PORTLAND — One in six Americans — about 48 million people — get sick from food-borne diseases every year. Worse, 128,000 are hospitalized and 3,000 die.

The most vulnerable population: children.

Those statistics, the latest available from the U.S. Centers for Disease Control’s 2011 report on food-borne illness, underscore the importance of food safety in schools.

In southern Maine, public school kitchens largely pass state health inspections. Only a handful have failed an inspection in the last five years.

In fact, of the more than 200 Maine Department of Environmental Health kitchen inspection reports reviewed by The Forecaster, covering 64 public school cafeterias from Scarborough to Brunswick, state and city health inspectors have only failed six school kitchens since 2007.

“The schools are great,” said Rebecca Walsh, senior health program manager for the department. “Really, their staff is among the best-trained staff as far as handling food and food safety.”

And unlike restaurants, in the last two years, school kitchens have received no complaints about illness, according to Health Inspection Program Manager Lisa Roy.

Despite the high rate of passing schools, more than a dozen schools were on the brink of failure, coming within one violation of failing. Most had at least one violation that could spread food-borne illnesses.

To fail an inspection, a kitchen must receive more than three critical violations and more than 10 noncritical violations, according to state inspection guidelines. Inspections are unannounced.

The presence of critical violations means there is a risk of spreading food-borne illness. They can range from storing food at temperatures that allow the growth of bacteria, to serving food from damaged or compromised packaging, to employees not washing their hands before serving food.

Noncritical violations can include food contact surfaces not being properly sanitized, equipment in need of repair and general cleanliness issues.

A failed inspection on Dec. 4, 2009, at Mahoney Junior High School in South Portland revealed hot and cold foods were not kept at proper temperatures, food was not protected from contamination during storage and employees were not following proper hand-washing procedures.

On Feb. 8, 2011, at Freeport Middle School, inspectors found food service employees were washing their hands in bleach instead of in the sink and that sanitation solution levels were low in the dishwasher.

At the Chebeague Island School on May, 5, 2010, inspectors found 11 non-critical violations, ranging from employees not wearing hair nets to cutting boards that were in disrepair. The school also was cited because the person in charge “could not demonstrate required knowledge” and was told to review the health code.

Although the reasoning for most of the violations is clear, the distinction between critical and noncritical violations is sometimes perplexing.

Some violations the public might consider serious, such as evidence of rodents or insects, are noncritical violations, while dented cans, which must be discarded, are considered critical violations.

Schools take priority

Schools are only required by law to be inspected every other year, although Roy said the department has made schools a priority, with a goal of annual inspections. Only a few of the required inspections have been missed in the last five years.

The state has only 11 inspectors for the more than 8,500 schools, restaurants, tattoo and micro-pigmentation (permanent makeup) shops, campgrounds and pools in the state.

That’s more than 770 inspections a year per inspector.

“(Maine Center for Disease Control) does make schools a priority because they’re a vulnerable population,” said Environmental Health Director Nancy Beardsley. She added that inspectors try to make best use of their time and make complaints of food-borne illness and new restaurant openings a priority.

But inevitably, they miss inspections.

“We do the best we can with our priorities,” she said. “We have to prioritize our work just due to the sheer volumes.”

The health inspection budget is generated from fees, which are $100 for schools, and range from $55-$220 for restaurants, depending on their size.

Although the state inspects most schools, Portland and South Portland are anomalies, along with three other municipalities: Lewiston, Auburn and Lisbon. They have their own designated health inspectors.

In the case of Portland, it doesn’t seem to have benefited schools.

From Sept. 1, 2010, to Aug. 31, 2011, of the 62 missed school inspections in the state, 20 were in Portland. There was improvement the following year, with only seven of a total of nine missed school inspections in Portland.

The other missed schools were Mahoney in South Portland and another school that closed earlier than the inspectors expected, Roy said.

Portland’s central kitchen

Portland schools have another unique feature: most of their food is made and shipped from a central kitchen at the old Reed School, built in 1926, at 28 Homestead Ave. The school’s classrooms were adapted to be used as kitchens, dish-washing rooms and storage areas. The former gym is now a freezer.

On the outside of the building, the age shows: worn brick, cracked windows and walls littered with graffiti.

