Food safety certification regulations in the United States.

Introduction

The vast number of foodborne illnesses in the United States today results in huge personal, medical, and productivity costs. The U.S. Department of Agriculture (USDA) estimates that medical costs and loss of productivity resulting from seven of the most serious food pathogens are between $6.5 million and $34.9 billion annually (Partnership for Food Safety Education, 1997; Food and Drug Administration, USDA, & U.S. Environmental Protection Agency, 1997). Estimates from the Food and Drug Administration (FDA) and the Food Safety Inspection Service (FSIS) suggest that hospitalizations due to foodborne illnesses cost more than $3 billion per year, and productivity losses between $20 and $40 billion per year (FDA & FSIS, 2002).

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Incidence is also staggering, with U.S. estimates ranging as high as 76 million foodborne illnesses per year (Mead et al., 1999), 325,000 hospitalizations, and 5,000 deaths. Almost three-quarters of the 76 million cases of foodborne illnesses estimated to occur annually in the United States are thought to be the result of employee mishandling in food service operations (McGorry, 1998; Centers for Disease Control and Prevention, 1999; Olsen, MacKinon, Goulding, Bean, and Slutsker, 2000). Studies indicate that food service workers often lack safe-food-handling knowledge, especially with respect to temperature control, personal hygiene, and the (sanitary) care of utensils (Burch & Sawyer, 1991; Manning & Snider, 1993; Wyatt, 1979). The lack of adequate food safety training is significant because the costs associated with outbreaks of foodborne illness result in an estimated $7.7 to $23 billion per year to consumers, the food industry, and the U.S. economy (Council for Agricultural Science and Technology, 1995). At least one report has paralleled the increase in consumption of restaurant food with the increased risk of illnesses being transmitted by food handlers (Cotterchio, Gunn, Coffill, Tormey, & Barry, 1998).

From the regulatory standpoint, most states traditionally have relied on health department inspections to evaluate the food handling (and adequacy of food safety training) in food service establishments. It is considered likely that some training in safe food handling will have occurred during, or as a result of, the inspections. In addition, some training may have been provided through occasional health department-sponsored training seminars. Most often, however, food safety training is largely left up to the food service establishment itself, or the chain that the food service represents.

In today's economy, it is not surprising that the tremendous growth of the food service industry, coupled with labor shortages and complicated by a literacy barrier, has resulted in food handlers who often are trained quickly and inadequately prepared, particularly in sanitation procedures (Colorado State University Cooperative Extension, 2001). The result is many dangerous food-handling practices related to temperature control, personal hygiene, and prevention of cross-contamination that could have been reduced with better food safety training. Effective training programs are therefore important, but effectiveness often is not recognized or even measured. It generally is evaluated through standardized examinations for which individuals are awarded a certificate or credentialing.

With the growing concern over food safety, some states have slowly begun to turn to mandatory certification of food safety managers as a way of demonstrating food safety knowledge acquired during training. The FDA Food Code (FDA, 2001) clearly recommends certification as part of the demonstration of adequate knowledge in food safety:

  ... upon request the person in charge shall demonstrate to the
  regulatory authority knowledge of foodborne disease prevention,
  application of the hazard analysis critical control point principles,
  and the requirements of this code. The person in charge shall
  demonstrate this knowledge by compliance with the code, by being a
  certified food protection manager who has shown proficiency of
  required information through passing a test that is part of an
  accredited program, or by responding correctly to the inspector's
  questions as they relate to specific food operation.

Studies have suggested that food safety training and certification have a positive impact on sanitation in food service establishments and on inspection scores, particularly in establishments with low initial baseline inspection scores (Cotterchio, Gunn, Coffill, Tormey, & Barry, 1998). Implementation of mandatory-certification regulations, however, is handled very differently from state to state. The impacts of different regulations have not been studied, nor has the nationwide trend toward mandatory certification. The purpose of this paper is to summarize the variety of regulations regarding mandatory certification across the United States. Such information may be useful for health department inspectors and regulators who are developing state regulations, as well as for restaurant chains that are standardizing training and certification policies for their employees and managers across the United States. In addition, this paper may provide additional information for studies that evaluate the impact of mandatory certification.

