Health Inspections and What Follows: Responding to Foodborne Illness Outbreaks

Tulsa County 2019 Flooding

At DC Health, the Food Safety and Hygiene Inspection Services Division (FSHISD), part of the Health Regulation and Licensing Administration (HRLA), is responsible for conducting inspections and implementing regulations for the city’s 6,500 food establishments. The team of sanitarians, along with two supervisory and two review sanitarians, conducts more than 7,500 inspections each year, examining restaurants, delicatessens, grocery stores, bakeries, and food trucks, to name just a few.

I spoke to Bruce Flippens, who has worked as a sanitarian, plan review officer, and shellfish standardization officer for DC Health for over 15 years, to learn a little more about what it takes to be a city health inspector.

The team of sanitarians at DC Health conducts between 60 –80 inspections per day, evaluating a number of restaurants, food trucks, and shops, including checking employee sanitation, food handling and storage, and preparation processes. They also conduct inspections of swimming pools, barbershops, and beauty salons.

“As regulators, we play a direct role in protecting public health. Our role is part of a larger regulatory food safety system that works mainly with the FDA to ensure wholesome, unadulterated food items in the commercial food supply,” said Bruce Flippens.

When I asked him to describe a “standard” inspection, Flippens said, “All inspections are slightly different. But I want [to preface this with the] idea that each inspection is just a snapshot of what the inspector saw while they were present for the inspection. The inspection can last as little as 30 minutes and as long as all day.” He added that he and the rest of the team understands that they could be catching an establishment on its worst day, or maybe its best day, which is why they do not issue “letter grades” like other cities such as New York or Los Angeles do. If issues or violations are spotted, the establishment will be given a chance to resolve them.

In addition to performing routine inspections, the team evaluates all complaints called in from customers within 48 hours of a call being made. When these reports regard people getting ill after eating at an establishment, sanitarians will conduct a foodborne illness inspection, which looks for a “probable source” or cause for the illness that could include food handling, food storage, and temperatures. As Flippens said of these inspections, “We are prepared to conduct [them] in an attempt to stop people from getting sick, identify food items that may have contributed to foodborne illness, and identify environmental factors that may cause illness. I don’t want to initiate a nationwide recall with the FDA if 40 people got sick from eating a food item that was prepared by an ill employee or with other improper food handling methods.”

Any food item determined or suspected to be the source of an outbreak is then sent to the Public Health Laboratory Division (PHL) at the DC Department of Forensic Sciences. The PHL works closely with DC Health, and specifically the FSHISD, to protect residents of and visitors to the district by conducting tests of possible disease-causing agents.

The PHL employs a method of testing called whole genome sequencing (WGS), which determines the order of all of the DNA bases in an organism; in this case, a foodborne disease-causing bacterium. PulseNet, the national network of laboratories that detects outbreaks of foodborne disease, named WGS as their gold standard for testing on July 15, 2019.

WGS plays an important role in fighting foodborne illnesses by helping scientists to quickly identify outbreaks and, furthermore, start to determine the source of those outbreaks. There are four main steps in the process of WGS: DNA shearing, DNA bar-coding, whole genome sequencing, and data analysis.

According to PulseNet, the advantage to using WGS is that “[it] provides more detailed and precise data for identifying outbreaks than [the current standard technique]. … [WGS] is a fast and affordable way to obtain high-level information about the bacteria using just one test.” By using WGS, labs like the PHL can quickly identify outbreaks and their causes, allowing for sanitarians to embargo and remove those food items or stop the practices that are making people sick.

The widespread use of WGS will allow public health laboratories to improve surveillance for foodborne disease outbreaks and to learn more about trends in foodborne infections and antibiotic resistance. As the technology develops, it will help public health labs to continue to successfully detect, respond to, and stop infectious diseases, and will help scientists to diagnose, solve, prevent, — and hopefully, limit — foodborne outbreaks.

You Might Also Enjoy These Articles in the Journal of Public Health Management and Practice:

Read all columns in this series:

As with community health improvement, we are stronger if we work together. If you are interested in sharing your story, please contact Dr. Cynthia Morrow at

Author Profile

Lily Coltoff
Lily Coltoff is a content/journalism intern in the Office of Communication and Community Relations (OCCR) within the Office of the Director (OD) at DC Health. She will graduate from American University in December with a bachelor’s degree in Communications Studies and Public Health.