Dine at Your Own Risk -- Part II
RESTAURANT FOOD CAUSES TOO MANY CASES OF FOOD
Eating Out Can Be Hazardous To Your Health
Americans are eating more of their meals in restaurants. The latest statistics available show that
in 1993, consumers spent a record 46% of their food dollar on food eaten away from home, up
from 39% in 1980.
The primary reason cited by consumers for eating away from home is that they do not have time
to cook. As greater numbers of adults are fully employed outside the home, consumers
increasingly rely upon the convenience of restaurant or delicatessen food to replace or
supplement home-prepared food. But consumers may not realize that food served in a restaurant
is at least as likely to carry the risk of foodborne illness and death as food prepared in the home.
Precise figures on the extent of food poisoning attributable to restaurants are not available
because there is no comprehensive national system to track food poisonings. The best available
data come from CDC, which collects food poisoning outbreak data from state and local health
departments. CDC data covering the years 1983 through 1992, the most recent data available,
show that 42% of all reported outbreaks were traced to food eaten in restaurants, delicatessens,
and cafeterias, compared to 21% for food eaten at home.
Although many public health officials believe that food poisoning from food prepared at home
may be a larger share of the food poisoning problem than CDC data indicate, they agree that
restaurant food poisoning outbreaks are more likely to affect a larger number of people. Better
food handling practices in restaurants coupled with adoption of national standards and better
enforcement by state and local regulators could greatly reduce food poisonings from food
prepared in restaurants.
One food safety mistake in a restaurant kitchen can sicken large numbers of people, sometimes
hundreds at a time. Some reasons for large restaurant-caused outbreaks include:
- Restaurants often prepare several different types of food in the same kitchen at the same time,
so that one food containing harmful bacteria can contaminate many other foods unless
- Restaurants handle large quantities of food at a time, making it harder to keep food at
temperatures that prevent growth of bacteria.
Highlighted below are just some of the larger outbreaks of restaurant food poisoning in recent
- One food handler who fails to practice good hygiene, such as proper hand washing, can
contaminate food that is then served to many people.
- Massachusetts, June 1996. Food contaminated with Salmonella that was served in a Wendy's
restaurant in suburban Boston sickened 38 people and may have contributed to a death.
Investigators determined that the outbreak was caused by employees who did not wash their
hands before handling food.
- Idaho, September 1995. At least 11 cases of illness due to E. coli O157:H7 were traced to
food eaten in a Chili's restaurant in Boise. The primary source of the E. coli O157:H7 bacteria
is beef, but in this outbreak, authorities believe raw beef carrying the bacteria probably
cross-contaminated other food served in the restaurant.
- Florida, August 1995. Salmonella newport bacteria sickened over 850 people in the largest
outbreak of foodborne illness in Florida history. Health officials who investigated the
outbreak believe that Salmonella bacteria in chicken cross-contaminated several other foods
served at Margarita y Amigas restaurant in West Palm Beach, at least in part because workers
used the same cutting board for raw meat as for vegetables.
- Utah, January 1995. An outbreak of 95 cases of hepatitis A was traced by the local health
department to an employee of a Taco Bell restaurant in Salt Lake City. The hepatitis A virus
is carried in human fecal matter and is spread when food handlers do not wash their hands
- Washington, D.C., August 1994. Hollandaise sauce contaminated with Salmonella served at a
brunch at a hotel sickened 56 people, 20 of whom were hospitalized. According to
investigators, the sauce was prepared from raw eggs and heated over a hot water bath. It was
then held for nine hours at a temperature at least 20 degrees lower than that recommended by
the FDA Food Code.
- Georgia, October 1993. A botulism poisoning outbreak killed a customer of a delicatessen in
a small south Georgia town and sickened seven others. Their illnesses were traced by CDC
officials to canned cheese sauce, which had been left opened and unrefrigerated for eight days,
served on baked potatoes stuffed with barbecued meat. Health officials said proper
refrigeration of the sauce could have prevented the outbreak.
- Illinois, June 1993. A Mexican restaurant in a Chicago suburb served Salmonella-tainted food
that sent 25 people to the hospital and sickened 16 others. County investigators attributed the
outbreak to prepared food not being held at hot enough temperatures, and to poor food handler
- Oregon, March 1993. In Grant's Pass and North Bend, 48 people were sickened by E. coli
O157:H7 bacteria in mayonnaise served at Sizzler's restaurants. According to data reported to
CDC, the mayonnaise was cross-contaminated by a food, mostly likely raw or insufficiently
cooked ground beef, that contained E. coli O157:H7 bacteria. An additional 50 cases of
illness caused by E. coli O157:H7 bacteria in food served in Sizzler's restaurants in Oregon
and Washington were reported to CDC in 1993.
Food Poisoning Is a Widespread and Costly Problem
- The Western U.S., December 1992 to January 1993. The largest E. coli O157:H7 outbreak in
the U.S. occurred in Washington, Idaho, Nevada, and California and was linked to
contaminated hamburgers served at Jack in the Box restaurants. At least 700 cases of
foodborne illness were reported. Nearly 100 of the victims developed hemolytic uremic
syndrome, a serious complication resulting from E. coli O157:H7 infection, and four children
died, the oldest just six years old.
Those outbreaks are just the tip of a deadly iceberg. Experts agree that foodborne illness is
seriously under reported by CDC. First, CDC maintains data only for outbreaks and not for
individual cases. Second, whether CDC ever hears about an outbreak depends on many factors,
including whether the victims ever seek medical attention; whether patients and their doctors
recognize the cause of the illness; whether doctors are motivated to contact the local health
department; and whether area laboratories have the resources to identify the pathogen. One
public health official estimates that only one of every 250 cases of foodborne disease is
eventually reported to a local or state health department. Finally, some states do not require
reporting of key foodborne diseases and may not be vigilant about reporting to CDC. In 1994,
twelve states had no surveillance staff specifically assigned to monitoring foodborne illness,
meaning that outbreaks are not reported routinely from those states.
Foodborne illness is a major public health risk. Particularly in children, the elderly, and those
with weak immune systems, foodborne pathogens can kill or cause long-term health effects,
including hemolytic-uremic syndrome and reactive arthritis. For thousands more people,
foodborne illness causes personal discomfort and lost days at work.
Foodborne illness is also costly. The federal government has estimated the cost of illness in 1993
from just seven pathogens (the bacteria Campylobacter, Salmonella, E. coli O157:H7,
Clostridium perfringens, Staphylococcus aureus, and Listeria, and the protozoan Toxoplasma
gondii) at $5 billion to $9 billion. This estimate does not include any illnesses caused by other
bacteria, viruses, or toxins commonly found in food.
HOW RESTAURANT FOOD CAN MAKE YOU SICK
Pathogens that cause food poisoning, such as bacteria and viruses, can show up in restaurant food
served to customers as a result of food handling mistakes like inadequate cooking,
cross-contamination in the kitchen, or improper cooling. At every stage of food preparation,
from purchasing food from suppliers to serving customers, restaurants need to be aware of
potential pathogens in food.