Source safe food: Cook, clean, chill separate doesn’t cut it

In related things Philly, Don Sapatkin writes that back in 2002, with at least 85 people sickened by Salmonella, Bucks County health inspectors discovered that kitchen workers at a Lone Star Steakhouse on Route 1 were washing tomatoes and raw chicken in the same sink. They shut the place down until an additional sink could be installed to prevent cross-contamination.

philadelphia.food“We thought we had it nailed,” recalled Bill Roth, who oversees food safety for the county health department.

Not exactly. When the Centers for Disease Control and Prevention analyzed victims’ stool samples, Roth recalled, they noticed something completely different: The same strain of Salmonella had been found elsewhere. Connecting the dots, federal investigators traced the outbreak to contaminated tomatoes from a Virginia farm that were making gastrointestinal life very unpleasant for hundreds of people in 26 states.

The missing-sink violations cited by inspectors at the local steakhouse had nothing to do with it.

The case illustrates both the strengths and weaknesses of restaurant inspections. On the one hand, they catch only a tiny percentage of potential problems, and only on the day that inspectors visit. On the other hand, they keep restaurateurs on their toes – using the same sink to rinse raw produce and uncooked poultry is a recipe for diarrhea, even if it wasn’t the cause that time.

“Put it this way,” said David Damsker, director of the Bucks County Health Department. “If you leave some children alone, they will be responsible. Some other children, take away parental supervision . . . and some places would be incredibly horrendous.”

Bucks provides restaurants with a lot of supervision. Its inspectors automatically visit the vast majority of the county’s 2,600 food establishments every six months – twice as often as routine inspections are performed in Philadelphia and every other county in the region except Montgomery (also twice a year).

Repeat inspections to follow up on violations are scheduled within 10 days, Bucks County officials said, compared with 30 in the city.

Yet Bucks finds fewer violations. And fewer violations mean fewer repeat visits – every inspection is a surprise – to follow up on the routine inspection.

Inspectors there recorded an average 1.1 serious violations per visit in 2014 compared with 1.6 for Philadelphia, according to an Inquirer analysis of inspection reports. The disparity was greater for all violations combined: 3.2 per inspection in Bucks vs. 6.0 in Philadelphia.

Whether the lower number of violations in the county means Bucks restaurants are cleaner is unclear. Philadelphia may simply have a higher proportion of full-service restaurants, which do more complex food preparation than convenience stores or other food establishments. That means more can go wrong, and can be spotted by inspectors.

But food safety officials in Bucks County speculated that their policy of routine inspections twice a year – a goal that most localities don’t have the resources to meet – are responsible for the difference.

“We go more for education than for enforcement,” Damsker said. More-frequent routine visits give kitchen workers a better understanding of food-safety issues, he said.

The emphasis on education has gained traction nationwide over the past decade. Throughout the region, most jurisdictions, including Philadelphia, now perform what are known as “risk-based inspections.”

They put a higher priority on violations that are known to increase the risk of foodborne illness than on cosmetic issues such as missing ceiling tiles. One of the highest priorities – and among the most common violations – is having an employee present at all times who is trained to recognize problems such as a refrigerator that isn’t quite cold enough to kill harmful bacteria.

100 lawyers and students sickened: Lawsuit filed against Chinatown restaurant in Philadelphia

A lawsuit has been filed against a Chinatown restaurant after about 100 lawyers and law students attending a private Lunar New Year dinner in February said they developed food poisoning.

Joy Tsin LauSamantha F. Green, a Philadelphia lawyer who attended the event at Joy Tsin Lau on 10th and Race streets and who said she was diagnosed with the norovirus, filed the lawsuit, citing a “sordid history of health code violation and food-borne illness.”

A copy of the document filed in the Philadelphia Court of Common Pleas on Monday was obtained by Philly.com, which reported the story.

Green’s lawyer wrote in the lawsuit that Joy Tsin Lau was cited for 249 health code violations by the Philadelphia Department of Health in the past six years.

The document also stated that on the morning after the dinner, Green began to feel ill and “raced to the emergency room at Pennsylvania Hospital in agonizing pain. Following nine hours of vomiting, she was unable to consume anything but bananas and tea for four days.”

The lawsuit also noted that 17 days before the banquet, a city health department restaurant inspector allegedly declared that management practices at Joy Tsin Lau allowed “unacceptable public health or food-safety conditions,” and four days after the food-poisoning incident, another city inspector allegedly found “41 violations that indicated a chronic inability to adhere to basic food safety standards.”

