Colorado State University Extension
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Restaurant Inspection Scores and Foodborne Disease
Edited by: Mary Schroeder, M.S., R.D. & Pat Kendall, Ph.D., R.D., Colorado State - Summer 2004
Restaurant patrons have been known to choose where and where not to eat based on restaurant inspection scores published in their local newspapers. Are these scores good indicators of the actual safety of the food being served in a restaurant? Interestingly, few studies have looked at the correlation between inspection scores or violations and incidence of foodborne illness.
Research Study
Researchers in Tennessee took on the task of determining what impact (if any) restaurant inspections have had on improving food safety. They examined over 167,000 statewide inspection records involving ~29,000 unique restaurants and 248 inspectors over a seven year period. Restaurants were selected based on known types of table service and cuisine and included both fast food and full service establishments.
Inspections were performed using standardized forms including 44 scored items with a possible total score of 100. Of those 44 items, 13 were designated as "critical." Critical items are defined as violations "which are more likely to contribute to food contamination, illness, or environmental degradation and represent substantial public health hazards and [are] most closely associated with potential foodborne disease transmission."
Inspection Results
From 1993 - 2000, the mean inspection score rose steadily from 80.2 to 83.8, and the mean number of violations cited per inspection fell from 11.1 to 9.9. Establishments scoring <60 had a mean improvement of 16 points on subsequent inspections with an additional mean increase of 5 on the next inspection. Establishments scoring >60 tended to have fairly stable scores on subsequent inspections, with a mean drop of 2 points on the subsequent inspection. None of the 12 most commonly cited violations were among those designated as "critical" food safety hazards. The critical violation most commonly cited was the improper storage or use of toxic items (i.e., storing cleaning fluids on a shelf next to food.)
Connection to Foodborne Disease
Restaurant inspection data were available from 49 restaurants that were identified as the source of foodborne disease outbreaks from 1999 to 2002 in Tennessee. These restaurants had a mean inspection score of 81.2 before the reported outbreak and a mean score of 81.6 after the outbreak. These mean scores did not differ from the mean score reported for all restaurants during the same period.
Based on the limited data available in this study, the researchers concluded that restaurant inspection scores alone do not predict the likelihood of a foodborne outbreak occurring in a particular establishment. Further, overall scores are not a good measure of the criticalness of the violations. For example, a substantial number of inspections with a final score >90 also had critical violations. Likewise, some restaurants with scores <80 had no critical violations. Thus, overall score alone is not necessarily a sufficient measure of restaurant safety.
Conclusion
Before consumers become discouraged by these results, remember there is more to a restaurant inspection than just the score. Simply the anticipation of routine inspections probably improves compliance with regulations, as many businesses are motivated to avoid bad publicity and negative economic repercussions. Additionally, inspections help to ensure the immediate physical safety of patrons and workers in the environment. The federal government has recently joined efforts with several states to launch an Environmental Health Specialist Network project to explore how this long standing and important public health system can be further improved. This along with further studies will help determine the most efficient and effective methods for assessing factors associated with food safety.
Source: Jones, T.F., et. al. Restaurant Inspection Scores and Foodborne Disease. Emerging Infectious Diseases online. www.cdc.gov/ncidod/EID/vol10no4/03-0343.htm. Vol. 10, No. 4, April 2004.
