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Food Safety Data Details

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  • FS-1 Reduce infections caused by key pathogens transmitted commonly through food

    • FS-1.1 Reduce infections caused by Campylobacter species transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      12.7 (2006–08)
      Target: 
      8.5
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number of culture-confirmed cases of illness caused by Campylobacter species reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.2 Reduce infections caused by Shiga toxin-producing Escherichia coli (STEC) O157 transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      1.2 (2006–08)
      Target: 
      0.6
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number of culture-confirmed cases of illness caused by Shiga toxin-producing Escherichia coli (STEC) O157 reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.3 Reduce infections caused by Listeria monocytogenes transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      0.3 (2006–08)
      Target: 
      0.2
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number culture-confirmed cases of illness cause by Listeria monocytogenes reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.4 Reduce infections caused by Salmonella species transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      15.0 (2006–08)
      Target: 
      11.4
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number of culture-confirmed cases of illness caused by Salmonella species reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.5 Reduce postdiarrheal hemolytic uremic syndrome (HUS) in children under 5 years of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      2.0 (2006–08)
      Target: 
      1.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis and based on reductions in Shiga toxigenic Escherichia coli infections, a more ambitious target is proposed.
      Numerator: 

      Number of cases of illness caused by postdiarrheal hemolytic uremic syndrome (HUS) in children less than 5 years of age reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.6 Reduce infections caused by Vibrio species transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      0.3 (2006–08)
      Target: 
      0.2
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number of culture-confirmed cases of illness caused by Vibrio species reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
    • FS-1.7 Reduce infections caused by Yersinia species transmitted commonly through food

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Foodborne Diseases Active Surveillance Network
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      per 100,000
      Baseline (Year): 
      0.4 (2006–08)
      Target: 
      0.3
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      Number of culture-confirmed cases of illness caused by Yersinia species other than Yersinia pestis reported to CDC

      Denominator: 

      Number of persons in FoodNet surveillance area

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FoodNet conducts surveillance for Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia infections diagnosed by laboratory testing of samples from patients.

        The network was established in July 1995 and is a collaborative program among CDC, 10 state health departments, the Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). FoodNet personnel located at state health departments regularly contact the clinical laboratories in Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, Tennessee and selected counties in California, Colorado, and New York to get reports of infections diagnosed in residents of these areas. The surveillance area includes 15% of the United States population (47 million persons) and is generally racially and ethnically representative of the entire U.S. population, with only a slight under-representation of Hispanics. FoodNet is the principal foodborne disease component of CDC's Emerging Infections Program.

        FoodNet accomplishes its work through active surveillance; surveys of laboratories, physicians, and the general population; and population-based epidemiologic studies. Information from FoodNet is used to assess the impact of food safety initiatives on the burden of foodborne illness. Please see Questions and Answers about FoodNet Data (PDF document on the FoodNet website) for more information about FoodNet and how the program works.

      References

      Additional resources about the objective

      1. Foodborne Disease Active Surveillance Network

      2. Patrick, Mary. 2009. An Introduction to FoodNet Sites. In Emerging Infections Program FoodNet News, 2(4):1.
  • FS-2 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with food commodity groups

    • FS-2.1 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with beef

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Outbreak Reporting System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      number
      Baseline (Year): 
      303 (2006–08)
      Target: 
      273
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with beef

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        CDC launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as waterborne outbreaks of non-enteric disease.

        National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

        A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained that meets specified criteria for that agent. Most reports are received from state and local health departments; they also may be received from tribal, territorial, or federal agencies. Not included in this surveillance system are FBDOs occurring on cruise ships and FBDOs due to consumption of food outside the United States, even if the illness occurs within the United States. Because the size of outbreaks can vary widely, and because improvements in outbreak detection, investigation, and reporting are likely to lead to a disproportionate increase in reports of relatively smaller outbreaks, tracking the number of reported outbreak-associated infections is more informative and valuable than tracking the number of reported outbreaks. The FBDO surveillance system is an open database; reporting agencies can add, modify, or delete current or past reports.

        Tracking disease associated with outbreaks attributed to food vehicles may help us determine how to prioritize outbreak prevention efforts and may enable us to determine the efficacy of focused prevention, education and other efforts on particular food commodity groups.

        Other organizations that collaborate with CDC on outbreak surveillance and prevention include CSTE, the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

      Caveats and Limitations: 
      CDC’s outbreak surveillance system is dynamic; agencies can submit new reports and can change or delete previous reports as new information becomes available. Therefore, the number of outbreak-associated illnesses for each category might differ from those published earlier or from future reports. A new categorization scheme was used to classify foods. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      A new categorization scheme was used to classify foods. In 2019, all of the data from the baseline through 2017 was updated using the new categorization scheme. In addition, the target was revised using the same target setting method.
    • FS-2.2 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with dairy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Outbreak Reporting System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      number
      Baseline (Year): 
      773 (2006–08)
      Target: 
      696
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with dairy

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        CDC launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as waterborne outbreaks of non-enteric disease.

        National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

        A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained that meets specified criteria for that agent. Most reports are received from state and local health departments; they also may be received from tribal, territorial, or federal agencies. Not included in this surveillance system are FBDOs occurring on cruise ships and FBDOs due to consumption of food outside the United States, even if the illness occurs within the United States. Because the size of outbreaks can vary widely, and because improvements in outbreak detection, investigation, and reporting are likely to lead to a disproportionate increase in reports of relatively smaller outbreaks, tracking the number of reported outbreak-associated infections is more informative and valuable than tracking the number of reported outbreaks. The FBDO surveillance system is an open database; reporting agencies can add, modify, or delete current or past reports.

        Tracking disease associated with outbreaks attributed to food vehicles may help us determine how to prioritize outbreak prevention efforts and may enable us to determine the efficacy of focused prevention, education and other efforts on particular food commodity groups.

        Other organizations that collaborate with CDC on outbreak surveillance and prevention include the CSTE, the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

        In 2017, the Interagency Food Safety Analytics Collaboration (IFSAC) published a food categorization scheme to better classify foods implicated in outbreaks. Foods reported to the Foodborne Disease Outbreak Surveillance System (FDOSS) through the National Outbreak Reporting System (NORS) are now classified using this scheme. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme....

      Caveats and Limitations: 
      CDC’s outbreak surveillance system is dynamic; agencies can submit new reports and can change or delete previous reports as new information becomes available. Therefore, the number of outbreak-associated illnesses for each category might differ from those published earlier or from future reports. A new categorization scheme was used to classify foods. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      A new categorization scheme was used to classify foods. In 2019, all of the data from the baseline through 2017 was updated using the new categorization scheme. In addition, the target was revised using the same target setting method.
    • FS-2.3 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with fruits and nuts

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Outbreak Reporting System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      number
      Baseline (Year): 
      779 (2006–08)
      Target: 
      701
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with fruits and nuts

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        CDC launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as waterborne outbreaks of non-enteric disease.

        National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

        A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained that meets specified criteria for that agent. Most reports are received from state and local health departments; they also may be received from tribal, territorial, or federal agencies. Not included in this surveillance system are FBDOs occurring on cruise ships and FBDOs due to consumption of food outside the United States, even if the illness occurs within the United States. Because the size of outbreaks can vary widely, and because improvements in outbreak detection, investigation, and reporting are likely to lead to a disproportionate increase in reports of relatively smaller outbreaks, tracking the number of reported outbreak-associated infections is more informative and valuable than tracking the number of reported outbreaks. The FBDO surveillance system is an open database; reporting agencies can add, modify, or delete current or past reports.

        Tracking disease associated with outbreaks attributed to food vehicles may help us determine how to prioritize outbreak prevention efforts and may enable us to determine the efficacy of focused prevention, education and other efforts on particular food commodity groups.

        Other organizations that collaborate with CDC on outbreak surveillance and prevention include CSTE, the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

      Caveats and Limitations: 
      CDC’s outbreak surveillance system is dynamic; agencies can submit new reports and can change or delete previous reports as new information becomes available. Therefore, the number of outbreak-associated illnesses for each category might differ from those published earlier or from future reports. A new categorization scheme was used to classify foods. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      A new categorization scheme was used to classify foods. In 2019, all of the data from the baseline through 2017 was updated using the new categorization scheme. In addition, the target was revised using the same target setting method.
    • FS-2.4 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with leafy vegetables

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Outbreak Reporting System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      number
      Baseline (Year): 
      215 (2006–08)
      Target: 
      194
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with leafy vegetables

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        CDC launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as waterborne outbreaks of non-enteric disease.

        National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

        A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained that meets specified criteria for that agent. Most reports are received from state and local health departments; they also may be received from tribal, territorial, or federal agencies. Not included in this surveillance system are FBDOs occurring on cruise ships and FBDOs due to consumption of food outside the United States, even if the illness occurs within the United States. Because the size of outbreaks can vary widely, and because improvements in outbreak detection, investigation, and reporting are likely to lead to a disproportionate increase in reports of relatively smaller outbreaks, tracking the number of reported outbreak-associated infections is more informative and valuable than tracking the number of reported outbreaks. The FBDO surveillance system is an open database; reporting agencies can add, modify, or delete current or past reports.

