Trends in Risk Factor Behaviors and Support Infrastructure in North Carolina Retail Food Facilities

Introduction: The U.S. Food and Drug Administration (FDA) quadrennially publishes a model food code, based on the best available science, to aid state and local health authorities in regulation of retail facilities. To support the model code, the FDA established a non-regulatory retail food risk factor study to measure the occurrence of practices and behaviors commonly identified by the U.S. Centers for Disease Control and Prevention (CDC) as contributing factors in foodborne illness outbreaks.

Purpose: The purpose of this study was to compare retail food risk factors within four North Carolina counties using a nationally-recognized standardized instrument.

Methods: Risk factor data were collected during non-regulatory visits by local health officials. Data collectors observed and documented behaviors related to operational risk factors associated with foodborne illness. Descriptive statistics were used to characterize trends by county, facility type, and risk factor. Significant factors (facility type, county) and pairwise comparisons of observed risk factor rates were analyzed using a generalized linear model.

Results: A total of 1,354 establishments in three categories (institutional food service, restaurants and retail food stores) were included. Significant differences were seen across facility type (P = 0.0063) with full service restaurants having a significantly higher rate of outbreak contributing factors than all other facility types (P < 0.001). Improper holding/time-temperature had the lowest compliance rate (< 75%) with 47% compliance for cold holding of potentially hazardous food (PHF); 58% for marking Ready-to-Eat (RTE), PHF after 24 hours; 43% for discarding RTE, PHF after 4 days (45°F) or 7 days (41°F), and 46% for marking dates on commercially processed RTE, PHF. Significant differences between observed risk factor rates were seen between counties.

Significance: This research is fundamental in understanding trends in food safety practices and behaviors, as measured by compliance with a standardized instrument to inform resource dedication, intervention development and policy evaluation.