The Future of Food Safety Inspections

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode: restaurant inspections go online in South Carolina, how they're working, and what's next as public health makes changes in response to the pandemic.

EDWARD SIMMER:
They work well both for our staff who don't have to travel as much, but also for the restaurants that we inspect.

SUSAN BEST:
You know, I said, "Well, let's try it, see what comes about." And it actually worked very well, and we have learned so much from that process.

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: virtual restaurant inspections. In two years, South Carolina inspectors have done more than 42,000 inspections online. Looking only at the numbers, we're left to assume they're working.

Our guests today fill in the blanks. Susan Best is the program manager for Food and Lead Risk at the South Carolina Department of Health and Environmental Control. She's along later to walk us through the process. But first, we hear from Dr. Edward Simmer. He's the director of the department. The program rolled out before he started; but today, he tells us, virtual inspections are working well so far.

SIMMER:
Before COVID-19, I think we, like many health departments, did these entirely in person—you know, one of our inspectors would go to the restaurant and do the inspection physically. And there's still a role for that, there's still a place, we do some in person.

But we knew that, with COVID-19, maintaining appropriate physical distance from others—including those that we regulate—was a key strategy to mitigate COVID-19. So, knowing this, our food protection team had to come up with new and innovative ways to ensure food safety while, at the same time, making sure that both the restaurant staff and the DHEC staff could engage in an inspection process that did not spread COVID-19. So, virtual inspections allowed us to inspect more facilities in a given period of time and provide increased education and support to our restaurant managers and owners.

Performing food safety inspections virtually is an approach that is proving to align with our agency's core values in inspiring innovation and promoting teamwork and is a great example of our improvement strategy pathway—really working to improve our processes to better support our internal and external partners by serving as a model for BEST: practices in environmental and health excellence, and promoting a culture of continuous improvement.

JOHNSON:
So, tell me: how, in your opinion, have the inspections gone so far? How are they performing?

SIMMER:
I think they're working very well. They work well both for our staff who don't have to travel as much, but also for the restaurants that we inspect. You know, we can often help them use these virtual visits to help answer questions that new food establishments may have, new restaurant operators may have, and also perform routine inspections of existing restaurants.

If our food safety team believes that an in-person inspection or visit is needed for follow up, we can schedule these quickly. But the most important thing is that we keep the public safe by making sure these establishments are storing foods at the right temperatures, sanitizing dishes correctly, and performing other key tasks that help prevent foodborne illness and outbreak affecting our citizens. And since performing virtual inspections, we've not seen a rise in foodborne illness outbreak or lower food grades across the state. We think they're effective.

That said, over the next six months to a year, our team is going to be leveraging data analysis, looking at travel costs and time saved, and also the number of inspections staff completed in the same period of time to help quantify the effectiveness of these virtual inspections.

JOHNSON:
Telehealth really took off during the pandemic and now we have these virtual restaurant inspections. Are there any other areas within your department where you think virtual technologies might be beneficial?

SIMMER:
Yes, absolutely.

You know, during COVID-19, we started performing visual lead hazard assessments when we were unable to make in-home visits to do those lead assessments. We also use virtual inspections to perform most of our group home sanitation inspections. And this approach allows one person to conduct these inspections statewide because they don't have to travel all around the state. So, both of these examples allow us to keep pace with our public health mission while also keeping our staff healthy, and realizing cost and time savings by reducing travel.

You may also know our agency is also responsible for environmental protection across the state. And we've actually now started doing virtual inspections of dams, looking for potential hazards to dams and making sure they're not going to breach or, you know, pose a risk to people downstream. And so, this has been very effective across both our health and environmental programs.

JOHNSON:
Thinking about the pandemic's overall impact on public health, how would you characterize this development?

SIMMER:
No, I think it's definitely a good outcome. If it was a bad outcome, we would have stopped doing them as COVID started to slow down.

But you know, the COVID-19 pandemic changed everything: how we worked, how we lived, learned, and even played as a society. And our core mission in public health is to keep people healthy. And we were challenged to devise ways to keep both our staff and the employees of restaurants from getting sick during inspection process, and to keep individuals well and keep them healthy after eating takeout or delivery foods.

