Cold hold: Despite years of notice, 40 percent of SENC restaurants violated stricter refrigeration rule

SOUTHEASTERN NORTH CAROLINA (WECT) - Despite more than six years notice, about 40 percent of food establishments in southeastern North Carolina violated a stricter food refrigeration requirement designed to prevent harmful bacteria growth, a WECT analysis of 662 health department inspection reports found.

Beginning Jan. 1, 2019, in North Carolina, cold holding units in food establishments are required to keep chilled contents at 41 degrees Fahrenheit or below, instead of 45 degrees or below as previously required.

This four-degree difference applies to restaurants, cafés, school cafeterias, grocery stores, gas stations, caterers, hotels, and any other type of food service facility requiring health department inspection.

Across WECT’s five-county viewing area, 262 out of 662 food establishments had cold hold violations, meaning health inspectors checking food with thermometers found at least one item above 41ºF, according to inspection reports and data provided by health departments online and through records requests.

More information about specific food establishments in New Hanover, Brunswick, Pender, Columbus, and Bladen Counties is found later in this article.

The colder refrigeration requirement is designed to slow down the growth of harmful bacteria, including Listeria monocytogenes which grows more rapidly at 45ºF compared to 41ºF.

A person infected with foodborne listeria could suffer from symptoms like fever and diarrhea, and those most at risk include pregnant women, newborns, older adults, and people with weakened immune systems, according to the U.S. Centers for Disease Control and Prevention (CDC).

Babies born to mothers who are sickened can develop serious bacterial infections, causing the body to attack itself in sepsis. Severe brain conditions like meningitis could also occur. About 1,600 Americans develop a severe infection every year from the bacteria, according to the CDC.

When you consider all foodborne illnesses, the CDC estimates yearly that 48 million people get sick, 128,000 are hospitalized, and 3,000 die.

“Does four degrees make a difference? Yes, it does," said Lexi Perillo, environmental health specialist with the Pender County Health Department who conducts inspections and educates restaurants.

In July 2017, Pender County started educating restaurants during routine inspections about the upcoming change, Perillo said. Health department officials in New Hanover, Columbus, and Bladen counties also said they provided education to restaurants.

“Foodborne-related illnesses are a very real thing. They cost a lot of money to not only the person falling ill because of medical expenses, but also businesses, because they could lose a reputation of their establishment, lose employees if employees ended up getting sick, loss of business," Perillo said.

The colder refrigeration requirements have been a long time coming for North Carolina restaurants. In 1993, the U.S. Food and Drug Administration’s (FDA) Food Code lowered the temperature requirement for cold hold from 45ºF to 41ºF. Nearly two decades later in 2012, North Carolina law was updated to match the 41ºF or colder requirement, but establishments were given until Jan. 1, 2019 for enforcement because of concerns raised by industry advocates, including the cost to replace outdated refrigeration equipment.

Still, "any refrigeration equipment replaced since 1999 is designed to meet the 41ºF standard,” according to a state analysis by the Commission for Public Health.

In total, seven inspection rules are impacted by the change from 45ºF to 41ºF, including cold holding, date marking, cooling, time as a public health control, thawing, slacking, and cooling method capacities.

“Simple changes can make drastic differences on temperatures. Overfilling a container -- I’ve seen restaurants that will just fill their product of cut tomatoes, and they’re overflowing out of the container in their prep units, and if you take a top temperature, that first layer, you’ll see 45 degrees, 46 degrees, but then if you go to the very bottom of the container, you see 42, 41, 39 degrees," said Perillo.

WECT’s analysis focused specifically on compliance for proper cold holding temperature. A cold hold violation during an inspection does not necessarily mean an establishment’s food is unsafe to eat.

Violations are observed during routine health department inspections and may or may not have been addressed by the establishment since the inspection occurred. Cold hold is just one aspect of restaurant inspection and food safety.

Because the rule is just now being enforced, state guidance instructed local health department inspectors to not deduct any points (called a demerit) for first violation, deduct half points for second violation, and deduct full points for third violation.