Methodology

Most data for this study of food safety manager certification regulations were obtained from state food codes found on health department Web sites (California Department of Health Services, 2002; Florida Department of Agriculture and Consumer Services, n.d.; Florida Department of Health, n.d.; Illinois Department of Health, 1999; Indiana State Department of Health, n.d.; Minnesota Department of Health, 2002; Mississippi State Department of Health, n.d.; Oregon Department of Human Services, 2002; Pennsylvania Department of Agriculture, 2002; University of Rhode Island, n.d.; Utah Legislature, 2002; Washington State Department of Health, n.d.). In addition, various food safety Web sites related to training and manager certification were used (Food Safety Training and Educational Alliance, 2002; National Restaurant Association Educational Foundation, 2001a). Finally, phone contacts were made to state health departments as necessary to clarify information from their Web sites. The data addressed the following issues:

* whether there is mandatory certification in that state,

* whether regulations pertained to managers as opposed to food handlers,

* whether the certified person must be on site at all times,

* recertification,

* approved examinations,

* training requirements,

* exemptions,

* turnover,

* fees,

* instructor requirements, and

* the way in which certification is checked.

Results

The oldest known mandatory certification regulation was found in the state of Washington, which started its program in the 1950s. Currently, at least 17 states/jurisdictions have passed legislation to make certification mandatory. Certification is not correlated with geographic location in the United States or with the size of the state population, but 17 of the top 20 largest populated cities are located in states where certification is mandatory. States with mandatory certification include California; Connecticut; Washington, D.C.; Florida; Idaho; Illinois; Indiana; Louisiana; Massachusetts; Minnesota; Mississippi; Oregon; Pennsylvania; Rhode Island; South Dakota; Utah; and the state of Washington. In addition, at least four states are developing legislation (Georgia, New Hampshire, Texas, and Vermont).

In addition to the above states, which have codes clearly mandating certification, several states have codes requiring the person in charge to "demonstrate knowledge of food safety" (one way is to pass an examination) modeled on language from the FDA Food Code. Examples of such states include Arizona and Delaware. Arizona's Food Code states:

     Based on the risks of foodborne illness inherent to the food
   operation, during inspections and upon request, the person in charge
   shall demonstrate to the regulatory authority knowledge of foodborne
   disease prevention, application of the Hazard Analysis Critical
   Control Principles, and the requirements of these rules. The person
   in charge shall demonstrate this knowledge by compliance with these
   rules, by being a certified food protection manager who has shown
   proficiency of required information through passing a test that is
   part of an accredited program, or by responding correctly to the
   inspector's questions as they relate to the specific food operation
   (Arizona Department of Health Services, n.d.).

Among the 17 state food codes that clearly mandate certification, regulations vary widely, but they generally cover 10 areas or issues:

* who must be certified (managers or food handlers),

* whether the certified individual must be on site at all times,

* recertification,

* approved examinations,

* training requirements,

* exemptions,

* allowed times for coming into compliance for new establishments and for turnover,

* fees,

* instructor requirements, and

* the way in which certification is checked.

The ways in which these issues are most often regulated are summarized below; examples from specific states follow.

Issues Covered in State Regulations

Issue 1 -- Certification of Managers Versus Food Handlers

Most state regulations apply to certification of a single responsible individual (generally an owner or manager or supervisor) per site, rather than to all food handlers within a food service operation. Examples of jurisdictions that require only one certified individual per site include California, Florida, Illinois, Louisiana, Massachusetts, Minnesota, Mississippi, Pennsylvania, Rhode Island, South Dakota, Utah, and Washington, D.C.

In a few states, regulations are written to include all food handlers (for example, regulation in the state of Washington). Certification and testing requirements in these states generally differ from those in states that require only manager certification; they reflect the need to affordably and efficiently qualify a vast number of individuals.

Issue 2 -- Must the Certified Individual Be on Site at All Times?

Most states do not require the certified individual to be on site at all times. Food service establishments are generally required, however, to designate a responsible individual for the (brief) time periods when the certified individual is not on site. Examples of states that do not require the individual to be on site at all times include California and Pennsylvania. Some codes specify that the certified owner or employee may not be responsible for more than one establishment at a time (the California code, for example). By contrast, some jurisdictions require an on-site individual at all times during business hours. These jurisdictions include Illinois (for Category I establishments), Oregon, and Washington, D.C.

