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Information Sharing Preferences, Inspection Perceptions, and Employee Illness Behavior: A Survey of More Than 1,500 Minnesota Food Workers
Nicole D. Hedeen, MS, RS Environmental Health Division, Minnesota Department of Health
50% of confirmed foodborne outbreaks are caused by norovirus (Minnesota Department of Health, unpublished data). To prevent nor- ovirus outbreaks, the Minnesota Food Code has several provisions that target foodborne illness prevention, including requirements for food workers to report symptoms of vom- iting and/or diarrhea to the person-in-charge (PIC), for the PIC to record employee symp- toms of vomiting or diarrhea, to exclude ill employees for at least 24 hr after they recover from vomiting or diarrhea, and for the estab- lishment to report any complaints of patron illness to the regulatory authority. Although these measures are outlined in the Minnesota Food Code, norovirus remains the leading cause of foodborne outbreaks. Restaurant inspections are the primary way health departments can verify that food safety practices and policies are being properly implemented (Barnes et al., 2022) . Inspections are also an opportunity for inspectors to build a relationship with opera- tors. The one-on-one interactions that occur during inspections are often used to help educate food workers about the requirements of the food code. The dissemination of food safety information through resources such as videos, fact sheets, trainings, and inspections are also a crucial way that health departments provide education and training to food work- ers. In Minnesota, and likely nationwide, relationships between restaurant operators and regulatory agencies became strained dur- ing the COVID-19 pandemic due to health departments having to enforce restaurant closure orders and ensure compliance with other COVID-19 prevention measures. As a result, many regulatory agencies had to put inspections and food safety outreach activi- ties on hold due to the pandemic.
)8tra*t In February 2022, the Food, Pools, and Lodging Ser- vices Section at the Minnesota Department of Health sent out a 29-question, anonymous electronic survey to food workers across Minnesota. The goals of the survey were to 1) identify the most eective methods for distributing food safety information to operators; 2) understand operator behaviors per- taining to illness reporting and other Minnesota-specific code requirements; and 3) understand how operators view health department inspections, their perceptions of the inspection process, and interactions with their inspector. A total of 1,535 food workers participated in the survey. The feedback and findings from the survey will be used to inform how the Minnesota Depart- ment of Health conducts future training and outreach and will help identify gaps in food safety training. Keywords: food worker survey, food safety preferences, food worker beliefs, inspection perceptions, illness behaviors
Introduction Foodborne disease is a substantial public health problem. The Centers for Disease Con- trol and Prevention (CDC, 2018) estimates that approximately 48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne disease annually in the U.S. Noro- virus is the most common cause of foodborne illness and foodborne outbreaks; ill food work- ers cause approximately 70% of the reported foodborne norovirus outbreaks in the U.S. annually (CDC, 2019a; White et al., 2022). Restaurants are the most common setting for foodborne outbreaks and account for approxi- mately 60% of such outbreaks (CDC, 2019b). The Food and Drug Administration (U.S. Department of Health and Human Services, 2017) publishes the Food Code that is used by state, local, and federal regulators as a model
for best practices to ensure food is handled safely in retail settings to prevent foodborne illness. Minnesota adopted the 2013 FDA Food Code that went into eect in the state on January 1, 2019, as the Minnesota Food Code. All restaurant inspections completed in Min- nesota are based on the requirements within the current food code (Minnesota Department of Health, 2019). The Food, Pools, and Lodg- ing Services Section at the Minnesota Depart- ment of Health (MDH) inspects approximately 14,000 food, pool, and lodging establishments and has delegation agreements with 28 local health departments, which also inspect a combined total of 14,000 additional establish- ments across Minnesota. Similar to the national data, norovirus is the leading cause of foodborne illness out- breaks in Minnesota, where approximately
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Volume 86 • Num)er 10
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