The most recent complaint by the city was filed May 6, but a July 6 court date on the complaint was canceled.

A representative of Joy Tsin Lau did not comment on the lawsuit or past complaints. The restaurant currently remains open.

100 lawyers sickened at banquet in Philly

“What do you call 100 lawyers at the bottom of the ocean?

“An excellent start.

“l used to resent jokes like that.

“Now l see them as simple truths.”

danny.devito.war.rosesDanny DeVito in the truly fabulous divorce movie, War of the Roses.

Sam Wood of Philly.com writes that nearly 100 lawyers and law students were sickened last month after attending a banquet celebrating the Lunar New Year in Chinatown.

But even though the restaurant has a history of food-safety problems stretching back several years, the city Health Department says it cannot publicly discuss details of its investigation, citing a 1955 state law.

That law hasn’t silenced the outbreak’s victims.

It’s that social media thing, and restaurants better get used to it – fast.

About 250 people attended the feast Feb. 27 at Joy Tsin Lau, the venerable dim sum restaurant at 10th and Race Streets. Dozens of the diners reported that they felt the first symptoms two mornings later.

Chi Mabel Chan, who has owned Joy Tsin Lau for more than 30 years, denied that the diners had suffered food poisoning from the banquet.

“It was not a problem with my restaurant,” she said, theorizing that chilly weather or festivities at a karaoke bar after the dinner might be to blame.

001679_12“Maybe they got cold or drank too much,” she said of the victims.

Wow.

Good luck with that in court. Against lawyers.

The eight-course dinner – well-documented on social media – was a fund-raiser for a group of Temple University law students, the Asian Pacific American Law Student Association.

“This was the worst case of food poisoning I’ve ever witnessed,” Antima Chakraborty, a Philadelphia assistant district attorney, wrote on Yelp, a restaurant review site. “Many individuals had to go to the ER.”

City inspection reports show that Joy Tsin Lau has long had a problem maintaining food-safety standards.

Just 17 days before the banquet, a Health Department sanitarian was at Joy Tsin Lau to check back on an earlier problem. In a report dated Feb. 10, Kyria Weng wrote “that current management practices have allowed unacceptable public health or food-safety conditions.”

An Inquirer analysis of city inspection reports found that the average eat-in restaurant in Philadelphia last year had 2.3 risk factors for foodborne illness, the more serious of the two main categories defined by the Food and Drug Administration.

Weng cited Joy Tsin Lau for five such risk factors. Several of those – dumplings held at a bacteria-friendly 57 degrees, and a lack of soap and paper towels in the employee restroom – were noted as repeat violations. Weng also found nine lesser violations, called “lack of good retail practices.”

But that was an improvement over Weng’s Dec. 22 visit, when she cited the restaurant for seven risk factors for foodborne illness (including a chicken held at unsafe temperatures) and 13 lesser violations.

Back in 2010, the city Health Department filed suit against Joy Tsin Lau after deeming it a “public nuisance” and issued a cease-and-desist order for “failure to ensure that public-health standards for a safe and sanitary operation . . . are being maintained.”

City legal officials did not respond to questions asking if the city ever acted on the order or if the restaurant ever was forced to close.

David S. Haase, a Center City lawyer, said he began to feel nauseated about 30 hours after the banquet. Contrary to Chan’s theory, he said he was warmly dressed and did not go to the karaoke bar.

A combination of nonstop puking and explosive diarrhea kept him bedridden for four days.

“It was freaking terrible,” Haase said. “I’d crawl back into bed and curl up into a ball, moaning like a child with the cramps.”

Organizers, in a post-banquet e-mail to attendees, said multiple guests had sought medical attention.

Thursday, nearly four weeks after the banquet, Health Department spokesman Jeff Moran would say only that a “food source” had been identified for the outbreak.

“We are not permitted, by law, to publicly release the findings of outbreak investigations,” Moran said.

Bullshit.

He cited the Pennsylvania Disease Prevention and Control Law of 1955, which prohibits health authorities from disclosing reports or records of diseases. Though the law primarily addresses patients with venereal diseases and tuberculosis, its confidentiality clause keeps secret the details of all health investigations.

Most states have similar laws, according to Scott Burris, the codirector at Temple University’s Center for Health Law, Policy, and Practice.

“It’s pretty typical,” Burris said. “Pennsylvania is not an outlier.”

Investigators need some secrecy to collect sensitive information, he said, but the laws may go too far when it comes to alerting the public of potential threats.

