Recurrent critical violations of the food code in retail food service establishments.

Records of restaurant inspections by public health departments provide sequential "snapshots" of conditions in retail food service establishments that can be used to identify risk factors and evaluate the effectiveness of interventions. Data from a random 10 percent sample of restaurant inspection files from 31 counties in Oklahoma, including 4,044 inspections conducted during 1996-2000 in "medium-risk" and "high-risk" establishments, were analyzed to determine rates of critical violations and recurrent violations for different categories of establishments. Repeat violations accounted for about half of all violations. Establishments subjectively designated as high risk by health department personnel were in fact found to have higher violation rates than those described as medium-risk establishments. Outside Oklahoma County, regional chain restaurants were significantly more likely than other restaurants to have recurrent violations of critical items related to food-holding temperature, hygiene practices, sanitization, and hygiene facilities. Differences observed in violation rates among individual establishments were not primarily attributable to inconsistent enforcement by individual inspectors; rather, they appeared to be indicative of real differences in hygienic conditions and practices.