What Are Restaurant Health Risks?

Each time you go to a restaurant, you put your gastrointestinal health in the hands of strangers.

Dining out safely has never been more important. Almost 50 billion meals are eaten in restaurants and cafeterias each year in this country. The nation's restaurants expect sales to reach $530 billion in 2007, according the National Restaurant Association. More than 70 billion meals and snacks will be served in 2007. On a typical day, more than four out of 10 adults are restaurant patrons.

All restaurateurs should ensure that their employees are adequately trained in food safety and consistently use safe food-handling methods. A single outbreak of foodborne disease can depress a restaurant's bottom line or even drive it out of business if the outbreak is identified and publicized. According to Safe Tables Our Priority, a nonprofit advocacy group for victims of foodborne disease, many outbreaks are never identified as such. Most people who experience a foodborne illness don't see a doctor. It usually takes two days or longer after eating contaminated food for symptoms to begin. Most people who get food poisoning mistakenly blame their last meal.

Luckily, the vast majority of foodborne illnesses, such as salmonellosis and Clostridium perfringens infections, amount to a few days of diarrhea, possibly accompanied by vomiting. However, each year in the United States, more than 300,000 victims of foodborne disease require hospitalization, and about 5,000 die, according to the U.S. Centers for Disease Control and Prevention.

Invisible threats

The most common foodborne infections are caused by the following bacteria:

Campylobacter: which comes from eating undercooked chicken or other food contaminated by the juices from raw chicken.

Salmonella: which comes from the intestines of birds, reptiles and animals. It can be spread through a variety of foods.

E.coli: which typically comes from food or water contaminated with cow feces.

Unlike spoilage bacteria that makes food foul-smelling, off-color or slimy, pathogenic (disease-causing) bacteria do not affect the appearance, smell or taste of food. Pathogenic bacteria can be transferred to food from a variety of places, including soil from the farm, an animal's intestinal tract in the slaughterhouse, contaminated trucks, contaminated countertops or cutting boards and, of course, unwashed hands. Because all foods are potentially contaminated, everything should be stored, cooked and served according to government-established food safety guidelines. That is the ideal.

But say you order a hamburger and visit the salad bar at a restaurant. You can't possibly know if:

• Your server and busboy spent the requisite 20 seconds washing their hands with soap and warm water after using the bathroom.
• The raw ground beef was kept adequately chilled before preparation.
• Your burger's cooking temperature got high enough to kill any germs that might have been present.
• The chef used the same utensil on the raw and cooked burger.
• The carrots, tomatoes, lettuce and other greens were washed before reaching the salad bar.
• The employee who stocked the salad bar sneezed on the radishes.

Despite the unknowns, you can minimize your risk of contracting a foodborne disease when dining out. All you need are your powers of observation and some basic food-safety knowledge.

How healthy are you?

Perhaps the most important thing to consider when dining out is your health status. If you or someone in your party is at high risk for a foodborne illness, you may wish to avoid ordering risky foods. According to the U.S. Food and Drug Administration, the riskiest foods include:

• Rare or medium-rare hamburger and turkey burger.
• Unpasteurized fruit juices.
• Raw sprouts.
• Raw or undercooked eggs.
• Raw shellfish, such as oysters.

Risk factors for foodborne diseases include:

• Being younger than 5 or older than 75.
• Being pregnant.
• Having a suppressed immune system stemming from a disease, such as AIDS or from taking medication that impairs the immune system.
• Having certain chronic diseases, such as liver disease, alcoholism, emphysema or heart failure.
• Taking antacids, which reduce stomach acidity; the stomach's natural acidity level is usually strong enough to kill most of the germs you ingest.
• Taking antibiotics, which wipe out all or most of the "good bacteria" that inhabit your intestinal tract; these harmless bacteria compete with harmful bacteria for nutritional resources; the "good bacteria" usually win, if there are enough of them around.
• Having had most or all of your stomach removed.

