developed inspection forms and scoring standards. The state of Georgia mandates that all restaurants have at least one CFSM (Georgia Department of Public Health, n.d.). Even though establishments are in compliance by having a CFSM, the violations cited on inspection reports show that employees are not being trained effectively (Hammond, Brooks, Schlottmann, Johnson, & Johnson, 2005). With a CFSM, risk factors that are known to cause foodborne illness should be decreased. Control measures should be in place that prevent outbreaks or at least reduce the occurrence of foodborne illness in all facilities (Cates et al., 2009). Analyzing inspection reports by examining the violations gives a clear understanding of whether these control measures are working to mitigate risk factors known to cause foodborne illness (Jones et al., 2004).
The purpose of this quantitative study was to examine a) the relationship between having a CFSM and the number of risk factors cited on restaurant inspections in Georgia; b) whether restaurant operation type (i.e., chain versus independent restaurant) has an impact on the number of risk factors cited on restaurant inspections; c) the relationship between having a CFSM and the restaurant food safety score identified on restaurant inspections; and d) whether or not restaurant operation type (i.e., chain versus independent restaurant) has an impact on the restaurant food safety score. Cates and coauthors (2009) looked at the effectiveness of food safety training and certification in restaurants located in Iowa and found certain risk factors can be controlled by having a certified kitchen manager--but that training and certification must be kept current to have a positive influence on reducing risk factors. Education is important, but also must address other...