Food Safety and Environmental Services annual report

              Bureau of Epidemiology and Disease Control
Office of Environmental Health
Food Safety & Environmental Services Section
November 2002
Jane Dee Hull, Governor
State of Arizona
Catherine R. Eden
Director, Arizona Department of Health Services
ARIZONA DEPARTMENT OF HEALTH SERVICES
Bureau of Epidemiology and Disease Control Services
Office of Environmental Health
3815 North Black Canyon Highway
Phoenix, Arizona 85015
(602) 230-5830
This publication can be made available in alternative format.
Please contact the numbers listed above.
Permission to quote from or reproduce materials from this publication
is granted when due acknowledgment is made.
“Equal Opportunity/Reasonable Accommodation Employer”
TABLE OF CONTENTS
Executive Summary……………………………………………………………………………….. 1
Section 1.0 – Introduction.………………………………………………………………………... 2
Section 2.0 – FY2002 Activities…………………………………………………………………… 2
Section 2.1 – Food Safety………………………………………………………………………….. 2
Section 2.1.1 – Inspection Programs……………………………………………………………... 2
Section 2.1.2 – Enforcement………………………………………………………………………. 4
Section 2.1.3 – Updating the Arizona Food Code………………………………………..........…. 4
Section 2.1.4 – Food Safety Accomplishments In Arizona………………………………………..5
Section 2.1.5 --FY 2003 Hot Topic – Food Biosecurity…………………………………….5
Section 2.1.6- Reports of Foodborne Illness………………………………………………...……6
Section 2.2 – Bottled Water……………………………………………………………………….13
Section 2.3 – Bathing Places………………………………………………………………………14
Section 2.4 – Public Accommodations……………………………………………………………15
Section 2.5 – Trailer Coach Parks………………………………………………………………..15
Section 2.6 – Schools……………………………………………………………………………….16
Section 2.7 – Children’s Camps…………………………………………………………………...16
Section 2.8- Environmental Health Points of Interest………………………………………….17
Section 3.0 – Registration and Training of Sanitarians………………………………………….17
Section 4.0 – Conclusions………………………………………………………………………….19
Appendix……………………………………………………………………………………………20
1
Executive Summary
The Arizona Department of Health Services organizes and directs the statewide public health sanitation
programs for food safety, bottled water, hotels and motels, trailer parks, children’s camps, public schools,
and swimming pool maintenance.
Staff that implement the inspection programs must be licensed as a Registered Sanitarian. Statewide, there
were 170 registered Sanitarians employed at the 15 county health departments and the Arizona Department
of Health Services. The Arizona Department of Health Services and the 15 local county health
departments met the state inspection goals during FY 2002. The following bullets highlight FY 2002
accomplishments and findings.
·  One-hundred seventy sanitarians at the 15 county health departments and the Arizona Department of
Health Services conducted more than 96,000 inspections at the approximately 45,200 regulated
facilities in Arizona.
·  In FY 2002, there were more than 28,500 food establishments in Arizona. State and county sanitarians
conducted approximately 68,400 food safety inspections at these establishments.
·  A total of 1896 cases of foodborne illness were reported in 2001. Children under the age of 5 had the
highest risk of having a foodborne illness. Of the cases with known race (60 percent), Native
Americans and Hispanics were approximately 4 times more likely to be reported with Shigellosis than
Whites.
·  Inspection goals were achieved for food establishments, bottled water facilities, bathing places, and
trailer coach parks.
Number and Type of Facilities and Public Health Inspections in Arizona, FY 2002
28524
12031
1869
1334
1177
11
38
79
68416
23364
1714
1516
1305
18
59
35
0 10000 20000 30000 40000 50000 60000 70000 80000
Food Establishments
Pools & Spas
Trailer Coach Parks
Public School Grounds
Public Accomodations
Camp Grounds
Children's Camps
Bottled Water
Inspections
Facilities
2
1.0 Introduction
The Food Safety and Environmental Services Section is located within the Arizona Department of Health
Services, Office of Environmental Health. The program exercises general supervision of food safety and
environmental sanitation monitoring and enforcement in the State of Arizona in accordance with Arizona
Revised Statues 36-136. The mission of the FS&ES section is:
To prevent and control human illness related to the transmission of infectious agents or toxic
substances in food and water, and to prevent disease transmission due to unsanitary conditions in
hotels and motels, trailer coach parks, bathing places, group homes, behavioral health centers,
adult foster care homes and children’s camps.