        Tracking disease associated with outbreaks attributed to food vehicles may help us determine how to prioritize outbreak prevention efforts and may enable us to determine the efficacy of focused prevention, education and other efforts on particular food commodity groups.

        Other organizations that collaborate with CDC on outbreak surveillance and prevention include CSTE, the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

      Caveats and Limitations: 
      CDC’s outbreak surveillance system is dynamic; agencies can submit new reports and can change or delete previous reports as new information becomes available. Therefore, the number of outbreak-associated illnesses for each category might differ from those published earlier or from future reports. A new categorization scheme was used to classify foods. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      A new categorization scheme was used to classify foods. In 2019, all of the data from the baseline through 2017 was updated using the new categorization scheme. In addition, the target was revised using the same target setting method.
    • FS-2.5 Reduce the number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with poultry

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Outbreak Reporting System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      number
      Baseline (Year): 
      205 (2006–08)
      Target: 
      185
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of outbreak-associated infections due to Shiga toxin-producing E. coli O157, or Campylobacter, Listeria, or Salmonella species associated with poultry

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        CDC launched NORS in 2009 as a web-based platform into which health departments enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as waterborne outbreaks of non-enteric disease.

        National foodborne and waterborne disease outbreak surveillance has been a core function of CDC since the 1970s. Two surveillance systems handle this responsibility: the Waterborne Disease and Outbreak Surveillance System (1971-present) and the Foodborne Disease Outbreak Surveillance System (1973-present). Foodborne disease outbreak data have been collected electronically since 1998. NORS was designed to integrate the outbreak reporting systems and enhance national outbreak reporting with new components.

        A foodborne disease outbreak (FBDO) is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. FBDOs are reported to CDC on a standard reporting form. Outbreaks of known etiology are those for which laboratory evidence of a specific agent is obtained that meets specified criteria for that agent. Most reports are received from state and local health departments; they also may be received from tribal, territorial, or federal agencies. Not included in this surveillance system are FBDOs occurring on cruise ships and FBDOs due to consumption of food outside the United States, even if the illness occurs within the United States. Because the size of outbreaks can vary widely, and because improvements in outbreak detection, investigation, and reporting are likely to lead to a disproportionate increase in reports of relatively smaller outbreaks, tracking the number of reported outbreak-associated infections is more informative and valuable than tracking the number of reported outbreaks. The FBDO surveillance system is an open database; reporting agencies can add, modify, or delete current or past reports.

        Tracking disease associated with outbreaks attributed to food vehicles may help us determine how to prioritize outbreak prevention efforts and may enable us to determine the efficacy of focused prevention, education and other efforts on particular food commodity groups.

        Other organizations that collaborate with CDC on outbreak surveillance and prevention include CSTE, the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Department of Agriculture (USDA).

      Caveats and Limitations: 
      CDC’s outbreak surveillance system is dynamic; agencies can submit new reports and can change or delete previous reports as new information becomes available. Therefore, the number of outbreak-associated illnesses for each category might differ from those published earlier or from future reports. A new categorization scheme was used to classify foods. For more information on the categorization scheme, please see: https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      A new categorization scheme was used to classify foods. In 2019, all of the data from the baseline through 2017 was updated using the new categorization scheme. In addition, the target was revised using the same target setting method.
  • FS-3 Prevent an increase in the proportion of nontyphoidal Salmonella and Campylobacter jejuni isolates from humans that are resistant to antimicrobial drugs.

    • FS-3.1 Prevent an increase in the proportion of nontyphoidal Salmonella isolates from humans that show reduced susceptibility to ciprofloxacin (fluoroquinolone)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      2.6 (2006–08)
      Target: 
      2.6
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in reduced susceptibility to Ciprofloxacin is vital to preserving the efficacy of this agent. The target represents part of an effort to address increasing resistance to antimicrobial drugs.
      Numerator: 

      Number of non-typhoidal Salmonella isolates that show reduced susceptibility to Ciprofloxacin

      Denominator: 

      Number of non- typhoidal Salmonella isolates tested for reduced susceptibility to Ciprofloxacin

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1996, surveillance for Salmonella in NARMS began in 14 sites. Since 2003, all 50 states have been participating, which represent a population of approximately 321 million (US Census Bureau, 2015). Participating sites forward every Salmonella serotypes Typhi and Paratyphi A, every twentieth non-typhoidal Salmonella, every twentieth Shigella, and every twentieth E. coli O157 isolates received at their public health laboratories to NARMS at CDC for susceptibility testing.

        Susceptibility testing involves determination of minimum inhibitory concentrations for antimicrobial agents, including: ampicillin, amoxicillin-clavulanic acid, azithromycin, cefoxitin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Resistance in non-typhoidal Salmonella is used for this objective. Non-typhoidal Salmonella excludes the following typhoidal Salmonella serotypes: Typhi, Paratyphi A, Paratyphi B (i.e., tartrate negative isolates), and Paratyphi C. Tartrate positive Salmonella serotype Paratyphi B isolates are referred to as Salmonella serotype Paratyphi B var. L(+) tartrate+ and are not typically associated with typhoidal disease.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 10-3a in that the word “species” was omitted from the Healthy People 2020 objective to reflect current Salmonella nomenclature. Typhoidal isolates are not included in the Healthy People 2020 objective because they are usually associated with international travel. Nalidixic acid was initially used to represent the quinolone class and was tracked in Healthy People 2020 rather than the generic fluoroquinolones.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Ciprofloxacin,is a fluoroquinolone commonly used to treat severe non-typhoidal Salmonella infections. The objective now tracks reduced susceptibility, which includes intermediate susceptibiliity and resistance; and Ciprofloxacin replaced nalidixic acid in October 2014. Consequently, the original baseline was revised from 2.0 (2006-08) to 2.6 (2006-08). The target was adjusted from 2.0 to 2.6 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

    • FS-3.2 Prevent an increase in the proportion of nontyphoidal Salmonella isolates from humans that are resistant to ceftriaxone (third-generation cephalosporin)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      3.3 (2006–08)
      Target: 
      3.3
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in resistance to ceftriaxone is vital to preserving the efficacy of this agent. The target represents part of an effort to address increasing resistance to antimicrobial drugs.
      Numerator: 

      Number of non-typhoidal Salmonella isolates that are resistant to ceftriaxone

      Denominator: 

      Number of non- typhoidal Salmonella isolates tested for resistance to ceftriaxone

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1996, surveillance for Salmonella in NARMS began in 14 sites. Since 2003, all 50 states have been participating, which represent a population of approximately 321 million (US Census Bureau, 2015). Participating sites forward every Salmonella serotypes Typhi and Paratyphi A, every twentieth non-typhoidal Salmonella, every twentieth Shigella, and every twentieth E. coli O157 isolates received at their public health laboratories to NARMS at CDC for susceptibility testing.

        Susceptibility testing involves determination of minimum inhibitory concentrations for antimicrobial agents, including: ampicillin, amoxicillin-clavulanic acid, azithromycin, cefoxitin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Resistance in non-typhoidal Salmonella is used for this objective. Non-typhoidal Salmonella excludes the following typhoidal Salmonella serotypes: Typhi, Paratyphi A, Paratyphi B (i.e., tartrate negative isolates), and Paratyphi C. Tartrate positive Salmonella serotype Paratyphi B isolates are referred to as Salmonella serotype Paratyphi B var. L(+) tartrate+ and are not typically associated with typhoidal disease.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 10-3b in that the word “species” was omitted from the Healthy People 2020 objective to reflect current Salmonella nomenclature. Typhoidal isolates are not included in the Healthy People 2020 objective because they are usually associated with international travel. Ceftriaxone is tracked in Healthy People 2020 rather than the generic third-generation cephalosporins. Ceftriaxone is particularly important in the treatment of life-threatening Salmonella infection in children.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Due to a change in methodology for data presentation, the original baseline was revised from 3.0 (2006-08) to 3.3 (2006-08). The target was adjusted from 3.0 to 3.3 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

    • FS-3.3 Prevent an increase in the proportion of nontyphoidal Salmonella isolates from humans that are resistant to gentamicin

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      1.9 (2006–08)
      Target: 
      1.9
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in resistance to gentamicin is vital to preserving the efficacy of this agent. The target represents part of an effort to address increasing resistance to antimicrobial drugs.
      Numerator: 

      Number of non-typhoidal Salmonella isolates that are resistant to gentamicin

      Denominator: 

      Number of non- typhoidal Salmonella isolates tested for resistance to gentamicin

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1996, surveillance for Salmonella in NARMS began in 14 sites. Since 2003, all 50 states have been participating, which represent a population of approximately 321 million (US Census Bureau, 2015). Participating sites forward every Salmonella serotypes Typhi and Paratyphi A, every twentieth non-typhoidal Salmonella, every twentieth Shigella, and every twentieth E. coli O157 isolates received at their public health laboratories to NARMS at CDC for susceptibility testing.

