Improving Retail Food Safety with the FDA Food Code

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson. On this episode, why the FDA food code could be right for your state or territory, and what it takes to adopt the national standard.

CYNTHIA COSTA:
We did have days that were really frustrating, but in the end, FDA food code.

MANISHA JUTHANI:
So, we've had to be clear that we were going to be working with people to help get them to where we need them to be in terms of the standard now.

I'm not saying it's easy.

MARYAM HOSSEINI:
Of course, just like anything else, any other changes, it's challenging, but the end result is pretty rewarding.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, we examine Connecticut's journey to adopt the FDA Food Code and the work it took to replace a state code from 1976. We have three people to take us through the process. Cindy Costa supervises Connecticut's food protection program. Mariam Hosseini manages environmental health programs for the Mashantucket Pequot Tribal Nation, also in Connecticut.

Both of them worked with the old food code and spent years working to replace it. But first, we hear from Connecticut Health Commissioner and ASTHO member, Dr. Manisha Juthani, on the case for adoption of the FDA food code.

JUTHANI:
We would consider the FDA food code the gold standard. And one of the primary benefits of it is that it provides that uniform standard.

That is well recognized by the industry, and therefore it helps actually streamline enforcement activities. So, the food code is based on provisions on the CDC risk factors that cause foodborne disease. This would include improper holding temperatures, improper cooking temperatures, poor personal hygiene, contaminated equipment, and unsafe food sources.

So, by setting those standards that are then universally adopted by all of our agencies of the state, so all those local and municipal Health departments or districts that actually go into food establishments. It's setting a standard that is current, that is contemporary, that takes into account the best available science we have right now and can be operationalized at the level of every food establishment in the state.

JOHNSON:
That said, not every state has adopted the FDA food code. What are some of the reasons for that, and why should states reconsider if they've not done it yet?

JUTHANI:
Every state may have their own historical reasons in terms of where they are in terms of alignment with the FDA. I can say for Connecticut, as an example, our regulations that then the local municipalities actually put into play.

We don't have county level government in Connecticut that was set by state standards. from 1976. So one of the reasons that other states should really consider this is that the food code is updated every four years and it's taking into account any new evolving science, any new best practices in terms of the food industry, and Establishing those guidelines at the federal level, which then the state, particularly if adopted by reference as a state, you now have the ability to every four years refer to guidance at the federal level that has taken into account all of the best practices and most available science that can help inform food safety.

JOHNSON:
Is it easier to adopt the FDA food code or to try and come up with one on your own?

JUTHANI:
What I've seen is that although the initial hurdle may feel big to adopt the FDA food code, in the end, because you are relying on experts in the field and leveraging the resources and expertise that exist at the CDC and the FDA already, it is, in the end, worth the initial lift.

So to do this because I think you really are setting yourself up for better execution and implementation of our regulatory authority as a health department regarding food safety. So, I think one of the other things that is useful to know is that there are supplements released every two years after the food quota is released, which again provides states with an opportunity every two years to really update.

So four years. There's a full revision, and every two years there are these supplements that are put out. So really, every two years you're having the opportunity to stay current. And I think every health department has food safety experts, but it's not going to be at the level that the CDC and FDA have.

And that's why leveraging those resources and that ability to leverage best scientific knowledge and best practices is worth the initial lift, which may be heavy. And why is it heavy? Like, why would it be difficult for a state to do this? You really need the buy in of the people who are going to be doing this work on the ground.

JOHNSON:
I'd imagine updating a food code written in 1976 was probably a pretty big lift. What are some of the things that you learned along the way?

JUTHANI:
So, I will say, the department was already doing this before I came into the role. A lot of that groundwork, a lot of the background work with the local health departments was already ongoing. But one of the things that I did when I came into the job was as I was making visits to some of our local health departments, understanding the pressure points with our food inspectors, understanding where restaurants would say, well, it used to be that we could have something within three feet, or maybe it now needs to be X number of feet, or this used to be the rule.

And now there's a different rule. And you know, I just built this new kitchen or I just. Did things to, you know, account for the former code and how are we going to do that going forward? And I think building some of that trust and building some of that information exchange and knowledge exchange to say look we had something we're going towards something that I think is going to be better and more long lasting and that we will partner with you To be able to help get you there, recognizing that maybe you were using pen and paper and maybe you're trying to switch to an online system or something that can communicate with us more easily.

And there are things that we need to do at the state level to make that easier as well. So, it is not a done process. It is continuing to evolve. But I do think that really listening to people on the ground, understanding where their pressure points were in this process and making sure they knew that we were going to be partners with them.