“That’s a price we pay,” Burris said of secrecy laws. “It’s probably worth working on our privacy laws to see if we can find an approach that lowers that price.”

But there is no law silencing the sickened.

“If you enjoy being on your back for the 48 hours post-dinner writhing in pain, burning up, and exploding out of all orifices, then this is the restaurant for you,” wrote Jack Jiang, a University of Pennsylvania researcher who attended the banquet with his girlfriend.

In an e-mail to a reporter, Jiang said he had been bedridden for three days and suffered lingering effects through the end of the week.

Haase, who missed his daughter’s championship track meet due to the illness, said he had contacted a Health Department coordinator, who told him the outbreak was likely brought on by norovirus.

Norovirus, the most common cause of foodborne illness, sickens about 20 million people a year in the United States, according to the Centers for Disease Control and Prevention. The pathogen is often spread by contact with an infected person or by ingesting food or water contaminated by fecal matter. Acute gastroenteritis strikes usually between 24 and 48 hours after exposure to norovirus.

Caroline Johnson, director of the city’s division of disease control, said she couldn’t talk specifics, but in general said the goal of investigations “is to find out what happened, correct that problem, and move on.”

As for the secrecy, she said, “We don’t want to drive underground the facts we want to uncover.”

Her agency told Haase about the norovirus because “we feel that by telling them, they won’t need to have the wrong antibiotic prescribed to them or have unnecessary testing. It’s the right medical thing to do. I wouldn’t withhold information from them because it might have medical significance to their situation.”

Norovirus would have a much quicker onset than two days.

‘Disgusting’ says Schaffner: Philly McDonald’s leaks sewage, continues to operate for 4 days

As the stench of backed-up sewage permeated the restaurant, a West Philadelphia McDonald’s continued selling Big Macs, Quarter Pounders, and fries over four days last fall, installing porta-potties in the parking lot but never notifying the city, which would have ordered a closure.

mcdonald'sA complaint led the Philadelphia Department of Public Health to dispatch an inspector to the franchise at 52d Street and Columbia Avenue on Sept. 15. She found ruptured plumbing in both restrooms and “smelled sewage throughout the facility.”

“The Person in Charge failed to notify the Department of an imminent health hazard and cease operations. Establishment has been operating with raw sewage backup for at least 4 days,” La’Sandra Malone-Mesfin wrote in her report. She listed 24 violations, four of which were related to the plumbing.

There is no evidence that any customers or employees got sick, although most cases of foodborne illness go unreported nationwide.

Raw sewage in a restaurant is “a very high-risk situation,” said Caroline Johnson, disease-control director for the city health department, who was talking generally.

“By design, a sewage line removes the nastiest, filthiest things from a food establishment,” said Janice Buchanon, an official at Steritech, a national brand-protection company that specializes in food safety. A common component, she said, would be E. coli O157, which can cause serious illness and lead to kidney failure in children.

“That the restaurant would continue to operate for even one day is beyond belief,” she said.

Four days after the restaurant was closed, a follow-up inspection by the city found that the plumbing was working, and management was given the go-ahead to reopen.

The city took no further action.

“We do not impose fines or penalties, and we do not have the authority to do so,” said Jeff Moran, spokesman for the city health department.

“Most health departments use closure of a facility as the most punitive action they can take,” said Buchanon, the Steritech official, who formerly worked as a restaurant inspector in various cities. The restaurants “lose face, have to explain to all the customers why they were closed, and lose revenue for a number of days.”

But she and others expressed surprise that the city had to find out about the sewage leak from a complaint.

“I don’t understand why the management didn’t immediately shut down the restaurant,” said Don Schaffner, a professor of microbiology at Rutgers University who also sits on McDonald’s Food Safety Advisory Council. “Not only is it disgusting, it’s a real risk. You can’t operate with nonfunctioning sewage lines.”

It’s a good thing: Restaurant inspection disclosure in Philadelphia

According to an editorial in the Philadelphia Inquirer, much about restaurants is a matter of taste, but we can all agree on minimizing the involvement of rodents and bacteria. Fortunately, a cadre of city food-safety inspectors stands between Philadelphia’s diners and its noroviruses. Unfortunately, their work is about as difficult to trace as a case of food poisoning.

inspection.philadelphiaIt’s not just that the city’s restaurant inspection reports are tucked away in an obscure corner of the Web, but also that any layman who takes the trouble to find them will be hard-pressed to understand their meaning and import. How many violations are too many? Which conditions are cause for the most concern? The Department of Public Health’s six-page explanation and annotation of its standard “Food Facility Inspection Report” will defeat all but the most curious and patient consumers.