        Susceptibility testing involves determination of minimum inhibitory concentrations for antimicrobial agents, including: ampicillin, amoxicillin-clavulanic acid, azithromycin, cefoxitin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Resistance in non-typhoidal Salmonella is used for this objective. Non-typhoidal Salmonella excludes the following typhoidal Salmonella serotypes: Typhi, Paratyphi A, Paratyphi B (i.e., tartrate negative isolates), and Paratyphi C. Tartrate positive Salmonella serotype Paratyphi B isolates are referred to as Salmonella serotype Paratyphi B var. L(+) tartrate+ and are not typically associated with typhoidal disease.

      Changes Between HP2010 and HP2020: 
      The word “species” was omitted to reflect current Salmonella nomenclature. Typhoidal isolates are not included in the Healthy People 2020 objective because they are usually associated with international travel.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Due to a change in methodology for data presentation, the original baseline was revised from 2.0 (2006-08) to 1.9 (2006-08). The target was adjusted from 2.0 to 1.9 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

    • FS-3.4 Prevent an increase in the proportion of nontyphoidal Salmonella isolates from humans that are resistant to ampicillin

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      10.3 (2006–08)
      Target: 
      10.3
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in resistance to ampicillin is vital to preserving the efficacy of this agent. The target represents part of an.effort to address increasing resisstance to intimicrobial drugs.
      Numerator: 

      Number of non-typhoidal Salmonella isolates that are resistant to ampicillin

      Denominator: 

      Number of non- typhoidal Salmonella isolates tested for resistance to ampicillin

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1996, surveillance for Salmonella in NARMS began in 14 sites. Since 2003, all 50 states have been participating, which represent a population of approximately 321 million (US Census Bureau, 2015). Participating sites forward every Salmonella serotypes Typhi and Paratyphi A, every twentieth non-typhoidal Salmonella, every twentieth Shigella, and every twentieth E. coli O157 isolates received at their public health laboratories to NARMS at CDC for susceptibility testing.

        Susceptibility testing involves determination of minimum inhibitory concentrations for antimicrobial agents, including: ampicillin, amoxicillin-clavulanic acid, azithromycin, cefoxitin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Resistance in non-typhoidal Salmonella is used for this objective. Non-typhoidal Salmonella excludes the following typhoidal Salmonella serotypes: Typhi, Paratyphi A, Paratyphi B (i.e., tartrate negative isolates), and Paratyphi C. Tartrate positive Salmonella serotype Paratyphi B isolates are referred to as Salmonella serotype Paratyphi B var. L(+) tartrate+ and are not typically associated with typhoidal disease.

      Changes Between HP2010 and HP2020: 
      The word “species” was omitted to reflect current Salmonella nomenclature. Typhoidal isolates are not included in the Healthy People 2020 objective because they are usually associated with international travel.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Due to a change in methodology for data presentation the original baseline was revised from 10.0 (2006-08) to 10.3 (2006-08). The target was adjusted from 10.0 to 10.3 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

    • FS-3.5 Prevent an increase in the proportion of nontyphoidal Salmonella isolates from humans that are resistant to three or more classes of antimicrobial agents

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      10.8 (2006–08)
      Target: 
      10.8
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in resistance to multiple antimicrobial agents is vital to preserving the efficacy of this agent. The target represents part of an effort to address increasing resistance to antimicrobial drugs.
      Numerator: 

      Number of non-typhoidal Salmonella isolates that are resistant to three or more classes of antimicrobial agents

      Denominator: 

      Number of non- typhoidal Salmonella isolates tested for resistance to three or more classes of antimicrobial agents

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1996, surveillance for Salmonella in NARMS began in 14 sites. Since 2003, all 50 states have been participating, which represent a population of approximately 321 million (US Census Bureau, 2015). Participating sites forward every Salmonella serotypes Typhi and Paratyphi A, every twentieth non-typhoidal Salmonella, every twentieth Shigella, and every twentieth E. coli O157 isolates received at their public health laboratories to NARMS at CDC for susceptibility testing.

        Susceptibility testing involves determination of minimum inhibitory concentrations for antimicrobial agents, including: ampicillin, amoxicillin-clavulanic acid, azithromycin, cefoxitin, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Resistance in non-typhoidal Salmonella is used for this objective. Non-typhoidal Salmonella excludes the following typhoidal Salmonella serotypes: Typhi, Paratyphi A, Paratyphi B (i.e., tartrate negative isolates), and Paratyphi C. Tartrate positive Salmonella serotype Paratyphi B isolates are referred to as Salmonella serotype Paratyphi B var. L(+) tartrate+ and are not typically associated with typhoidal disease.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The criteria for measurement was changed as isolates resistant to three or more antimicrobial classes will be calculated using reduced susceptibility to ciprofloxacin,to define resistance to the quinolone class. NARMS will continue to use resistance criteria for other drug classes. Amikacin and kanamycin (aminoglycosides) and ceftiofur (cephalosporin), have been eliminated from the panel. Due to a change in the methodology the original baseline was revised from 10.6 (2006-08) to 10.8 (2006-08). The target was adjusted from 10.6 to 10.8 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

    • FS-3.6 Prevent an increase in the proportion of Campylobacter jejuni isolates from humans that are resistant to erythromycin

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Antimicrobial Resistance Monitoring System for Enteric Bacteria
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      1.6 (2006–08)
      Target: 
      1.6
      Target-Setting Method: 
      Maintain the baseline value.
      Target-Setting Method Justification: 
      Antimicrobial use in humans and food animals provides selective pressure that favors resistant bacteria. Preventing an increase in resistance to erythromycin is vital to preserving the efficacy of this agent. The target represents part of an effort to address increasing resistance to antimicrobial drugs.
      Numerator: 

      Number of Campylobacter jejuni isolates that are resistant to erythromycin

      Denominator: 

      Number of Campylobacter jejuni isolates tested for resistance to erythromycin

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The primary objectives of NARMS are to:

        1. Monitor trends in antimicrobial resistance among foodborne bacteria from humans, retail meats, and animals
        2. Disseminate timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria
        3. Conduct research to better understand the emergence, persistence, and spread of antimicrobial resistance
        4. Assist the FDA in making decisions related to the approval of safe and effective antimicrobial drugs for animals

        In 1997, surveillance for Campylobacter in NARMS began in sites participating in the Foodborne Disease Active Surveillance Network (FoodNet). There were 5 participating sites in 1997. Since 2003 10 FoodNet sites have been participating: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, New Mexico, Oregon, and Tennessee. The 10 FoodNet sites represent about 49 million or 15% of the US population (US Census Bureau, 2015). Participating sites forward a representative sample of Campylobacter isolates received at their public health laboratories to NARMS at CDC for susceptibility testing. Susceptibility testing involves determination of minimum inhibitory for antimicrobial agentsincluding: azithromycin, ciprofloxacin, clindamycin, erythromycin, florfenicol, gentamicin, nalidixic acid, telithromycin, and tetracycline.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Due to a change in methodology for data presentation, the original baseline was revised from 2.0 (2006-08) to 1.6 (2006-08). The target was adjusted from 2.0 to 1.6 to reflect the revised baseline using the original target-setting method.

      References

      Additional resources about the objective

      1. National Antimicrobial Resistance Monitoring System

      2. National Antimicrobial Resistance Monitoring System for Enteric Bacteria

  • FS-4 Reduce severe allergic reactions to food among adults with a food allergy diagnosis

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Food Safety Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    29.3 (2006)
    Target: 
    21.0
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The number of adults with a food allergy diagnosis reporting severe allergic reactions did not change significantly between years 2001 (26.4 percent) and 2006 (29.3 percent). Based on this trend analysis, a more ambitious target is proposed.
    Numerator: 

    Number of persons 18 years and older with doctor-diagnosed food allergies who report an allergic reaction within the last 5 years and who report that the allergic reaction was severe (required the use of epinephrine, or treatment in a hospital or doctor’s office, or an overnight stay in a hospital)

    Denominator: 

    Number of persons 18 years and older with doctor-diagnosed food allergies

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2006 Food Safety Survey:

      [NUMERATOR:]

      I'd like to ask if you have any current food allergies, or do you suspect you have a food allergy?

      1. Yes*
      2. No or not aware of
      3. Someone in household died from food allergy
      4. Don't know
      5. Refused

      Has a medical doctor diagnosed your condition as a food allergy?

      1. Yes*
      2. No
      3. Don't know
      4. Refused

      When was the last time you had an allergic reaction to food, or had symptoms you thought were caused by an allergic reaction to food?

      1. Less than one month*
      2. One - 2 months*
      3. 3 - 6 months*
      4. 7 - 11 months*
      5. 1 - 2 years*
      6. 3 - 5 years*
      7. 6 - 9 years
      8. 10 - 14 years
      9. 15 - 19 years
      10. 20 years or more
      11. Never

      Was epinephrine [EP eh NEF rin] used to treat this most recent reaction?

      1. Yes*
      2. No
      3. Does not recall specific instance
      4. Don't know
      5. Refused

      Were you [was he/she] treated in a hospital or doctor's office for this reaction? Which?

      1. Yes, hospital*
      2. Yes, doctor's office*
      3. No
      4. Does not recall specific instance
      5. Don't know
      6. Refused

      Did you/he/she have to stay overnight in the hospital?

