Foodborne Outbreak Rates Associated with Restaurant Inspection Grading and Posting at the Point of Service: Evaluation Using National Foodborne Outbreak Surveillance Data

A previously conducted national survey of restaurant inspection programs associated the practice of disclosing inspection results to consumers at the restaurant point of service (POS) with fewer foodborne outbreaks. We used data from the national Foodborne Disease Outbreak Surveillance System (FDOSS) to assess the reproducibility of the survey results. Programs that participated in the survey accounted for approximately 23% of the single-state foodborne illness outbreaks in restaurant settings reported to FDOSS during 2016 to 2018. Agencies that disclosed inspection results at the POS reported fewer outbreaks (mean ¼ 0.29 outbreaks per 1,000 establishments) than those that disclosed results online (0.7) or not at all (1.0). Having any grading method for inspections was associated with fewer reported outbreaks than having no grading method. Agencies that used letter grades had the lowest numbers of outbreaks per 1,000 establishments. There was a positive association (correlation coefficient, R² ¼ 0.29) between the mean number of foodborne illness complaints per 1,000 establishments, per the survey, and the mean number of restaurant outbreaks reported to FDOSS (R² ¼ 0.29). This association was stronger for bacterial toxin–mediated outbreaks (R² ¼ 0.35) than for norovirus (R² ¼ 0.10) or Salmonella (R² ¼ 0.01) outbreaks. Our cross-sectional study findings are consistent with previous observations that linked the practice of posting graded inspection results at the POS with reduced occurrence of foodborne illnesses and outbreaks associated with restaurants. Support for foodborne illness surveillance programs and food regulatory activities at local health agencies is foundational for food safety systems coordinated at state and federal levels.