So, I think what we have found is that this is a method that, in many cases, increases our staff's productivity, again, allows the restaurant staff to learn some new skills about how to keep people safe, and certainly has led to a more efficient process for all. So, I think this is definitely a plus and something we plan to continue.

JOHNSON:
Susan Best has worked in public health for 28 years, with most of that time spent poking around restaurant kitchens. She wasn't sure about doing that work remotely, but the pandemic required it. After two years of virtual inspections, Susan Best says they're here to stay.

BEST:
As an inspector, it was like, "What?"

But then, you know, as we started doing them—it was a contractor that first requested it, and it was right as COVID put us on lockdown, and he requested it. I spoke with our team lead that it came from, and our team lead had already been out and done a preliminary site inspection, so he'd already had his eyes in the facility himself and walked through the facility. So, you know, I said, "Well, let's try it, see what comes about." And it actually worked very well, and we have learned so much from that process.

JOHNSON:
Were you worried that maybe the results could be tainted, or that you might not see something that you could see if you were there in person?

BEST:
Yeah, definitely, you have that worry, especially if you've never been in the actual facility before. You have that, that owners aren't going to show you all areas, you know, like their problem areas. So, a lot of times, what we would do is start off our introduction by saying, "Hey, can you show me a 360 version of your kitchen."

And so, at that point, as an inspector, you're kind of taking notes of, you know, "Tell me about where you do prepping, where you do this." And as an inspector, when you're going through the process and you're actually talking to the owner, you know, and they say, "Oh, we make, you know, like a chicken," or something, you know, they've got to have a prep cooler for that chicken. So, you want to make sure, from that same point, you take those notes down and you do make sure you follow that process through to see where the chicken came from, where they prep the chicken.

So, yes, I mean, you always do have that issue. And then again, another worry was technology, making sure that was going to work.

JOHNSON:
Tell us about the very first virtual inspection that you remember doing and how it went.

BEST:
It actually went very well. We were shocked. We—it was a coworker, a team lead, and myself did the actual permit issue. And we were actually shocked. The contractor actually gone in—and we do check the light intensity of a facility, making sure you have enough light in your kitchen—and they had actually downloaded an app, a light meter app.

And so, we actually went through that process and it actually went very well. They showed us throughout the entire facility. They checked temperatures, we got them to use their thermometers to check temperatures, we calibrated the thermometers. So, it went very well.

JOHNSON:
What did that experience teach you about doing the second, third, fourth, or fifth inspection? Did you learn anything that helped you improve the process?

BEST:
We learned a ton. We learned that we can use this to our advantage as supplemental to the actual inspection itself. We can use this for training, for compliance assistance, for teaching for all kinds of aspects. Because when you're doing these virtual inspections, the manager that's going around with you sometimes has, you know, their certain staff that do the dishwashing or do the temperature checking, and we're actually teaching them themselves how to do things.

So, we learned a ton from this. And we learned that we can use these to our advantage in a lot of ways.

JOHNSON:
As you think about the virtual inspection, is it pretty much the same thing as being there? And, if not, what's different about it?

BEST:
Well, of course, the difference is the being in-person versus virtual. So yes, I mean, there were a lot of similarities because, again, while we're there we're teaching and educating and doing our inspection, and we can do that virtually also. And it's up to them to show us, using their eyes, the facility when we're doing it virtually.

But I do believe it's very close. We use them now. We still can use them in our, you know, future with the virtual inspections. So, they are very close. But yet, still, you're not actually in the facility yourself.

JOHNSON:
How many virtual inspections have you done since that first one?

BEST:
We have done over 42,000 inspections virtually.

JOHNSON:
That's a fairly serious number. How would you say it's going so far? Do you think it's going well?

BEST:
I think it's going great. It's definitely an innovative approach. And again, it's educational, it's a lot of compliance assistance. We can use it to maximize our staff resources, especially during COVID. We were locked down, we had a lot of our employees who were out sick with COVID or had family members out sick with COVID. So, other inspectors miles away could actually do in the virtual inspections for them in that area.

JOHNSON:
I probably know the answer to this already, given how many you've done in South Carolina, but do you think virtual inspections are here to stay?