In accordance with our mission, the program plans, organizes and directs a statewide public health
sanitation program which includes food safety, institutional sanitation, children’s camps, recreational
sanitation, bottled water, produce warehouses, and swimming pool maintenance. The program also
conducts epidemiological investigations, interprets sanitation laws for local health departments and
establishes and maintains liaisons with federal agencies and local health departments.
2.0 FY 2002 Activities
The Arizona Department of Health Services delegates many of the program activities to the 15 county
health departments in order to most effectively accomplish mission objectives. The delegation of
responsibilities allows local governments to decide the level and cost of the services they wish to provide.
Local control makes it easy for the public to interact with their government.
Counties accepting delegated responsibilities are required to perform duties in accordance with conditions
outlined within the delegation agreements. As part of the agreement, the county health department must
submit annual reports summarizing their activities.
Most of the 15 counties within Arizona also perform delegation functions for the Arizona Department of
Environmental Quality. As part of the delegation with the Arizona Department of Environmental Quality
many of the local county health departments had new regulations pertaining to wastewater that were very
time consuming in their implementation. The burden imposed on local county health departments to
implement two complex regulatory changes within the same fiscal year was daunting. Yet, the delegated
Arizona Department of Health Services functions were carried out very well.
Facilities regulated by the state and county programs include various food establishments, bottled water
facilities, swimming pools, hotels and motels, trailer parks, public schools, and children’s camps. One-hundred
seventy Registered Sanitarians at the 15 county health departments and the Arizona Department
of Health Services conducted more than 96,000 inspections at the 45,200 regulated facilities in Arizona.
Sections 2.1 through 2.8 discuss statewide data from each of the major sanitation programs.
2.1 Food Safety
2.1.1 Inspection Programs
Registered Sanitarians from the Arizona Department of Health Services and the 15 county health
departments routinely inspect restaurants, food processors, prisons and jails, food warehouses, bakeries,
and school cafeterias to evaluate the food safety practices in these establishments.
3
There were more than 28,500 food establishments in Arizona during FY 2002, a decrease of 8% from FY
2001. State and county sanitarians conducted approximately 68,400 inspections in these facilities. The
statewide goal is to inspect each of the 28,500 food establishments at least twice per year. The statewide
goal was achieved, with an average of 2.4 inspections per food establishment.
Types of Food Establishments by
Percentage, FY 2002 of
Complex
Simple 32%
30%
Mobile
9%
Medium
29%
A new food establishment classification system was initiated during FY 2001. The objective of the new
classification scheme is to provide a way to organize and prioritize food establishment inspections. The
classification scheme categorizes food establishments by the complexity of the food service operations.
The new definition of a food establishment apparently was the cause for the reduction in the number of
food establishments. Some establishments that were previously food establishments were removed due to
the very limited nature of the food operation.
More complex operations conduct a greater variety of food service operations. More complex food
operations may require more frequent inspections in order to ensure that all food safety measures are being
observed. The classification scheme is as follows:
Complex Food Preparation Facilities
·  The facility prepares and holds hot or cold food for more than 12 hours before serving; and/or
·  The facility cooks and cools a significant number of foods during the food handling process;
and/or
·  The facility prepares food for off-site service; and/or
·  The facility vacuum packs food; and/or
·  The facility serves a highly susceptible population.
Moderate Complexity Food Preparation Facilities
·  The food prepared in the facility from raw ingredients requires minimal assembly; and/or
·  Hot or cold food preparation in the facility is restricted to same day service; and/or
·  Foods requiring preparation in the facility are from approved processing facilities.
Simple Food Preparation Facilities
·  Only pre-packaged potentially hazardous foods are available or sold; and/or
4
·  The potentially hazardous foods served are commercially pre-packaged in an approved food
processing facility; and/or
·  The facility only has limited preparation of potentially hazardous foods and beverages; and/or
·  The facility only serves beverages.
Mobile Food Establishments
·  The establishment is not a fixed establishment, and has the ability to be moved by motor vehicle or
by a person.
Statewide, food establishments that are of high and medium complexity were inspected more frequently
than simple facilities. There were 3.0 inspections done per complex facility, 2.3 inspections per medium
facility and 2.1 per simple facility. This pattern is consistent with Arizona Department of Health Services
recommendations to inspect complex food service operations more frequently than simple food service
facilities.
