NEHA January/February 2025 Journal of Environmental Health

cal authority of each military installation generally delegates this responsibility to the director of the DPH (i.e., chief of preventive medicine services). The Army Food Service Sanitation Program provides the framework for military public health regulators to estab- lish food safety training, education, and inspection programs to protect personnel who consume food that is stored, prepared, and served on military installations. Role of Food Service Managers and Food Safety Training Requirements in the Military The food service manager (FSM) is respon- sible for actions within the facility during operating hours. The FSM should be the PIC or appoint a PIC who is a certified food pro- tection manager and is at the facility during operating hours. The FSM/PIC demonstrates knowledge of foodborne illness prevention, application of control measures to mitigate illness, and sanitation inspections; this per- son also provides food safety training to FSEs (HQDA, 2019b). Importance of Managerial Food Safety Training on Food Service Sanitation Minimal published research exists on the ecacy of food safety training for military installations. Studies on other types of food facilities, however, support the importance of having a certified food protection man- ager present during food service operations to mitigate foodborne illness risk factors (Brown et al., 2014). The Environmental Health Specialists Network (EHS-Net) is a cooperative program of partners including CDC, FDA, and the U.S. Department of Agri- culture (USDA), with state or local public health departments that investigate sources of foodborne illness (CDC, 2024). EHS-Net investigated the association between FSM and worker food safety certification, train- ing, and knowledge and showed that certi- fied personnel had more food safety knowl- edge than noncertified personnel (Brown et al., 2014). Role of Food Service Employees and Food Safety Training Requirements in the Military Although the FSM/PIC is the first line of defense for food safety, the FSE also plays an important role (Brown et al., 2014). FSEs

FIGURE 1

Percent Difference Between Missing Person-in-Charge and Employee Food Safety Training and Foodborne Illness Risk Factors and Facility Types at Fort Liberty, 2021

Childcare Facilities (17) Fast Food and Retail Establishments (64) Mobile Food Unit and Truck Vendors (21)

Elementary and Middle Schools (8) Military Cafeterias (14)

100

No Yes ** No Yes ** No Yes ** No Yes ** No

Yes ** No Yes *

Food From Unsafe Sources

Contaminated Equipment

Improper Holding Temperature

Inadequate Cooking

Missing Food Safety Training

Poor Personal Hygiene

Deficiencies

*Correlation significant at p < .05. **Correlation significant at p < .001.

pathogen growth, and 5) consumer educa- tion (HQDA, 2019a). The 2017 FDA Food Code includes the requirement that the person-in-charge (PIC) of a food service facility maintains a food pro- tection manager certification (FDA, 2022). The PIC must demonstrate food protection knowledge by passing an exam from a course accredited by an agency approved by the Conference for Food Protection (2024). A certified PIC must be present during operat- ing hours of facilities that store, prepare, and serve food. In 2019, the TSFC was updated to include this training requirement for a certified food protection manager (HQDA, 2019a), thereby reducing foodborne illnesses (Brown et al., 2014). At Fort Liberty, all PICs must be certified food protection managers; additionally, any food service employee (FSE) who engages in food storage, preparation, and service must complete food safety training no later than 30 days after the start of employment as well as 4 hr of refresher food safety training within 12 months (HQDA, 2019a). The Fort Liberty DPH provides food safety training to all FSEs, and certified personnel can provide instruc- tion and proctor the associated certified food

protection manager exams from programs accredited by the American National Stan- dards Institute (ANSI) and the Conference for Food Protection (HQDA, 2019a). The five major foodborne illness risk factors contributing to foodborne illness include: 1) poor personal hygiene, 2) obtain- ing or using food from unsafe or unapproved sources, 3) contamination of equipment, 4) improper hot or cold holding temperatures, and 5) improper or insucient cooking (FDA, 2022). Food service facility inspec- tion reports cover these five risk categories. In 2018, foodborne pathogens associated with these five risk factors were responsible for approximately 8.9 million illnesses— including 54,000 hospitalizations and 1,480 deaths—and $14.4 billion in healthcare costs in the U.S. (Homan & Ahn, 2021). Army Food Service Sanitation Program The Army Food Service Sanitation Program was created to implement Army Regulation (AR) 30-22 (HQDA, 2019b). The U.S. Army Public Health Center has oversight of the program, which is managed by the medi- cal authority of each military installation (Defense Health Agency, 2018). The medi-

January/February 2025 • Journal of Environmental Health