Its latest inspection report doesn’t look good either.

The central kitchen failed its last available inspection on Dec. 11, 2011. Portland Health Inspector Michelle Sturgeon cited the kitchen for 16 violations, five critical.

Sturgeon cited the facility for inadequate food temperatures, employees not washing their hands, being out of soap at one hand-washing sink and wood-cutting tables in disrepair, among other violations.

Although a newer building is being adapted for the kitchen next year, the current building’s disjointed rooms make production awkward, and the distribution to schools makes keeping food at proper temperatures a challenge, said Ron Adams, food service director for the city schools.

“The food safety issues that we have are keeping food at proper temperatures and also food’s quality,” he said. “I think that’s a big point around here. We’re the only district with a central commissary, and many of the schools don’t have cooking kitchens in them, so we’re sending food out hot today to be served hot later.”

Central kitchens are common in large, urban areas, Adams said, noting he’s visited kitchens in Los Angeles and Indianapolis recently in preparation for Portland’s move.

Food is cooked at the kitchen, and put into electric warming boxes at “as high of temperature without destroying food totally,” Adams said. Then the boxes are loaded onto trucks and shipped to 10 schools.

“It adds a lot to our day,” he said. “That’s a huge challenge to cook for that many schools that have nothing but a serving counter.”

The central kitchen makes about 5,500 breakfasts and lunches every day, nearly a million per year, Adams said.

The city plans to upgrade kitchens at all the schools to allow food to be shipped out cold and reheated at the schools, which will reduce waste and hopefully make the food taste better, he said.

Adams said the School Department has made efforts in recent years to improve food safety, including paying almost $4,400 to make all 35 central kitchen employees certified food protection managers. The certification is attained after passing a test that covers prevention of food-borne illnesses.

At the new building, Adams said they’ll be able to make improvements, including getting rid of Styrofoam trays, by adding a dishwasher that can handle the amount of reusable trays the school will go through.

“It’s a pretty big, new world starting next fall,” he said. “The shortcomings of a facility designed over 30 years ago and how much that has changed, is a lot of the drive to push us into putting a new facility in place.”

Preventing foodborne illness

Patricia Buck and her daughter, Barbara Kowalcyk, have become national food safety advocates since the death of Buck’s grandson, Kevin Kowalcyk, in 2001 from a preventable food-borne illness. He was 2½ years old.

Buck and Kowalcyk founded the North Carolina-based Center for Foodborne Illness in 2006.

“One month before Kevin died, we were in Maine, [on Cadillac Mountain], and of all of the people that were there, he was the very youngest,” she said. “Within a month he was dead.”

Kevin died from E. coli, Buck said. He ate contaminated meat processed at a major packing plant outside of Maine, where the bacteria had originated, while he was on the Cadillac Mountain trip.

The center promotes outreach and education about issues related to food safety, from schools to Congress.

Buck, who now lives in Pennsylvania, stresses the importance of safe food handling. “Some of the biggest errors that can transmit illness are hand-washing and temperatures,” she said.

Schools can improve food safety by doing all the things required in health inspections, Buck said, but one of the most effective ways that’s often overlooked is inserting it into the curriculum.

“What we have to do to prevent food-borne illness and how we approach feeding children in institutional situations becomes more important,” she said, noting higher rates of disease from contaminated food in younger children. “There might be a need for more attention paid for food safety practices in lower grades, because these children have to be told what to do about almost everything. They’re curious and don’t think beyond what’s currently in front of them, which is true of all of us, but especially true in the 6-12 age group.”

Buck, a former elementary school teacher, said teachers should be allowed time to teach about hygiene and food safety as part of the curriculum.

“Over the course of the week, if a teacher is allowed 10 minutes to spend on health, I’d be surprised,” she said.

Younger children also are more likely to develop serious complications from food-borne illnesses, something that can turn into long-term health problems, Buck said.

Foodborne illness is not only a problem at the prepared food level, but at a much larger, national, and increasingly international, level, she said, noting that the Federal Drug Administration only inspects about 3 percent of food at processing plants, including imported food.

“So, when you say one in six Americans, that’s a lot of people being impacted by contaminated food,” she said. “This problem isn’t going to go away; it’s only going to get larger.”

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