Effect of a Certified Food Protection Manager on Employee Food Safety Behaviors in Rural Washington Counties
Alice Robison
Environmental Health Specialist II
Northeast Tri County Health District
International Food Protection Training Institute (IFPTI)
2011 Fellow in Applied Science, Law, and Policy: Fellowship in Food Protection
Abstract
The Centers for Disease Control and Prevention (CDC) estimates that each year, roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases (Scallan et al., 2011). The U.S. Food and Drug Administration (FDA) Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types (2009) found that the presence of a certified food protection manager (CFPM) correlated with higher compliance levels with food safety practices and behaviors than in establishments without a CFPM present (U.S. Food and Drug Administration [FDA], 2009). In 2010, the Conference for Food Protection (CFP) was asked to consider modifying the FDA Model Food Code to require that at least one person in charge at each food establishment is a CFPM (Julian, 2010). The CFP accepted this recommendation, and the Supplement to the 2009 FDA Model Food Code now requires food establishments to employ a CFPM (U.S. Public Health Service, 2011). The purpose of this study was to determine if a violation trend similar to the one shown in the 2009 FDA study is observed in food establishments located in northeastern Washington State. Results of food safety inspections performed in the Northeast Tri County Health District over a five-year period confirm that food establishments that employ a CFPM have significantly fewer employee-related violations of retail food safety requirements than food establishments without a CFPM.
Background
The northeast corner of Washington state, consisting of Ferry, Stevens, and Pend Oreille counties, is a rural area (United States Department of Agriculture, 2010). The population density of the tri-county area is 10.5 persons per square mile, compared with Washington state’s population density of 101.2 persons per square mile (U. S. Census Bureau, 2010). Colville (population: ~5,000) is largest city in the tri-county area. (Northeast Washington Trends, 2011)
Chapter 246-215 Washington Administrative Code (WAC), Washington State Retail Food Code is a modification of the 2001 FDA model Food Code. Washington State is in the process of adopting the 2009 FDA model Food Code. The Washington State Environmental Health Directors expressed interest in modifying the 2009 FDA Food Code to require mandatory manager certification in the State of Washington. The Washington State Department of Health formed a committee to explore the issue. The committee determined the Department of Health could legally require manager certification but chose not to include mandatory manager certification in the Washington State Retail Food Code at the time of this rule revision for the following reasons.
Mandatory manager certification is not included in the 2009 FDA Model Food Code because the state delegates to the Conference for Food Protection (CFP) did not recommend that the FDA incorporate mandatory manager certification in the 2009 model retail food code (U. S. Public Health Service, 2009). Unilateral adoption would have caused confusion across governmental jurisdictions and among the retail food industry. Additionally, because not all stakeholders currently support mandatory manager certification, proposing mandatory certification may have significantly increased the time and expense of the rule revision process.
Currently, the Washington State Retail Food Code requires employees in food establishments to obtain a Food Worker Card within 14 days of beginning work. The format of the Food Worker Card training varies from county to county. Since 1992, the Northeast Tri County Health District has fulfilled this requirement by showing a 30-minute food safety video and then allowing participants to use the notes they took while watching the video to complete a multiple-choice test. A Food Worker Card is issued upon successful completion of the test. In February 2012, the Northeast Tri County Health District began offering the Food Worker Card training in an online format, as well as in-person at the Health District’s office locations.
The Washington State Retail Food Code requires a “Person in Charge” (PIC) to be present during operation. The PIC is usually the manager or owner of the food establishment. The Food Code requires the PIC to demonstrate food safety knowledge. Food safety knowledge can be demonstrated by any of the following: being a certified food protection manager, correctly answering relevant food safety questions posed during an inspection, and/or by the food establishment not having any violations during an inspection. The Food Code also requires the PIC to provide food safety training to all employees and ensure that they have valid Food Worker Cards.
Currently, three food protection manager programs are accredited by the American National Standards Institute (ANSI)-Conference for Food Protection (CFP) Accreditation Program. The accredited food protection manager programs are offered by: 1) National Restaurant Association Solutions–ServSafe, 2) Environmental Health Testing, and 3) Prometric Inc. These programs provide a comprehensive training program, which educates managers on food safety issues, such as foodborne illness prevention, good personal hygiene, temperature control, cross-contamination, receiving, food storage, and facility sanitation. Managers also learn how to take active managerial control of foodborne illness risk factors and provide ongoing employee training. For this study, a manager that has been certified by an ANSI-CFP accredited certification program is considered to be a Certified Food Protection Manager (CFPM).
Problem Statement
In many food establishments, the only food safety training the manager has received is the Food Worker Card class. This class provides a baseline level of food safety education, but it does not provide specific training for managers about their role in the food safety system or how to provide food safety training to food employees. Situations arise in which managers expect that because employees have Food Worker Cards, they know how to apply what they have learned in the Food Worker Card class to the actual work situation without receiving additional, more specific training. Employees who have not received food safety training specific to their job may be more likely to make errors in the food establishment that will increase the risk of unsafe food being served, and the resulting increased risk of foodborne illness to customers.
Research Question
Does the presence of a certified food protection manager in a food establishment result in fewer violations related to employee food safety behaviors being cited during inspections?
