According to USDA, the National School Lunch Program and the National School Breakfast Program share the goals of improving children’s nutrition, increasing lower-income children’s access to nutritious meals, and supporting the agricultural economy. USDA’s commodity program contracts for the purchase of food for these programs with manufacturers that it selects through a competitive bidding process. At the state level, state education departments typically administer the meals programs and forward the commodity selections of individual schools to USDA’s commodity program, which purchases and distributes the food selected by schools. In 2009, schools most commonly ordered chicken, mozzarella cheese, potatoes, and ground beef items purchased by the commodity program, in addition to fresh produce purchased for the commodity program by DOD in conjunction with DOD’s large-scale efforts to supply fresh produce to its troops. Overall, USDA provides about 15 to 20 percent of the food served in school meals. Schools purchase the remainder independently using their own procurement practices, either purchasing foods directly from manufacturers or distributors or contracting with food service management companies that procure the food for them. Three agencies within USDA are primarily responsible for the planning, purchase, allocation, and distribution of commodities to states and school districts: the Food and Nutrition Service, the Agricultural Marketing Service, and the Farm Service Agency (referred to collectively in this report as USDA’s commodity program). In addition to administering the National School Lunch Program and the National School Breakfast Program, the Food and Nutrition Service has overall authority to administer USDA’s commodity program and coordinate all commodity orders submitted by states. The Agricultural Marketing Service purchases meats, poultry, seafood, fruits, and vegetables; while the Farm Service Agency purchases dairy products, grains, peanut products, and other items. Virtually all food for sale in the United States must comply with federal food safety laws and regulations. Federal efforts for ensuring food safety include focusing on preventing or reducing contamination by bacterial pathogens such as E. coli O157:H7, a toxin-producing strain of the intestinal bacterium E. coli; Salmonella; and Campylobacter; and monitoring levels of other bacteria, such as generic E. coli and fecal coliforms, which indicate the extent to which food was produced under sanitary conditions. USDA, through its Food Safety and Inspection Service (referred to throughout this report as USDA’s meat and poultry regulatory program), is responsible for ensuring the safety of meat, poultry, and processed egg products, and FDA is responsible for ensuring the safety of virtually all other food products, including grains, nuts, and produce. GAO has reported that federal oversight of food safety remains fragmented in several areas, and that this fragmentation has caused inconsistent oversight, ineffective coordination, and inefficient use of resources. Existing statutes give these agencies different regulatory and enforcement authorities. For example, food products under USDA’s jurisdiction must generally be inspected and approved as meeting federal standards before being sold to the public. Under current law, thousands of regulatory inspectors of meat and poultry are to maintain continuous inspection at slaughter facilities and examine all slaughtered meat and poultry carcasses. They also visit other meat- and poultry-processing facilities at least once each operating day. FDA is responsible for ensuring that all foods it regulates are safe, wholesome, and properly labeled. To carry out its responsibilities, FDA has authority to, among other things, conduct examinations and investigations and inspect food facilities. But unlike foods regulated by USDA, food products under FDA’s jurisdiction may be marketed without FDA’s prior approval. For fresh cut fruits and vegetables, FDA has issued guidance, which food manufacturers may voluntarily use to minimize microbial contamination. FDA has also established regulations that serve as the minimum sanitary and processing requirements and may take enforcement actions against firms that do not comply with these requirements. Under the FDA Food Safety Modernization Act, the agency is required to promulgate regulations for produce safety that would establish science-based minimum standards for the safe production and harvesting of certain raw fruits and vegetables for which FDA determines such standards could minimize the risk of serious adverse health consequences or death. While food may be contaminated by many different bacteria, viruses, parasites, toxins, and chemicals, this report focuses on disease-causing, or pathogenic, bacteria. Contamination may take place during any of the many steps in growing, processing, storing, and preparing foods. Some potentially life-threatening pathogens live in soil, water, or the intestinal tracts of healthy birds, domestic animals, and wildlife. As a result, produce may become contaminated if irrigated with tainted water, and the carcasses of livestock and poultry may become contaminated during slaughter if they come into contact with small amounts of intestinal contents. Foods that mingle the products of many individual animals— such as bulk raw milk, pooled raw eggs, or raw ground beef—are particularly susceptible, because a pathogen from any one of the animals may contaminate the entire batch. A single hamburger, for example, may contain meat from hundreds of animals. Pathogens can also