That’s what I told Chris Woolston of the Los Angeles Times last week when he asked me what I look for in a restaurant inspection report.

Handwashing compliance and cross-contamination are two of the factors WHO and CDC have identified as often linked to illnesses and outbreaks. And they are also pretty tough to inspect for in the short time that an environmental health officer is in a kitchen. Folks act different when the inspector is around so when handwashing problems show up on an inspection report I get the sense that the place doesn’t have a great food safety culture.

Another violation I look for on an inspection report is cross-contamination — but it’s a pretty complex process that takes time and often does not make an inspection report.  In our infosheet evaluation study we saw raw chicken cut on a cutting board by one staff member and 20 minutes later a different food handler used the same knife and cutting board to chop up a head of lettuce. Pretty hard for an inspector whose departmental budgets are stretched to sit and watch a few pieces of equipment for 20 or 30 minutes waiting for the magic event.

In our study, we had cameras.

Woolston writes:

Restaurant inspections have definitely helped prevent outbreaks across the country, says food safety expert Margaret Binkley, an assistant professor in the department of consumer sciences at Ohio State University in Columbus. But the grades hanging in the window — or even a full report on public health websites — offer only a vague glimpse of the real risk of foodborne illness, Binkley says. "These places are often open 365 days a year, 12 hours a day," she says. "A two-hour inspection is only going to be a very small snapshot."

Out of necessity, inspectors tend to focus on things that can be easily checked, such as the temperature of a walk-in fridge, the cleanliness of the floors and countertops or whether cockroaches and mice have set up shop in the pantry. But these factors may not have much to do with actual diseases, says Benjamin Chapman, a food safety specialist at North Carolina State University in Raleigh. "You can’t look at an inspection report and know how likely you are to get sick," he says.

Chapman says he would want to know one thing about a restaurant — and it’s not the health score. "I want to know whether workers are washing their hands."

He notes that noroviruses — a leading cause of foodborne illness — are spread primarily through contaminated hands. (These viruses, which have also made the rounds on cruise ships in recent years, can cause diarrhea, vomiting, muscle aches and a mild fever.) And, he adds, restaurants often get shut down for violations that are much less dangerous than unwashed hands. "A cockroach infestation is not going to increase the chances that you’re going to get sick."

As my friend Mag Binkley points out, there are limitations of any inspection posting regime because an inspection only reflects conditions at one point in time (and there are other influences like variability between jurisdictional focus and inspector biases). However, the information collected by inspectors, no matter how limited, needs to accessible and clear. 

Inspection results aren’t going to tell anyone how likely they are to get sick from eating at a place but accessibility to reports is a must, even if it’s just a snapshot – because it’s a chance to increase dialogue around food safety.