      1. Yes*
      2. No
      3. Don't know
      4. Refused

      *RESPONSE IS INCLUDED IN THE CALCULATIONS.

    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      The estimate for this measure is calculated by first defining a sub-sample of survey respondents who report a doctor-diagnosed food allergy. The percentage of this group that had an allergic reaction to food within the last 5 years and whose reaction required the use of epinephrine, or treatment in a hospital or doctor's office, or an overnight stay in a hospital is the numerator. Weights are applied that adjust for probability of selection (the number of telephones in the house and the number of adults in the house) and that adjust the sample to census estimates on the characteristics of sex, race, and education.

    References

    Additional resources about the objective

    1. Food Safety Survey

    2. Food Safety Survey (OMB Control Number 0910-0345-Reinstatement). Federal Register; 74:177. September 15, 2009. pp 47256-47257.
  • FS-5 Increase the proportion of consumers who follow key food safety practices

    • FS-5.1 Increase the proportion of consumers who follow the key food safety practice of “Clean: wash hands and surfaces often.”

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Food Safety Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      67.2 (2006)
      Target: 
      73.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      The percent of consumers aged 18 years and older who report they follow the key food safety practice: Clean: Wash hands and surfaces often

      Denominator: 

      Number of practices measured among persons aged 18 years and older who prepare food (consumers)

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 Food Safety Survey:

        [NUMERATOR:]

        Before you begin preparing food, how often do you wash your hands with soap? Would you say

        1. All of the time*
        2. Most of the time
        3. Some of the time, or
        4. Rarely

        After you have cracked open raw eggs, do you usually continue cooking, or do you first rinse your hands with water, wipe them, or wash them with soap?

        1. Continue cooking
        2. Rinse or wipe hands
        3. Wash with soap*
        4. Never handle raw eggs

        After handling raw meat or chicken, do you usually continue cooking, or do you first rinse your hands with water, or wipe them, or wash them with soap?

        1. Continue cooking
        2. Rinse or wipe hands
        3. Wash with soap*
        4. Don't cut raw meat or chicken

        After handling raw fish, do you usually continue cooking, or do you first rinse your hands with water, wipe them, or wash them with soap?

        1. Continue cooking
        2. Rinse or wipe hands
        3. Wash with soap*
        4. Never handle raw fish

        *RESPONSE IS INCLUDED IN THE CALCULATIONS.

      Data Collection Frequency: 
      Periodic
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 10-5 in that it tracks one of the four components of the Healthy People 2010 objective (Clean, Separate, Cook, and Chill). These components are tracked as separate objectives in Healthy People 2020 to more clearly show where progress is being made, or where more effort towards improvement is needed.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      Target was changed from 74.0% to 73.9% in February 2017 to correct original baseline calculation.

      References

      Additional resources about the objective

      1. Food Safety Survey

      2. Food Safety Survey (OMB Control Number 0910-0345-Reinstatement). Federal Register; 74:177. September 15, 2009. pp 47256-47257.
    • FS-5.2 Increase the proportion of consumers who follow the key food safety practice of “Separate: don’t cross-contaminate.”

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Food Safety Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      88.6 (2006)
      Target: 
      92.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Based on the high proportion of compliance, a target representing a 3.4 percent increase is proposed.
      Numerator: 

      The percent of consumers aged 18 years and older who report they follow the key food safety practice: Separate: Don’t cross-contaminate

      Denominator: 

      Number of practices measured among persons aged 18 years and older who prepare food (consumers)

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 Food Safety Survey:

        [NUMERATOR:]

        After you have used a cutting board or other surface for cutting raw meat or chicken, do you use it as it is for cutting other food to be eaten raw for the same meal, or do you first rinse it, or wipe it, or wash it with soap?

        1. Use it as it is
        2. Rinse or wipe it
        3. Wash with soap*
        4. Wash with bleach*
        5. Use a different cutting board*
        6. Don't cut raw meat or poultry*

        After cutting raw fish or shellfish, what do you do with the cutting board or surface? [Do you use it as it is for cutting food to be eaten raw for the same meal, or do you first rinse it, or wipe it, or wash it with soap?]

        (NOTE: MATERIAL IN BRACKETS MAY NOT NEED TO BE READ).

        1. Use it as it is
        2. Rinse or wipe it
        3. Wash with soap*
        4. Wash with bleach*
        5. Use a different cutting board*

        *RESPONSE IS INCLUDED IN THE CALCULATIONS.

      Data Collection Frequency: 
      Periodic

      References

      Additional resources about the objective

      1. Food Safety Survey

      2. Food Safety Survey (OMB Control Number 0910-0345-Reinstatement). Federal Register; 74:177. September 15, 2009. pp 47256-47257.
    • FS-5.3 Increase the proportion of consumers who follow the key food safety practice of “Cook: cook to proper temperatures.”

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Food Safety Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      36.9 (2006)
      Target: 
      76.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Following a trend analysis, a more ambitious target is proposed.
      Numerator: 

      The percent of consumers aged 18 years and older who report they follow the key food safety practice: Cook to proper temperatures

      Denominator: 

      Number of practices measured among persons aged 18 years and older who prepare food (consumers)

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 Food Safety Survey:

        [NUMERATOR:]

        In your home, are hamburgers usually served...(PROBE: IF DIFFERENT WAYS FOR DIFFERENT PEOPLE: What is the rarest degree of doneness hamburgers are served?)

        1. Rare
        2. Medium, or
        3. Well done?*
        4. Hamburgers are never served

        [If 2:] When you say hamburgers are usually served "medium," do you mean they are...

        1. Brown all the way through,* or
        2. Still have some pink in the middle?

        In the past 12 months, did you eat any of the following foods that contain raw eggs? (Did you eat. . .) (In the past 12 months, did you eat . . .)

        1. Raw, homemade cookie or cake batter?
        2. Homemade frosting with raw egg?
        3. Caesar salad with raw egg?
        4. Chocolate mousse with raw egg?
        5. Homemade eggnog?
        6. Homemade mayonnaise?
        7. Homemade ice cream with raw egg?
        8. Shakes with raw egg?
        9. Homemade hollandaise sauce?

        NOTE TO INTERVIEWERS: COMMERCIAL FROZEN OR REFRIGERATED COOKIE DOUGH IS PASTEURIZED; IT DOES NOT CONTAIN RAW EGGS EVEN BEFORE IT IS BAKED. COMMERCIAL CAKE AND COOKIE MIXES USUALLY CALL FOR ADDING RAW EGGS, SO THEY COUNT AS EATING RAW EGGS.)

        In the past 12 months, which of the following raw foods did you eat?

        1. Raw oysters
        2. Sushi, ceviche (se - VEE - chay), or other raw fish

        Thinking of your usual habits over the past year, when you prepare the following foods, how often do you use a thermometer?

        a) Roasts or other large pieces of meat—how often do you use a thermometer when you cook roasts? Would you say...

        1. Always*
        2. Often*
        3. Sometimes,* or
        4. Never
        5. Never cook the food

        b) Chicken parts, such as breasts or legs--how often do you use a thermometer when you cook chicken parts? Would you say...

        1. Always*
        2. Often*
        3. Sometimes,* or
        4. Never
        5. Never cook the food

        c) How about hamburgers--how often do you use a thermometer when you cook hamburgers? Would you say...

        1. Always*
        2. Often*
        3. Sometimes,* or
        4. Never
        5. Never cook the food

        *RESPONSE IS INCLUDED IN THE CALCULATIONS.

      Data Collection Frequency: 
      Periodic

      References

      Additional resources about the objective

      1. Food Safety Survey

      2. Food Safety Survey (OMB Control Number 0910-0345-Reinstatement). Federal Register; 74:177. September 15, 2009. pp 47256-47257.
    • FS-5.4 Increase the proportion of consumers who follow the key food safety practice of “Chill: refrigerate promptly.”

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Food Safety Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      88.1 (2006)
      Target: 
      91.1
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Based on the high proportion of compliance, a target representing 3.4 percent increase is proposed.
      Numerator: 

      The percent of consumers aged 18 years and older who report they follow the key food safety practice: Chill: Refrigerate promptly

      Denominator: 

      Number of practices measured among persons aged 18 years and older who prepare food (consumers)

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2006 Food Safety Survey:

        [NUMERATOR:]

        If you cook a large pot of soup, stew, or other food with meat or chicken and want to save it for the next day, when do you put the food in the refrigerator? Would it be (READ 1-3) . . .

        1. Immediately*
        2. After first cooling it at room temperature, or
        3. After first cooling it in cold water?*
        4. Do not cook such foods
        5. Would not refrigerate it

        [If (2):] For about how long would you let it cool at room temperature? (DO NOT READ LIST)

        1. Less than 2 hours*
        2. 2 hours or more

        How about if the soup or stew contains fish or shellfish instead of meat or chicken. If you want to save it for the next day, when do you put the food in the refrigerator? Would it be (READ 1-3)

        1. Immediately*
        2. After first cooling it at room temperature, or
        3. After first cooling it in cold water?*
        4. Do not cook such foods
        5. Would not refrigerate it

        [If (2):] For about how long would you let it cool at room temperature (DO NOT READ LIST)

        1. Less than 2 hours*
        2. 2 hours or more

        *RESPONSE IS CODED AS SAFE.

