Safety of Vendor-Prepared Foods: Evaluation of 10 Processing Mobile Food Vendors in Manhattan

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1 Reserch Articles Sfety of Vendor-Prepred Foods: Evlution of 10 Processing Mobile Food Vendors in Mnhttn Bryn M. Burt, MD Croline Volel, MD, MPH Mdelon Finkel, PhD SYNOPSIS Objectives. Unsnitry food hndling is mjor public helth hzrd. There re over 4,100 mobile food vendors operting in New York City, nd of these, pproximtely forty percent re processing vendors mobile food units on which potentilly hzrdous food products re hndled, prepred, or processed. This pilot study ssesses the food hndling prctices of 10 processing mobile food vendors operting in 38-block re of midtown Mnhttn (New York City) from 43rd Street to 62nd Street between Mdison nd Sixth Avenues, nd compres them to regultions stipulted in the New York City Helth Code. Methods. Ten processing mobile food vendors locted in midtown Mnhttn were observed for period of 20 minutes ech. Unsnitry food hndling prctices, food storge t potentilly unsfe tempertures, nd food contmintion with uncooked met or poultry were recorded. Results. Over hlf of ll vendors (67%) were found to contct served foods with bre hnds. Four vendors were observed vending with visibly dirty hnds or gloves nd no vendor once wshed his or her hnds or chnged gloves in the 20-minute observtion period. Seven vendors hd previously cooked met products stored t unsfe tempertures on non-heting or non-cooking portions of the vendor crt for the durtion of the observtion. Four vendors were observed to contminte served foods with uncooked met or poultry. Conclusions. Ech of these ctions violtes the New York City Code of Helth nd potentilly jeoprdizes the sfety of these vendor-prepred foods. More stringent dherence to food sfety regultions should be promoted by the New York City Deprtment of Helth. Deprtment of Public Helth, Weill Medicl College of Cornell University, New York, NY Address correspondence to: Mdelon Finkel, PhD, Dept. of Public Helth, Weill Medicl College of Cornell Univ., 411 E. 69th St., Rm. 324, New York, NY 10021; tel ; fx ; e-mil <mf2011@mil.med.cornell.edu> Assocition of Schools of Public Helth 470

2 Sfety of Vendor-Prepred Foods: Evlution of 10 Food Vendors in NYC 471 The sidewlk vendor is culturl icon of New York City. At present, more thn 4,100 mobile food vendors re operting in New York City, round 40% of whom re clssified s processing mobile food vendors. Mobile food processing units include ny mobile food unit on which foods re prepred or processed, or in which potentilly hzrdous foods re hndled. 1 This includes the sle or distribution of ny foods tht require cooking or ny other tretment (e.g., slicing, mixing, pckging, etc.) tht exposes food to possible contmintion. It does not include the boiling of hot dogs. 1 A mobile food vendor license, crt permit, nd vlid food sfety certificte issued by the Deprtment of Helth re the only requirements for operting processing mobile food vending unit in New York City. A fee of fifty dollrs must be pid to obtin the necessry license nd three hundred dollrs to obtin permit. Vendors re not required to hve vlid food sfety certificte if they cn produce current receipt showing registrtion for the food sfety course, even without evidence of completion. Although processing vendors re required by the city to enroll in 15-hour course to obtin the food sfety certificte, mny vendors do not ttend the clss. Filing to show sfety certificte is one of the most common inspection violtions. 2 In recent yers, the rnge of products served by mobile vendors hs chnged. Since the mid-1980s, mobile food vendors hve been expnding their menus from the bourgeois hot dog nd pretzel to more ethniclly diverse cuisine; e.g., curried chicken with rice, lmb souvlki, ox-til, jerk pork, brtwurst, vegetble lo mein. Any of these involve products tht re defined by the city s potentilly hzrdous foods consisting of (in whole or in prt) milk or milk products, eggs, met, poultry, fish, shellfish, crustce, cooked potto, cooked rice, or ingredients in form cpble of supporting rpid nd progressive growth of infectious or toxogenic microorgnisms, including C. botulinum (Article 81.03q). 