Dirty Restaurants: Sounding an Alarm

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The public-advocacy group that helped maneuver the trans-fats ban in New York City restaurants and pushed national chains to divulge fat and calorie content on their menus is agitating for more change. The Washington-based Center for Science in the Public Interest (CSPI) is now calling for easy public access to restaurant health-code grades, improved health-inspector training and a nationwide standard for restaurant inspections.

"If you can walk by a restaurant and see which credit cards it takes and whether Zagat recommends them, then you should also be able to see how the local health authority rates them," says Sarah Klein, a staff attorney with CSPI, which made its recommendations in an Aug. 7 report, "Dirty Dining: Have Reservations? You Will Now."

As the title suggests, if you are of the ignorance-is-bliss camp when it comes to restaurant dining, you might be advised to stop reading now — there is a sizable "ick" factor to the CSPI's findings. Klein and her team sought the most recent routine reports from 30 restaurants in each of 20 cities the CSPI selected across the U.S., analyzing 539 reports in total. They revealed the gamut of infractions, from mold growing in ice machines (in a restaurant in Atlanta) to live cockroaches skittering across kitchen cutting boards (in Pittsburgh, Pa.). The reports cited violations in restaurants of every caliber: though the data does not detail which specific restaurants committed which offenses, the aggregated inspections represent popular national fast-food chains as well as posh $90-a-head eateries.

The term health-code violation typically conjures images of germ-sodden hands wrangling the steak tartare or gangs of mice and roaches commandeering the pantry. These are indeed serious problems, but according to the CSPI report, consumers should be more concerned with the risk of unclean food contact or prep surfaces (26% of restaurants committed this violation), which can allow for dangerous cross-contamination between, say, raw meat and fruit. Another big problem: improper holding temperatures (22% of restaurants kept food either not hot enough or not cold enough), which can potentially lead to bacteria festering in poorly cooked food. Inadequate hand-washing accounted for 16% of the violations recorded, putting diners at risk for contagion of norovirus or salmonella. Infestations of rodents and insects were cited in 13% of restaurants, most often in New York City, Boston and Philadelphia, while 11% of restaurants were cited for workers using dirty cloths to wipe down tables or food-preparation surfaces.

Of the 20 cities studied, 66% had at least one high-risk safety problem. Boston's restaurants led the pack with 63 violations among them, most of which had to do with unclean food surfaces; other transgressions included spoiled food and inadequate hand-washing by employees. Austin, Texas, eateries came in second, with 58 violations, including a leaking roof over a food-prep area and rodent droppings on utensils. Most of the city's violations, however, had to do with food kept at improper temperatures.

It's unclear whether cities with more violations simply had dirtier kitchens or more dogged restaurant inspectors. New York City, Milwaukee, Austin and Atlanta had the better inspector-to-restaurant ratios, where inspectors covered fewer than 200 restaurants each. Philadelphia, Pittsburgh and Chicago had the highest ratios, with each inspector responsible for evaluating 400 to 500 restaurants. In some cities, however, inspectors appeared to work overtime: Colorado Springs, which employs just eight food inspectors for about 2,000 restaurants, reported the third highest number of violations in the study, at 46; most cited unclean food surfaces, as well as food being inadequately refrigerated and outside openings being left vulnerable to rodents. The cities with the fewest violations were Tucson, Ariz., where 20 inspectors reported 14 violations; San Francisco, whose 20 inspectors came up with 15 violations; and Philadelphia, where 26 inspectors ferreted out 16 offenses, over half of which were related to insects and rodents.

The CSPI estimates that the average American eats out five times a week. The vast majority of them survive unscathed, but every year, 76 million Americans fall ill from unsafe food. More than 15 years of data show that 41% of all food-borne illness outbreaks in the U.S. can be directly traced to restaurant food. In 2005 a single employee reportedly infected with norovirus at a Blimpie sub shop in Michigan ended up sickening more than 100 customers. Investigators think the virus was transferred to food products and between employees who used the same sink to wash hands and wash lettuce without sanitizing the sink between uses.

Part of the safety issue may be lack of oversight and accountability. Only nine state governments have fully adopted the Food and Drug Administration's 2005 Food Code, which lays out safe food-handling and sanitation standards. The CSPI, along with the National Restaurant Association, which represents food establishments, is pushing for all 50 states to adopt this code. The restaurant association would also like to see a standardized inspection form that would make it easier for evaluators to identify problem areas quickly, helping to advance food safety. Yet the industry group calls the CSPI report a "misleading caricature" and insists that it does not present an accurate picture of the restaurant industry as a whole. "We wouldn't be spending millions of dollars to advance food safety training and certification programs for workers if we weren't serious about food safety," says Donna Garren, who oversees health and safety issues for the restaurant association.

Klein thinks restaurants still have a long way to go. She says they aren't motivated to set a very high safety bar, noting that a restaurant may commit violations that the Centers for Disease Control and Prevention would classify as most critical — improper holding temperatures, poor employee hygiene, food bought from unsafe sources, food that is not thoroughly cooked or food surfaces that are not properly disinfected — without much fear of being shut down. Even violations that involve rat infestations or unwell employees (restaurant workers tend not to get paid sick days) may not lead to closure. "Restaurants only have the incentive to do what they need to do to stay open," says Klein. "The consumer would never know how close they were to being shut down." According to the CSPI, violations that justify immediate shutdown are relatively extreme — such as an open sewer line in the kitchen or a broken water heater.

But some cites are doing things right, Klein says, and setting a constructive example. Ten years ago, Los Angeles County implemented a grade-card system that requires restaurants to display letter grades given to them by health inspectors. Restaurants that score 90 or above on the 100-point health-inspection measure receive an A; those that score 80 to 89 receive a B; and so forth. The program, which Las Vegas and St. Louis, Mo., have since adopted, has been well-received by consumers. Surveys suggest that most diners notice the grade cards, approve of the system overall and feel convinced that it ensures food safety — most surveyed consumers also said that a restaurant's letter grade directly affected their decision to eat there.

At the moment, says Klein, this kind of health-inspection information isn't very easily accessible in all locales. In many cities, such as New York City, Chicago and Denver, restaurant-inspection reports are available online. In others, like San Francisco and Atlanta, restaurants keep their reports on-site and give them to the customer upon request. But some cities, including Pittsburgh and Washington, share inspection results only through Freedom of Information Act requests — which is not very useful for the consumer unless he's planning dining reservations months in advance.

Amid the report's stomach-churning details, however, one vote of confidence: Klein still dines out. "You gotta eat," she says. "I take my chances, and look for the obvious signs — like mice or the fact that the water in the bathroom doesn't get hot — that indicate a problem in the back of the house. I mean, if someone has a sloppy living room, chances are, there are dirty dishes in their sink."