      Data Collection Frequency: 
      Periodic

      References

      Additional resources about the objective

      1. Food Safety Survey

      2. Food Safety Survey (OMB Control Number 0910-0345-Reinstatement). Federal Register; 74:177. September 15, 2009. pp 47256-47257.
  • FS-6 Increase the proportion of fast-food and full service restaurants that follow food safety practices that prevent foodborne illness outbreaks

    • FS-6.1 Increase the proportion of fast-food restaurants where employees practice proper handwashing

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      61.2 (2008)
      Target: 
      69.3
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of fast-food restaurants where employees practice proper handwashing.

      Denominator: 

      Total number of fast-food restaurants that were surveyed for handwashing practice.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Proper, Adequate Handwashing.

        Hands are clean and properly washed when and as required.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Employees practice proper handwashing.

        A. Hands are cleaned and properly washed using hand cleanser / water supply / appropriate drying methods / length of time as specified in Section 2-301.12 of the Food Code.

        1. IN (yes)
        2. OUT (no)

        B. Hands are cleaned and properly washed when required as specified in Section 2-301.14 of the Food Code .

        1. IN (yes)
        2. OUT (no)

        NOTE: If either item in 2014 is marked out of compliance then the overall objective is out of compliance.

        NOTE: The data item Employees practice proper handwashing MUST be marked IN or OUT of compliance. The data collector MUST be in the restaurant facility long enough to make observations of handwashing practices. The data collector is to rely only on actual observations of handwashing practices.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        IN – Mark IN when food employees are observed washing their hands as specified in Section 2-301.12 of the Food Code.

        OUT – Mark OUT when ONE or MORE food employees are observed failing to follow the handwashing procedures specified in Section 2-301.12 of the Food Code.

        This information statement CANNOT be marked NO or NA.

        Item B Notes:

        IN – Mark IN when food employees are observed washing hands when required as specified in Section 2-301.14 of the Food Code.

        Mark OUT when ONE or MORE food employees are observed failing to wash their hand when required as specified in Section 2-301.14 of the Food Code.

        This information statement CANNOT be marked NO or NA.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper handwashing in fast-food restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 67.3% to 69% in 2017. The target was revised from 69% to 74.9% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 74.9% to 69.3%.
    • FS-6.2 Increase the proportion of fast-food restaurants where food employees do not contact ready-to-eat (RTE) foods with bare hands

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      73.7 (2008)
      Target: 
      81.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of fast-food restaurants where food employees do not contact RTE foods with bare hands.

      Denominator: 

      Total number of fast-food restaurants that were observed for employee bare hand contact with RTE foods.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Prevention of Contamination From Hands.

        Employees do not contact exposed, ready-to-eat food with their bare hands. NOTE: In determining the status of this data item, an assessment of alternative methods when otherwise approved is to be made to determine implementation in accordance with the guidelines contained in Annex 3, 2001 Food Code, page 289.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food employees do not contact ready-to-eat foods with bare hands

        1. IN (yes)
        2. OUT (no)

        Data item does not contain any information statements. The language in the data item is intended to be all encompassing of observations related to bare hand contact of exposed ready-eat-foods.

        Since this data collection period is focusing on the restaurant segment of the industry, data collectors CANNOT select the NO or NA marking options that have been BLACKED-OUT. All restaurants selected for the Study will have processes that include preparation or service of ready-to-eat foods.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        IN – Mark IN when food employees are observed using suitable utensils or single-use gloves to prevent bare hand contact with exposed ready-to-eat foods OR are observed properly following a pre-approved alternative procedure to no bare hand contact.

        NOTE: When fruits and vegetables are being washed, food employees may touch them with their bare hands.

        OUT – Mark OUT when ONE or MORE food employees are observed touching exposed ready-to-eat foods with their bare hands OR are observed NOT properly following a pre-approved alternative procedure to no bare hand contact. NOTE: This data item MUST be marked OUT of compliance if one person is observe touching exposed ready-to-eat foods with their bare hands..

        This information statement CANNOT be marked NO or NA.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks bare hand contact with ready-to-eat foods in fast-food restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 81.1% to 81% in 2017. The target was revised from 81% to 86% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 86.0% to 81.0%.
    • FS-6.3 Increase the proportion of fast-food restaurants where food contact surfaces are properly cleaned and sanitized

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      58.3 (2008)
      Target: 
      66.2
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of fast-food restaurants where food contact surfaces are properly cleaned and sanitized.

      Denominator: 

      Total number of fast-food restaurants that were surveyed for proper cleansing and sanitization of food contact surfaces.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food contact surfaces cleaned and sanitized.

        Food-contact surfaces and utensils are clean to sight and touch and sanitized before use.

        1. IN (yes)
        2. OUT (no)

        NOTE: This item will require some judgment to be used when marking this item IN or Out of compliance. This item should be marked Out of Compliance if observations are made that supports a pattern of non-compliance with this item. One dirty utensil, food contact surface or one sanitizer container without sanitizer would not necessarily support an Out of Compliance mark. You must provide notes concerning an Out of Compliance mark on this item.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food contact surfaces cleaned and sanitized.

        A. Food contact surfaces and utensils are clean to sight and touch and sanitized before use.

        1. IN (yes)
        2. OUT (no)

        B. Equipment food contact surfaces and utensils are cleaned and sanitized properly using manual warewashing procedures.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Equipment food contact surfaces and utensils are cleaned and sanitized properly using mechanical warewashing equipment.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        D. Other (describe in the comments section below).

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: If any item in 2014 is marked out of compliance then the overall objective is out of compliance.

        NOTE: This item will require some judgment to be used when marking the information statements IN or OUT of compliance. The information statement should be marked OUT of compliance if observations are made that support a pattern of non-compliance with the procedure or practice. One dirty utensil, food contact surface or one sanitizer container without sanitizer, would not necessarily support an OUT of Compliance marking. The data collector MUST complete the comment section when an OUT of Compliance marking is documented for one or more of the information statements.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        Information statement “A” is specific to observations of clean and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use. Do NOT include observations made of food contact surfaces and utensils that are part of a manual warewashing procedure or cleaning / sanitizing in place equipment which are addressed in information statement “B”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement “C”.

        IN – Based on an overall assessment of the establishment’s operation, mark IN when direct observations indicate a substantive pattern for properly cleaning and sanitizing dishware, utensils, and cookware considered ready-for-use.

        OUT – Based on an overall assessment of the establishment’s operation, mark OUT when direct observations indicate a substantive pattern of soiled and/or un-sanitized dishware, utensils, and cookware considered ready-for-use.

        This information statement CANNOT be marked NO or NA

        Item B Notes:

        NOTE: Information statement “B” is specific to observations of cleaned and sanitized food contact surfaces as part of a manual warewashing or clean-in-place procedure. Do NOT include observations of cleaned and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use which are addressed as part of information statement “A”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement C.

        IN – Mark IN when direct observations indicate the proper washing and sanitizing of dishes / utensils using a MANUAL procedure or clean-in-place procedures for equipment such as a meat slicer, large mixer, microwave oven, tilting kettle, etc., result in food contact surfaces that are cleaned and sanitized. Examples for this information statement would include observations of food contact surfaces and equipment being properly washed, rinsed, and sanitized in a three compartment sink or observations of the cleaning and sanitization of a tilting kettle (CIP).

        OUT – Mark OUT when direct observations indicate the lack of, or improper methods / procedures for, washing and sanitizing of dishes / utensils using a MANUAL procedure or clean-in-place equipment such as a meat slicer, large mixer, microwave oven, tilting kettle, etc., result in food contact surfaces that are NOT cleaned and sanitized. Examples would include observations of food contact surfaces and equipment immersed in sanitizing concentrations lower than the critical limits contained in the Food Code; or washing food contact surfaces in dirty water containing little of no detergent solution; or washing food contact surfaces using an improper set-up of the three compartment sink, such as wash-sanitize-rinse; etc. NOTE: Lack of temperature measuring devices and/or chemical tests kits for determining sanitizing rinse temperatures and/or sanitizer concentration is NOT marked under information statement “B” --- mark these observations under information statement “15E”.

        NO – Mark NO when washing and sanitizing dishes / utensils using a MANUAL procedure is part of the establishment’s operation but is not conducted during the data collection.

        NA – Mark NA when all equipment and utensils are washed and sanitized in a mechanical dish machine.

        Item C Notes:

        NOTE: Information statement “C” is specific to observations of cleaned and sanitized food contact surfaces as part of a manual warewashing or clean-in-place procedure. Do NOT include observations of cleaned and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use which are addressed as part of information statement “A”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement B.

        NOTE: Observations related to accurate temperature measuring devices and/or test kits provided and accessible for use to measure sanitization rinse temperatures and/or sanitization concentration are recorded under information statement “15E”.