And although we are regulators, we were going to be working in partnership with them to be able to get them to the standard, because I think that was going to be necessary. You know, I think just saying one fine day that this is the day the switch turns on and everything you did before. Is now going to be regulated a different way was operationally not going to work, and so we've had to be clear that we were going to be working with people to help get them to where we need them to be in terms of the standard now, because that in the long run is going to be a better way for us to be able to ensure food safety in the state of Connecticut.

JOHNSON:
It sounds like you're saying that this whole switch is a process that really does take a lot of time.

JUTHANI:
There's no doubt about that. I think that we held many webinars, recorded them, distributed them again, had office hours where people could talk. The other thing I would say is that the FDA has retail food specialists that also are a very valuable resource both during and after adoption.

So, we have been leveraging our federal experts as well. In addition to what the state health department could do. And I think that was really important to be able to make sure to leverage the federal expertise because We, as the state alone, are adopting something that they developed, and they have done this in many states.

There have been many other states that have already done this. So, they have that expertise in being able to help us not reinvent the wheel, or kind of come up with processes that are going to be more streamlined to be able to actually operationalize in a more efficient way.

JOHNSON:
You're also working to make the process more efficient.

Tell us about the approach you took to automatically update the food code each time the FDA does so.

JUTHANI:
So, in our regulations, specifically stating that we were adopting the food code, quote, by reference, allowed us to have that ability always to refer back to the FDA food code. And the benefit of that is the regulatory process in Connecticut is a systematic but tedious process that also is required to go through the legislature for approval.

And so, in order to have something that could be adopted and implemented every two years with each supplement and every four years with each change in a streamlined way, doing that adoption by reference was critical because otherwise we'd be bogged down in updating regulations on such a time sensitive basis every time that it really operationally would not make sense.

JOHNSON:
You might even get so far behind that you could start to feel like it was 1976 again. So, how has it been going from your perspective as one of the leaders there in Connecticut? Is it rolling out well? Are the goals being achieved? How are the restaurants doing?

JUTHANI:
By and large, I would say that there has been In acceptance of this, that there has been actually a longing for this in many ways that there is a recognition that we are being brought up to speed with what the best available science and technology that is out there and recommendations to ensure safety.

Like I said, there are challenges with when you make a change like this, but a lot of the industry had been flagged for a couple of years, actually, before it was actually adopted that this was coming. And so, in fact, I think. By and large, although there may be some people who weren't happy, but by and large, I would say the industry has been happy that this finally happened. Because they had been flagged for some time that it was coming and that it was going to happen.

JOHNSON:
Many states, a lot of your peers, are not doing this yet. Maybe they want to, maybe they can't for some reason. What's your advice to them?

JUTHANI:
I would suggest learning about it. First of all, learning about the model food code, seeing what the benefits are, and doing a survey in your own state of where the challenges would be to implementing such a thing, and what is the appetite for doing it, because I think the benefits are there. Very clear. The benefits are absolutely clear in my mind, but it's all those operational steps that may be the hurdles.

JOHNSON:
Cindy Costa began her public health career in 1993. She was a local health educator but quickly discovered a passion for environmental health work, including food inspections, working with Connecticut's decades old food code. Costa went to work for the state in 2010. She's been an advocate for the FDA food code ever since.

COSTA:
A lot of it is the science, which is so key to public health and learning new information. They're always doing studies, the scientists, the FDA, the CDC. They're always looking at ways to improve. And as they learn new things doing these studies, they incorporate those changes into the current food code.

So that's what's so important. important about adopting the FDA food code is that it takes the burden off the state from having to make all of those changes because the FDA does that for us.

JOHNSON:
We can assume that an update is good for the customers, but in the end, isn't it also good for the establishments?

COSTA:
Yes, yes, it helps protect them too. I mean, they want to have a good business, you know, one that provides for all of the workers. They make money. I mean, a lot of people say, you know, it's all about money, but it's also about They're not going to make money if they're involved in a foodborne outbreak, so if their workers aren't properly trained to protect their customers, then they're not going to have a profitable business.

So, yes, it protects everybody. It really does.

JOHNSON:
What are some of the steps that Connecticut took to adopt the new FDA food code?

COSTA:
It was a very long process. I think that's really important to know. We were told that by other states that have adopted the food code, that it's not something that you can do within a year.

It really does take several years to go through the full process. The first thing we did was start meeting with our legal team to craft the language. Connecticut had some unique situations where we didn't just adopt the FDA food code. We also had to create statutes and regulations. So, there was a lot that needed to be done before we could move forward with adopting the food code.