Issue 3 -- Recertification

States are almost evenly divided on how often recertification needs to be done. Many require that it be done every five years. Examples include Florida, Idaho, Illinois, Louisiana, Massachusetts, Mississippi, and Pennsylvania. Also common is a three-year recertification period. Examples of states that require recertification every three years include California, Minnesota, New Hampshire, Oregon, Rhode Island, Texas, Utah, and Vermont. South Dakota requires recertification every four years.

Some states require recertification at different intervals for food handlers and managers. The state of Washington, for example, requires manager recertification every five years and food handler recertification every three years.

Recertification requirements also vary. Most states require an examination only. Some states require training but no examination (Pennsylvania). Others require both (such as Rhode Island and South Dakota).

Issue Four -- Approved Examinations

Accepted examinations vary tremendously. Most states accept the four examinations that are offered through the National Restaurant Association (National Restaurant Association Educational Foundation, 2001b), Experior (2001), the National Registry of Food Safety Professionals (2002), and the Dietary Managers' Association (DMA) (1997). Examples of these states include California, Florida, and Massachusetts. These four examinations used to be recognized by CFP (see sidebar at right). (Some state codes specify "Conference for Food Protection-approved examinations.")

Other states allow different exams not recognized by CFP or accredited by CFP-ANSI. Some allow two or three of the CFP-ANSI-accredited examinations. A very few states have a state (written) examination (e.g., Illinois and Washington) that may be taken in place of or in addition to the four examinations previously recognized by CFP, depending on state regulations.

Issue 5 -- Training Requirements

States are also split over the issue of training requirements prior to taking of examinations or re-examinations. Examples of states that have no prior training requirements include California, Louisiana, Massachusetts, and Utah; these states rely instead on the national examinations as proof of knowledge. Policies also differ from state to state with respect to training requirements for certification as compared with recertification. Following are some examples of training requirements:

* Minnesota -- 4 "contact" hours required for certificate renewal;

* Mississippi -- 8 hours required for certification, 4 for recertification;

* Pennsylvania -- 15 hours required for certification, 7.5 for recertification;

* Rhode Island -- 15 hours required for certification, 6 for recertification;

* South Dakota -- 8 hours required for certification, 4 for recertification;

* Washington state -- 30 minutes (must be taught by a health inspector); and

* Washington, D.C. -- no training requirements for certification, 2 hours required for recertification.

Issue 6 -- Exemptions

Many state codes do not specifically list exemptions. Among those that do, facilities that sell non-potentially hazardous foods, those that sell prepackaged food, and temporary food services are most often exempt. Other exemptions may include food services that are regulated by other government agencies (health care facilities, for example). Examples of common exemptions are as follows:

* California -- mobile food facilities, temporary food services, farmers' markets, produce stands, any food facility that handles prepackaged food only;

* Florida -- facilities that sell only nonpotentially hazardous foods and prepackaged food, and seafood establishments that are in full compliance with the mandatory state hazard analysis critical control points (HACCP) provisions;

* Oregon -- temporary food services; and

* Pennsylvania -- retailers or manufacturers of prepackaged, nonpotentially hazardous foods, and nonprofit organizations.

Issue 7 -- Times Allowed for Establishments to Come into Compliance

Most state codes do not specify a time period for coming into compliance when a certified individual has left the employment of the establishment or when a new establishment is opened. Examples of "grace periods" for coming into compliance when turnover has occurred are 60 days (California) and 90 days (Illinois). With respect to new establishments, Illinois requires new facilities to be in compliance upon opening, whereas California allows new facilities 60 days to come into compliance.

Issue 8 -- Fees

Most states do not list specific fees, perhaps because the cost of certification is already incorporated into the examination fees. In states that do require fees, the state-written exams generally cost less than a national examination (which ranges in price from $33 to $109). In addition, state-written examinations that are required for all food handlers generally cost less than state-written examinations that are required only for managers or owners. For example, the state of Washington's examination fee (which covers all food handlers) costs $8, whereas Illinois' examination fee (which covers only managers/owners) costs $35.

Issue 9 -- Instructor Requirements

Many states do not mention instructor requirements. In state codes that deal with instructor requirements, it is often simply stated that instructor approval is regulated by the health department.

Issue 10 -- How Certification Is Checked

Few state codes address this issue. Regulations that cover this issue require that certificates be kept on file in the food service facility. Some states require that they be brought to the health department (to obtain a permit, for example). Proof of employment may also be part of this requirement so that certificates from individuals who no longer work for an establishment are not used.