3 Preprtion of these foods involves the storge nd processing of these potentilly hzrdous products in mobile vending units tht lck bsic kitchen equipment nd refrigertion, yet require the sme sfety stndrds demnded of resturnts. These dngers re not specific to mobile vendors. They re the sme controllble dngers present t ny site of food preprtion nd cn be minimized with proper ttention to the city helth code (see Appendix I). The New York City Helth Deprtment, through its Division of Mobile Vendor Inspections, is responsible for monitoring vendor prctices by inititing unnnounced inspections. However, these inspections re spordic nd vendors without permits, sfety trining, nd even chronic helth violtors continue to sell food on the streets of New York City. 2 In contrst to resturnts with estblished loctions, informtion regrding the pst history of helth violtions of mobile vendors is much more difficult for the public to cquire. Our requests to the New York City Office of Public Records to obtin records of mobile food vendor inspections nd violtions were not processed. Thus, it is hrd to determine how often the thousnds of mobile vendors re inspected, wht types of violtions re most commonly issued, nd how regulrly vendors re forced off the streets. The potentil for unsfe or unsnitry food hndling is gret. For ny vendor who prepres food, clen hnds nd fcilities for hndwshing re conditions mndted by New York City legislture (Article 81.07k). 3 Bre hnd contct is violtion of the New York City Helth Code nd vendors re obligted to provide brrier between bre hnds nd served foods (Article 81.07l). 3 Gloves re recommended but not required. Vendors re lso obliged to hve commissry loction in which the vending unit cn be regulrly clened nd stored overnight (Article 89.31). 1 The New York City Council Office of Oversight nd Investigtions conducted surveillnce study of the prctices of 254 New York City vendors in They reported tht the mjority of vendors, () did not wsh their hnds fter selling food or hndling money, (b) touched food with their bre hnds, nd (c) did not hve their hir covered. 4 At present, there re no precise sttistics on how mny pushcrt customers develop food poisoning, lthough 1995 City Council unrepresenttive nd self-reported survey of 401 New York pedestrins found tht one out of 10 reported becoming ill fter eting from New York pushcrt. 2 The purpose of this study ws to (1) determine the numbers nd clssifictions of mobile food vendors currently operting in New York City, nd (2) observe the everydy food sfety prctices of selected smple of processing mobile food vendors on the City s streets. The prctices of 10 processing mobile food vendors in midtown Mnhttn were observed by the investigtor, noting violtions of the New York City Helth Code. METHODS This is non-rndomized, observtionl study of the prctices of 10 processing mobile food vendors found operting on Mrch 2001 weekdy in 38-block re of midtown Mnhttn (New York City) bounded by 43rd nd 62nd Streets nd Mdison nd Sixth Avenues. The number of ctive mobile food vendor per-

3 472 Reserch Articles mits nd types of mobile food vendor permits in New York City s of Mrch 2001 were requested from the Inspections Division of the New York City Deprtment of Helth (see Tble 1). Of the 4,115 mobile food vendor permits, over 80% were citywide permits for vending privileges in ny of the five boroughs. Sesonl permits re vlid in ll of the boroughs of the city from April 4 to October 25 of one yer. To become fmilir with the prctices of mobile vending inspection nd the spectrum of issued violtions, we rrnged to spend dy in the field with deprtment inspector of the New York City Deprtment of Helth. On weekdy in Mrch 2001 between the hours of 1:00 nd 4:00 p.m., one of the uthors (BMB) ccompnied helth inspector on n evlution of five mobile food vendors. In this three-hour period, five mobile food vendors were inspected nd four received t lest one violtion. (See Tble 5 for list of the most commonly issued violtions.) The following week, on Fridy fternoon between the hours of 12:00 nd 5:00 p.m., 10 processing mobile food vendors in midtown Mnhttn were privtely evluted for helth code violtions. The investigtor csully observed the prctices of ech of these vendors for twenty minutes. Evluted vendor ctions re shown in Tble 2. Vendor hnds (Article 81.07k, NYC Helth Code) 3 The number of foods prepred for customers during 20-minute period ws recorded, nd we documented the incidence of hnd contct, either gloved or nongloved. The number of gloves worn by vendors ws recorded, s were the number of