It makes for a stark contrast with the letter grades that restaurants in New York and Los Angeles have to display prominently. Although New Jersey’s rules are less robust, its restaurants must post notice of whether their most recent inspections were “satisfactory.” Philadelphia mandates nothing of the kind.

Into this breach comes a searchable database compiled by The Inquirer and Philly.com and unveiled this week at philly.com/cleanplates. With nearly 70,000 inspection reports spanning the past five years, the database encompasses 12,000 restaurants and other institutions, from stadiums to schools. It also groups them by notable restaurateur (Stephen Starr, Jose Garces) and location (Reading Terminal Market, the airport). And it helpfully highlights the more serious and repeat violations, along with neighborhood averages for comparison.

Besides making food-safety findings more transparent, the database – like a separate effort by City Paper and AxisPhilly that debuted last month – showcases the work of about 35 so-called sanitarians and supervisors who handle the daunting task of inspecting 5,000 restaurants and 7,000 other kinds of kitchens. They have made substantial progress in increasing the frequency of inspections to at least yearly for most establishments, while honing their focus on the conditions most likely to cause food-borne illnesses.

But the reports also reveal that repeat violators present one of the greatest challenges to the city. That may be because the inspectors prefer a collaborative approach that works well for most establishments but fails when eateries lack the will or ability to address persistent problems. Health officials don’t have the power to impose major penalties, so they rely on other departments and the courts to take action in the most recalcitrant cases, with uneven results.

Greater transparency would be a relatively easy and inexpensive remedy. Given the restaurant industry’s importance to Philadelphia, it’s puzzling that the city has done so little to help consumers reward good practices. From a simplified rating system to mandatory public notices, the city has a range of options for appealing to the public appetite for food safety.

How clean is your favorite Philadelphia restaurant?

To better understand how Philadelphia enforces food regulations, The Inquirer and Philly.com created a database of nearly 70,000 inspection reports. The public can query www.philly.com/cleanplates for restaurants, school lunchrooms, nursing homes, even prisons (they are particularly clean), back to mid-2009.

gyllenspoon.rest.inspecSome inspectors’ comments are not for the squeamish.

When one visited Jack’s Firehouse, the Fairmount eatery with historic cachet, on July 23, she found foods “not covered throughout the establishment” and cheese and bacon held warm enough to breed bacteria.

Mouse droppings were seen in 20 different locations – “on prep table next to small dough mixer,” “on shelves in the walk-in cooler,” and even “on deli slicer.”

The 33 separate violations were a record for Jack’s, but many were not new. The restaurant had been described as “not satisfactory” in nine of its 10 previous inspections over four years.

At inspection No. 11, inspector Tiana Montgomery-Noel wrote in her July report that the place should “cease and desist” all operations until it met two conditions: “zero mouse droppings” and having a certified food-safety worker present at all times. Owner Mick Houston closed voluntarily and met both requirements in four days; he has vowed to do better.

restaurant_food_crap_garbage_10There is no evidence that violations there or elsewhere led to foodborne illness.

In the consumer-friendliness arena, Philadelphia is far from alone in not summarizing findings for diners. Bucks and Montgomery Counties don’t do this either. Many food-safety experts say oversimplification can lead to misunderstandings. But summaries are “easier for the public to understand,” said Lydia Johnson, food-safety director for the Pennsylvania Department of Agriculture, which conducts most inspections around the state outside Southeastern Pennsylvania.

Johnson said her staff would handle ongoing serious violations with “a progressive response” – a warning letter followed by citations, administrative hearings, and, if necessary, fines.

With all that can go wrong in a full-service establishment, it’s hard to get a perfect report.

Even without an inspection report, customers can gauge a restaurant’s health standards – or not

Ken Gruen, a retired Philadelphia restaurant inspector (“sanitarian”) who advises food establishments at Philadelphia International Airport told the Philadelphia Inquirer, “If the bathroom is kept in good condition – it’s clean, there is soap, there are paper towels, there is not a lot of litter on the floor – probably the kitchen is the same.”

NEHA.sylvanusMaybe but not necessarily.

Other signs of general sloppiness, health, and hygiene could be indicators as well. Is the knife used to slice limes at the bar left on the counter without cleaning? Has the buffet been ignored for hours? If the kitchen is visible, are workers wearing gloves? Is your waiter a mess?