We also had to identify our key partners. Who are we going to be working with? We needed to gain support for adoption of the food code because it's a legislative process. At any point, even though we spent years putting together. the statutes and the regulations preparing for this at any point in the legislative process, someone could have objected, and it could have been pulled out at any point.

So it was really important in those early stages to work with our partners, to gain their support, to explain to them why it was important for Connecticut to adopt the FDA food code. And we did that through forming a food safety advisory group, which. Included all our partners in the industry from several of the big chains that are national chains, restaurants, we had local health departments.

We had directors of health. So we met for several years working on just studying the FDA food code so that we knew if we're adopting this, we understand what it includes, what work we have to do once it's adopted.

JOHNSON:
It sounds like moving from a state food code to the FDA food code takes a lot of front-end work.
Is that right?

COSTA:
Correct. Correct. Yes. Yes. It took several years. We started probably in earnest in 2013, and then, In 2017, the statutes were passed through a public act. So in 2017, the statute said that we would take steps to adopt the food code. And even though we thought that was gonna be imminent, like okay, 2017, so we were preparing for enforcing the food code in 2018 and we did a lot of training and prepared, but then it didn't happen as we anticipated.

You know, someone along the way. Objected to something, so it was pulled at that point. And so, we were kind of stuck. That's one of the problems is, you know, those things happen, you have to be flexible. You have to listen to what the concerns are and make some adjustments so that it does pass. So even though the statute to adopt the food code passed in 2017, we needed the regulations to implement the food code to pass.

And that didn't happen until last year in February of 2023. We finally adopted the food code and enforced the food code. So it was a very, very long process.

JOHNSON: About six years, right?

COSTA:
Yes. Very long. Very long.

JOHNSON:
In Connecticut's case, it really is a drastic change going from a code that was Essentially, from the bicentennial year to something that is 21st century, I guess it's not that surprising that it would take that long.

COSTA:
Right. I think, you know, the legislative process itself is cumbersome, but, you know, that's what we had to go through and as much as we prepared. We didn't anticipate some of the stumbling blocks, but yeah, it was needed. We needed time to prepare. There's a lot to do. Our old regulations were very short compared to the FDA food code.

Our old regulations were vague in some areas where it was really open to interpretation, which of course leads to. Things not being uniformly applied, so the FDA food code is definitely more comprehensive and provides more details to be enforced.

JOHNSON:
So, the legislative process, of course, was a big lift, but were there any other challenges over those six years that stand out for you?

COSTA:
I would say not only the long process, but also gaining support. It was a challenge in that Even though we thought we had support from some groups, you know, you hear things along the chain that, you know, yeah, they said they were on board with it, but there are some misgivings. We're not really sure about it because the FDA food code is a lot more and because it was going to include so much work after adoption with training of the food inspectors There were many who said we need more time.

We need more time. So it really took a lot to get support from All of our partners. So that was something that can't be escaped. You can't just skip over that piece. The state can't just adopt it on their own and just expect everyone else to go along with it. I think working up to the adoption, you need to have everybody on board, so it goes smoothly and it, and it worked pretty well, I'd say.

JOHNSON:
Was anyone else along for the ride? Did anyone else help get this done?

COSTA:
We had great help from our FDA retail food person specialist Steve Natras. He was instrumental. He was at all of our food safety advisory group meetings. He provided support to us He met with us separately And explained how other states had done it and some of the problems they may have had that we could You know, hopefully Get around And So he was great.

And the two tribes were also really helpful. Mashantucket Pequot Tribal Nation and Mohegan Tribal Nation. They both had been enforcing the FDA food code since they started doing their inspections. So, we relied on them an awful lot with questions we had along the way, and still do as we're enforcing it now.

We still have questions, and we can always count on them to help us out.

JOHNSON:
You've been at this now for a little more than a year. How's it been going?

COSTA:
It's been very busy. We're learning every day of things we didn't anticipate. You know, you, you adopt the FDA food code. Everything's right there for you. But again, Connecticut is a little bit different where we did have to have some regulations and some statutes.

Some of the definitions are a little different than what's in the food code. We had to put in the certification for inspector's piece. So there are some changes. But I think that everything is going pretty smoothly. I think most inspectors are comfortable with enforcing the code. The inspection form is new, but it's very similar to the one we had before with our former regulations.

And I think as obviously as we go along, things will get smoother all the time. So it's been a great experience. I think we're really on a good path right now for food safety in Connecticut.

JOHNSON:
And ultimately worth six years of effort.

COSTA:
Most definitely. It was, you know, we did have days that were really frustrating, but in the end, here we are.