vendors with dirty hnds or dirty gloves, defined to include only hnds or gloves tht were obviously discolored or gresy nd Tble 1. Active mobile food vendor permits in New York City s of Mrch 2001 Permit type Active permits Citywide 218 Citywide sesonl b 657 Restricted c 610 Borough-specific d 130 Totl 4,115 Vlid for two yers with ccess to ny of the five boroughs of New York City. b Vlid for one seson (April 4 to October 25) with ccess to ny of the five boroughs of New York City. c Agreement with the City of New York to vend in specific loction in one of the five boroughs. d Vlid for two yers with ccess to only one prticulr borough. noticeble from distnce of pproximtely 10 feet. We lso recorded the number of times the vendor either wshed his/her hnds or chnged gloves. Food sfety (Chpter 6.01 nd Article 81, NYC Helth Code) 3,5 It is mndted by the New York City Deprtment of Helth tht uncooked mets must be kept t temperture of less thn 40 C. Cooked mets must be held t temperture below 40 C or bove 145 C nd should be served t temperture greter thn 145 C to void potentil bcteril contmintion hzrd. The tempertures of ny met or poultry tht re not on heting or cooking portion of the vendor crt re routinely mesured directly vi thermometer by helth inspectors. Becuse this study ws conducted by csul observtion, temperture mesurements were not obtined; however, it ws possible to quntify how previously cooked food ws hndled. Previously cooked food refers to met products tht ppered previously cooked nd then stored on non-heted portion of the vendor crt for the durtion of the 20-minute observtion period, likely t temperture below the temperture 145 C necessry to prevent bcteril contmintion. Potentil contmintion from uncooked mets ws evluted by observing the number of times the vendors hnds or vendors utensils mde contct with uncooked beef or poultry nd shortly fterwrd contcted nother food product subsequently served to customer. Other unsnitry behviors (Article NYC Helth Code) 3 Other potentilly contminting vendor ctions, including spitting on the sidewlk, smoking, or touching the mucous membrnes of one s mouth or nose, were lso noted. RESULTS All of the food vendors observed during the study period were processing vendors locted in midtown Mnhttn nd ech served similr menus. Foods prepred were minly Middle-Estern cuisine consisting of chicken, beef, kebb, susge, vegetbles, nd rice. All evluted vendor ctions re presented in Tble 2. Vendor hnds Of 10 processing mobile food vendors, five did not wer gloves, three wore gloves on both hnds, nd two wore glove on one hnd (Tble 3). Forty percent of vendors hd hnds (two vendors) or gloves (two vendors) tht were dirty to the nked eye from distnce

4 Sfety of Vendor-Prepred Foods: Evlution of 10 Food Vendors in NYC 473 Tble 2. Violtions by ten processing mobile food vendors, ech evluted for twenty minutes of csul observtion Wshed Food not Number Any Vending w/ hnds/ Previously protected Smoking Touched of hnd dirty hnds/ chnged cooked from or mucous Vendor exchnges b contct c Gloves d gloves e gloves f food g contmintion h spitting i membrnes k Totl Vendors were locted in 38 block rdius in midtown Mnhttn from 43rd to 62nd Streets between Mdison nd Sixth Avenues. b Number of mets cooked nd served to customers. c Number of times vendor hnds (gloved or non-gloved) contcted mets cooked nd served to customers. d Number of gloves worn by vendor. e Number of vendors with hnds or gloves tht were obviously dirty or gresy nd noticeble from distnce of 10 feet. f Number of times vendors either wshed hnds or chnged gloves. g Refers to mets previously cooked nd stored on non-heting/cooking re of vendor crt. h Refers to incidence of vendor touching uncooked poultry or beef with the sme gloved hnd(s), non-gloved hnds, or utensil tht less thn one minute lter contcted bred product tht ws served to customer. i Number of incidences vendor smoked or spit. j Refers to violtions of crt loction. All violtions of this type were crts within 10 feet of crosswlk, subwy, or drivewy. k Vendor touched with gloved or non-gloved hnds orl or nsl mucous membrnes nd not followed by hnd wshing or glove chnge. of pproximtely 10 feet (Tble 3). No vendors wshed their hnds or chnged gloves in the 20-minute observtion period. Non-gloved vendors touched 71% of prepred foods served to customers with bre hnds nd gloved vendors touched 50% of prepred foods served