Other Issues

The 10 issues outlined above are addressed in several of the state food codes; two other issues are regulated in at least one state food code. One of these issues is the penalty for failure to comply (California's code states that the state may revoke permits for a failure to comply and Illinois' code states that an injunction may be filed against an establishment). The second issue is the requirement for multiple permits per site (for example, in superstores where separate permits may be required for the deli, the bakery, and so forth) and how that affects the number of certifications required. California, for example, specifies that grocery stores with multiple permits are not required to have more than one person certified.

Discussion

In summary, mandatory state food safety manager certification regulations vary. This study provides information for regulators as states continue to move to mandatory food safety manager certification.

Variations in regulations were not unexpected. Differences in the setup of state regulations occur because of differences in

* state and local health department budgets (which affect the ability to develop, manage, and enforce regulations, training, and examinations);

* local standards (which may exceed federal Food Code guidelines in various areas such as frequency of inspection);

* credentials and background of regulators (which affect the ability to write examinations and coordinate sanitation training);

* the size of the health department (which affects the amount of time available for training, examination management, and administration);

* the priorities of the health department (education versus inspection); and

* perceived needs (risk assessment).

Support in passing legislation (or lack of support) from legislative authorities, the food service industry, and consumers will have an impact as well.

The growing trend toward mandatory certification of food safety managers in sanitation should be a concern for the food service industry as well. Food service establishments need to become involved in the process and become more proactive in meeting requirements across the country. This involvement is particularly important for restaurant chains that hire, train, and move managers across the country. In this age of high turnover, the best course of action for national restaurant chains would be to meet the "strictest" state requirements in order to achieve the highest levels of food safety as well as provide flexibility in meeting labor needs.

Mandatory certification of food safety managers also raises the issue of inspector credentials and inspector "certification." Food service managers may question the right of inspectors to require certification when the inspectors themselves may not have fulfilled any mandatory education or examination requirements.

Finally, the idea of mandatory certification also raises the issue of using universally accepted examinations that are based on nationally accepted standards. The use of validated examinations accredited by CFP-ANSI simplifies the work of determining which are the best examinations, but some states have decided to use their own examinations. When they do so, the states become responsible for administration of the examinations, as well as validation, security, and periodic revision. Some of the benefits of having a nationally accepted standard for the testing of certified food protection managers include the "free movement" of managers with the necessary credentials from state to state, and the reduced duplication-of-effort costs in testing and training (Cotterchio, Gunn, Coffill, Tormey, & Barry, 1998).

More studies need to be done on the impact of mandatory certification, particularly as it is affected by differences in state regulations. Possible studies include its impact on food service inspection scores and on foodborne-illness outbreaks. In addition, it would be useful to determine how mandatory certification affects managers' attitudes regarding food safety and their implementation of good food sanitation practices.

Limitations of this study of state regulations include the small sample size (more information about county or city regulations would have been useful and are also recommended for a future study), the dynamic nature of changing regulations as more states consider mandatory certification, and the fact that the study does not evaluate differences in interpretation of regulations at local levels or the impact of local regulations that may be more "strict" than state regulations. In addition, it would have been useful to interview all jurisdictions about future plans regarding mandatory certification, and this kind of research is recommended for a future study.

Mandatory certification is one tool states may use to ensure adequate food safety knowledge of food handlers and food managers. As the labor shortage continues, it will likely become more important, with adequate food safety training also continuing to be problematic. Variation in state regulations are not unexpected, but may make regulations difficult for the food service industry to understand or meet. Regulators and the food service industry need to work together to develop regulations that help ensure the safety of food and help prevent foodborne illnesses.

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RELATED ARTICLE: Recent Changes in CFP Standards for Certification Exams

In 2003, CFP discontinued its "recognition" program for certification exams because of its new and more rigorous "accreditation" standards for certification exams. CFP adopted these standards in partnership with the American National Standards Institute (ANSI). Only three of the four exams that CFP used to recognize became accredited by CFP-ANSI in 2003:

* the National Restaurant Association's exam (National Restaurant Association Educational Foundation, 2001b),

* Experior's exam (2001), and

* the National Registry of Food Safety Professionals' exam (2002).

Barbara A. Almanza, R.D., Ph.D. Melissa S. Nesmith, M.S.

Corresponding Author: Barbara A. Almanza, 700 W. State Street, HTM Department, Purdue University, West Lafayette, IN 47907-2059. E-mail: [e-mail].