MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord - Have you eaten at an excellent restaurant lately? Do you think it was excellent because it tasted good, and the service was fast and friendly? Of course, those are important factors in choosing a place to have a meal out with the family. But you likely also want to know if the handling of the food, the cleanliness of the kitchen and the training of the staff on food safety were all up to par too. Joint Base Lewis-McChord and its Department of Public Health are making that easier than ever with the new grading and placarding system.

"JBLM Public Health's routine food safety inspections at all on-base eating establishments is nothing new, and it is critical to service member, family member and civilian employee health and readiness," said Col. Kent Park, JBLM Commander. "The inspection grading placards are a useful addition to our food safety program. Whether it's a Warrior restaurant, an AAFES or MWR facility, or a food truck, I want people to know - not only are their eateries inspected - but know the place they are eating is safe."

JBLM DPH has been working with all the food facilities on base to implement the new elements of the base's updated policy on food safety. Bringing the results of food safety inspections more directly to the public and making them look similar to those already in the local civilian community are key additions.

"Just like Tacoma-Pierce County Health Department, JBLM Department of Public Health will provide a grade, based on inspection results, at the entrances of food facilities on JBLM and, the Yakima Training Center, starting in September. Inspections will continue to follow the Tri-Service Food Code, which has been in place since 2019," said Lt. Col. Matt Holuta, the chief of Environmental Health Service, the section that conducts both food safety inspections as well as food handler safety classes that enable people to work in food production on base.

Like all of the JBLM DPH, Environmental Health Service serves the entire base and is a part of Madigan Army Medical Center. It is headquartered in the Brig. Gen. Guthrie L. Turner, Jr. Preventive Medicine Clinical Services Building (9025) on 5th Street across Gardner Loop from the medical center.

More than 300 food operation inspections are conducted annually by EHS to identify and correct violations, assist food establishment managers in compliance and to protect the health of service members and their families.

As Park pointed out, EHS has been inspecting these establishments for many years. It is just this particular grading and placarding aspects that are new. Grades have been issued in the past, but JBLM Reg. 40-1 sets out the new system to align with what diners see in the local community and to make those inspection results clearer as a potential diner approaches a food facility.

Inspectors are basically looking for things that can cause foodborne illness, which is any illness from contaminated food. A foodborne disease outbreak is two or more cases of similar illness from people eating a common food. These can have a real impact on the health, wellness and readiness of the base.

Anything that is out of line with the regulation is considered a violation. The range of violations is broad, but they fall into two basic categories: critical and non-critical.

Examples of critical violations are employees not washing hands or not keeping food hot enough to prevent growth of pathogens. These put diners at high risk of illness and quickly reduce a facility's grade.

Examples of non-critical violations are wearing jewelry when preparing food or having equipment in poor repair. When added together, a few of these can risk illness.

The most critical violation is one that can shut down a facility on the spot. That is an imminent health hazard. This is a significant threat or danger to health. This situation requires immediate correction or stopping the operation to prevent injury.

Holuta explained that most critical violations are things that are very objective - a temperature, for example. A piece of food that is to be held at a certain temperature to keep it from spoiling is either at that temperature when a thermometer is inserted into it, or it isn't. Most issues that can be seen as judgment calls are in the non-critical realm.

The basis of inspection - the Tri-Service Food Code - was introduced in 2014 as a way to standardize food safety criteria, procedures and roles across the services. Even the current publication, issued in March 2019, maintains the numbers of all the original branch regulations and spans 454 pages of explanation, definition, instruction and guidance.

To bring further consistency to the inspection efforts, EHS is enrolled in the U.S. Food and Drug Administration's Retail Program Standards. EHS also conducts internal audits to review its reports, using Defense Public Health Center guidelines, to constantly keep a check on how well it is living up to its own inspection standards.

These placards will not be displayed at every place where food can be found on base, not all are inspected by EHS. The commissaries, for example, are inspected by Public Health Command-Pacific which is concerned with packaged food while EHS focuses on food facilities that prepare food onsite.

Not all establishments that prepare food onsite will have placards either. Child development centers, for example, are inspected but will not display a grade as their food is not for retail sale to the public. Expect to see the placards at permanent food facilities like restaurants, dining facilities and food trucks.

The goal, notes Holuta is to, "Provide the transparency that surrounding local health departments already provide so that service members, civilians, retirees, and family members will be able to make more informed decisions about where they choose to eat."

The EHS works closely with the managers of these establishments to help them understand and meet the standards outlined in regulation. This is especially true of dining facilities across the installation since so many service members rely on them for their daily nutrition.

"Our job is to assist them - to make them better," agreed Grant Brenneka, an environmental health technician who is one of the main inspectors as well as a former Army cook.

Part of that assistance is the food handler's class that is presented multiple times each month. Local health department food handler's permits are also accepted for use on base. The assistance must be working because Holuta reported that over the past five years, 82 percent of food facility inspection ratings on JBLM would have received one of the top two ratings had this new system been in place during those inspections.

The ratings are divided into four categories:

"Excellent" means that a facility is fully compliant with the standards where no violations were observed or there were four or fewer non-critical violations that were corrected onsite.

A "Good" rating denotes a substantially compliant facility that had two or fewer critical violations that were corrected onsite and/or five or fewer non-critical violations.

"Okay" means a facility is partially compliant with three or more critical violations that were corrected onsite and/or six or more non-critical violations.

A "Needs to Improve" rating tells diners that an imminent health hazard was present or one or more critical violations were found that were not corrected onsite.

When a facility receives a "Needs to Improve" rating and the violations were severe enough, affected parts of the facility can be closed for operation until the violations are corrected. The facility will be re-inspected within five business days and will receive a rating of "Okay" if the previously noted violations are corrected.

Ninety percent of food facilities on JBLM are inspected on a quarterly basis.

While EHS has not yet met its long-term goal of making all inspection reports immediately available online, reports can be obtained by emailing the service at: usarmy.jblm.medcom-mamc.mbx.ehs@health.mil. Visit the EHS webpage for more information on inspections and food handling courses at: https://madigan.tricare.mil/Health-Services/Preventive-Care/Environmental-Health-Service/Food-Safety-and-General-Sanitation.

The Tri-Service Food Code can be found at: https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN15052_TB_MED_530_FINAL.pdf.