Number of Food Establishments and Inspections by Food
Service Complexity, FY 2002
9012 8238 8645
2629
26938
18553 18157
4768
0
5000
10000
15000
20000
25000
30000
Complex Medium Simple Mobile
Facilities
Inspections
2.1.2 Enforcement
The goal of food safety inspection programs is to encourage compliance with the state food safety
requirements without resorting to compliance proceedings and enforcement actions. Unfortunately, these
actions are sometimes necessary to achieve compliance with the minimum requirements. In FY 2002,
approximately 581 enforcement actions were taken at food establishments in Arizona. Statewide,
compliance proceedings or enforcement actions were taken at approximately 2% of food establishments.
2.1.3 Updated Arizona Food Code
One of the primary goals of the statewide food safety program in FY2002 was to adopt and prepare to
implement the new food safety requirements that were initiated on October 3, 2001. The new food safety
requirements incorporate the principles of Hazard Analysis and Critical Control Point principles. These
principles evaluate the critical procedures used by a food establishment, and outline individualized ways of
controlling those processes which may lead to foodborne illness. As a result, the new food safety rules and
inspection procedures will focus directly on items that affect food safety. The program will put less
emphasis on the cosmetic elements.
5
The following are some of the most important changes:
·  People in charge of restaurants and other food establishments are required to know how to prevent
foodborne illness in their operations. They can demonstrate this by successfully completing an
accredited Food Safety Manager Certification course on food safety, by answering food safety
questions asked by inspectors, or by complying with the new food code.
·  People in food establishments working with foods that are ready to eat without additional cooking must
use utensils or non-latex gloves. In some cases, directly touching these ready-to-eat foods is permitted
if the facility has a specific food safety management plan to prevent contamination.
·  The cooking temperature for hamburger is raised to 155 o F. Food that has already been cooked may be
held at 130 o F. Cold foods must be held at or below 41 o F. The proposed rules also have detailed
alternatives that apply the latest knowledge in food safety science.
·  Potentially hazardous ready-to-eat food generally must be date marked when it is held refrigerated or
frozen. The new rules have specific requirements that limit how long the food can be held before being
served.
·  The operator of a food establishment must advise consumers of the risks of consuming raw or
undercooked animal foods such as shellfish or eggs.
·  The critical elements that must be evaluated by regulators during inspections are prescribed. County
health departments may develop their own criteria for scoring or rating food establishments. County
health departments will also have greater flexibility in determining how frequently to inspect food
establishments.
2.1.4 Food Safety Accomplishments In Arizona
·  Maricopa County was the winner of the Samuel J. Crumbine Award. This national award is presented
to the County that has demonstrated the most innovative and effective food safety program within the
United States.
·  Coconino and Maricopa County were individual recipients of grants from the FDA for Innovative
Food Safety. There were only 13 grants awarded nationally.
·  Four Arizona counties participated in the FDA’s National Program to conduct an extensive self-assessment
on their food safety programs. When the assessment is competed a baseline will be
established from which future program activities are compared. There are 11 program areas to be
assessed, with a goal to attain 9 of the 11 standards within 5 years. This program is highly ambitious
and forward thinking. The four counties participating are La Paz, Maricopa, Pinal and Yavapai. It is
anticipated that additional counties will participate in upcoming years.
2.1.5 FY 2003 Hot Topic – Food Biosecurity
The Arizona Department of Health Services will be addressing the need for food biosecurity. A Food
Biosecurity Specialist was added to the Food Safety and Environmental Services Section with funds from
a grant from the Centers for Disease Control and Prevention. This position will be charged with the
responsibility of coordinating a statewide effort to protect the food and water supply of Arizona.
6
Reports of Foodborne Illnesses
The Arizona Department of Health Services conducts surveillance for foodborne illnesses and other enteric
diseases and helps the county health departments to conduct additional investigations of disease outbreaks.
Environmental investigations, including a focused inspection, are conducted when gastrointestinal diseases
are suspected to be associated with a foodborne illness. When a link between foodborne illness and a food
establishment is made a detailed investigation in conducted to determine the source.
The following sections provide a foodborne illness epidemiology update for 2001.
10
30
483
635
738
0 100 200 300 400 500 600 700 800
Listeriosis
E. Coli
Shigellosis
Campylobacteriosis
Salmonellosis
Types and Number of Bacterial Foodborne Illnesses
Reported in Arizona 2001
Campylobacteriosis
There were 635 cases of Campylobacteriosis reported in 2001, equaling approximately 12 cases
per 100,000 population. Apache, Coconino and Navajo counties had the highest rates in 2001,
3.9, 3.6 and 1.7 times the state rate, respectively. Twenty percent of reported cases were children
under five years of age. Campylobacter was not known to be a common cause of diarrheal
disease in humans until 1977, when a practical method for isolating the organism from stool was
described. Campylobacteriosis is not a nationally notifiable disease. Even though surveillance is
very limited, over 10,000 cases are reported to the Centers for Disease Control and Prevention
(CDC) each year, equaling approximately six cases for each 100,000 persons in the population.
