When it comes to food safety in restaurants, the lyric above from a song by Charlie Rich seems apropos. Each time you patronize a commercial eating establishment, you put your gastrointestinal health in the hands of complete strangers.

Dining out safely has never been more important. Almost 50 billion meals are eaten in restaurants and cafeterias each year in this country. In 2001, the nation's restaurant tab is projected to total $399 billion, an increase of 5.2% over 2000. According to the National Restaurant Association, America's rise in busy dual-income households has almost half (46%) of all adults eating a restaurant meal on any given day.

It behooves all restaurateurs to ensure that their employees are adequately trained in food safety and consistently use safe food-handling methods. A single outbreak of food-borne disease can depress a restaurant's bottom line or even drive it out of business--if the outbreak is identified and publicized. According to Safe Tables Our Priority, a nonprofit advocacy group for victims of food-borne disease, many outbreaks are never identified as such. Most people who experience a food-borne illness don't consult a doctor. It usually takes two days or longer after eating contaminated food for symptoms to begin. Most people who get food poisoning erroneously point their finger at their last meal.

Mercifully, the vast majority of food-borne illnesses, such as salmonellosis and Clostridium perfringens infections, amount to little more than a few days of diarrhea, possibly accompanied by vomiting. However, each year in the United States, tens of thousands of victims of food-borne disease require hospitalization, and an estimated 9000 die, according to the US Centers for Disease Control and Prevention.

Concern over about microbial hazards in restaurant food reached a fevered pitch during a 1993 outbreak of Escherichia coli O157:H7 infections in the Pacific Northwest. That so-called "hamburger disease" outbreak was traced to undercooked burgers served by the Jack in the Box fast-food chain. About 700 people were hospitalized and four children died. Since then, Jack in the Box and other fast-food restaurants have put additional food-safety controls into place.

Unlike spoilage bacteria that makes food foul-smelling, off-color, or slimy, pathogenic (disease-causing) bacteria do not affect the appearance, smell, or taste of food. Pathogenic bacteria can be transferred to food from a variety of places, including soil from the farm, an animal's intestinal tract in the slaughterhouse, contaminated trucks, and contaminated countertops or cutting boards, and, of course, unwashed hands. Since all foods are potentially contaminated, everything should be stored, cooked, and served according to government-established food-safety guidelines. That is the ideal.

But say you order a hamburger and visit the salad bar at your local diner. You can't possibly know whether:

• Your server and busboy spent the requisite 20 seconds washing their hands with soap and warm water after using the bathroom.
• The raw ground beef was kept adequately chilled prior preparation.
• Your burger's cooking temperature got high enough to kill any germs that might have been present.
• The chef used the same utensil on the raw and cooked burger.
• The carrots, tomatoes, lettuce, and other greens were washed before reaching the salad bar.
• The employee who stocked the salad bar sneezed on the radishes.

Despite all the unknowns, there are steps you can take to minimize your risk of contracting a food-borne disease when dining out. All you need are your powers of observation and some basic food-safety knowledge. A little chutzpah can't hurt, either.

Perhaps the most important thing to consider when dining out is your current health status. If you or someone in your party is at high risk for a food-borne illness, you may wish to avoid ordering risky foods. According to the Food and Drug Administration, the riskiest foods include:

• Rare or medium-rare hamburger and turkey burger
• Unpasteurized fruit juices
• Raw sprouts
• Raw or undercooked eggs
• Raw shellfish, such as oysters

Risk factors for food-borne diseases include:

• Being under age 5 or over age 75
• Being pregnant
• Having a suppressed immune system stemming from a disease, such as AIDS, or from taking medication that impairs the immune system
• Having certain chronic diseases, such as emphysema or heart failure
• Taking antacids, which reduce stomach acidity; the stomach's natural acidity level is usually strong enough to kill most of the germs you ingest
• Taking antibiotics, which wipe out all or most of the "good bacteria" that inhabit your intestinal tract; these harmless bacteria compete with harmful bacteria for nutritional resources; the "good bacteria" usually win, if there are enough of them around.

