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Properly executed hand washing by food service employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food service employee hand washing is often not done correctly or does not occur as often as it should. The purpose of this study was to assess the relative impact of (i) the convenience and accessibility of hand washing facilities; (ii) the maintenance of hand washing supplies, (iii) multiunit status, (iv) having a certified food protection manager, and (v) having a food safety management system for compliance with proper hand washing. Results revealed marked differences in hand washing behaviors between fast-food and full-service restaurants; 45% of 425 fast-food restaurants and 57% of 396 full-service restaurants were out of compliance for washing hands correctly, and 57% of fast-food restaurants and 78% of full-service restaurants were out of compliance for employee hands being washed when required. Logistic regression results indicated the benefits of accessibility and maintenance of the hand washing sink and of a food safety management system for increasing the likelihood of employees washing hands when they are supposed to and washing them correctly when they do. HIGHLIGHTS

Preventing ill food employees from spreading pathogens to food and food contact surfaces remains an important objective of retail food safety policy in the United States. Since 2005, the U.S. Food and Drug Administration (FDA) has recommended food establishments implement employee health policies that include requirements for the exclusion or restriction of ill food employees and reporting, to the person in charge, symptoms or diagnosis of certain diseases transmitted by food. However, the incorporation of this recommendation has not been widely studied. The purpose of this exploratory study was to assess the presence and prevalence of employee health policies at fast-food and full-service restaurants in the United States. More than 50% of fast-food and full-service restaurants were found to have nonexistent employee health policies for each of the five recommended components specified in the FDA Food Code. Results showed 17.41% of fast-food restaurants and 12.88% of full-service restaurants had all five recommended components. Moreover, most restaurants with all five recommended employee health policy components were part of a multiple-unit operation and were found to have more developed food safety management systems than restaurants with none of the recommended components. Further attention and research into the impediments associated with developing and implementing employee health policies in restaurants is warranted. HIGHLIGHTS

Listeria monocytogenes is a widespread pathogen of public health concern that is capable of persisting in food processing and retail food environments. Both industry and regulatory agencie...

Food employee contamination of ready-to-eat foods through improper food handling practices is an important contributing factor for foodborne illness in retail and food service establishments. Decreasing the incidence of improper food handling practices is a frequent topic of retail food policy deliberations that often involves estimating the degree to which a proposed policy might affect a specific food handling practice. However, the potential reduction in contaminated servings of food, and therefore foodborne illnesses avoided, associated with a given proposed policy change, is all too often uncertain. This article discusses the components, assumptions, and applications of the food handling practices model, a quantitative model that estimates the impact of food handling practices on servings of food moving along three consecutive stages: the contamination stage, the pathogen control stage, and the foodborne illness stage. To our knowledge, this article is the first time the model has been presented in an academic platform, and we also explore unique and interesting aspects of the model not addressed in publicly available documents. Risk-based estimates for contaminated servings of food attributed to changes in one or multiple food handling practices are derived that provide an important link between increased compliance with proper food handling practices and public health. Model estimates show that decreases in the incidence of inappropriate food handling practices lead to varying levels of contaminated food servings avoided, depending on the food handling practice. The ability to derive such estimates provides stakeholders and the general public with a means of understanding the relative impact of proposals to reduce improper food handling and to help inform regulatory food safety policy discussions and decision making.