Purpose: The purpose of this study is to investigate the hypothesis that restaurant-associated foodborne outbreaks are associated with the frequency of restaurant inspections.
Methods: We invited all local US health departments to complete a web-based survey to collect jurisdictional demographics, frequency of foodborne outbreaks and frequency of restaurant inspections. One hundred sixty-seven jurisdictions from 36 states participated in the survey. To examine sanitarian workload, we calculated the mean restaurant to sanitarian ratio (the average number of restaurants assigned to each sanitarian) and the mean inspection to sanitarian ratio (the average number of inspections performed by each sanitarian). Pearson correlation coefficients were calculated to describe the relationship between the outbreak rates and these continuous variables.
Results: During 2012, 59 jurisdictions reported at least one foodborne outbreak (total 187 outbreaks, range 1 - 27). On average, there were 0.55 restaurant-associated outbreaks per jurisdiction per 100,000 population (range 0 - 6.98/100,000). Sanitarians visited an average of 159 restaurants (range 12 - 546) and performed 296 inspections (range 17 - 1012). The mean number of annual inspections per restaurant did not correlate with outbreak rate (mean = 2.02, range 0.65 - 4.9, p = 0.8). However, both the mean restaurant to sanitarian ratio (mean = 159, range 12 - 546) and mean inspection to sanitarian ratio (mean = 295, range 17 - 1012) were significantly associated with higher outbreak rates (P = 0.029 and P = 0.036, respectively).
Significance: These data reveal that the number of restaurant inspections performed per sanitarian varies considerably throughout the country and that a greater inspection workload is associated with higher foodborne illness outbreak rates. Future studies are needed to determine if there may be differences in the quality of inspections performed by inspectors with higher workload.