Of the 286 food establishments inspected since Jan. 1:

• 52% did not have a cold hold violation.
• 35% had a cold hold violation, but with no points off.
• 13% had a cold hold violation causing point deductions.

Of the 196 food establishments inspected since Jan. 1:

• 55% did not have a cold hold violation.
• 32% had a cold hold violation, but with no points off.
• 13% had a cold hold violation causing point deductions.

Of the 88 food establishments inspected since Jan. 1:

• 64% did not have a cold hold violation.
• 31% had a cold hold violation, but with no points off.
• 5%  had a cold hold violation causing point deductions.

Perillo, who inspects locations in Pender County, said these results are “pretty good" considering that the rule is new this year.

“I think the true test will be the summer, when it’s the hottest months and the busiest time, to see where these establishments are standing. They might be OK now, but are they going to be OK when it gets hot outside again? We will continue to work with them and readdress and figure out solutions as they come up," said Perillo.

Of the 34 food establishments inspected since Jan. 1:

• 100% did not have a cold hold violation.

After a records request, Columbus County’s health department emailed WECT scanned copies of the handwritten inspection reports, which are not available publicly online.

WECT asked Kristie Priest, environmental health supervisor with the Columbus County Health Department, what could explain why zero locations inspected in the county had cold hold violations, while neighboring counties had higher violation rates.

“The only thing I can attribute it to is the education we started doing months back. We started doing education in the middle of the summer with restaurants,” said Priest.

Of note in the inspection reports’ temperature observations, one atypical practice by a health inspector in Columbus County was the use of a "~" to indicate an approximate temperature, and a less than symbol (<).

But according to state instructions for marking the food establishment inspection reports, temperatures must be recorded as indicated on the thermometer.

WECT asked Priest why a health inspector would record temperatures in this manner.

“He was just taking temperatures at different places in the same product and writing down an approximation," said Priest.

“I know my inspectors, I know my staff, and I am confident in the job that they do for the people of Columbus County," Priest added.

After our initial conversation, Priest said she spoke with the inspector and he is going to change his methodology moving forward.

There have been a total of 58 food establishment inspections with a total of 4 facilities out of compliance for cold holding since Jan 1, according to Diana Nobles, Environmental Health Specialist with the Bladen County Health Department.

NOTE: A more detailed breakdown is not available, as the Bladen County Health Department was not able to provide copies of inspection reports in time for the publication of this article. The inspection reports are not available online.

One restaurant in compliance with the new cold hold requirement was Jax 5th Avenue Deli & Ale House in Wilmington, which earned a 98.5 score after an inspection on Jan. 15.

The restaurant serves a variety of foods that require refrigerated ingredients and kitchen preparation.

“I think it starts with good practices,” said Jimmy Hart, owner and general manager. “Our (New Hanover County) health inspector was very proactive in keeping us informed of the change. Our chef, Jason, worked very closely with her and asked questions. She gave us checklists to go over.”

Hart said his restaurant invested in new refrigerated prep units, researching in-depth to make sure it would fit the kitchen size and keep food cold.

The kitchen staff follow a series of “good practices,” including staying on top of food preparation, having food ready in the walk-in refrigerator, maintaining proper air flow around the prep units, and making sure food doesn’t sit in the prep units too long.

“One of the biggest challenges in this town is there are a lot of hot kitchens, so ambient temperature has a big thing to do with your units working properly," said Hart, who was has worked in food service for 25 years.

Steps to avoid breaking the cold hold rule include taking temperatures often in the topmost section of food, not overfilling food containers, rearranging coolers, and moving lesser-used food into walk-in refrigeration, according to a health department checklist.

Other preventative measures include making sure unit fans are not blocked, keeping prep units closed when not in use, and modulating kitchen temperature.

WECT reached out to the NC Department of Health and Human Services (NCDHHS) to learn about state oversight.

“Each county is required to have a quality assurance program and to send in a QA report to regional staff each year. DHHS staff also perform ride along inspections with the supervisor of each county and with specialists for quality assurance,” said Kelly Haight, NCDHHS Press Assistant.

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