More specific measures, like storing cheese at temperatures that are too cold for dangerous microbes, are noted in official inspection reports – if you have the patience and knowledge to interpret them.

To make them easier to understand – there are hundreds of potential code violations – all restaurants in New Jersey must display overall findings as “Satisfactory,” “Conditionally Satisfactory,” or “Unsatisfactory,” although the sign may not be visible from outside. Some cities (Toronto, Pittsburgh) post green, yellow, or red placards in the window. Another handful (New York, Los Angeles, San Francisco) put up consumer-friendly A-B-C letter grades.

doug.honolulu.rest.inspecPhiladelphia does none of the above.

No scoring system “has been found to be effective for food safety,” said Palak Raval-Nelson, who oversees inspections of nearly 12,000 food establishments for the Philadelphia Department of Public Health.

In fact, there is limited evidence that inspections themselves protect against foodborne illness. They are a snapshot in time: Only a stroke of luck would have the sanitarian present at the exact moment that a refrigerator malfunctions or a cook shows up sick.

But they may work in a different way.

“No one wants to be embarrassed,” said Doug Powell, a food-safety consultant in Australia and anchor of barfblog. “So inspections and disclosure systems make [restaurateurs] try harder. And it also contributes to the public conversation about food safety.”

Food-safety laws are written and enforced almost entirely at the state and local levels. Since the late 1990s, most jurisdictions, including Philadelphia, have adopted U.S. Food and Drug Administration recommendations that for the first time are based on the science of disease transmission. Cooking to a temperature high enough to kill microorganisms is a high-priority item; ceilings with missing tiles is low.

“It is really hard, I think, for a consumer to make very much sense of these detailed reports,” said food-safety specialist Craig Hedberg, a professor in the University of Minnesota’s School of Public Health.

But Hedberg doesn’t think inspections prevent much sickness anyway.

“We talk about food-borne illness like it’s a single thing,” Hedberg said. In reality, there are several kinds, each causing extremely uncomfortable (and sometimes dangerous) diarrhea and abdominal cramps, from one day to a week:

Between 10 percent and 20 percent of outbreaks are due to salmonella, increasingly carried on fresh produce that will be served without cooking. It’s not visible, and washing often fails to remove it.

Chopping and mixing quantities of, say, parsley or tomatoes, as most full-service restaurants must do, could spread the contamination through the entire batch, however. “The restaurant will simply be a pass-through,” Hedberg said. “The best they can do is try not to make the problem worse.”

And an inspection will not stop it.

Another 10 percent to 20 percent of outbreaks are traced to Clostridium perfringens. The bacteria grow and produce a toxin when spores germinate after cooking if foods are not cooled quickly enough before storage. It used to be more common, and has been successfully reduced through the priority that inspectors place on temperature control and cross-contamination, Hedberg said.

More than 50 percent of outbreaks in the United States are norovirus. It is spread when infected workers handle salads and serve sandwiches. Frequent hand washing helps, but ill employees simply should not show up for work. “Workers can come in sick a few hours a year,” Hedberg said, enough to start an outbreak but unlikely to be spotted during an inspection.

So what would work?

qr.code.rest.inspection.gradeFor a 2006 paper in the Journal of Food Protection, Hedberg led a team that compared various characteristics of 22 restaurants that had experienced outbreaks of food-borne illness and 347 that had not. The main difference was the presence of a certified kitchen manager – someone who has the power to change attitudes and atmosphere. These managers are regular kitchen employees or supervisors who have received additional training in food safety. They can spot and respond to risks, like sending home workers with symptoms of norovirus.

Toronto’s DineSafe program began in 2001. The most critical violations are noted in simple language on a green, yellow, or red sign posted out front. Ninety-two percent of restaurants get a “green” on their first inspection, said Sylvanus Thompson (above, left, pretty much as shown), associate director of Toronto Public Health. Polls show the program is overwhelmingly popular.

Most Philadelphia school cafeterias flunk – Health Dept

More than half of the schools in the Philadelphia School District – 53 percent – failed their most recent health inspection, according to state Department of Agriculture records, while a staggering 66 percent of charter schools were out of compliance.

The Philadelphia Daily News reports that of the 40 schools in the Archdiocese of Philadelphia that were inspected last school year, 35 percent were out of compliance.

Some schools on the list were hit with as many as 20 risk-factor violations, ranging from mouse feces found on cooking utensils to food being stored next to chemicals.