to customers with gloved hnds in 20 minutes (Tble 4). These differences were not found to be sttisticlly significnt by chi-squre test. Food sfety Redy-to-et foods my lso be contminted by bcteri from rw met. 2 Four of ten vendors in this study demonstrted unsnitry behviors tht contminted bred products served to customers with bcteri from rw poultry or beef. In ech of these four cses, vendors touched uncooked poultry or beef with bre hnds (two vendors), gloved hnds (one vendor), or tongs (one vendor). Shortly fterwrd, while serving the sme customer, these sme hnds or tongs touched bred product tht ws served to customer. These prctices promote the spred of pthogens of food-born illness including Slmonell nd Listeri. 6,7 Of 10 processing mobile food vendors, seven hd previously cooked chicken or beef locted on non-heting/cooking re of the vendor crt. Tble 3. Percent of vendors, gloved or non-gloved, with dirty gloves or hnds, nd wshed hnds or chnged gloves during the observtion period Vendors (percent) No gloves 3 (30) Two gloves 3 (30) One glove 2 (20) Dirty gloves or hnds 4 (40) Wshed hnds or chnged gloves 0 (0)

5 474 Reserch Articles Tble 4. Percent of food-hnd contct by gloved nd non-gloved vendors Non-gloved vendors Hnd contct (percent) Gloved vendors Hnd contct (percent) Vendor 1 14 of 14 (100) Vendor 3 6 of 12 (50) Vendor 2 9 of 10 (90) Vendor 4 1 of 7 (14) Vendor 5 3 of 7 (43) Vendor 6 5 of 8 (63) Vendor 7 3 of 9 (33) Vendor 8 7 of 9 (78) Vendor 10 8 of 12 (67) Vendor 9 4 of 10 (40) Totl 37 of 52 (71) Totl 23 of 46 (50) There is no significnt difference in percent of hnd contct between non-gloved nd gloved vendors by chi-squre test. Other unsnitry behviors No food vendors were found spitting or smoking. Two non-gloved vendors were observed touching the mucous membrnes of their mouth. One non-gloved vendor ws observed touching the mucous membrnes of his nose. One singly gloved vendor ws seen blowing his nose into npkin. None of these ctions were followed by hndwshing or chnging glove(s). DISCUSSION The incredible vriety of vendor-prepred foods tht is currently offered on the sidewlks of New York hs quickly become prt of the city s street culture. On ny dy there cn be up to 4,115 food vendors operting on the city streets. The mjority of vendors hve citywide permits tht llow them vending privileges on ny street of the five boroughs, with the exception of some loctions restricted by the city government. Thus, it cn be difficult for the New York City Helth Deprtment to keep trck of individul vendors. Some opertors re nomdic, lwys looking for better loction. Other vendors elude regultion by frequently chnging home ddresses nd vending corners. City records show tht over 800 times in 1996 nd 1997 the city could not find crt tht it went out to inspect. 2 These fctors lso mke it difficult for the public to ccess informtion bout specific street vendors nd to report complints. Informtion requests nd submission of complints regrding mobile vendors require either the vendor or crt identifiction number, but these vendors my not be in the sme loction the following dy. On the other hnd, records of helth violtions by ny estblished resturnt in New York City re vilble to the public by the Helth Deprtment nd re redily ccessible on the internet. 8 Officils from the Deprtment of Helth reveled to the Dily News tht in 1998, the city executed 7,500 unnnounced inspections nd issued 4,050 violtions. 9 This ws up from the previous yer, in which 1,826 inspections were performed nd 1,340 violtions were issued. 9 In New York Times study conducted in 1997, review of 610 records of food-crt opertors found tht hlf hd received t lest one criticl violtion. 2 In this smpling of 10 processing mobile food vendors in midtown Mnhttn, every vendor violted the New York City Helth Code t lest one time within 20 minutes of observtion. These violtions included brehnd contct with food, vending with dirty hnds, foods stored t inpproprite tempertures, nd foods not protected from contmintion with rw met. Three non-gloved vendors were seen touching the mucous membrnes of their lips or nose nd one gloved vendor ws seen blowing his nose into npkin. All of these violtions compromise the sfety of the vendor prepred foods; none of them wshed their hnds or chnged gloves. These re criticl prctices in preventing food hndlers from spreding pthogenic orgnisms such s Heptitis A, fecl coliforms, nd Stphylococcus ureus. 