Food Protection Trends - May/June 2020 - 155

Foodborne illness, which occurs after consumption of
contaminated foods or beverages (5), is also referred to as
"food poisoning" (5). Numerous contaminants can cause
such outbreaks; a growing number of them are caused by
bacteria, viruses, and parasites (29). Salmonella is identified
as one of the most frequently implicated pathogens (5).
Common foodborne illness symptoms are vomiting,
diarrhea, fever, respiratory failure, nausea, and abdominal
pain (29). Each year during the early 2010s, an estimated
1 in 6 Americans reported having had a foodborne illness;
128,000 people were hospitalized, and approximately 3,000
died as a result of consuming contaminated foods each year
(4). Obviously, contaminated food can result in substantial
numbers of illnesses, hospitalizations, and deaths (4, 5).
During the 1990s, foodborne illness outbreaks occurred in
numerous schools in the U.S., affecting approximately 16,000
students, with around 300 cases reported (7). A study by
Dewey-Mattia (9) states that 69 foodborne outbreaks and
2,164 illnesses were reported between 2009 and 2015. At
schools, the average number of illnesses per outbreak was 31
cases. With regard to these findings, schools are required to
constantly comply with food safety policies and regulations
to minimize the risk of foodborne illness. Since students
consume the majority of the meals served at schools and
are particularly vulnerable (9, 11, 22), and because schools
serve more meals than restaurants do, it is crucial that schools
implement food safety policies that ensure students' wellbeing (20, 26).
Restaurant inspection results are an important aspect of
evaluating the risk of foodborne outbreaks (12, 25). Many
people use publicly available restaurant inspection results
to help them decide where to dine, as health inspections
can ensure the adequacy of food hygiene and food safety
practices at restaurants (2, 32). Moreover, as Seiver and
Hatfield (23) pointed out, health inspection plays a key
role in increasing awareness on the part of restauranteurs to
comply with regulations. According to the CDC (7), a total
of 139 and 147 foodborne illnesses occurred at schools in
the State of Missouri in 2016 and 2017, respectively. School
foodservice operations in Missouri receive at least one
health inspection annually (7). Kwon et al. (14) stated that a
higher frequency of inspection indicates a lack of food safety
practices, as an increased number of inspections is due to
complaints and the need for follow-up visits.
According to the Missouri Department of Health and
Senior Services (18), all health inspections, including
inspections of schools in the State of Missouri, should use
the principles of Hazard Analysis Critical Control Points
(HACCP) as a basis for food safety practice. Local health
departments in Missouri routinely inspect all foodservice
facilities for risks to public health. One of the food code
categories, called "compliance and enforcement," explains
that foodservice establishments should maintain and
demonstrate their HACCP plans accordingly. According

to the food code for food establishments in the State of
Missouri; (19), management and personnel; food; equipment, utensils, and linens; water and plumbing; physical
facilities; poisonous or toxic materials; and compliance
and enforcement are the seven major categories in the
Missouri state inspection food code. Foodservice establishments with poor inspection results are at an increased
risk of being the source of foodborne outbreaks (12).
In Missouri, two different types of food violations
can be detected during the health inspection: critical
and non-critical violations (18). Foodservice operation
violations are classified as either critical or non-critical,
depending on the condition of the facility during the
inspection. According to Ambrose (1), critical violations
pose unacceptable health risks that can lead to foodborne
illness, while non-critical violations do not. Common
critical violations can include failure to maintain proper
food temperature, food storage, employee hand washing,
labeling, pest control, and poisonous material use (1,
27, 28). A study by Philips, Elledge, Basara, Lynch, and
Boatright (21) revealed that unacceptable food-holding
temperatures and employee hygiene practices were the two
most frequently cited critical violations during the health
inspections. Because critical violations have a direct impact
on the safety of diners, immediate actions are required
to adjust the problem (1). Restaurants repeatedly given
reports of critical violations are subject to being suspended
for at least a day. Although non-critical violations are not
required to be adjusted immediately, they may possibly
lead to critical violations in the future (3). When routine
inspections are conducted at schools, the schools are
required to be prepared for immediate adjustments if
critical violations occur (15, 24). If the violations are noncritical, follow-up inspections must be performed within a
short period of time to verify that corrective actions have
been taken (24).
This study examined the relationship between the
number of critical and non-critical violations recorded
and food safety issues in a sample of schools in Missouri,
to predict which aspects of health inspections are most
lacking in schools in Missouri. Although previous studies
have investigated restaurant inspection results in other
states in the U.S., none has explored school foodservice
inspection results specifically in the state of Missouri.
Thus, the main objective of this research study is to access
the current food safety practices at school foodservice
operations in Missouri by reviewing health inspection
reports. Specifically, this study will use secondary data
to review the past six years of health inspection results at
school foodservice operations, to assess which categories
of violations are most frequently seen, and to provide
recommendations on improving food safety practices, with
the ultimate goal of preventing foodborne disease outbreaks
at schools.

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