        IN – Mark IN when direct observations of food contact surfaces and utensils indicate the proper washing and sanitizing of dishes / utensils using a MECHANICAL procedure. An example would include observations (visual inspection) of dishware indicating no food debris remaining on surfaces after the mechanical warewashing process has been completed and proper sanitization temperature or concentration has been measured and meets Food Code critical limits.

        OUT – Mark OUT when direct observations of dishware and food contact surfaces indicate the lack of, or improper methods / procedures for, washing and sanitizing of dishes / utensils using a MECHNICAL procedure resulting in dishware or food contact surfaces that are NOT cleaned and sanitized. Examples of observations include a pattern of dishware containing food debris after the mechanical warewashing procedure has been completed; or measurements of the hot water or chemical sanitization in the final rinse cycle does NOT meet Food Code critical limits. Observations of this information statement are specific to whether the food contact surface is cleaned and sanitized. Do NOT mark observations of equipment defects, such as a broken temperature gauge, missing baffle plate, etc., under this information statement. NOTE: Lack of temperature measuring devices and/or chemical tests kits for determining sanitizing rinse temperatures and/or sanitizer concentration is NOT marked under information statement “C”--- mark these observations under information statement “15E”..

        NO – Mark NO when washing and sanitizing dishes / utensils using a MECHANICAL procedure is part of the establishment’s operation but is not conducted during the data collection.

        NA – Mark NA when all equipment and utensils are washed and sanitized using a manual procedure.

        Item D Notes:

        Marked IN / OUT when a food procedure / practice related to the cleaning and sanitizing of food contact IS observed that none of the previous information statements accurately describes, and represents a food procedure / practice that is designated as a PRIORITY ITEM in the Food Code. If the "Other" information statement is marked IN or OUT, the collector MUST provide a description of the observation in the "Comment" section for the data item.

        NA – Mark NA when no additional food procedures or practices to the ones presented in the previous information statements for the cleaning and sanitizing of food contact surfaces are observed.

        The NO is NOT used for the "Other information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks food contact surfaces cleaned and sanitized in fast-food restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 64.2% to 66% in 2017. The target was revised from 66% to 71.7% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 71.7% to 66.2%.
    • FS-6.4 Increase the proportion of fast-food restaurants where foods requiring refrigeration are held at the proper temperature

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      32.0 (2008)
      Target: 
      39.6
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of fast-food restaurants where foods requiring refrigeration are held at the proper temperature

      Denominator: 

      Total number of fast-food restaurants that were surveyed for holding foods requiring refrigeration at the proper temperature

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Cold Hold 41°F (5°C) in in fast-food restaurants.

        PHF/TCS Food is maintained at 41°F (5°C) or below, except during preparation, cooking, cooling, or when time is used as a public health control. (Record products and temperatures in the space below).

        1. IN (yes)
        2. OUT (no)

        NOTE: For the purposes of this Study, 41°F (5°C) or below will be used as the criteria for assessing all potentially hazardous food (PHF)/time-temperature control for safety (TCS) food that are maintained/held cold. If one product is found out of temperature the item is marked OUT of Compliance.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Foods requiring refrigeration are held at the proper temperature.

        A. TCS Food is maintained at 41°F (5°C) or below, except during preparation, cooking, cooling or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)

        B. Raw shell eggs are stored under refrigeration that maintains ambient air temperature of 45ºF (7º C) or less.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Other (describe in the temperature chart and comments section below).

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: If any item in 2014 is marked out of compliance then the overall objective is out of compliance

        NOTE: ALL observations MUST be based on actual food product temperature measurements using a calibrated food temperature measuring device. The data collector should verify that the TCS food requiring refrigeration is not in the process of cooling, or being held using time as a public health control; or has been processed in such a manner as to render it a non-TCS food. ALL food product temperatures taken are to be recorded in the temperature chart on the data collection form. If ONE product is found to be out of temperature, the appropriate information statement for that food product is marked OUT of Compliance.

        NOTE: Observations made of procedures where Time, is used as a Public Health Control as it pertains to TCS foods that would normally be held under refrigeration temperatures are to be recorded for information statement “14B”.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        IN – Mark IN when ALL product temperatures taken of TCS food requiring refrigeration are 41ºF or below.

        OUT – Mark OUT when ONE or MORE product temperatures taken of TCS food requiring refrigeration are above 41ºF.

        NOTE: Do NOT assess the cold holding of raw shell eggs as part of this information statement. Cold holding of raw shell eggs is assessed under information statement 6(B).

        This information statement CANNOT be marked NO or NA.

        Item B Notes:

        IN – Mark IN when the AMBIENT air temperature of the refrigeration equipment used for the storage of raw shell eggs is maintaining 45ºF or below.

        OUT – Mark OUT when the AMBIENT air temperature of the refrigeration equipment used for the storage of raw shell eggs is above 45ºF.

        NO – Mark NO when the establishment receives raw shell eggs but there were no raw shell eggs on the premises at the time of the data collection.

        NA – Mark NA when the establishment does not receive raw shell eggs.

        Item C Notes:

        Mark IN / OUT when a cold holding procedure or practice IS observed that none of the previous information statements accurately describes. If the “Other” information statement is marked IN or OUT, the data collector MUST provide a description of the observation in the “Comment” section for the data item.

        NA – Mark NA when no additional food procedures or practices to the ones presented in the previous information statements for cold holding are observed.

        The NO marking is NOT used for the "Other" information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper refrigeration in fast-food restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 35.2% to 40% in 2017. The target was revised from 40% to 44.8% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 44.8% to 39.6%.
    • FS-6.5 Increase the proportion of fast-food restaurants where foods displayed or stored hot are held at the proper temperature

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      71.3 (2008)
      Target: 
      79.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of fast-food restaurants where foods displayed or stored hot are held at the proper temperature.

      Denominator: 

      Total number of fast-food restaurants that were surveyed for displaying or storing hot foods at the proper temperature.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Hot Hold 140°F (60°C)

        A. PHF/TCS Food is maintained at 140°F (60°C) or above, except during preparation, cooking, or cooling or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        B. Roasts are held at a temperature of 130°F (54°C) or above.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        NOTE: Products held between 135°F (57°C) and 140°F (60°C) should be marked OUT in 8A, but IN under Supplemental Item number 18A. Record actual product and measured temperatures in the space below.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Foods displayed or stored hot are held at the proper temperature

        A. TCS Food is maintained at 135°F (57°C) or above, except during preparation, cooking, cooling, or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        B. Roasts are held at a temperature of 130°F (54°C) or above

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Other (describe in the temperature chart and comments section below)

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: ALL observations MUST be based on actual food product temperature measurements using a calibrated food temperature measuring device. ALL food product temperatures taken are to be recorded in the temperature chart on the data collection form. If ONE product is found to be out of temperature the appropriate information statement for that food product is marked OUT of Compliance.

        NOTE: Observations made of procedures where Time, is used as a Public Health Control as it pertains to TCS foods that would normally be held hot are to be recorded for information statement “14A”

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        NOTE: Do NOT assess hot holding of roasts as part of this information statement. Hot holding of roasts is assessed under information statement 7(B).

        IN – Mark IN when ALL product temperatures taken of TCS food that is being held hot are 135ºF or above.

        OUT – Mark OUT when ONE or MORE product temperatures taken of TCS food that is being held hot are below 135ºF.

        NO – Mark NO when the establishment does hot hold foods, but no foods are being held hot during the data collection.

        NOTE: Every attempt should be made to conduct the data collection during a time when hot holding temperatures can be taken.

        NA – Mark NA when the establishment does not hot hold food.

        Item B Notes:

        IN – Mark IN when ALL product temperatures taken of ROASTS that are being held hot are 130ºF or above.

        OUT – Mark OUT when ONE or MORE product temperatures taken of ROASTS that are being held hot are less than 130ºF., AND time is not used as a public health control.

        NO – Mark NO when the establishment hot holds cooked roasts but no roasts are being held hot during the data collection.

        NA – Mark NA when the establishment does not prepare or serve roasts.

        Item C Notes:

        Mark IN / OUT when a hot holding procedure or practice IS observed that none of the previous information statements accurately describes. If the “Other” information statement is marked IN or OUT, the data collector MUST provide a description of the observation in the “Comment” section for the data item.

        NA – Mark when no additional food procedures or practices to the ones presented in the previous information statements for hot holding are observed.

        The NO marking is NOT used for the “Other” information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper hot holding in fast-food restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 78.4% to 79% in 2017. The target was revised from 79% to 84.2% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 84.2% to 79.0%.
    • FS-6.6 Increase the proportion of full-service restaurants where employees practice proper handwashing

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      24.2 (2008)
      Target: 
      31.4
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of full-service restaurants where employees practice proper handwashing.

      Denominator: 

      Total number of full-service restaurants that were surveyed for handwashing practice.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Proper, Adequate Handwashing.

        Hands are clean and properly washed when and as required.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Employees practice proper handwashing.

        A. Hands are cleaned and properly washed using hand cleanser / water supply / appropriate drying methods / length of time as specified in Section 2-301.12 of the Food Code.