6 These findings re consistent with the findings from the limited number of studies looking t the sfety of mobile vendor foods. In 1995, the New York City Council Office of Oversight nd Investigtion compred the food hndling prctices of 254 Mnhttn processing nd non-processing mobile food vendors with the city helth code. Seventy percent of these vendors were found to hve touched food with their bre hnds nd none of the vendors wshed their hnds fter selling food or hndling money. It ws lso found tht 77% did not hve their hir covered, 85% did not keep utensils in clening fluid, nd 11% kept condiments in open continers. 4 Interestingly, the City Council study lso found tht tests on one chicken kebb showed the food to hve 28 times the cceptble bcteri limit nd two flfels hd lrmingly high streptococcl bcteril counts. 2 Another importnt issue influencing food contmintion is food storge temperture. Food tht is mintined outside sfety zone of less thn 40 C for cold

6 Sfety of Vendor-Prepred Foods: Evlution of 10 Food Vendors in NYC 475 Tble 5. Descriptions nd codes of the most commonly enforced mobile food vendor regultions by the New York Stte Deprtment of Helth. Minimum nd mximum penlty fines nd uthoriztion for seizure of vendor equipment re lso reported. The violtions evluted in this study re represented by *. Code Fine Seizure Violtion Article $500-$1000 Y No license (ID bdge) Food vendor processing Determined by judge N *Decl not conspicuously displyed on crt Determined by judge Y Refusl to permit inspection Determined by judge N *Crt on sidewlk less thn 12 feet wide Determined by judge N *Crt ginst building or structure Determined by judge N Items not in or under crt Determined by judge N *W/in 20 ft. of entrnce, ginst disply window Determined by judge N *In bus stop, w/in10 ft. of crosswlk/subwy/drivewy Determined by judge N Vending where prking is prohibited Determined by judge Y Vending in prk with no prk permit Determined by judge Y Filure to move for exigent circumstnces Determined by judge Y Vending t restricted time or plce Chpter 6.01 $200-$400 Y Non-processing crt selling processing food 1 24R RCNY Article 81 $200-$400 N *Food not protected from contmintion 1 NYC Helth Code $300-$600 N *Food not kept t proper temperture 1 $300-$600 N Food worker with communicble disese 1 $200-$400 N No food protection certificte $300-$600 N *Bre hnd contct 1 $100-$200 N Indequte plumbing 1 $100-$200 N Improper storge of wste 1 $100-$200 N *Smoking or spitting nd hndling food 1 $200-$400 Y No hot/cold wter, no hnd wshing fcility 1 $100-$200 N Crt nd equipment unclen 1 Article 89 $1000 N *No permit decl NYC Helth Code $500 N Creting nuisnce (smoke) $1000 N *Crt not butting the curb $1000 N No permit vilble $400 N Crt occupying 10 ft. liner spce on sidewlk $500 N *Vending with dirty hnds 1 1 Violtions tht re relevnt to food sfety. food nd greter thn 145 C for hot foods cts s n incubtor for pthogenic bcteri whether the food is rw, prtilly cooked, or fully done. 6 Food vendors often prtilly or fully cook pork, chicken, nd beef products hed of time, store them, nd then rehet them when requested by customer. These finl stges of cooking re often indequte to destroy bcteri tht my be present. 10 In this study, 70% of vendors were discovered to hve cooked met products stored on non-heting or non-cooking portion of the vending crt. Although the tempertures of these foods were not directly tested, these products remined sttionry for the entire 20-minute observtion of ll vendors. It is possible tht these foods remined there for n extended time outside of the observtion period nd were not mintined within the temperture sfety zone. Similr findings were reveled by n Inside Edition Investigtive Report tht found over hlf of foods purchsed from New York City street vendors were served t tempertures well below the sfety zone for cooked foods. 11 In ddition, New York Times study heded by Dr. Robert Grvni, food scientist t