Rates of Reported Campylobacteriosis in Arizona,
1990-2000
12.6 13.0 13.5
11.6
9.4 10.2 10.0 10.0
7.6
10.1
12.0 12.0
0
5
10
15
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Year of Onset or Diagnosis
7
Gender and Age Specific Rates of Reported
Campylobacteriosis in Arizona, 2001
12.9 11.4
33.0
13.3
7.9 8.4
14.6 12.8
10.4 10.8 9.2
6.4
9.9
5.1
8.8
0
5
10
15
20
25
30
35
Gender and Age Groups (Yrs)
E. coli
There were 30 reported cases of E. coli O157:H7 infection in Arizona in 2001, representing a 46 percent
decrease from 2000. Of the 53 percent of cases for which race is known, 47 percent of cases were
Caucasian. E. coli O157:H7 became reportable in Arizona in April 1997 thus trend data is still limited.
National rates have increased steadily from .82 per 100,000 in 1994 to 1.77 in 1999.
8
Rates of Reported E. coli O157:H7 Infection in Arizona,
1990-2000
0.07
0.81
0.63
1.13
0.55
0
0.2
0.4
0.6
0.8
1
1.2
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Year of Onset or Diagnosis
Cases per 100,000 population
Listeriosis
There were 10 cases of Listeriosis reported in 2001, which equates to a 50 percent decrease in cases from
2000 figures. Sixty percent of reported cases were female and 70 percent of cases, for which race was
reported, were white. Cases of Listeria peaked in April with 40 percent of cases occurring during this
month.
9
Gender and Age Specific Rates of Reported
Listeriosis in Arizona, 2001
0.2 0.2
0.0 0.0 0.0 0.0
0.3 0.1 0.0
0.3
0.0
0.5 0.3 0.4
4.4
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Male
Female
< 5
5-9
10-15
15-19
20-24
25-34
35-44
45-54
55-59
60-64
65-74
75-84
85+
Gender and Age Groups (Yrs)
Cases per 100,000
Salmonellosis
There were 738 cases of Salmonellosis reported in 2001, reflecting a case rate of 14.38 per 100,000 population.
Salmonellosis is most common in children under five years of age and 26 percent of reported cases were under
five years of age, equating to approximately 50 cases per 100,000. Cases of Salmonella peak in the late summer
with 35 percent of cases reported between July and September. Apache, Coconino, and Pinal counties reported
the highest rates in 2001, 2.1, 1.9, and 1.4 times the state rate. There were three reported outbreaks of Salmonella
in 2001, which were associated with alfalfa sprouts, cantaloupe, and potentially green grapes. Although rates
appeared to be declining through 1994, resulting in lower state rates versus national rates, the trend now appears
to have reverted and Arizona rates are now comparable with national levels.
Rates of Reported Salmonellosis in Arizona,
1990-2000
12.5
13.7
11.7 10.8
8.4
9.8
11.0
15.7 14.9
16.3 15.6
14.4
0
2
4
6
8
10
12
14
16
18
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Year of Onset or Diagnosis
10
Gender and Age Specific Rates of Reported Salmonellosis in
Arizona, 2001
13.7 14.9
50.7
14.1
11.1
7.3
11.0 11.3 10.3 9.4 9.6 11.3 11.8
15.3
21.9
0
10
20
30
40
50
60
Male
Female
< 5
5-9
10-15
15-19
20-24
25-34
35-44
45-54
55-59
60-64
65-74
75-84
85+
Gender and Age Groups (Yrs)
Cases per 100,000
Shigellosis
There were 483 cases of Shigellosis reported, representing a rate of 9.4 cases per 100,000, reported in
2001. This represents an approximate sixteen percent decrease in cases from 2000 maintaining a general
trend of decreasing enteric disease rates. On the average, there were twice as many cases during the
months from August through November. Of the cases with known race (60 percent), Native Americans
and Hispanics were approximately 4 times more likely to be reported with Shigellosis than Whites.
11
Apache and Pinal counties reported the highest rates, 28.81 and 20.59 cases per 100,000 population,
respectively. State rates have been consistently higher than the national rates, which have fluctuated from
10.89 in 1990 to 6.43 in 1999.
