Food Protection Trends - July/August 2021 - 404

card is obtained after a negative intestinal parasites test of
a submitted stool (feces) sample. Requirements include
that the card is renewed annually and in the possession of
the employee at all times. Based on interviews with survey
participants, the following is a brief summary of the food
service establishment's demographics within the study. In
this study, 20 restaurants (of 23) and two charity kitchens
provided various food during lunch and dinner hours (11
a.m. to 9 p.m.), including seafood, beef, pork, poultry,
fresh produce, and pastries prepared in American, Italian,
Asian, or Caribbean styles. The remaining 3 restaurants (of
23) provided fruits, smoothies, fruit juices, and ice cream,
whereas the three roadside food vendors provided only
fresh fruits and fruit juices. The roadside food vendors sold
homemade unpasteurized juices, and 2 restaurants (of 23)
served homemade veggie burgers and desserts. Three major
food distribution companies supplied food to the retail food
establishments in the USVI, and food was imported primarily
from sources in California, Florida, and Massachusetts
(Boston), as well as the neighboring islands. One distributor
noted that on a given day, food distribution takes about 6
h in refrigerated trucks, and both road and ferry are used
to transport food between St. Thomas and St. John islands.
It was observed by the researchers that during the hot
summer months, the temperature of food within the trucks
was not maintained adequately because of the absence of
thermometers within the trucks. The number of employees at
the restaurants, charity kitchens, and roadside businesses in
this study ranged from 1 to 10, with roadside food businesses
staffed by one person who was in charge of all activities,
including food preparation, serving, and handling money.
Managers and chefs in restaurants in this study reported
taking responsibility for teaching other food handlers about
appropriate food handling practices.
Food safety issues within USVI retail food
establishments
The most frequent food safety issues identified (total = 172
times) in retail food service establishments in this study were
inadequate hygiene and sanitation, temperature abuse, lowquality
food, and cross-contamination, which are consistent
with the high-risk factors noted within the FDA Food Code
(41). The leading food safety issue identified in the study was
inadequate hygiene and sanitation (noted 67 of 172 times).
Specific observations included that food handlers prepared
food without hair coverings; handled ready-to-eat food with
bare hands; did not wash hands between tasks, before glove
use, or after touching money; and wore loose jewelry, painted
or artificial fingernails, and visibly dirty clothing. These
insanitary and unhygienic practices have been reported in
health inspections as common violations of the Food Code
in restaurants and roadside vended food in the United States
and could be related to foodborne disease outbreaks (1, 3,
20). In this study, 6 restaurants (of 23) had visibly dirty floors
404 Food Protection Trends July/August
and food contact surfaces, with overflowing open trash cans
that could attract flies, potentially spreading E. coli (8). The
three roadside food vendors sold homemade unpasteurized
fruit juices packaged in reused water bottles, a practice that has
been linked to Salmonella outbreaks (19, 22). Key informants
in this study noted that the unhygienic and unsanitary
condition issues were rarely noticed during inspections.
Temperature abuse was the second food safety issue noted
in this study and appeared 43 of 172 times. Respondents
reported occasionally receiving meat that had thawed and
refrozen, which compromises temperature control for safety
(TCS) food. Of 23 restaurant managers, 9 respondents
mentioned that they did not use thermometers when cooking
food, because they could tell doneness by the color and
texture, which can leave food undercooked (6) and has been
linked to Salmonella outbreaks in shrimp and beef roasts (35,
46). Observations at two restaurants showed that raw chicken
was thawed in sinks without water at room temperature
overnight, which promotes multiplication of pathogens.
When food supplies were delivered during busy lunch and
dinner hours, employees were too occupied to store frozen
and refrigerated food appropriately. The Food Code (41)
provides cooking and holding temperatures, as well as thawing
recommendations that minimize food safety risks of TCS food.
The FDA also recommends that a thermometer be used to
correctly measure temperature and doneness of TCS food to
ensure microbial safety. Two respondents noted that the USVI
experiences power outages during late-night hours, which has
been linked to diarrheal illness from consuming temperatureabused
food in New York City (25). An undependable power
supply, combined with hot and humid climatic conditions,
puts a strain on refrigeration and makes the USVI prone to
food temperature abuse (13). The key informants in this study
noted that food handlers needed to learn how to calibrate
thermometers, a finding that was supported by Robertson
et al. (32), who reported that up to 26% of food handlers in
southwest and southern Virginia grocery store delis wanted to
be trained in calibration of thermometers.
The issue of low-quality, imported food was noted 36 of
172 times, but the topic was not addressed as part of the
food safety educational materials, because the food supply
chain from the United States to USVI was not controlled
by restaurants, charity kitchens, and roadside enterprises.
Respondents that obtained food from grocery stores reported
that they perceived the USVI receives food that is nearing
the end of its shelf life; common food they listed were dairy
products, juices, and bruised fruit and vegetable produce that
spoiled shortly after it was displayed for sale on the shelves
in stores. We observed that food was stored without labels of
ingredients or use-by dates, which could lead to unintentional
use of expired food and allergen contamination. Because
the USVI imports about 97% of its food, a trend that has
increased over the years (14, 48), it continues to rely on a
few food distribution companies to provide high-quality and
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