4/9/2018

The Essentials of Health Care Food Safety

• Elaine Farley‐Zoucha, RD, LMNT • EZ Nutrition Consulting, PC

Objectives • Review the CMS regulations for food safety and sanitation. • Identify how food becomes unsafe • Identify core competencies for the health care food service employee • Establish a plan to implement an effective training and monitoring program in your food service department.

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The Facility Must: • §483.60(i)(1) ‐ Procure food from sources approved or considered satisfactory by Federal, State or local authorities. • (i)This may include food items directly from local producers, subject to applicable State and local laws/regulations. • (ii) This provision does not prohibit or prevent facilities from using produce grown in facility F371 FOOD gardens, subject to compliance with applicable safe growing and food‐handling practices. • (iii) This provision does not preclude residents from SAFETY consuming goods and procured by the facility. • §483.60(i)(2) Store, prepare, distribute, and serve food REQUIREMENTS in accordance with professional standards of food service safety; • §483.60(i)(3) Have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption.

• The intent of this requirement is to ensure that the facility: • Obtains food for resident consumption from sources approved or considered satisfactory by Federal, State, local authorities; and • Follows proper sanitation and food handling F371 INTENT practices to prevent the outbreak of foodborne illness. Safe food handling for the prevention of foodborne illnesses begins when food is received from the vendor and continues throughout the facility’s food handling processes.

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• 483.60(i)(4) Dispose of Garbage and Refuge F372 DISPOSE Properly OF GARBAGE Interpretive Guidelines AND REFUGE • The intent of this regulation is to assure that PROPERLY garbage and refuse be properly disposed.

Sanitary Condition

 “Sanitary conditions” is defined as storing, preparing, distributing, and serving food properly to prevent food borne illness.  Potentially hazardous foods must be subject to continuous time/temperature controls in order to prevent either the rapid and progressive growth of infectious or toxigenic micro‐ organisms such as Salmonella or the slower growth of Clostridium Botulinum.  In addition, foods of plant origin become potentially hazardous when the skin, husk, peel, or rind is breached, thereby possibly contaminating the fruit or vegetable with disease causing micro‐organisms.  Potentially hazardous food tends to focus on animal products, including but not limited to milk, eggs and poultry.

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Food Borne Illness

• An illness caused by bacteria or other pathogen in food. • Who is at risk? • Very young children • Pregnant Women • Elderly • People with compromised immune systems

Type of Contaminants

• Biological‐ Bacteria, viruses & parasites • Physical – hair, glass, metal shavings, etc. • Chemical – cleaning chemicals, improper concentration of sanitizer

PREVENTION IS IMPORTANT

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Bacteria – greatest concern

• Living, single‐celled organisms • Carried by food, water, soil, humans, or insects • Reproduce rapidly • Some can survive freezing • Some can turn into spores, a change that protects them form unfavorable conditions • Some can produce toxins, which are not typically destroyed by cooking.

Major Foodborne Illness caused by Bacteria

• Salmonella – poultry & • Clostridium perfringens swine ‐meat & beans • Shigellosis – feces • Bacillus cereus – rice products, starchy foods • Listeria – unpaterized • Clostridium botulinum milk & soft cheeses, – (Botulism) improperly prepared deli foods canned foods, time temp • Staphylococcus aureus‐ abused foods, baked reheated improperly held potatoes foods • E Coli – feces, undercooked ground beef, unpasterized jc.

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Viruses

• Smallest of the microbial food contaminants • Rely on living host to reproduce • Usually contaminate food through food handler’s improper personal hygiene. • Some can survive freezing and cooking temperatures.

Major Illnesses Caused by Viruses

• Hepatitis B – feces contaminated water, fruit & juices, any food that will not receive further heat treatment. • Norovirus – feces contaminated water, RTE foods including salads, bakery products, salad dressings • Rotavirus – feces contaminated water, water & ice and RTE foods.