Rates of Reported Shigellosis in Arizona,
1990-2000
33.7
23.6
17.4
14.4 13.6
30.7
19.6 20.6
11.3 10.3 11.3 9.4
0
5
10
15
20
25
30
35
40
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Year of Onset or Diagnosis
Cases per 100,000 population
Gender and Age Specific Rates of Reported
Shigellosis in Arizona, 2001
8.9 9.8
48.9
24.4
6.9 4.1 5.5 5.4 4.0 3.8 3.8 2.0 3.9 3.8 1.5
0
10
20
30
40
50
60
Male
Female
< 5
5-9
10-15
15-19
20-24
25-34
35-44
45-54
55-59
60-64
65-74
75-84
85+
Gender and Age Groups (Yrs)
Cases per 100,000
12
2.2 Bottled Water
Sanitarians from the Arizona Department of Health Services and the county health departments routinely
inspect facilities that bottle water for distribution within Arizona to evaluate the practices in these
establishments. In FY 2002, there were 35 bottled water facilities in Arizona. State and county sanitarians
conducted 79 inspections in these facilities. The statewide goal is to inspect each of the bottled water
facilities at least twice per year. The statewide goal was achieved, with an average of 2.3 inspections per
facility. There was one compliance proceeding involving a bottled water facility.
Updating of Bottled Water Rules
In FY 2003 the Arizona Department of Health Services will be preparing a new rule package for bottled
water. The update is necessary to provide a current standard of water quality consistent with the Code of
Federal Regulations. The current rules also reference sections of the Code of Federal Regulations that
have been changed and re-numbered.
13
43
35
98
79
0
20
40
60
80
100
Number of Bottled
Water Plants
Number of
Inspections
Bottled Water Plants - Facilities & Inspections in Arizona
FY 2001
FY 2002
2.3 Bathing Places
Inspection Programs
Sanitarians from the Arizona Department of Health Services and the county health departments routinely
inspect public and semipublic swimming pools and spas, as well as a few natural bathing places to evaluate
whether these facilities are operated so that they prevent the spread of disease.
In August 2002, the Governor’s Regulatory Review Council approved a new rule package for public and
semipublic swimming pools and spas. The rules establish minimum standards that are consistent with the
voluntary national standards for public swimming pools and spas that have been developed by the
American National Standards Institute and the National Spa and Pool Institute. The minimum sanitary
criteria are also generally consistent with the current swimming pool and spa ordinances of Maricopa and
Pima counties. The rules provide the flexibility to use alternative disinfection methods as long as the
method used effectively maintains the proper oxidation-reduction potential in the water. The new rules
also prescribe specific actions for handling fecal accidents.
Another goal of establishing the new rules for the sanitary operation of public and semipublic swimming
pools and bathing places was to create consistency with the Arizona Department of Environmental Quality
rules for the design, construction, and sanitation of public and semipublic swimming pools.
The rules apply only to the sanitary conditions of public and semipublic swimming pools and bathing
places. A swimming pool or bathing place is “public” if it is open to members of the general public,
regardless of whether a fee is charged for admission. A swimming pool or bathing place is “semipublic”
if it is operated in conjunction with a lodging such as a hotel, motel, resort, apartment, townhouse or
condominium complex, trailer court, mobile home park, or recreational vehicle park.
There were more than 12,000 public and semipublic swimming pools and spas in Arizona in FY 2002.
State and county officials conducted more than 23,300 bathing place inspections. State and county health
departments implemented 170 enforcement actions at bathing places in FY 2002.
14
12178 12031
23499 23364
0
10000
20000
30000
Number of
Pools & Spas
Number of
Inspections
Swimming Pools & Spas - Number & Inspections in Arizona
FY 2001
FY 2002
2.4 Public Accommodations
Registered Sanitarians from the Arizona Department of Health Services and the county health departments
routinely inspect public accommodations such as hotels, motels, and boarding houses. The inspections
focus primarily on general sanitation.
In FY 2002, there were 1,305 public accommodations in Arizona. State and county sanitarians conducted
1,177 inspections in these facilities. The statewide goal is to inspect each of the public accommodations
once per year. In FY 2002, 90% of the public accommodation facilities were inspected at least once. State
and county health departments implemented 13 enforcement actions at public accommodations in FY
2002.