be introduced later in the process—such as after cooking, but before packaging—or by unsanitary conditions—including contact with infected food handlers or contact with contaminated equipment or surfaces. Still, pathogens are generally destroyed when foods are properly cooked. In addition, the presence of pathogens can be greatly reduced by subjecting food to ionizing radiation, known as food irradiation. On the basis of extensive scientific studies and the opinions of experts, we reported in 2000 that the benefits of food irradiation outweigh the risks. According to the Centers for Disease Control and Prevention (CDC), foodborne disease is a major cause of illness and death in the United States. CDC routinely gathers information from local and state health departments and laboratories and reports information about a range of foodborne illnesses and the foods with which they are associated. In 2011, CDC estimated that approximately 48 million people become sick, 128,000 are hospitalized, and 3,000 die each year from foodborne diseases. CDC attributed about 90 percent of the illnesses, hospitalizations, and deaths having a known cause to eight pathogens, including four bacteria— Salmonella, Campylobacter, E. coli O157:H7, and Listeria monocytogenes—that are included in USDA’s regulatory oversight of meat and poultry and in the purchasing specifications of USDA’s commodity program (see table 1). The four other pathogens are norovirus, Clostridium perfringens, and Staphylococcus aureus—which are most often spread by improper food handling or contamination by infected food handlers—and Toxoplasma gondii, a parasite commonly found in people and the environment that typically does not result in illness. The commodity program requires testing for Staphylococcus aureus as an indicator of poor sanitary handling or preparation conditions in raw ground beef, diced cooked chicken, and baby carrots. Information reported to CDC shows hundreds of instances of foodborne outbreaks affecting children in schools during a recent 10-year period. An outbreak occurs when two or more similar illnesses result from the consumption of a common food. According to CDC documents, many clusters of illnesses are not investigated or reported to CDC because of, among other reasons, competing priorities at state and local health agencies, and because only a small proportion of all foodborne illnesses reported each year are identified as associated with outbreaks. Nevertheless, based on CDC’s outbreak data for the 10 years from 1999 through 2008 (the most recent year for which data are available), we identified 478 foodborne outbreaks, affecting at least 10,770 children, that were associated with schools. Although these outbreaks were associated with foods prepared or consumed at schools, they do not all relate to food served as part of school meal programs. For example, the implicated food may have been prepared at home and consumed at school as part of an event. Nevertheless, the number of outbreaks associated with schools represents about 4 percent of the approximately 12,000 foodborne outbreaks reported to CDC during that period by state and local public health agencies. As with foodborne disease outbreaks generally, most outbreaks associated with schools could not be attributed to a single contaminated ingredient, and many outbreaks’ association with a pathogen could not be confirmed by a laboratory. We found that Salmonella was among the most common bacterial pathogens identified as causing outbreaks associated with schools. Moreover, when outbreaks associated with schools could be linked to a specific food, they were most commonly associated with contaminated ingredients such as poultry, fruits, grain and bean products, dairy, beef, leafy vegetables, and pork. For seven of the foods it purchases, the commodity program’s specifications related to microbial contamination are more stringent than federal regulations for those foods in the commercial marketplace. Nevertheless, the program’s more-stringent purchasing specifications may not apply to all foods and pathogens of concern. For 7 of the approximately 180 commodity foods offered to schools, USDA’s commodity program has established purchasing specifications with respect to microbial contamination that are more stringent than the federal regulations for the same foods available in the commercial marketplace. For example, the commodity program will not purchase raw ground beef that tests positive for Salmonella. On the other hand, USDA regulations for commercially available raw ground beef tolerate the presence of a certain amount of Salmonella. Specifically, a facility meets regulatory performance standards if, on the basis of USDA’s regulatory inspections, 7.5 percent or less of raw ground beef samples the agency collects test positive for Salmonella. In addition, while the commodity program rejects all raw boneless or ground beef that tests positive for E. coli O157:H7, USDA regulations allow such beef to enter commerce if it is first cooked. Moreover, the commodity program, through its purchasing specifications, rejects ground turkey and diced cooked chicken if microbial testing reveals levels of certain bacteria, which indicate deficiencies in sanitation during production of these foods, are above established limits. Federal regulations, on the other hand, do not require that these same foods destined for the commercial marketplace be tested for these organisms. Table 2 lists the seven foods for which the commodity program’s purchasing specifications related to microbial contamination are more stringent than federal regulations.