Methodology
A secondary data analysis was conducted of inspection reports for routine inspections conducted from 2006 through 2011. Inspection reports were obtained from the Northeast Tri County Health District. All inspections and inspection reports were completed by the same inspector. All food establishments that require a CFPM were included in the study. Food establishments requiring a CFPM included one full-service restaurant, three quick-serve restaurants, and one multidepartment grocery store. Forty-five inspection reports of food establishments that require CFPMs were reviewed. A matched number of food establishments that do no require a CFPM were also selected for use as the comparison group.
Establishments were selected based on their similarity to establishments requiring a CFPM using various characteristics, such as menu similarity and franchise or corporate affiliation. Food establishments not requiring a CFPM included one full-service restaurant, three quick-serve restaurants, and one multidepartment grocery store. Forty-one inspection reports of food establishments that do not require a CFPM were reviewed. Inspection report data were analyzed for violations of the following employee practices relating to retail food safety requirements:
· Hands washed as required
· Proper methods used to prevent bare-hand contact with ready-to-eat foods
· Raw meats below or away from ready-to-eat food
· Proper cooling methods
· Proper hot holding temperatures
· Proper cooking temperatures
· Proper cold holding temperatures
Results
Food establishments with a CFPM had fewer violations of all risk factors except for cooking temperature (see Figure 1).
The most significant differences were seen among violations related to the following risk-based requirements: The “Proper methods used to prevent bare-hand contact with ready-to-eat foods” requirement was documented as a violation on inspection reports for 4.44% of establishments with a CFPM versus 12.20% of establishments without a CFPM. Documented violation of the “Proper cooling methods used” requirement was not cited for establishments with a CFPM but was documented on 5.88% of inspection reports of establishments without a CFPM. Violation of the “Proper cold holding temperatures” requirement was documented on 15.56% of inspection reports of establishments with a CFPM versus 24.39% of establishments without a CFPM. Full-Service Restaurants had significant differences among violations related to the following risk-based requirements: The “Proper methods used to prevent bare-hand contact with ready-to-eat foods” requirement was documented as a violation on inspection reports for 9.00% of establishments with a CFPM versus 63.00% of establishments without a CFPM. Documented violation of the “Proper cooling methods used” requirement was not cited for establishments with a CFPM but was documented on 50.00% of inspection reports of establishments without a CFPM (see Table 1).
Further investigation revealed that the high incidence of cooking temperature violations in establishments having a CFPM were due to problems with a specific type of cooking equipment being used by a corporate quick-serve food establishment, as well as failure by employees to properly follow company-provided temperature-monitoring procedures for this equipment.
Conclusions
The presence of a certified food protection manager has a positive effect on the food safety behaviors of employees and results in fewer violations being observed during inspections. A limited number of food establishments in northeast Washington have CFPMs due to the limited availability of training programs. Regularly scheduled classroom training opportunities are not currently available. Online training and exams are available; however, the availability, cost, and quality of Internet service vary in rural areas. The cost of online CFPM certification ranges from $83 to $125. The cost associated with manager certification may create a competitive disadvantage between businesses willing to pay for manager certification and those that are not. Also, the economic differences between the rural Tri County area and the rest of Washington state, such as the per capita personal income ($27,931 in 2010 for Tri County area vs. $42,570 in 2010 for Washington state) and the percentage of the population living below the federal poverty rate (18.1% in 2010 for Tri County area vs. 15.3% for Washington state), may be more financially burdensome for individuals seeking manager certification (Northeast Washington Trends, 2011).
Recommendations
The Northeast Tri County Health District should explore the possibility of offering an accredited CFPM certification program locally. Because the Northeast Tri County Health District covers a large geographic area, the certification program could be offered at multiple sites to minimize the travel distance and cost for participants. A survey of local food establishment owners should be conducted to determine the following: awareness of existing manager certification programs, existing barriers to obtaining manager certification for employees, interest in manager certification opportunities offered locally for employees and the costs that food establishments would be willing to incur for manager certification. The data generated by the survey could help the Northeast Tri County Health District determine if offering a manager certification program locally would be a viable option.
Further research should be conducted in other counties in Washington, including in both urban and rural areas, to determine if food establishments with a CFPM have fewer violations related to employee behaviors than food establishments without CFPMs. If the findings of this further research confirm that employee practice violations are significantly fewer in retail food businesses with CFPMs, the Washington State Retail Food Code should be amended to require that all food establishments employ a certified food protection manager.
Acknowledgments
This project has been generously supported by the International Food Protection Training Institute (IFPTI) 2011 Fellowship in Food Protection. I would like to thank my mentor, Steve Steinhoff, for his insight and direction. I would also like to thank all of the IFPTI instructors and fellows for their encouragement and support. Thanks also to David Windom and the Northeast Tri County Health District for supporting my participation in the fellowship program; Matt Schanz, Northeast Tri County Health District, for all of the support and direction he has given me during my career; Joe Graham, Washington State Department of Health, for his assistance and encouragement; and Mary Ferluga, retired member of the Washington State Department of Health, for her positive attitude and perspective.
Corresponding Author
Alice Robison, Northeast Tri County Health District (Washington)
Email: arobison@netchd.org
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