Regulator Perceptions and Treatment of Temporary Food Establishments
Melissa Lombardi
Environmental Health Specialist
New Hanover County, NC
International Food Protection Training Institute (IFPTI)
2012 Fellow in Applied Science, Law, and Policy: Fellowship in Food Protection
Abstract
Temporary food establishments (TFEs) are venues for the handling, preparation, distribution, and consumption of foods for a period of no more than 14 days in conjunction with a single event or celebration (U.S. Food and Drug Administration, 2009). Food safety implicating characteristics of TFEs include limited space, sanitation facilities, and regulatory uniformity. Thus, there is a potential for an increased likelihood of a rapid, efficient spread of foodborne and water-borne outbreaks of infectious diseases from these parameters (Abubakar, 2012). This research explored retail food program managers’ perceptions of TFEs through a national survey (including Puerto Rico) mailed to members of the Association of Food and Drug Officials (AFDO). The survey inquired about: 1) TFE types, 2) application of regulatory oversight to TFEs, and 3) using the five Centers for Disease Control and Prevention (CDC) risk factors to rank the perception of those risk factors at TFEs. The most noted CDC risk factor across all TFEs was improper hot/cold holding temperature. Recommendations are provided to improve inconsistencies and inadequate regulations.
Background
Temporary Food Establishments (TFE) were mentioned in the first edition of the Food and Drug Administration’s (FDA) 1993 Model Food Code. The 2009 Food Code defines a TFE a food establishment that operates for a period of no more than 14 days in conjunction with a single event or celebration (Food and Drug Administration, 2009).
Foodborne and water-borne outbreaks of infectious diseases have the potential to spread efficiently and rapidly on a large scale (Abubakar, 2012). According to the CDC 2008 Outbreak Morbidity and Mortality Weekly Report, there were 356 outbreaks associated at known locations of fairs and festivals (CDC, 2008). The 1998-2010 CDC Foodborne Outbreak Online Database (FOOD) indicates there were 4,634 foodborne outbreaks that occurred in the United States at a fair, festival, or temporary mobile service (CDC, 2012). Although there have been limited studies on outbreaks associated with TFEs, the CDC reports, most foodborne infections go undiagnosed and unreported (CDC, 2012). Catering at large outdoor events is considered to be of greater risk than catering in other settings due to the large numbers of people, the temporary nature of the accommodation, the frequent use of temporary staff, reduced storage facilities, a frequent lack of access to an approved water source and potential exposure to extreme weather conditions (Willis, 2012).
TFE regulations and practices vary by jurisdiction. Regulatory practice may consist of a plan review, permit, and an inspection. TFE plan reviews ensure regulatory requirements are met by identifying potential food-safety code violations associated with construction or renovations. Plan review guidance documents by FDA advise that all TFEs submit an application, a plan review, and menu options for each event. The regulatory authorities review the application and plans to determine if all the specifications and requirements are met.
A TFE permit, according to the 2009 Model Food Code, means the document issued by the regulatory authority that authorizes a person to operate a food establishment (Food and Drug Administration 2009). Regulatory authorities may issue a permit for the facility to operate based on an approved plan review and an inspection of the facility.
TFE regulatory inspections involve a process that is guided by each establishment’s menu, potential hazards related to menu ingredients, and control measures to mitigate those hazards (CDC, 2011). Control measures and hazards are reflective of laws and regulations for each jurisdiction’s food safety regulatory programs. Types of inspections vary from risk-based inspections to inspections that just note violations of regulatory requirements. In 2011, the Conference for Food Protection released a guidance document suggesting inspection and plan review forms for states to follow.
Problem Statement
Little empirical evidence exists regarding regulatory treatments of TFEs or regulator perceptions of the extent to which TFEs expose the public to the risk of foodborne illnesses.
Research Questions
1. What types of regulations are implemented for TFEs?
2. What types of TFEs receive a pre-operational plan review?
3. What are regulator perceptions of TFEs based on the five CDC risk factors?
Methodology
For the purpose of this study, TFEs consisted of fairs, festivals, farmers’ markets, and non-profit events. These settings are normally high-risk food operations as operators prepare, store, serve, and dispose of foods often having limited physical space and sanitary facilities (Food and Drug Administration, 2000). A survey was created using a PDF fillable form and sent to all retail food program managers on The Association of Food and Drug Officials (AFDO) electronic distribution list, which contained representatives of all 50 states and Puerto Rico. AFDO is an international non-profit organization that is at the forefront of streamlining and simplifying regulations by drafting regulatory rules or commenting on government proposals. AFDO’s membership is comprised of high level regulatory officials, industry, and trade and consumer organizations (AFDO, 2013).
Participants were directed to forward complete surveys to the email address of the principal investigator. Two weeks following the initial distribution of surveys a reminder email was sent by AFDO to the distribution list. One week later the survey participation period closed.
For the states of Utah, New Hampshire, Illinois, and Arizona with multiple regulations in different jurisdictions, the state director supplied a list of the individual jurisdiction representatives for the state, and the representatives on these lists were emailed with the same survey. Four states had multiple respondents; their responses were averaged by state to provide one representative response per state. Excel was used to conduct an analysis of mean responses, job titles, departments, and states.
