On a Nile cruise I saw crew washing dishes in the spew from the bilge pump.
If you see a cockroach in a resturant, it usually means he is dying. They run from the light unless they are too poisoned to see straight. I've seen roaches in three-star joints.
Here in DC the same government that runs the dysfunctional schools and the cratered roads also runs the health department. I stick to top-rated joints and hope for the best. We also keep our shots current.