In some cases, a risky food can be hidden amid other ingredients. For instance, if the restaurant makes its Caesar salad dressing or hollandaise sauce from scratch, ask your server whether raw or pasteurized eggs are used.

Wash your hands

Regardless of your health status, you can greatly reduce your risk for foodborne illness and many other contagious diseases by washing your hands often with soap and water, particularly before eating and after touching an animal. After washing your hands, dry them thoroughly with a paper towel, if available. On your way out of a public restroom, avoid touching the bathroom door with your hand (push it open with your foot or hip, or use a paper towel, a piece of toilet paper or a shirtsleeve to turn the knob). You may even wish to carry a small dispenser of alcohol-based hand sanitizer to use immediately before digging into your meal.

Using food safety sense in restaurants

Most restaurant meals are safe, but lapses do occur. Here are some things to look for in a restaurant or cafeteria that may indicate how seriously management regards food safety:

A recent sanitation report. This document should be displayed in a visible place, such as at eye-level on a wall near the cash register. A restaurant should be willing to display this document regardless of whether it must do so by law.

Clean bathrooms. In many restaurants, employees and customers use the same bathrooms. There should be plenty of soap, paper towels and toilet paper. The hot water tap should be functioning properly, the toilets should flush and the floors should be relatively clear of cigarette butts and other debris. A clean, pleasant bathroom suggests employees are probably paying attention to detail elsewhere in the restaurant, such as the kitchen. If there are no paper towels or soap in the bathroom, if the hot-air drier is broken, if the sink drain is stopped up or if the garbage pails are overflowing, report the problem to the manager. If the manager does not seem to care, consider eating somewhere else.

Clean dining room. Clean floors and sparkling surfaces suggest management is concerned with cleanliness, orderliness and has a sense of pride. These visible virtues suggest that the food is being handled properly in places that customers don't see.

Tidy servers and busboys. Servers' and busboys' uniforms and aprons should be reasonably clean, their hair should be up or netted and they should be washing their hands often. Open cuts or sores on hands can harbor bacteria that potentially can be transferred to food, plates and eating utensils.

Tidy tables. The most sanitary way to clean tables and countertops is with a disinfecting spray and paper towels. Unless they are freshly laundered or dipped in a fresh disinfectant solution, cloths and sponges can harbor pathogens, which may be transferred to hands, tables, dishes and eating utensils.

Safety precautions in visible food-prep areas. In some eating establishments, such as pizza parlors, grills and sushi bars, food-safety violations are difficult to hide. Notice whether the food handlers are washing their hands often, especially after touching their hair, clothing, or face or blowing their nose. A fresh pair of plastic gloves should be used for each order. The same spatula should not be used to transfer a raw hamburger patty to the grill and a cooked burger to a plate. The glass in front of the raw fish at a sushi bar should be very cold to the touch.

Spot-free utensils and dishes. Forks, spoons and knives should be clean and free of water stains. If you see evidence of lipstick or old food on your place setting, the dishwasher may be malfunctioning. Insist on replacements.

Fork marks in solid cuts of meat. The interior of solid muscle meat is generally sterile--even when cooked medium-rare (the exterior should be seared). However, a fork or knife may have transferred surface bacteria to the interior before the meat was cooked. These germs can survive and possibly multiply unless the meat is cooked well-done.

Temperature control. Salads and cold entries should be crisp and cold to the touch. Wilted or brown-edged lettuce leaves do not bode well for the freshness and safety of salad-bar items. Hot foods should be steaming when delivered to your table. If food that is supposed to be cold or hot is served at room temperature, send it back to the kitchen or order something else.

Really hot buffets. Steam ought to be rising from hot foods on buffet tables, which should maintain food temperature at 140 degrees F or higher. Try to select your portion from the bottom of the steam table where the temperature is highest.

Related Articles When to Run to the Doctor Grilling the World's Safest Burger Eating Out Safety Tips

External Sources U.S. Food and Drug Administration Centers for Disease Control and Prevention National Restaurant Association

This article was reviewed and updated June 2007.

Search