Explaining the risk of foodborne illness associated with restaurants: the environmental health specialists network (EHS-Net).

A foodborne illness outbreak happens when a group of people eats food that is contaminated with a sufficient dose of a disease-causing agent. Illness may result because the food is contaminated with an agent that can cause illness after a small number of organisms are consumed or because the food was mishandled in a way that allowed a large number of organisms to grow. Because restaurants bring people together for shared food experiences, they provide opportunities for both types of contamination events to occur and be recognized. Almost half of reported foodborne illness outbreaks in the United States occur in restaurant settings (4). The Environmental Health Specialists Network (EHSNet) was established to conduct research and surveillance that would contribute to a greater understanding of the risk of foodborne illness associated with restaurants and to translate knowledge of how and why outbreaks occur into improved prevention practices (7). For the past decade, EHS-Net’s federal and state partners have systematically explored restaurant policies and food handling practices that have led to the occurrence of outbreaks (7–9). Several important features of the interplay between policies and practices have emerged from early studies. Restaurants with certified kitchen managers had lower odds of having an outbreak, had fewer outbreaks associated with bare-hand contact of food, and had fewer norovirus infection outbreaks (7). Approximately half of restaurants that prepared breakfast egg entrees pooled eggs before use, a practice that could allow one contaminated egg to contaminate a large batch (9). Pooled eggs also were held a median of 4 h or longer before use, frequently at temperatures that would allow growth of Salmonella in the pooled eggs (9). Similarly, half of restaurants using cut tomatoes held them for a median of 4 h at temperatures that would allow growth of pathogens such as Salmonella and Escherichia coli (8). These findings are important because norovirus, Salmonella, and E. coli caused almost 80% of foodborne illness outbreaks with a known or suspected etiology in the United States during 2009 and 2010 (4).