1286 1305
1147 1177
1050
1100
1150
1200
1250
1300
1350
Number of Hotels
& Motels
Number of
Inspections
Public Accomodations - Number of Facilities and Inspections
in Arizona
FY 2001
FY 2002
2.5 Trailer Coach Parks
Sanitarians from the Arizona Department of Health Services and the county health departments routinely
inspect trailer coach parks. The inspections focus primarily on general sanitation including garbage and
trash removal, sewerage connections, and water and wastewater.
In FY 2002, there were 1,714 trailer parks in Arizona. State and county sanitarians conducted 1,869
inspections in these facilities. The statewide goal is to inspect each of the trailer parks once per year. The
statewide goal was achieved, with an average of 1.1 inspections per year. State and county health
departments implemented 55 enforcement actions at trailer coach parks in FY 2002.
15
1695 1714
1807
1869
1600
1700
1800
1900
Number of Trailer
Parks
Number of
Inspections
Trailer Parks - Number of Facilities and Inspections in
Arizona
FY 2001
FY 2002
2.6 School Grounds
Sanitarians from the Arizona Department of Health Services and the county health departments routinely
inspect public schools (including charter schools) to determine whether they are in compliance with
sanitation requirements. The inspections focus primarily on general sanitation including garbage and trash
removal, drinking fountains, locker rooms, and restrooms. Cafeterias at the schools are considered food
establishments and inspections are made under the food safety program (Section 2.1).
1440
1516
1446
1334
1200
1300
1400
1500
1600
Number of
Public Schools
Number of
Inspections
Number of Public School Grounds & Inspections in Arizona
FY 2001
FY 2002
In FY 2002, there were 1,516 public schools in Arizona. State and county sanitarians conducted
approximately 1,334 inspections in the schools. The statewide goal is to inspect each of the schools
grounds once per year. In FY 2002, 88% of the public schools were inspected at least once. State and
county health departments implemented 3 enforcement actions at public schools in FY 2002.
2.7 Children’s Camps
Registered Sanitarians from the Arizona Department of Health Services and the county health departments
permit and routinely visit children’s camps to determine whether they are in compliance with sanitation
and food safety requirements. The inspections focus primarily on general sanitation including garbage and
trash removal, locker rooms, restrooms, and sleeping quarters. Inspections are also conducted at the food
service kitchens. Inspections for children’s camps are tracked by annual year rather than by fiscal year
since the camps are open seasonally in the summer months of June to September. Tracking by annual year
allows for more effective management of children’s camp inspections.
16
In 2002 there were 59 children’s camps that applied for an annual permit in Arizona. Most of the camps
are located in Yavapai and Gila counties. Some of the camps operate for several months during the
summer, while others may operate for only a few days.
Arizona Sanitarians conducted 38 inspections at children’s camps. One enforcement action was necessary
at a children’s camp in FY 2002.
2.8 Environmental Health Points of Interest
During FY 2002, Coconino County implemented a body art ordinance. Coconino has formally recognized
injuries, infections and occasional transmission of diseases such as Hepatitis, HIV, and other
communicable diseases are occurring as a result of improper body art or after care procedures. As part of
the ordinance, tattoo establishments are required to be permitted and inspected for sanitation standards,
training requirements, client education and disclosure. This is the first ordinance or regulation of its type
in Arizona.
Environmental Health personnel were put to a task during the Rodeo-Chediski fire in Apache and Navajo
counties at the end of FY 2002. The fire, largest in American history, put the local counties under
tremendous stress during all of the events associated with the fire, including evacuation of many residents.
Virtually every state and area local agency participated in some aspect of the event.
Pima County implemented a “No Smoking” Ordinance for restaurants. This is the first known county-wide
regulation of its type in Arizona. A similar regulation was passed by the City of Tucson in 1999.
Under the new ordinance, smoking is prohibited in a restaurant unless the restaurant has received an
exemption or is a nonprofit civic fraternal organization. Violations of the ordinance will be a Class 3
misdemeanor.
3.0 Registration and Training of Sanitarians
Inspectors that implement the inspection programs for the statewide public health sanitation program must
be licensed as a Registered Sanitarian. Registration as a sanitarian requires that an applicant meet the
statutory requirements in ARS 36-136.01 and pass an exam. Sanitarians are also required to submit annual
renewal applications. These requirements ensure that a trained and competent work force is implementing
the inspection programs.
Statewide, there were 170 Registered Sanitarians employed at the 15 county health departments and the
Arizona Department of Health Services. Sixty-one of the sanitarians have been standardized according to
the former food code requirements. Three sanitarians have been standardized in the new food code
requirements. Standardization is a process by which experienced sanitarians can be trained to focus on
critical factors and to maintain consistency. The updated standardization procedure is far more complex
and time consuming than previous standardization requirements, reflecting the increased professional
nature of the work involved.