Results
Participants from 24 states (no responses from Puerto Rico) responded to the first questions on types of regulation and plan reviews conducted. Eleven states responded to the risk perception ranking of CDC risk factors. The survey respondents’ titles ranged from State Director of Environmental Health, Program Managers of local jurisdictions, lead Environmental Health Specialists, and general Environmental Health Officers. For all types of events, eleven (11) out of 24 states perceived the highest CDC risk factor ranked by importance on a scale of 1 to 5 to be improper cold/hot holding temperature with an overall average of 3.7. Respondents ranked dirty/contaminated utensils and equipment equally high in the same category for TFEs found at fairs with an average ranking of 3.5. For festivals, the second ranked risk factor by importance was poor employee health and hygiene with an average ranking of 3.4. For farmers’ markets, the second ranked risk factor was food from unsafe sources with an average ranking of 3.1. At non-profit events, the second ranked risk factor was dirty/contaminated utensils and equipment at 3.2 followed closely by improper cooking at 3.1 (Figure 1).
Ninety-two percent (92%) of participants indicated that their states permit TFEs at fairs and festivals and 96% of respondents indicated that their states inspect TFEs at fairs and festivals (Figure 2). TFEs at farmers markets and non-profits are permitted by 71% of the states represented. Seventy-nine percent (79%) of respondents indicated that TFEs at their state farmers’ markets are inspected and seventy-five percent (75%) of respondents indicated that their states inspect non-profits. A pre-operational plan review is conducted for TFEs at farmers’ markets by 42%, at fairs by 71%, at festivals by 67%, and for non-profits by 58% of the states represented by respondents (Figure 2).
Conclusions
While most states responding to the survey permit and inspect all types of TFEs, there were notable gaps in regulatory approaches used for TFEs at different venues. TFEs at farmers’ markets and non-profit events appear to receive less regulatory control than those found at fairs and festivals. Overall, less than half of the responding states conduct a pre-operational plan review for all types, an integral part of foodservice review and regulation. Improper hot/cold temperature was the most important risk factor according to the survey, suggesting it is one of the most difficult types of risk factors to control at this type of establishment.
The second most important risk factor was different for three of the four event types. This interesting finding could be explored further in future studies as it may indicate TFE characteristics unique to event types or common regulatory concerns in these different settings. It is concerning that not all respondents indicated at least one of the three regulatory interventions were used in 100% of the cases.
Limitations
Limitations of this study include: 1) lack of definition, 2) lack of uniform respondent authority, 3) lack of consistency among event types, and 4) combining of responses to represent a state.
A limitation in the study was not defining the different types of TFEs for survey recipients. For example, there may have been confusion among respondents between the definition of a fair and a festival. A second limitation to the study was the lack of uniformity of the levels of authority that responded to the survey, which may have had a role in the ranking of the variables.
Inconsistency of events may be another limitation. For example, fairs are a type of TFE held at a designated fair ground at a set time of year while festivals are a celebration or event set up at any location and may not occur at a set time each year.
Another limiting factor of the study was the averaging of data for four states due to the fact that there were multiple respondents represented within each of these states. Certain jurisdictions and state laws and regulations limit the authority of these jurisdictions and states to permit and inspect certain types of TFEs.
Recommendations
States would benefit from: 1) applying the recommendations from the FDA and Conference for Food Protection 2011 Temporary Food Establishment Guidelines when updating TFE rules and regulations for both plan review and inspections, 2) using a pre-operational plan review as a requirement prior to operation, permitting, and inspecting of TFEs, 3) adopting the FDA Model Food Code which would require the same type of regulations for all food establishments including TFEs, and 4) studying the regulation of non-profit organizations. Future studies should allow for clear determination of the types of TFEs, identify jurisdictions with regulatory authority, and allow an opportunity for the respondent to list additional types of TFEs allowed in their jurisdiction.
Acknowledgements
I would first like to thank my mentor Cameron Smoak, for all his support and guidance throughout this process. A special thanks to Dr. Preston Hicks with the Global Food Protection Institute for his patience and expertise with the many changes to the project. A big thanks to the International Food Protection Training Institute (IFPTI) for the opportunity to participate as a 2012-2013 Fellow in Food Protection. Thank you to all of the mentors, fellows, and staff of IFPTI. Lastly, thank you to New Hanover County for allowing me to participate in this fellowship and providing guidance along the way.
References
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Association of Food and Drug Officials (2013). About. Retrieved, from http://www.afdo.org/about.
Center for Disease Control and Pervention. Surveillance for foodborne-disease outbreaks---United States, 1998—2002. In Surveillance Summaries, MMWR 2006; 55 (No. SS-10).
Center for Disease Control and Prevention (2008). Number of reported foodborne disease outbreaks and outbreak- associated illnesses, by etiology and place where food was eaten*- United States, 2008. Retrieved from: http://www.cdc.gov/outbreaknet/pdf/2008MMWR-Table3.pdf.
Center for Disease Control and Prevention. (2011). Food safety and environmental assessments. Retrieved from http://www.cdc.gov/nceh/ehs/eLearn/EA_FIO/food-safety-environmental-assessment.htm.
Center for Disease Control and Prevention (2012). Foodborne Outbreak Online Database. Retrived from http://wwwn.cdc.gov/foodborneoutbreaks/Default.aspx.
Center for Disease Control and Prevention. (2012). Foodborne Illness, Foodborne Disease, (sometimes called “Food Poisoning”). Retrieved from http://www.cdc.gov/foodsafety/facts.html.
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U.S. Food and Drug Administration. 2000. Pre-operational Guide for Temporary Food Establishments – 2000 Food and Drug Administration and Conference for Food Protection. Retrieved from http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/ComplianceEnforcement/ucm095200.htm
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