BEST:
I think they're here to stay. definitely. They help us with follow-ups, we can use them when—if it's for a core violation, for a follow up, we can definitely use them from that instead of—saving the inspector from driving miles and miles out into the country, if it's for something simple, they can definitely use them. I think they're definitely here to stay: education, compliance, and for you know, inspections, definitely.

JOHNSON:
Do you think you've been able to maintain the same level of public health in restaurants around the state?

BEST:
I do. I think we have definitely maintained it. We've been able to stay in contact, and that was a big thing during COVID lockdown was letting them know we're here for we're here to help. We're here to, you know, educate. And for compliance, I definitely think we've been able to. And we always have that option when you're doing the virtual if something raises a red flag, if you see something you're unsure of, we can go out in-person then.

JOHNSON:
What are some of the challenges that you think remain with this approach?

BEST:
I think technology has been the biggest challenge. We started with Teams, is the system we use, and then FaceTime. And then you know, with Android phones, you have the Duo. So, I think technology was one thing, but having a standard operating procedure that leaves it open to where you can use other forms has definitely helped that.

JOHNSON:
For those of us who've not done one of these, is it basically someone walking around with a phone that's dialed into Zoom, or is there more than that? How does it work?

BEST:
There's a lot more to it than that.

So, what they do is they do have their phone on it—again, like we said, we start with gettiung them to show us a 360 of the kitchen. We get them to open the refrigerators, take their probe thermometer or their, you know, digital thermometer that we've got them to calibrate right there in front of us to make sure it's reading the proper temp, and we check temps. We get them to do cooling rates for us for something they have cooling, something that's been fully cooked we get them to check temps on that. Sanitizer and dish machines—we can pretty much do everything, you know, virtually and we get them to do it for us.

JOHNSON:
And you can still see a violation doing it this way.

BEST:
Yes, you definitely still can. Yes, sir. You can see if the temperature is off. Then, again, it's educational because you go through the process of telling them if the product needs to be discarded, if it needs to be reheated, if it needs to be cooled down.

So, yes, you can definitely find violations this way.

JOHNSON:
What do the restaurant owners in South Carolina think about this approach?

BEST:
We've had very good feedback from our restaurant owners saying that it's definitely been a help. Because they know they can call us now if they need to do a quick—show them how to do something, you know. Or like cooling down, if they're having issues with cooling down. They can call us and say, "This is the process we're going through. Does this look right?"

They have definitely had a good—because, again, we've been able to stay in contact with them. And especially during COVID lockdown, we were able to. And they could still see us face to face, and we were able to go through their kitchen with them. So, we've had great feedback from our restaurant owners.

JOHNSON:
What do the inspectors think about doing these reviews online?

BEST:
Our inspectors liked them for easy follow-ups, to be able to save them time. And they can do more at one time. So, our inspectors do like to process virtual inspections, having access to do them. And again, we can still always go out and do them in person. But you still have that option to do virtual and you're able, again, to stay in contact with them to just follow up on something that you know you might want to touch base with them on after you left. Or if there's still some question, you know, they're concerned about, you're able to still stay in contact with them.

JOHNSON:
What's your big takeaway from doing virtual inspections these last couple of years and doing so many during that time?

BEST:
So, we've been doing them roughly over two years, successfully performing them also. I think we've ensured our facilities that will provide safe food to our customers, and, especially in a post-pandemic world, learning in new ways to produce the same or better results, and that we're improving, going over these challenges and improving them and becoming innovative ways to approach the virtual inspection.

JOHNSON:
Last question for you. As we all know, inspectors like to give restaurants grades, right? So, what grade do you give the virtual inspection process?

BEST:
I would give it an A just because it's been a great addition to our program. It's been something that we didn't know we had option to do. And you know, you learn when you're locked down, you learn a lot of new things about yourself and ways to push you to another level and it's using technology.

And I think we have done a phenomenal job. I think our staff has done a phenomenal job with these. The response we're getting back from the restaurant owners has been amazing. I really do think we've done a phenomenal job with it—not to brag on us, but I need to.

 

JOHNSON:

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This show is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be will.