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Common Viral & Bacterial Infections

Infectious Organism Type Disease Facts and Figures – US* Norovirus Virus Acute gastroenteritis 21 million illness, 70,000 hospitalizations, 800 deaths. Very young and elderly suffer the most influenza Virus Seasonal flu Range from 3,000 – 49,000 deaths. 90% of deaths occur in people 65 years and older rhinovirus Virus Common cold One of over 200 different viruses causing the common cold Clostridium difficile Bacteria CDI (C. diff infection) 14,000 deaths; $1 B in additional healthcare costs MRSA Bacteria Staph infections Pneumonia, bacteremia, endocarditis, osteomyelitis Legionella Bacteria Legionnaires’ Disease 4,000 ‐ 18,000 hospitalizations annually in US. pneumophila Fatality rate 5 – 30% Salmonella, L. mono, E. Bacteria Foodborne disease Elderly often most susceptible coli O157:H7, Others

* Source: US Centers for Disease Control – annual estimates

14 Infections: Common in LTC

Norovirus: Virus causing VRE: Bacteria in intestine that “stomach flu” or vomiting and can cause infections diarrhea ‐ Symptoms are fever and ‐ 62% outbreaks in LTC lesions Life span on surface: Life span on surface: 3 weeks! 4 months

Influenza: Respiratory infection C‐Diff (Clostridium difficile): with severe fever Bacteria causing diarrhea and Life span on surface: serious intestinal issues Few days ‐ Can be painful and sometimes life threatening Life span on surface: MRSA: Bacteria that is difficult to > 5 months treat. What do all of these infections ‐ Can be life threatening infection in the bloodstream have in common? Life span on surface: All are easily transmitted; person 9 months to person or from hard surfaces!

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Parasites

• Organism that needs a living host • Proper cooking and freezing will kill parasites • Avoiding cross contamination and proper handwashing can prevent this

Fungi

• Mold, yeast, and mushrooms • Most often cause food spoilage

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FAT TOM: What microorganisms need to grow

• Food • Specifically protein and carbohydrate • These proteins are commonly found in potentially hazardous food items such as meat, poultry, dairy products, and eggs. • Acidity • Do not grow in alkaline or highly acid environments • Grow best in slightly acidic or neutral pH of 4.6‐7.5 • Temperature • Most grow well between 41‐135° F – DANGER ZONE • Exposing to temps outside the danger zone does not guarantee to kill microorganism • Food must be handled carefully when it is thawed, cooked, and reheated

FAT TOM

• Time • Bacteria can double in 20 min, limit time in danger zone • Oxygen • Some need oxygen and others don’t • Moisture • Require water to grow, moist food items potentially hazardous food items

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Danger Zone

• 40‐135° F • Thaw Properly • Cool Quickly

Potentially Hazardous Foods & Bacterial Growth Meat Soy Products Poultry Gravy & Cream Sauce Fish/shellfish Soups Milk Product Sprouts (bean, alfalfa, Eggs etc.) Garlic Pudding and Custards Cut Melon Baked Potato Cooked Rice Cooked pasta

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10 most common causes of FBI • Improper cooling • Food from unsafe • 12+ hrs between prep sources & eating • Improper cleaning • Infected food handler • Cross – contamination • Inadequate reheating • Inadequate cooking • Improper hot‐holding temps • Contaminated ingredients

Clean vs Sanitary • Clean means the • Sanitize means removal of visible dirt reducing the number of bacteria to a safe level

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Hand Washing & Personal Hygiene & Proper Glove Use

How to Identify Core Competencies for FSD

• Evaluate type of food service • Evaluate the menu and what is needed to prepare daily • Evaluate job duties and descriptions • Basic knowledge of Nutrition and Dietary related regulations and Food Code • Types of equipment used in your department • Utilize HACCP as well

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HACCAP

Determine Record Keeping Implement Take Corrective Identify Hazards Critical Control Monitor Controls & Verification Controls Action Points Documentation

Training Plan

• Orientation • Training time frame for each position • How will initial core competencies be met? • How will you continue with ongoing education?

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