7 476 Reserch Articles Cornell University, tested street fir food, choosing crts t rndom over two dys. Only 12 of 51 items were hot enough to be considered sfe. 2 Severl limittions of this study should be mentioned. The vendor popultion ws limited to 10 vendors nd demogrphic dt on these vendors ws lcking with respect to ge, sex, yers of experience, nd previous history of violtions. Ech of the vendors in this study ws locted in the sme neighborhood in midtown Mnhttn nd ll served similr processed food, minly Middle-Estern cuisine. Vendor licenses nd food sfety certifictes re the first documents to be requested during city inspection but, unlike crt permits, re not required to be displyed on the crt. Due to the csul observtion methods used in this study, vendor licensing could not be ssessed. All of the crt permits, however, were clerly exhibited on the crts of these prticulr vendors. Vendors were observed for 20 minutes ech, nd lthough this is limited observtion period, significnt number of vendor-customer food exchnges (98 exchnges, Tble 2) were recorded. In ddition, lthough foods previously cooked nd kept on non-heted portion of the vendor crt for the 20-minute period were considered by the uthors to be t n unsfe temperture, confirmtion with thermometer ws similrly precluded by the design of this study. Despite the clerly pprent dngers of unsnitry vending shown in this nd other reports, there re no good dt linking food poisoning with mobile food vending. This my be due either to under-reporting of suspected food-borne illness or to filure of the helth deprtment to investigte complints. In New York Times review of 2,700 city inspection reports from 1996 nd 1997, weeks nd months often pssed before inspectors investigted pushcrts blmed for illness. 2 These reports lso show tht vendors without permits or sfety trining nd even chronic helth violtors re llowed to continue selling food. In these two yers, fewer thn 20 crts were shut down for food violtions. Another pitfll of the system lies in the food sfety eduction of vendors. One of the necessry prerequisites for mobile vending of foods in New York City is enrollment in 15-hour food sfety course nd pssing score on 50-question multiple-choice exmintion. Those fulfilling these criteri re wrded food protection certificte. However, vlid food protection certificte is not required on inspection if vendor cn produce current receipt showing registrtion in the food sfety course. Thus, the current system is set up to ccommodte inexperienced vendors by llowing them to operte for some time with no trining in food sfety. Others in the vending industry feel tht the course is unsuccessful becuse it is gered too brodly to ll food service workers nd lcks specific focus on mobile vending food sfety. 9 A potentil solution is not complicted nd would involve redily vilble resources. The city government bers huge responsibility to ensure proper regultion of the sfety prctices of street food vendors. At this time, further studies nd joint efforts with the New York City Deprtment of Helth re needed to firly ssess their mens of promoting food sfety nd the resulting effects on vendor prctices. A few specultions on improvements cn be mde. At the vendor level, implementtion of comprehensive, mndtory vendor eduction progrm with exclusive focus on mobile vending issues my improve the current sitution. Anyone who is so inclined cn purchse license nd permit; however, the Deprtment of Helth could consider implementing stricter inspection system with more stringent consequences for violtors to mximize the public s sfety nd protection from food-borne diseses. As more vendors tke to the streets to prepre food for the public, there is n incresing burden on the city to protect the public from these potentil dngers. This pper ws wrded First Prize in the Goldmnn Student Merit Awrd, Public Helth Assocition of New York City student pper competition, REFERENCES 1. New York City Helth Code. Mobile food vending, rticle St. George D. In street vendors smorgsbord, thret of sickness lurks. The New York Times 1998 My 17;Sect. 1:1 (col. 2). 3. New York City Helth Code. Mobile food vending, rticle Liff, B. City council food fight stte. New York Dily News 1995 Sept New York City Helth Code. Chpter 6.01, 24 RCNY. 6. Roller S. Physiology of food spoilge orgnisms. Int J Food Microbiol 1999;50: Schwrtz B, Broome, CV, Brown, GR, et l. Assocition of spordic listeriosis with consumption of uncooked hot dogs nd undercooked chicken. Lncet 1988;8614: New York City Deprtment of Helth resturnt inspection informtion. Avilble from: URL: 9. Rein L. Crckdown on food crts. New York Dily News 1998 Dec Med PS, Slutsker L, Griffin PM, Tuxe RV. Foodrelted illness nd deth in the United Sttes. Emerg Infect Dis 1999;5: Meger M. Vendor Food. Inside edition. New York: CBS Television; 1998 Sep 9.