2005 Idaho Baseline Survey “Gems of Wisdom to Consider and Apply for Baseline Surveys”

Idaho Notes State Population = ~1.3 Million (2002) ~30% of that population live in the Treasure Valley (Boise, Nampa, Caldwell) area. ~9,000 licensed food establishments in state 2002, Idaho became first state to have all health jurisdictions enrolled in program standards

Panhandle North Central South Central Central Southeastern District VII Idaho Public Health Districts Southwest

Relationship Between State and Districts State is designated authority to promulgate rules State provides technical and other support as well as training as requested State establishes overall goals of food safety program Districts are designated as regulatory authority Districts are contractually obligated to conduct inspections Set own (internal) QA goals and programs

Program Standards Many of the program standards are met through a “symbiotic relationship” with the districts Standard 1 – districts could not meet it until state met it Standard 6 – state cannot meet until all districts meet it Standard 9 (baseline) presented some significant concerns – cost, consistency

Different Approaches to Baseline Have each health district conduct their own baseline Have the state collect everything Ignore it – maybe it would have gone away Combine efforts to collect data and report on findings

FDA Auditor’s Class, July 2004 Concerns about the Idaho baseline raised “Why did you (state) enroll if your health districts are the ones doing the inspections?” I asked the FDA clearinghouse about conducting one baseline, based on a weighted proportion of establishments, and allowing the districts to use the information to get credit for Standard 9

One Baseline Would Work IF: One set of intervention strategies identified and used by all agencies Study was proportionally divided to so that all agencies participated Statistically valid sample sizes maintained Data could not be interpreted to apply to individual districts

Overall Plan Collect an inventory from each district for each facility type involved with the baseline Determine proportion (specific to individual district) of total of each facility type Randomly assign establishments from inventory Conduct baseline in conjunction with regular inspections 7 Facility types included

Methodology Suppose 50 surveys needed for baseline District X has 20% of all establishments District X assigned 10 of the 50 surveys (20%) 10 establishments randomly chosen of District X’s total inventory Randomization done with

30 (9.3%) 16 (5.0%) 52 (16.2%) 85 (26.5%) 42 (13.1%) 40 (12.5%) Inventory Sizes – Elementary Schools (321 Total – 79 Needed for Baseline) 7 (8.9%) 4 (5.1%) 13 (16.5%) 21 (26.6%) 10 (12.7%) Total InventoryBaseline Inventory 56 (17.4%)14 (17.7%)

33 (20.6%) 13 (8.1%) 15 (9.4%) 39 (24.4%) 28 (17.5%) 14 (8.8%) Inventory Sizes – Produce Departments (160 Total – 63 Needed for Baseline) 13 (20.6%) 5 (7.9%) 7 (11.1%) 15 (23.8%) 11 (17.5%) 6 (9.5%) Total InventoryBaseline Inventory 18 (11.3%)7 (11.1%)

(21.0%) 38 (66.7%) 5 (8.8%) 0 Inventory Sizes – Seafood Departments (57 Total – 39 Needed for Baseline) (23.1%) 26 (66.7%) 3 (7.7%) 0 Total InventoryBaseline Inventory 2 (3.5%)1 (2.6%)

General Results – IN Compliance Facility Type Time/temperature control Contaminated Equipment Poor Personal Hygiene Inadequate Cook Food From Unsafe Source Elementary School92.14%94.68%95.68%97.98%99.40% Fast Food83.27%87.97%91.36%100%99.40% Full Service72.51%83.46%82.94%97.84%98.47% Deli Department77.95%84.98%92.73%96.80%97.01% Meat Department89.74%89.21%92.70%100%98.46% Produce Dep’t88.63%93.06%90.98%100% Seafood Dep’t70.52%97.38%94.18%75.00%99.32%

Significant Out of Compliance Items Elementary Schools – RTE, PHF date marking – 18% out of compliance Produce Department – Cold holding at or below 41°F – 17.46% out of compliance Seafood Departments – commercially processed RTE, PHF date marked – 55% out of compliance RTE, PHF date marking – 58.82% out of compliance

Results There are some limitations with these results – will be discussed later Some of the percentages are high, but are based on only a few observations One of the most revealing results is the need for better information about inspection process and how to improve consistency

33 (18.5%) 9 (5.1%) 30 (16.9%) 40 (22.5%) 26 (14.6%) 17 (9.6%) Inventory Sizes – Meat Departments (178 Total – 69 Needed for Baseline) 13 (18.8%) 3 (4.3%) 12 (17.4%) 15 (21.7%) 10 (14.5%) 7 (10.1%) Total InventoryBaseline Inventory 23 (12.9%)9 (13.0%)

Out of Compliance – Meat Depts. Cold holding – 26.74% Protection from environmental contamination – 14.49% Handwashing facility properly stocked – 14.49%