In some cases, a risky food can be hidden amid other ingredients. For instance, if the restaurant makes its Caesar salad dressing or hollandaise sauce from scratch, ask your server whether raw or pasteurized eggs are used.

Regardless of your health status, you can greatly minimize your risk for food-borne illness and many other contagious diseases by washing your hands frequently with soap and water, especially before eating and after touching an animal. After washing your hands, dry them thoroughly with a paper towel, if available. On your way out of a public restroom, avoid touching the bathroom door with your hand (push it open with your foot or hip, or use a paper towel, a piece of toilet paper, or a shirtsleeve to turn the knob). You may even wish to carry a small bottle of waterless hand sanitizer to use immediately before digging into your meal.

Using food safety sense in restaurants

To be sure, the majority of restaurant meals are safe to consume, but lapses do occur. Here are some things to look for in a restaurant or cafeteria that may indicate how seriously management regards food safety:

A recent sanitation report. This document should be displayed in a readily visible place, such as at eye-level on a wall near the cash register. A restaurant should be willing to display this document regardless of whether it must do so by law.

Clean bathrooms. In many restaurants, employees and customers use the same bathrooms. There should be plenty of soap, paper towels and toilet paper. The hot water tap should be functioning properly, the toilets should flush, and the floors should be relatively clear of cigarette butts and other debris. A clean, pleasant bathroom suggests that employees are probably paying attention to detail elsewhere in the restaurant, such as the kitchen. If there are no paper towels or soap in the bathroom, if the hot-air drier is broken, if the sink drain is stopped up, or if the garbage pails are overflowing, report the problem to the manager. If the manager does not seem to care, consider eating somewhere else.

Clean dining room. Clean floors and sparkling surfaces suggest that management is concerned with cleanliness, orderliness, and has a sense of pride. These visible virtues suggest that the food is being handled properly in places that customers don't see.

Tidy servers and busboys. Servers' and busboys' uniforms and aprons should be reasonably clean, their hair should be up or netted, and they should be washing their hands frequently. Open cuts or sores on hands can harbor bacteria that potentially can be transferred to food, plates, and eating utensils.

Tidy tables. The most sanitary way to clean tables and countertops is with a disinfecting spray and paper towels. Unless they are freshly laundered or dipped in a fresh disinfectant solution, cloths and sponges can harbor pathogens, which may be transferred to hands, tables, dishes, and eating utensils.

Safety precautions in visible food-prep areas. In some eating establishments, such as pizza parlors, grills, and sushi bars, food-safety violations are difficult to hide. Notice whether the food handlers are washing their hands frequently, especially after touching their hair, clothing, or face, or blowing their nose. A fresh pair of plastic gloves should be used for each order. The same spatula should not be used to transfer a raw hamburger patty to the grill and a cooked burger to a plate. The glass in front of the raw fish at a sushi bar should be very cold to the touch.

Spot-free utensils and dishes. Forks, spoons, and knives should be clean and free of water stains. If you see evidence of lipstick or even old food on your place setting, the dishwasher may be malfunctioning. Insist on replacements. As an extra precaution, you can dip your fork or chopsticks into a cup of hot tea to sanitize them before eating. If you don't drink tea, ask for a cup of boiling hot water for this purpose.

Fork marks in solid cuts of meat. The interior of solid muscle meat is generally sterile--even when cooked medium-rare (the exterior should be seared). However, a fork or knife may have transferred surface bacteria to the interior before the meat was cooked. These germs can survive and possibly multiply unless the meat is cooked well-done.

Temperature control. Salads and cold entries should be crisp and cold to the touch. Wilted or brown-edged lettuce leaves do not bode well for the freshness and safety of salad-bar items. Hot foods should be steaming when delivered to your table. If food that is supposed to be cold or hot is served at room temperature, send it back to the kitchen, or order something else.

Really hot buffets. Steam ought to be rising from hot foods on buffet tables, which should maintain food temperature at 140 degrees Fahrenheit or higher. Try to select your portion from the bottom of the steam table, where the temperature is highest.