17
Number of Sanitarians Employed by Jurisdiction in FY 2002
Jurisdiction Sanitarians Sanitarian Aides
ADHS/ASU 7 0
Apache 3 0
Cochise 7 1
Coconino 6 3
Gila 3 0
Graham 1 0
Greenlee 1 0
La Paz 2 2
Maricopa 94 1
Mohave 6 6
Navajo 3 0
Pima 17 1
Pinal 7 5
Santa Cruz 4 2
Yavapai 4 0
Yuma 5 0
Total 170 21
143 170
23 21
0
50
100
150
200
Registered
Sanitarians
Sanitarian Aides
Number of Sanitarians Empoyed in County and State
Government
FY 2001
FY 2002
Updated Registration Requirements
The Arizona Department of Health Services updated the requirements for the registration of sanitarians in
Arizona. The new rules are designed to update the current requirements to conform with Arizona
Department of Health Services statutory authority and to improve clarity and efficiency. The new
requirements will focus more attention on timeliness and reporting requirements, and will enable the
Arizona Sanitarian’s Council to more effectively maintain professional standards for sanitarians.
18
The new rules are similar to requirements for registration of various other professions in Arizona. There
are many differences between the prior requirements and the new rules. The following are some of the
most important changes:
·  Registration by reciprocity is eliminated. Registration as a Sanitarian in Arizona requires an
individual to pass the Professional Examination Service exam.
·  Continuing education requirements are eliminated.
·  The exam fee is increased from $40 to $110 to reflect the actual cost for the exam.
·  The prior requirement that limited an applicant to 3 exams within a 4- year period is eliminated.
·  Sanitarians that do not renew by the February 15 renewal grace period lose their registration.
Once registration lapses, the individual needs to pass the exam to register.
·  Applications for initial registration and renewal have additional requirements including questions
regarding whether the individual has been convicted of a crime.
·  Suspension and revocation procedures are clarified and updated.
·  The authority of sanitarians is clarified.
In addition to the new registration requirements, the Arizona Department of Health Services will be
developing a Professional Sanitarian program for county sanitarians to assist inspectors to more effectively
manage the complex environmental health issues of the current times.
4.0 Conclusions
·  More than 96,000 inspections at the approximately 45,200 regulated facilities in Arizona were
conducted by the one hundred seventy sanitarians at the 15 county health departments and the
Arizona Department of Health Services.
·  There were more than 28,500 food establishments in Arizona, a decrease of 8% over FY 2002.
State and county sanitarians conducted approximately 68,400 food safety inspections at these
establishments.
·  A total of 1,896 cases of foodborne illness were reported in 2002. Children under the age of 5 had
the highest risk of having a foodborne illness. Of the cases with known race (60 percent), Native
Americans and Hispanics were approximately 4 times more likely to be reported with Shigellosis
than Whites.
·  Inspection goals were achieved for food establishments, bottled water facilities, bathing places,
and trailer coach parks.
·  The Arizona Department of Health Services implemented new requirements for the registration of
sanitarians in Arizona.
·  The new Food Code was implemented on October 3, 2001.
