Operational and structural risk factors associated with foodborne outbreaks in Malaysian food service establishments

Abstract Foodborne illnesses remain a persistent threat to public health as well as the reputation and the sustainability of food service businesses. This study examined 225 food service establishment (FSE) inspection records (2022–2023) classified into outbreak-associated, routine, and control groups to identify the compliance factors most strongly linked to outbreak risk. Comparative analysis, and network-based analysis were applied to assess compliance trends, identify key risk elements, and explore interaction patterns among violations. Outbreak-associated establishments exhibited higher non-compliance, particularly in critical control (PR1), supplier verification (PR2), cross-contamination prevention (PR3), flooring (B5), and food contact surfaces (E13). Routine and control inspections showed similar compliance profiles, indicating comparable baseline standards. Network analysis uncovered distinct interaction structures in outbreak-associated networks, with structural integrity (B6, B5) and food handler training (FH12) functioning as highly influential nodes. Strong co-occurrences, such as B5–equipment (E15) and PR3–drainage system maintenance (D20), highlight how operational and structural lapses combine to elevate outbreak risks. These findings carry important implications for food service businesses and regulators. For operators, monitoring high-risk compliance areas provides a basis for proactive risk management, reducing the likelihood that minor issues evolve into major outbreaks. For regulators, the findings suggest that the inspection framework should evolve beyond isolated violations to prioritize risk-sensitive and system-based indicators. Together, these insights provide both business and policy stakeholders with a roadmap for strengthening food safety resilience, safeguarding public health, and protecting customer trust in food service operations.