Decline of bacterial isolation in infectious diarrhea in los angeles — the impact of intensive health code enforcement on the food vendors

Community acquired bacterial diarrhea is a significant cause of morbidity. Each year, diarrhea outbreaks are common due to contaminated food and drinks from food vendors, such as restaurants, etc. LA County has developed a rating system after onsite inspection and scoring by health inspectors. To ensure compliance, disciplinary actions in the form of publishing the facility's name and rating in the media, as well as closing facilities have been taken. This enforcement of the health code for public protection seems well conceived but data demonstrating effectiveness are lacking. METHODS. Diarrheal specimens are submitted to one central facility (Southern California Permanente Regional Laboratory in North Hollywood, Cal from the regional hospitals and clinics of Southern California Permanente Medical Group. Fecal analysis data, in terms of culture positivity or negativity, bacterial identification and month of the year were acquired for 1997,1998 and 1999. The LA County program was instituted in 1998. Data from these years were compared for differences. RESULTS I.The total number of diarrheal specimens studied in each year were as follows 34,167 in 1997,35,309 in 1998 and 28,937 in 1999 (until Oct.99) 2.A significant decline in the positive stool culture rate was noted from 1997 to 1998/99. The decline was generally evenly distributed among the different medical centers. CONCLUSION: These data show a statistically significant decline in the rate of bacterial isolation in infectious diarrhea in Los Angeles. No other major changes in the public health system such as, changes in public water treatment/supply or in the food processing industry were made during this period. This temporal association of the decline in positive stool culture rates with the enforcement of public health code in Los Angeles suggests that it may be the impact of this program.