NEHA January/February 2025 Journal of Environmental Health

ADVANCEMENT OF THE SCIENCE

TABLE 1

Correlation Between Deficiencies at Fort Liberty Associated With Foodborne Illness Risk Factor Categories, 2021

Measure

Missing Food Safety Training

Poor Personal Hygiene

Food From Unsafe Sources

Inadequate Cooking

Improper Holding Temperature

Contaminated Equipment

0.56** ( p < .001) 0.42** ( p < .001)

0.43** ( p < .001) 0.31** ( p < .001) 0.60** ( p < .001)

0.45** ( p < .001) 0.34** ( p < .001) 0.60** ( p < .001) 0.86** ( p < .001)

0.49** ( p < .001) 0.40** ( p < .001) 0.75** ( p < .001) 0.36** ( p < .001) 0.46** ( p < .001)

Missing food safety training

1.00

0.20* ( p = .02)

Poor personal hygiene

0.20* ( p = .02) 0.56** ( p < .001) 0.43** ( p < .001) 0.45** ( p < .001) 0.49** ( p < .001)

1.00

Food from unsafe sources

0.42** ( p < .001) 0.31** ( p < .001) 0.34** ( p < .001) 0.40** ( p < .001)

1.00

Inadequate cooking

0.60** ( p < .001) 0.60** ( p < .001) 0.75** ( p < .001)

1.00

Improper holding temperature

0.86** ( p < .001) 0.36** ( p < .001)

1.00

Contaminated equipment

0.46** ( p < .001)

1.00

*Correlation significant at p < .05 (2-tailed). ** Correlation significant at p < .01 (2-tailed).

must report personal health information (e.g., diarrhea, vomiting) to the FSM/PIC, use personal hygiene techniques regarding their hands or exposed body parts, and maintain cleanliness of clothing and uniforms (HQDA, 2019a). FSEs must obtain a minimum of 4 hr of initial food safety training within 30 days of starting work and an additional 4 hr of training annually related to the five food- borne illness risk factors identified by CDC. All FSEs must complete a food safety training course and maintain a certificate of comple- tion (HQDA, 2019a). One study determined inconsistencies in food safety knowledge related to foodborne illness risk factors among facilities in subur- ban Chicago (Manes et al., 2013). A baseline knowledge questionnaire was administered to 729 FSEs from 211 facilities to gather information on knowledge, personal hygiene, and behaviors. The results showed that 39% of respondents had never participated in a food safety training course (Manes et al., 2013). Further, the most commonly identi- fied knowledge gaps were related to optimal bacterial growth temperatures during refrig- eration, holding and cooking, hygiene, and cross-contamination. According to CDC, a 10% reduction in foodborne illness risk fac- tors would prevent 5 million illnesses annu-

ally in the U.S. (National Center for Emerging and Zoonotic Infectious Diseases, 2012). In our study, we examined the relation- ship between the foodborne illness risk fac- tors identified via inspection reports and the extent to which Fort Liberty PICs and FSEs were trained in food safety training. Our main objectives were to 1) examine the extent to which insucient food safety training related to deficiencies associated with CDC foodborne illness risk factors among five facility categories and 2) compare deficien- cies between facilities with and without food safety training. Other than internal reports from the Fort Liberty DPH, we know of no other studies that have investigated food safety training at a military installation. Methods Our study used internal 2021 inspection reports from the DPH for each facility within Fort Liberty. We received a review waiver from the East Carolina University Medical Center Institutional Review Board, as exist- ing data had no identifiers and no interac- tion with participants was required. Inspec- tion reports are accessible to the public on request, but internal data are primarily used for trend analyses. Our study analyzed 716 food service sanitation inspections of 124

facilities: 17 childcare facilities, 8 elementary and middle schools, 64 fast food and retail establishments, 14 military cafeterias, and 21 mobile food units and trucks. Each sanita- tion inspection consisted of 51 inspectable items ranging from proper handwashing and the use of disposable gloves to proper inter- nal product cooking temperatures and hot/ cold holding temperatures (Supplementary Figure 1, www.neha.org/jeh-supplementals). Inspectable items align with CDC foodborne illness risk factors, as well as PIC duties, responsibilities, and food safety training. Deficiencies identified from sanitation inspections during the study period (except for missing food safety training) were assigned to one of the five CDC categories. Deficiencies incurred by each food service facility within each category and the status of food safety training for each employee were tabulated by category. Data Analysis Spearman’s rank correlation coecient and Fisher’s exact test ( p < .05) were used to examine the relationship between missing food safety training and deficiencies associ- ated with the five CDC foodborne illness risk factor categories found during inspections. Fisher’s exact test ( p < .05) was used to show

Volume 87 • Number 6