We have the FDA food code. Connecticut adopted the food code by reference, which means we didn't adopt the 2022 food code in that language. We adopted Each one as it comes. So every four years we will get the most updated food code. We will get the most updated FDA supplement that comes in between the new food codes.

So, we won't have to go through this process again, is what I'm saying. We went through it once. And now we're on the path to keeping up to date with all of the science and the new food code requirements, any changes that come along. So, it was definitely worth it.

JOHNSON:
The Mashantucket Pequot Tribal Nation is in Connecticut. Maryam Hossaini joined their team right out of college, doing health inspections at the nation's restaurant properties. After about nine years on the job, she recommended tribal leadership consider adoption of the FDA food code.

HOSSEINI:
Well, it started with attending training, FDA food code training.

So, I attended FDA food training. I liked the presentation. And basically, I like the code, the sections of the code they talked about, the overall food code. And that's when I contacted our FDA food specialists to get more information and also, I asked them to provide a presentation for the Tribal Council.

So I arranged a meeting for them to provide a presentation to the Tribal Council about the FDA food code and the comparison between the FDA model food code and Connecticut.

JOHNSON:
So how has the tribal community benefited from the move?

HOSSEINI:
Well, I think it had a lot of benefits. It improved our, uh, food safety program because, as I said, we have a now food code that has already been recognized and adopted by industry.

Since we have chain food establishments at Foxwoods, we were speaking the same language. Also, because of adopting the FDA food code, we were also able to enroll in FDA voluntary retail program standards.

JOHNSON:
Connecticut is much newer to this process, and in fact, they turned to you for help. That must have been a good feeling.

HOSSEINI:
Absolutely, absolutely. We were able, actually we were happy that the state, they agreed to adopt the FDA food code. We are in the same state. And you have two tribal nations that they already adopted the FDA food code. So, we were all on the same page. So, if we have a food establishment, for example, we're in Mashantucket, Connecticut, and if we have workers, uh, employees coming, or even, uh, operators, management, coming from another restaurant in Norwich, Connecticut, for example, to work in Mashantucket, you know, they're not confused about regulations.

HOSSEINI:
So speaking the same language, I actually joined the um, state food safety advisory group, which state chaired that committee in 2017. So we met on a regular basis to discuss the steps and work that needed to be done in order for the state to adopt the, FDA Food Code. Because I was familiar with the FDA Food Code and we have already implemented in Mashantucket, I provided presentations to the Connecticut Directors of Health, to the Connecticut Environmental Health Association, which also known as

CEHA, those members, which include food inspectors and sanitarians, also to the Connecticut Restaurant Associations.

HOSSEINI:
Basically, I discussed the benefits of adopting the FDA food code, did a comparison between the Connecticut regulations as well as the FDA regulations, and how would it benefit the inspectors as well as food establishments. Also, I provided, uh, in person testimony at the state legislative office in Hartford, Connecticut in supporting adopting the FDA food code.

And after adopting the FDA food code during the state of Connecticut online training with inspectors, I also did an online PowerPoint presentation on our enforcement policy and protocol because the FDA model food code doesn't give specific information or detail as far as how to enforce it.

JOHNSON:
Why do you think other agencies ought to consider moving to the FDA food code?

HOSSEINI:
I highly recommend other tribes or other jurisdictions to adopt the FDA food code. So, this way they can enhance their food safety and eventually protect the public because they have a better food code. Basically follow and they can do this by contacting their regional food specialists, FDA food specialists, they're great resources to provide them with the information and if other jurisdictions would like to visit us in Mashantucket to see how it works here, that how our food operators are dealing with our code or with our inspections, then actually I would be happy to set up a meeting or ask, you know, answer specific questions they may have.

But overall, it worked for us. It worked for our inspectors. When they're out there, inspectors from our jurisdictions go to other jurisdictions and they get jobs in other places. They feel confident because they have good training, thanks to FDA program standards that we enrolled into, and they have the knowledge to perform their jobs.

JOHNSON:
Remember to visit the show notes where you can get more information about today's topic. Thank you for listening to Public Health Review. If you like the podcast, please share this episode with your colleagues on social media. And if you have comments or questions, we'd like to hear from you. Email us at pr at ASTHO. org. That email address again, pr at ASTHO. org. You can also follow us using the follow button on your favorite podcast player. Finally, stay up to date on everything happening at ASTHO by tuning in every morning for Public Health Review Morning Edition. We cover news like this every day. Listen using the link in the show notes and be sure to tell us what you think.

This podcast is a production of the Association of State and Territorial Health Officials. For Public Health Review, I'm Robert Johnson. Be well.