Cities Ranked by Dirty Restaurants

Aug. 7, 2008 -- Is your city a haven for restaurant health hazards?

A consumer group has ranked 20 U.S. cities for restaurant health. Austin, Texas, and Boston rank worst, while Tucson, Ariz., and San Francisco rank best.

But it's not at all clear whether diners are dirtiest in Austin and Boston, or whether these towns simply have the toughest inspectors -- or if inspectors in Tucson?and San Francisco are more lenient.

The report, "Dirty Dining," comes from the consumer group the Center for Science in the Public Interest. CSPI food-safety attorney Sarah Klein, JD, is co-author.

"How do you know whether it is a robust inspection force really uncovering the bad practices, or whether restaurants in that city have poor health practices?" Klein tells WebMD.

The CSPI ranking considers how often city inspectors found five major health hazards and five less critical concerns in 30 high-end, medium-range, and fast-food eateries in each city.

The major health hazards:

• Food held at an unsafe temperature. According to a 2004 FDA report, 65% of restaurants don't fully comply with federal Food Code guidelines on food temperature. Perishable foods should be cooled to 41 degrees Fahrenheit. And bacteria multiply in warming pans if the temperature is not high enough and if foods are left there long enough.
• Hand washing. According to a 2007 CDC report, 20% of food-borne illnesses caused by bacteria come from infected workers.
• Improper cooking. The 2004 FDA report estimated that about 16% of full-service restaurants don't fully cook their food. Two of the most harmful food-poisoning bacteria -- salmonella and E. coli -- lurk in undercooked meats.
• Contaminated food-contact surfaces. The FDA report found 56% of full-service restaurants were not ?were not compliant.
• Food from unsafe sources. The FDA report suggested that 13% of full-service restaurants don't comply with food-source guidelines.

Less serious concerns include:

• Substandard employee cleanliness and hygiene
• Rodents and insects
• Improper use of wiping cloths
• Presence of sick restaurant workers
• Bare-hand contact with raw food

Can rodents and roaches really be less of a concern than, say, improper food temperature? Yes, Klein asserts.

"The presence of rodents and insects is certainly disgusting and certainly shows a restaurant is not focusing on food safety," she says. "But the things most dangerous to consumers are the things we would never see. Unless we had the tools and the training, even if we went into the kitchen we would not be able to see the things that would really harm us."

That is why the CSPI urges every city and state to adopt a restaurant grading program. As is done in Los Angeles County, restaurants would be required to post -- in their front window -- a letter grade from inspectors showing whether they got an A, B, or C. Lower grades would result in the restaurant being closed.