Justin Carter, a recent West Philadelphia High School graduate, said he gave up eating school lunches long before he graduated. He said the news doesn’t come as a surprise.

"It’s atrocious," he said, recalling his food woes at his alma mater, which was hit with 10 violations last spring.

"They served chicken twice a week, and it wouldn’t be cooked all the way through – it was soft and pink in the middle. The food worker would put it in a microwave for five minutes like that would make it better. It would be the same way every time."

Ringo says, yum yum hospital food; hospital kitchen inspections in Philadelphia region yield range of results

Don Sapatkin of the Philadelphia Inquirer has been writing for at least a year about deficiencies in the antiquated Philly system and that even with improvements in inspections, most food establishments don’t publicize even their most positive inspection reports, and no government in the Philadelphia region requires that they be tacked up for easy viewing like a menu.

Last week, Sapatkin turned his investigative focus to Philadelphia’s hospital kitchens, and found they were far more likely than food establishments as a whole to be out of compliance with food-safety regulations, averaging six violations apiece in their most recent quarterly inspections by the city health department.

The Hospital of the University of Pennsylvania, routinely named among the nation’s best medical centers, was cited 14 times. The largely organic kitchen at Cancer Treatment Centers of America’s Eastern Regional Medical Center in the Northeast had eight violations.

And in New Jersey, Virtua Memorial Hospital in Mount Holly was rated "conditional satisfactory" after inspections in November and last month found several violations.

"Many live German cockroaches observed on or at base of wall in dish-washing room, dead roaches observed under shelving in paper storage, next to ice machine, and behind refrigerator in vegetable prep area," a Burlington County health department inspector wrote June 28.

All three hospitals said the violations had been quickly corrected.

Food generally isn’t considered when patients choose a hospital. Yet a review of inspection reports from around the region found scores of violations, as well as wide variations in what was cited from county to county. Some evidence suggests that the scrutiny is more rigorous in the city.

Inspections are a far-from-perfect measure of risk: Inspectors found nothing amiss before or after an outbreak sickened 54 people and killed three patients at a Louisiana state hospital in May. And experts say most hospital kitchens go overboard with food safety, cooking so thoroughly to kill microbes that flavors may be lost.

Sheri Morris, food program manager at the Pennsylvania Department of Agriculture, which regulates restaurants and stores but not hospitals, said,

"Anybody who has a compromised immune system is going to be more susceptible to food-borne illness. And hospitals are full of people with compromised immune systems.”

Since inspections are a snapshot of a constantly changing kitchen, they have limited ability to predict either safety or danger. "Just because you went in there and the place had no violations doesn’t mean that 15 minutes later the place didn’t go to pot," said Dennis J. Bauer, food-safety coordinator for the Bucks County Health Department.

Restaurant inspection changes in Philadelphia

Restaurant inspectors in Philadelphia have abandoned the "floors, walls, ceilings" focus and instead are phasing in a more scientific, "risk-based" approach that emphasizes food workers’ knowledge and behavior – do they know how contamination is spread and how to prevent it? – and calls for more frequent inspections of eateries that pose greater risks.

Don Sapatkin of the Philadelphia Inquirer writes this morning that Philadelphia is playing catchup in adopting changes that most counties around here have already made, in some cases many years ago. Yet the city’s new approach is expected to mean more inspections of the 12,621 establishments that sell or serve food – four times a year at institutional kitchens, for example – than most places.

Still, this region is hardly progressive compared to places like Toronto, which posts red, yellow or green signs in restaurants, or Los Angeles (A-B-Cs), or Denmark (smiley faces). No county in the Philadelphia region requires restaurants to post full inspection reports on location.

It’s not clear that food is any safer when there is greater transparency or even more frequent inspections, "but it does get people to think about food safety," said Doug Powell, an associate professor of food safety at Kansas State University who operates barfblog.

Don Schaffner, a professor of food microbiology at Rutgers University, said inspections traditionally have focused as much on appearance as on cooking temperatures. And they often made little distinction between sushi bars that serve raw fish and drug stores that sell prepackaged food.

"What we’ve learned over time is, not everything is equal.”

Ben Chapman, a food-safety extension specialist at North Carolina State University and a contributor to barfblog said prevention is really about "the culture of the restaurant”

Meaning, says Powell,

"If two workers are from the same restaurant (and go to the bathroom) and (only) one washes his hands, I want one to say to the other: ‘Dude, wash your hands.’ "