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Risk assessment for foodservice establishments.

Background

The city of Plano, Texas, is located approximately 20 miles north of downtown Dallas and serves a diverse population of approximately 165,000. In 1990, the City of Plano Environmental Health Department, Food Protection Program operated with extremely limited resources and a minimal budget. As a result, the Food Protection Program suffered due to inadequate inspection, enforcement, personnel, and funding. To compensate for shortcomings in these areas, training and implementation of a Risk-Based Food Protection Inspection Program was initiated (1,2,3). The system effectively allowed reallocation of resources and personnel that increased inspections and safety. Ultimately, the Risk-Based Food Protection Program led to increased staff, funding, and credibility. Today, the simplicity of the program provides for continuous modification through regular updates of computer-generated questionnaires and inspection forms and allows the city of Plano (which contains more than 660 foodservice establishments) to better manage and protect the public's health.

Method

The frequency and type (standard 44-point or Hazard Analysis Critical Control Point, HACCP) of foodservice establishment inspection is based on whether an operation is categorized as high, moderate, or low risk and characterized by the following:

High Risk Establishment

Foodservice operations that through the type of food served, population served, previous inspection history, or operational risks present an above average risk for potential foodborne illness.

Moderate Risk Establishment

Foodservice operations that through the type of food served, population served, previous inspection history, or operational risks present average risk for potential foodborne illness.

Low Risk Establishment

Foodservice operations that through the type of food served, population served, previous inspection history, or operational risks present nominal risk of foodborne illness (4).

These risk category assignments (i.e., high, moderate, and low) are based on four criteria:

1. Food Property Risks

Food property risks are those which may cause food to become a vehicle for, or source of, foodborne illness. Food property risks include time-temperature relationships, acidity or alkalinity (pH), amount of water available in food to support growth of microorganisms (Aw), product constituents such as salts and preservatives, and common microflora associated with the product or environment.

2. Population at Risk

Specific populations such as the young, aged, and infirm are predisposed to illness caused by foodborne pathogens or toxins.

3. Foodservice Establishment History

Records indicating complaint and inspection history are evaluated.

4. Foodservice Operational Risks

Operational risks are those which exist due to process or procedures that influence survivability of microorganisms (e.g., cooking, handling, cooling, storage, training, etc.) (5).

A simple weighted point system is assigned specific criteria in each of the four categories, the sum of which is 100 [ILLUSTRATION FOR FIGURE 1 OMITTED]. Establishments with net scores of 70 or above are categorized as high risks and are inspected using routine 44-point inspection at least six times a year. Hazard Analysis and Critical Control Point (HACCP) evaluation is assigned based on risk analysis score. At least 35 establishments are targeted for HACCP evaluation each year. Establishments with the highest risk scores are evaluated using HACCP with succession in descending order of risk. Moderate risk establishments with net scores from 50 to 69 are inspected routinely using the standard 44-point inspection system at least three times per calendar year. HACCP may be assigned based on risk, resources, and management review. For example, HACCP may be scheduled in a moderate risk establishment as a result of a foodborne illness outbreak, an inordinate complaint history, or on request by the establishment. Low risk establishments, those with risk analysis scores of 49 or less, are inspected a minimum of once each year using the standard 44-point inspection system.

Scores and delineation of risk category are reassessed each calendar year and input into a database for easy reference, retrieval, and referral.

Implementation

Foodservice establishment risk assessment surveys are conducted by Environmental Health Specialists as each new operation opens for business or annually on existing establishments [ILLUSTRATION FOR FIGURE 2 OMITTED]. Survey questions/statements correspond to weighted scores on the risk analysis form [ILLUSTRATION FOR FIGURE 1 OMITTED]. Points are derived for each affirmative answer provided on the questionnaire. The sum of points minus any credit provided for foodservice employee certification determines if the establishment is categorized as a high, moderate, or low risk. (Credit for foodservice employee certification was provided as an incentive for training and allows operators the potential to determine risk category if scores are marginal. Foodservice manager certification is required by ordinance.)