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Appendix
Jurisdiction activity by type
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Food Establishments
Current number of food establishments 122 642 1086 489 152 49 218 16749
Mobile 2 19 13 63 3 2 0 2158
Simple 43 200 314 170 30 20 91 5784
Medium 42 186 185 75 45 10 29 3983
Complex 35 237 574 181 74 17 98 4824
Number of routine inspections 130 1368 889 416 206 97 360 43617
Number of reinspections 3 211 644 11 0 84 95 4731
Number of pre-operational inspections 3 69 301 53 4 4 16 3173
Number of foodborne illness complaints 3 58 58 3 4 10 0 1080
Number of non-foodborne illness complaints 1 561 347 32 0 19 37 2456
Number of compliance proceedings 0 2 15 0 0 3 0 518
Number of temporary food establishment
inspections
13 483 110 49 21 17 241 1803
Outreach
Number of presentations 4 35 134 4 5 37 64 143
Number of consultations/counseling provided 76 2053 388 16 0 10 260 1174
Number of media contacts 0 6 4 1 0 4 5 159
Non-food related activities
Public & semi-public bathing places 2 92 214 18 16 2 22 8499
Routine inspections 3 345 183 18 23 2 42 17078
Complaint inspections 0 6 5 1 0 0 4 397
Enforcement actions 0 0 0 0 0 0 0 11
Trailer coach parks NR 90 86 NR 11 7 196 542
Routine inspections NR 44 60 NR 11 5 204 567
Complaint inspections 0 0 10 0 0 3 26 46
Enforcement actions 0 0 0 0 0 1 24 0
Public school grounds 0* 0* 32 0* 0* 0* 16 921
Routine inspections 0* 0* 2 0* 0* 0* 18 860
Complaint inspections 0 0 12 0 0 0 1 41
Enforcement actions 0 0 0 0 0 0 1 0
Camp grounds 0 0 14 0 0 1 2 0
Routine inspections 0 0 7 0 0 1 2 0
Complaint inspections 0 0 0 0 0 0 0 0
Enforcement actions 0 0 0 0 0 0 0 0
Children’s camps 0 1 0 0 0 0 0 0
Routine inspections 0 1 0 0 0 0 0 0
Complaint inspections 0 0 0 0 0 0 0 0
Enforcement actions 0 0 0 0 0 0 0 0
Public accommodations 36 77 187 43 11 5 24 465
Routine inspections 27 52 78 22 11 5 4 501
Complaint inspections 2 2 20 1 0 1 0 27
Enforcement actions 0 0 20 0 0 0 0 4
Bottled water 0 0 1 0 0 0 1 27
Routine inspections 0 0 1 0 0 0 0 68
Complaint inspections 0 0 0 0 0 0 0 12
Enforcement actions 0 0 0 0 0 0 0 1
NR = Not Reported
* = Performed by ADHS, and not within County reports
20
Appendix
Jurisdiction activity by type
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
ADHS
Food Establishments
Current number of food establishments 1008 551 3856 689 288 1004 794 827
Mobile 94 38 1230 38 42 58 96 3
Simple 239 70 939 216 94 181 139 115
Medium 555 145 1712 218 41 349 237 328
Complex 120 114 1205 217 111 416 322 381
Number of routine inspections 1648 367 6727 810 420 2048 1515 1064
Number of reinspections 305 13 186 57 93 239 23 39
Number of pre-operational inspections 158 39 273 149 9 116 98 0
Number of foodborne illness complaints 56 24 156 27 3 12 15 1
Number of non-foodborne illness complaints 61 4 676 65 23 169 83 5
Number of compliance proceedings 13 0 32 0 0 1 0 0
Number of temporary food establishment
inspections
NR 33 991 171 16 103 62 94
Outreach
Number of presentations NR 10 49 6 26 340 15 42
Number of consultations/counseling provided NR 29 620 34 6 314 32 7
Number of media contacts NR 13 16 1 0 0 14 18
Non-food related activities
Public & semi-public bathing places NR 31 2478 220 35 168 210 23
Routine inspections NR 4 3890 429 54 446 772 74
Complaint inspections NR 1 194 25 2 8 44 0
Enforcement actions NR 1 148 0 0 12 0 10
Trailer coach parks NR 43 432 75 21 NR 211 0
Routine inspections NR 3 428 44 18 NR 485 0
Complaint inspections NR 3 52 2 2 0 10 0
Enforcement actions NR 3 27 0 0 0 0 0
Public school grounds NR 0* 224 53 24 44 47 128
Routine inspections NR 0* 218 0 25 21 62 128
Complaint inspections NR 0 10 0 1 1 2 0
Enforcement actions NR 0 2 0 0 0 0 0
Camp grounds NR 0 0 1 0 0 0 0
Routine inspections NR 0 0 1 0 0 0 0
Complaint inspections NR 0 0 0 0 0 0 0
Enforcement actions NR 0 0 0 0 0 0 0
Children’s camps NR 7 2 2 1 17 0 29
Routine inspections NR 2 2 2 0 22 0 9
Complaint inspections NR 2 0 1 0 1 0 0
Enforcement actions NR 1 0 0 0 0 0 0
Public accommodations NR 78 200 10 19 112 38 0
Routine inspections NR 4 191 6 20 183 73 0
Complaint inspections NR 4 14 0 0 9 0 0
Enforcement actions NR 4 5 0 0 0 0 0
Bottled water NR 1 2 1 1 2 0 0
Routine inspections NR 1 4 2 1 3 0 0
Complaint inspections NR 1 0 0 0 0 0 0
Enforcement actions NR 0 0 0 0 0 0 0
NR = Not Reported
* = Performed by ADHS, and not within County reports