        1. IN (yes)
        2. OUT (no)

        B. Hands are cleaned and properly washed when required as specified in Section 2-301.14 of the Food Code .

        1. IN (yes)
        2. OUT (no)

        NOTE: If either item in 2014 is marked out of compliance then the overall objective is out of compliance

        NOTE: The data item Employees practice proper handwashing MUST be marked IN or OUT of compliance. The data collector MUST be in the restaurant facility long enough to make observations of handwashing practices. The data collector is to rely only on actual observations of handwashing practices.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        IN – Mark IN when food employees are observed washing their hands as specified in Section 2-301.12 of the Food Code

        OUT – Mark OUT when ONE or MORE food employees are observed failing to follow the handwashing procedures specified in Section 2-301.12 of the Food Code.

        This information statement CANNOT be marked NO or NA.

        Item B Notes:

        IN – Mark IN when food employees are observed washing hands when required as specified in Section 2-301.14 of the Food Code.

        Mark OUT when ONE or MORE food employees are observed failing to wash their hand when required as specified in Section 2-301.14 of the Food Code.

        This information statement CANNOT be marked NO or NA.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper handwashing in full service restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 26.6% to 31% in 2017. The target was revised from 31% to 36.4% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 36.4% to 31.4%.
    • FS-6.7 Increase the proportion of full-service restaurants where food employees do not contact RTE foods with bare hands

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      53.7 (2008)
      Target: 
      62.1
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of full-service restaurants where food employees do not contact RTE foods with bare hands.

      Denominator: 

      Total number of full-service restaurants that were surveyed for employee bare hand contact with RTE foods.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Prevention of Contamination From Hands.

        Employees do not contact exposed, ready-to-eat food with their bare hands. NOTE: In determining the status of this data item, an assessment of alternative methods when otherwise approved is to be made to determine implementation in accordance with the guidelines contained in Annex 3, 2001 Food Code, page 289.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food employees do not contact ready-to-eat foods with bare hands

        1. IN (yes)
        2. OUT (no)

        Data item does not contain any information statements. The language in the data item is intended to be all encompassing of observations related to bare hand contact of exposed ready-eat-foods.

        Since this data collection period is focusing on the restaurant segment of the industry, data collectors CANNOT select the NO or NA marking options that have been BLACKED-OUT. All restaurants selected for the Study will have processes that include preparation or service of ready-to-eat foods.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        IN – Mark IN when food employees are observed using suitable utensils or single-use gloves to prevent bare hand contact with exposed ready-to-eat foods OR are observed properly following a pre-approved alternative procedure to no bare hand contact.

        NOTE: When fruits and vegetables are being washed, food employees may touch them with their bare hands.

        OUT – Mark OUT when ONE or MORE food employees are observed touching exposed ready-to-eat foods with their bare hands OR are observed NOT properly following a pre-approved alternative procedure to no bare hand contact. NOTE: This data item MUST be marked OUT of compliance if one person is observe touching exposed ready-to-eat foods with their bare hands..

        This information statement CANNOT be marked NO or NA.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks bare hand contact with ready-to-eat foods in full service restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 59.1% to 62.0% in 2017. The target was revised from 62.0% to 67.9% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 67.9% to 62.1%.
    • FS-6.8 Increase the proportion of full-service restaurants where food contact surfaces are properly cleaned and sanitized

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      36.5 (2008)
      Target: 
      44.5
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of full-service restaurants where food contact surfaces are properly cleaned and sanitized.

      Denominator: 

      Total number of full-service restaurants that were surveyed for proper cleansing and sanitization of food contact surfaces.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food contact surfaces cleaned and sanitized.

        Food-contact surfaces and utensils are clean to sight and touch and sanitized before use.

        1. IN (yes)
        2. OUT (no)

        NOTE: This item will require some judgment to be used when marking this item IN or Out of compliance. This item should be marked Out of Compliance if observations are made that supports a pattern of non-compliance with this item. One dirty utensil, food contact surface or one sanitizer container without sanitizer would not necessarily support an Out of Compliance mark. You must provide notes concerning an Out of Compliance mark on this item.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Food contact surfaces cleaned and sanitized.

        A. Food contact surfaces and utensils are clean to sight and touch and sanitized before use.

        1. IN (yes)
        2. OUT (no)

        B. Equipment food contact surfaces and utensils are cleaned and sanitized properly using manual warewashing procedures.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Equipment food contact surfaces and utensils are cleaned and sanitized properly using mechanical warewashing equipment.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        D. Other (describe in the comments section below).

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: If any item in 2014 is marked out of compliance then the overall objective is out of compliance

        NOTE: This item will require some judgment to be used when marking the information statements IN or OUT of compliance. The information statement should be marked OUT of compliance if observations are made that support a pattern of non-compliance with the procedure or practice. One dirty utensil, food contact surface or one sanitizer container without sanitizer, would not necessarily support an OUT of Compliance marking. The data collector MUST complete the comment section when an OUT of Compliance marking is documented for one or more of the information statements.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        Information statement “A” is specific to observations of clean and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use. Do NOT include observations made of food contact surfaces and utensils that are part of a manual warewashing procedure or cleaning / sanitizing in place equipment which are addressed in information statement “B”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement “C”.

        IN – Based on an overall assessment of the establishment’s operation, mark IN when direct observations indicate a substantive pattern for properly cleaning and sanitizing dishware, utensils, and cookware considered ready-for-use.

        OUT – Based on an overall assessment of the establishment’s operation, mark OUT when direct observations indicate a substantive pattern of soiled and/or un-sanitized dishware, utensils, and cookware considered ready-for-use.

        This information statement CANNOT be marked NO or NA

        Item B Notes:

        NOTE: Information statement “B” is specific to observations of cleaned and sanitized food contact surfaces as part of a manual warewashing or clean-in-place procedure. Do NOT include observations of cleaned and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use which are addressed as part of information statement “A”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement C.

        IN – Mark IN when direct observations indicate the proper washing and sanitizing of dishes / utensils using a MANUAL procedure or clean-in-place procedures for equipment such as a meat slicer, large mixer, microwave oven, tilting kettle, etc., result in food contact surfaces that are cleaned and sanitized. Examples for this information statement would include observations of food contact surfaces and equipment being properly washed, rinsed, and sanitized in a three compartment sink or observations of the cleaning and sanitization of a tilting kettle (CIP).

        OUT – Mark OUT when direct observations indicate the lack of, or improper methods / procedures for, washing and sanitizing of dishes / utensils using a MANUAL procedure or clean-in-place equipment such as a meat slicer, large mixer, microwave oven, tilting kettle, etc., result in food contact surfaces that are NOT cleaned and sanitized. Examples would include observations of food contact surfaces and equipment immersed in sanitizing concentrations lower than the critical limits contained in the Food Code; or washing food contact surfaces in dirty water containing little of no detergent solution; or washing food contact surfaces using an improper set-up of the three compartment sink, such as wash-sanitize-rinse; etc. NOTE: Lack of temperature measuring devices and/or chemical tests kits for determining sanitizing rinse temperatures and/or sanitizer concentration is NOT marked under information statement “B” --- mark these observations under information statement “15E”.

        NO – Mark NO when washing and sanitizing dishes / utensils using a MANUAL procedure is part of the establishment’s operation but is not conducted during the data collection.

        NA – Mark NA when all equipment and utensils are washed and sanitized in a mechanical dish machine.

        Item C Notes:

        NOTE: Information statement “C” is specific to observations of cleaned and sanitized food contact surfaces as part of a manual warewashing or clean-in-place procedure. Do NOT include observations of cleaned and sanitized dishware, utensils, and cookware that have been stored and are considered ready-for-use which are addressed as part of information statement “A”. Do NOT include observations of food contact surfaces and utensils as part of a mechanical warewashing procedure which is addressed in information statement B.

        NOTE: Observations related to accurate temperature measuring devices and/or test kits provided and accessible for use to measure sanitization rinse temperatures and/or sanitization concentration are recorded under information statement “15E”.

        IN – Mark IN when direct observations of food contact surfaces and utensils indicate the proper washing and sanitizing of dishes / utensils using a MECHANICAL procedure. An example would include observations (visual inspection) of dishware indicating no food debris remaining on surfaces after the mechanical warewashing process has been completed and proper sanitization temperature or concentration has been measured and meets Food Code critical limits.

        OUT – Mark OUT when direct observations of dishware and food contact surfaces indicate the lack of, or improper methods / procedures for, washing and sanitizing of dishes / utensils using a MECHNICAL procedure resulting in dishware or food contact surfaces that are NOT cleaned and sanitized. Examples of observations include a pattern of dishware containing food debris after the mechanical warewashing procedure has been completed; or measurements of the hot water or chemical sanitization in the final rinse cycle does NOT meet Food Code critical limits Observations of this information statement are specific to whether the food contact surface is cleaned and sanitized. Do NOT mark observations of equipment defects, such as a broken temperature gauge, missing baffle plate, etc., under this information statement. NOTE: Lack of temperature measuring devices and/or chemical tests kits for determining sanitizing rinse temperatures and/or sanitizer concentration is NOT marked under information statement “C”--- mark these observations under information statement “15E”..