172 (11.2%) 60 (3.9%) 205 (13.4%) 609 (39.8%) 172 (11.2%) 156 (10.2%) Inventory Sizes – Fast Service (1530 Total – 87 Needed for Baseline) 10 (11.5%) 3 (3.4%) 12 (13.8%) 35 (40.2%) 10 (11.5%) 9 (10.3%) Total InventoryBaseline Inventory 156 (10.2%)8 (9.2%)

Out of Compliance – Fast Service Cold holding – 26.74% Clean surfaces – 23.53% Poisons/toxics stored and identified correctly – 15.29% (We include this with the cross contamination risk factor) Proper, adequate handwashing – 13.33%

27 (17.6%) 9 (5.9%) 21 (13.7%) 38 (25.5%) 24 (15.7%) 13 (8.5%) Inventory Sizes – Deli Departments (153 Total – 64 Needed for Baseline) 11 (17.2%) 4 (6.3%) 9 (14.1%) 16 (25.4%) 10 (15.6%) 5 (7.8%) Total InventoryBaseline Inventory 21 (13.7%)9 (14.1%)

Out of Compliance Deli Dept’s Cold holding – 33.85% Clean surfaces – 29.69% Hot holding (135°F) – 26.23% Commercially processed RTE date marking – 24.00% Proper, adequate handwashing – 17.24% Protection from environmental contamination – 15.38% RTE, PHF date marking – 18.52%

303 (19.0%) 121 (7.6%) 270 (16.9%) 344 (21.6%) 131 (8.2%) 243 (15.2%) Inventory Sizes – Full Service (1594 Total – 87 Needed for Baseline) 17 (19.5%) 7 (8.0%) 13 (14.9%) 19 (21.8%) 7 (8.0%) 13 (14.9%) Total InventoryBaseline Inventory 182 (11.4%)11 (12.6%)

Out of Compliance – Full Service Cold holding – 44.32% Clean surfaces – 28.09% Handwashing – 26.14% RTE, PHF date marking – 35.59% Bare hand contact – 21.84% Toxics – 19.32% RTE, PHF discarded at proper time – 35.42% Raw/RTE foods separated – 20.00% Commercial RTE, PHF date marked – 31.91% Environmental contamination – 16.85% Handwash sink stocked – 14.77% Good hygienic practices – 14.63%

Limitations Several practices marked “not observed” Inconsistent interpretations of questions and answers on forms Potential misinterpretation of data Intervention strategies identified might not be applicable for all agencies

Not Observed Inadequate cooking had 12 possible observations Time/Temperature had 10 possible observations Personal hygiene had 5 possible observations

N/O for Elementary Schools Cooking – 61.7% Time/temperature – 36.7% Hygiene – 5.8%

N/O – Fast Service Cooking – 57% Time/temperature – 33.1% Hygiene – 9.3%

N/O - Deli Cooking – 56.7% Time/temperature 33.5% Hygiene – 5.3%

N/O – Full Service Cooking – 61.2% Time/temperature – 37.5% Hygiene – 2.3%

Why All the N/O Marks? Time of day – prep not taking place that late in the morning or afternoon Particular day – especially true for meat departments (risk factor practice not performed every day) Time spent collecting the data

Time for Data Collection Full service – 88.2 minutes Fast food – 55.4 minutes Elementary schools – 51.5 minutes Meat Dep’t – 50.4 minutes Deli Dep’t – 49.2 minutes Produce Dep’t – 37.0 minutes Seafood Dep’t – 30.8 minutes

Inconsistent Interpretations of Data Collection School and toxics held for retail sales Cooking of poultry Protection from environmental contamination Shellfish records and tags

Potential Misinterpretation of Data Full service – Hygienic practices out ~14% This is not to suggest that 14% of full service restaurants are out of compliance This is the general interpretation applied and it is not an accurate statement Real interpretation is that 14% of the observations that were made were out of compliance (2% of the total possible observations were not made)

Intervention Strategies Apply information from the study into food safety courses – all districts might not offer consistent food safety courses Training for EHS’s – districts employ different training techniques Commitment to standardized staff – presents time and resource issues for districts

Significant Results Cold holding is an issue – however, the requirement changed during the baseline survey Holding times (date marking) Cross contamination (especially surfaces and chemical storage) Personal hygiene

Now what? Each district provided with a copy of the report Study to be repeated in 5 years and compare data Begin implementing intervention strategies to help educate in order to reduce risk factors In the meantime, Idaho data collection looks like...

Current Data Collection

Risk Factor Violations

Follow-Up Inspections

Not Observed Risk Factors

Other Questions Patrick Guzzle, Food Protection Program Manager Idaho Department of Health and Welfare (208)