Do restaurant food handler knowledge gaps predict violations identified during inspections?

Approximately half of the foodborne outbreaks reported to the CDC are associated with restaurants or delicatessens. Periodic restaurant inspection by the local health authority helps to assess food handling behaviors but it is not designed to identify gaps in knowledge related to food safety. Therefore, the combination of measuring food handler knowledge and review of restaurant inspection scores allows a more complete understanding of the restaurant food handler.  To determine food safety knowledge gaps, we interviewed 729 suburban Chicago food handlers in 211 participating restaurants.  A 50 question survey was administered in English or Spanish during June 2009 through January 2010. 

The reports for inspections performed just prior to conducting the surveys were reviewed and violations were quantified.  Participants scored an average of 72% on the survey, with substantial knowledge gaps related to cross contamination, cooking temperatures and thawing and storage of food. The mean score for certified food managers was 79%.  Restaurants had an overall mean inspection score of 90.6 and the number of violations ranged from 0 to 19.  Among the most commonly reported violations, two were critical; one for the failure to maintain temperature requirements of potentially hazardous food (29%) and the other for inadequate food protection from potential cross-contamination (28%).  No significant correlation was observed between overall inspection score and certified food manager knowledge score as a result of regression analysis.  In general, knowledge gaps were not directly correlated with food safety citations in practice. However, there was a significant association between an inspection with a violation related to food handler hygiene and employing at least one certified food manager who missed at least one hand hygiene question, on the knowledge survey (RR=1.96, p=0.05). The results of this study suggest that restaurant inspection reports do not correlate well with certified food manager knowledge. Interpretation of these results should consider that some violations may be corrected during the inspection and not recorded on the report form.  Future research should focus on enhancing restaurant manager knowledge and determining what factors may motivate restaurant managers to ensure compliance with food safety policies that inspections are intended to monitor.