        NO – Mark NO when washing and sanitizing dishes / utensils using a MECHANICAL procedure is part of the establishment’s operation but is not conducted during the data collection.

        NA – Mark NA when all equipment and utensils are washed and sanitized using a manual procedure.

        Item D Notes:

        Marked IN / OUT when a food procedure / practice related to the cleaning and sanitizing of food contact IS observed that none of the previous information statements accurately describes, and represents a food procedure / practice that is designated as a PRIORITY ITEM in the Food Code. If the "Other" information statement is marked IN or OUT, the collector MUST provide a description of the observation in the "Comment" section for the data item.

        NA – Mark NA when no additional food procedures or practices to the ones presented in the previous information statements for the cleaning and sanitizing of food contact surfaces are observed.

        The NO is NOT used for the "Other information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks food contact surfaces cleaned and sanitized in full service restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 40.1% to 45% in 2017. The target was revised from 45% to 50.1% in 2017 due to technical reasons. In 2018 the target-setting method was changed from mnimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from % to 69.3% In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 50.1% to 44.5%.
    • FS-6.9 Increase the proportion of full-service restaurants where foods requiring refrigeration are held at the proper temperature

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      28.1 (2008)
      Target: 
      35.7
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of full-service restaurants where foods requiring refrigeration are held at the proper temperature

      Denominator: 

      Total number of full-service restaurants that were surveyed for holding foods requiring refrigeration at the proper temperature

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Cold Hold 41°F (5°C) in in fast-food restaurants.

        PHF/TCS Food is maintained at 41°F (5°C) or below, except during preparation, cooking, cooling, or when time is used as a public health control. (Record products and temperatures in the space below).

        1. IN (yes)
        2. OUT (no)

        NOTE: For the purposes of this Study, 41°F (5°C) or below will be used as the criteria for assessing all potentially hazardous food (PHF)/time-temperature control for safety (TCS) food that are maintained/held cold. If one product is found out of temperature the item is marked OUT of Compliance.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Foods requiring refrigeration are held at the proper temperature.

        A. TCS Food is maintained at 41°F (5°C) or below, except during preparation, cooking, cooling or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)

        B. Raw shell eggs are stored under refrigeration that maintains ambient air temperature of 45ºF (7º C) or less.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Other (describe in the temperature chart and comments section below).

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: If any item in 2014 is marked out of compliance then the overall objective is out of compliance

        NOTE: ALL observations MUST be based on actual food product temperature measurements using a calibrated food temperature measuring device. The data collector should verify that the TCS food requiring refrigeration is not in the process of cooling, or being held using time as a public health control; or has been processed in such a manner as to render it a non-TCS food. ALL food product temperatures taken are to be recorded in the temperature chart on the data collection form. If ONE product is found to be out of temperature, the appropriate information statement for that food product is marked OUT of Compliance.

        NOTE: Observations made of procedures where Time, is used as a Public Health Control as it pertains to TCS foods that would normally be held under refrigeration temperatures are to be recorded for information statement “14B”.

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        IN – Mark IN when ALL product temperatures taken of TCS food requiring refrigeration are 41ºF or below.

        OUT – Mark OUT when ONE or MORE product temperatures taken of TCS food requiring refrigeration are above 41ºF.

        NOTE: Do NOT assess the cold holding of raw shell eggs as part of this information statement. Cold holding of raw shell eggs is assessed under information statement 6(B).

        This information statement CANNOT be marked NO or NA.

        Item B Notes:

        IN – Mark IN when the AMBIENT air temperature of the refrigeration equipment used for the storage of raw shell eggs is maintaining 45ºF or below.

        OUT – Mark OUT when the AMBIENT air temperature of the refrigeration equipment used for the storage of raw shell eggs is above 45ºF.

        NO – Mark NO when the establishment receives raw shell eggs but there were no raw shell eggs on the premises at the time of the data collection.

        NA – Mark NA when the establishment does not receive raw shell eggs.

        Item C Notes:

        Mark IN / OUT when a cold holding procedure or practice IS observed that none of the previous information statements accurately describes. If the “Other” information statement is marked IN or OUT, the data collector MUST provide a description of the observation in the “Comment” section for the data item.

        NA – Mark NA when no additional food procedures or practices to the ones presented in the previous information statements for cold holding are observed.

        The NO marking is NOT used for the "Other" information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper refrigeration in full service restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 30.9% to 36% in 2017. The target was revised from 36% to 40.9% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 40.9% to 35.7%.
    • FS-6.10 Increase the proportion of full-service restaurants where foods displayed or stored hot are held at the proper temperature

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Retail Food Risk Factor Studies
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      60.2 (2008)
      Target: 
      68.6
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The 10% improvement default target setting method originally used to determine targets for 2020 resulted in targets for objectives FS-6.1 – FS-6.10 that were not significantly different from the baseline. A more meaningful target was sought in 2015 to show that by reaching the target, there has been significant improvement in the retail practices objectives. In 2015, FDA proposed setting targets based on 95% upper confidence bounds that would be significantly different from the baseline.
      Numerator: 

      The number of full-service restaurants where foods displayed or stored hot are held at the proper temperature.

      Denominator: 

      Total number of full-service restaurants that were surveyed for displaying or storing hot foods at the proper temperature.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Hot Hold 140°F (60°C)

        A. PHF/TCS Food is maintained at 140°F (60°C) or above, except during preparation, cooking, or cooling or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        B. Roasts are held at a temperature of 130°F (54°C) or above.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        NOTE: Products held between 135°F (57°C) and 140°F (60°C) should be marked OUT in 8A, but IN under Supplemental Item number 18A. Record actual product and measured temperatures in the space below.

        From the 2014 Retail Food Risk Factor Study:

        [NUMERATOR:]

        Foods displayed or stored hot are held at the proper temperature

        A. TCS Food is maintained at 135°F (57°C) or above, except during preparation, cooking, cooling, or when time is used as a public health control.

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        B. Roasts are held at a temperature of 130°F (54°C) or above

        1. IN (yes)
        2. OUT (no)
        3. NO (not observed)
        4. NA (not applicable)

        C. Other (describe in the temperature chart and comments section below)

        1. IN (yes)
        2. OUT (no)
        3. NA (not applicable)

        NOTE: ALL observations MUST be based on actual food product temperature measurements using a calibrated food temperature measuring device. ALL food product temperatures taken are to be recorded in the temperature chart on the data collection form. If ONE product is found to be out of temperature the appropriate information statement for that food product is marked OUT of Compliance.

        NOTE: Observations made of procedures where Time, is used as a Public Health Control as it pertains to TCS foods that would normally be held hot are to be recorded for information statement “14A”

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        From the 2014 Retail Food Risk Factor Study:

        Item A Notes:

        NOTE: Do NOT assess hot holding of roasts as part of this information statement. Hot holding of roasts is assessed under information statement 7(B).

        IN – Mark IN when ALL product temperatures taken of TCS food that is being held hot are 135ºF or above.

        OUT – Mark OUT when ONE or MORE product temperatures taken of TCS food that is being held hot are below 135ºF.

        NO – Mark NO when the establishment does hot hold foods, but no foods are being held hot during the data collection.

        NOTE: Every attempt should be made to conduct the data collection during a time when hot holding temperatures can be taken.

        NA – Mark NA when the establishment does not hot hold food.

        Item B Notes:

        IN – Mark IN when ALL product temperatures taken of ROASTS that are being held hot are 130ºF or above.

        OUT – Mark OUT when ONE or MORE product temperatures taken of ROASTS that are being held hot are less than 130ºF., AND time is not used as a public health control.

        NO – Mark NO when the establishment hot holds cooked roasts but no roasts are being held hot during the data collection.

        NA – Mark NA when the establishment does not prepare or serve roasts.

        Item C Notes:

        Mark IN / OUT when a hot holding procedure or practice IS observed that none of the previous information statements accurately describes. If the “Other” information statement is marked IN or OUT, the data collector MUST provide a description of the observation in the “Comment” section for the data item.

        NA – Mark when no additional food procedures or practices to the ones presented in the previous information statements for hot holding are observed.

        The NO marking is NOT used for the “Other” information statement.

      Trend Issues: 
      Data for this objective are not comparable with data from Healthy People 2010.
      Changes Between HP2010 and HP2020: 
      In Healthy People 2010 a set of food safety practices was tracked separately for nine different facility types. The objective was modified to track five key food safety practices separately in fast-food restaurants and full-service restaurants only.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Objective 6 moved from developmental to measurable status. Ten new objectives were created addressing five key food safety practices in fast-food and full-service restaurants. This objective tracks proper hot holding in full service restaurants. Target-setting method was changed from 10% improvement to minimal statistical significance Sept. 2015. As a result the target was revised from 60.2% to 68% in 2017. In 2017, the target was revised from 68% to 69% to fix rounding errors. The target was revised from 69% to 74.3% in 2017 due to technical reasons. In 2018 the target-setting method was changed from minimal statistical significance to maintain consistency with laws, regulations, policies or national program. As a result the target was revised from 74.3% to 68.6%.