Survey information is compiled and scored on the risk analysis form [ILLUSTRATION FOR FIGURE 1 OMITTED]. All information is then input into a database which provides computer printouts that can be generated based on risk category, risk analysis score, frequency of inspection, or other criteria [TABULAR DATA FOR FIGURE 3 OMITTED] of frequency and type of inspection are then determined by management with health specialist assistance.

Results

Risk analysis was incorporated into the City of Piano Food Protection Program in the 1991-92 fiscal year (1). Figure 4 suggests the program has reduced the number of high risk establishments 13.6% from 44 establishments in 1991 to 38 in 1993, even though restaurant growth has exceeded 8% per year since program inception (111 new food establishments have been permitted in the last three years). Other factors that may have contributed to the reduced number of high risk establishments indicated in Figure 4 include staff, owner and operator training, menu modification, procedure modification, HACCP, and increased inspection frequency.

Risk assessment has also allowed better management of health department personnel. Health specialists spend time, inspect, and educate more in establishments that present the greatest potential for foodborne illness (6).

A secondary but equally important benefit of the Risk-Based Food Protection Program is an increase in the department's staff and budget. Risk assessment allowed Environmental Health Specialists to inspect high and moderate risk establishments a minimum of three times in the 1992-93 fiscal year. This was compared to an average of 0.8 inspections/year/establishment in 1990. Frequency of inspection, consistency, and a newfound rapport with foodservice establishment owners and operators provided health department management with a level of comfort initiating increased foodservice establishment fees. Fees were raised from a flat $150 annual permit to graded levels from $275 to $575 per year based on risk category and labor intensity. Fee changes met little resistance after implementation and more than doubled previous years' revenues (1991 food permit revenues, $89,500, compared to 1993 food permit revenues, $179,500). These increased revenues provided a foundation for requisition of three new Environmental Health Specialist positions. The specialists contribute to a HACCP team and participate in testing of the U.S. Food & Drug Administration's Electronic Inspection System (EIS), an opportunity which was precipitated through funding of notebook computers for all field staff.

Summary

Use of risk assessment and analysis for prioritizing food inspection frequency and type in the city of Plano has elicited better management of personnel and budget resources. The system simply and systematically prioritizes establishments into high, moderate, and low risk categories and provides for optimal food safety while operating under personnel and budget restraints common to many jurisdictions.
Figure 4. Results, Priority Analysis, FY 1991-1994.


1991-1992
Risk Category Analysis Score Range # of Establishments % Total


High Risk 70-100 44 8.4%
Moderate Risk 50-59 200 38.2%
Low Risk 49-0 279 53.4%
Total 524 100.0%


1992-1993
High Risk 70-100 42 7.4%
Moderate Risk 50-69 264 46.6%
Low Risk 49-0 261 46.0%
Total 567 100.0%


1993-1994
High Risk 70-100 38 6.0%
Moderate Risk 50-69 280 44.4%
Low Risk 49-0 315 49.6%
Total 635 100.0%


References

1. Bryan, F.L. (1985), "Procedures for Local Health Agencies to Institute a Hazard Analysis Critical Control Point Program for Food Safety Assurance in Foodservice Operations," J. Environ. Health, 47:241-245.

2. Bryan, F.L. (1988), "Food Safety Through the Hazard Analysis Critical Control Point Approach," Training Seminar Manuscript, Dec. 12-17, Plano, Tex.

3. International Assoc. of Milk, Food and Environmental Sanitarians (1991), "Procedures to Implement the Hazard Analysis Critical Control Point System," 1:9-22.

4. Bryan, F.L. (1988), "Risk Associated with Vehicles of Foodborne Pathogens and Toxins," J. of Food Protection, 51:498-508.

5. Bryan, F.L. (1982), "Foodborne Disease Risk Assessment of Foodservice Establishments in a Community," J. of Food Protection, 45:93-100. 6. Kaplan, O.B., and E. El-Ahraf (1979), "Relative Risk Ratios of Foodborne Illness in Foodservice Establishments: An Aid in Development of Environmental Health Manpower," J. of Food Protection, 42:446-447.

Brian Collins, R.E.H.S., Environmental Health Manager, City of Plano, P.O. Box 860358, Plano, TX 75086-0358.
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Author:Collins, Brian
Publication:Journal of Environmental Health
Date:Mar 1, 1995
Words:1429
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