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.

F812 FOOD SAFETY

REQUIREMENTS

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 gardens, subject to compliance with applicable safe growing and food-handling practices.

• (iii) This provision does not preclude residents from consuming goods and procured by the facility.

• §483.60(i)(2) Store, prepare, distribute, and serve food in accordance with professional standards of food service safety;

F812 INTENT

• 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 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.

F813 Personal Food Policy

The facility must:

• §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.

F813 GUIDANCE

• The facility must have a policy regarding food brought to residents by family and other visitors. The policy must also include ensuring facility staff assists the resident in accessing and consuming the food., if the resident is not able to do so on his or her own. The facility also is responsible for storing food brought in by family or visitors in a way that is either separate or easily distinguishable from facility food.

• The facility has a responsibility to help family and visitors understand safe food handing practices. If the facility is assisting family or visitors with reheating or other preparation activities, facility must use safe food handling practices.

F814 DISPOSE OF GARBAGE AND REFUGE

PROPERLY

• 483.60(i)(4) Dispose of Garbage and Refuge Properly

Interpretive Guidelines

• The intent of this regulation is to assure that 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.

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

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 & swine

• Shigellosis – feces

• Listeria – unpaterized milk & soft cheeses, prepared deli foods

• Staphylococcus aureus-reheated improperly held foods

• Clostridium perfringens - meat & beans

• Bacillus cereus – rice products, starchy foods

• Clostridium botulinum – (Botulism) improperly canned foods, time temp abused foods, baked potatoes

• E Coli – feces, undercooked ground beef, unpasterized jc.

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.

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

Legionellapneumophila

Bacteria Legionnaires’ Disease 4,000 - 18,000 hospitalizations annually in US. Fatality rate 5 – 30%

Salmonella, L. mono, E. coli O157:H7, Others

Bacteria Foodborne disease Elderly often most susceptible

* Source: US Centers for Disease Control – annual estimates

Infections: Common in LTC16

Norovirus: Virus causing “stomach flu” or vomiting and diarrhea- 62% outbreaks in LTC

Influenza: Respiratory infection with severe fever

MRSA: Bacteria that is difficult to treat.- Can be life threatening infection in the bloodstream

VRE: Bacteria in intestine that can cause infections - Symptoms are fever and lesions

C-Diff (Clostridium difficile): Bacteria causing diarrhea and serious intestinal issues - Can be painful and sometimes life threatening

What do all of these infections have in common?

All are easily transmitted; person

to person or from hard surfaces!

Life span on surface: 3 weeks!

Life span on surface: > 5 months

Life span on surface: 4 months

Life span on surface:9 months

Life span on surface:Few days

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

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

Danger Zone

• 40-135° F

• Thaw Properly

• Cool Quickly

Potentially Hazardous Foods & Bacterial Growth

Meat

Poultry

Fish/shellfish

Milk Product

Eggs

Garlic

Cut Melon

Soy Products

Gravy & Cream Sauce

Soups

Sprouts (bean, alfalfa, etc.)

Pudding and Custards

Baked Potato

Cooked Rice

Cooked pasta

10 most common causes of FBI

• Improper cooling

• 12+ hrs between prep & eating

• Infected food handler

• Inadequate reheating

• Improper hot-holding temps

• Contaminated ingredients

• Food from unsafe sources

• Improper cleaning

• Cross – contamination

• Inadequate cooking

Clean vs Sanitary

• Clean means the removal of visible dirt

• Sanitize means reducing the number of bacteria to a safe level

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

HACCAP

Identify HazardsDetermine

Critical Control Points

Implement Controls

Monitor ControlsTake Corrective

Action

Record Keeping &

DocumentationVerification

Training Plan

• Orientation

• Training time frame for each position

• How will initial core competencies be met?

• How will you continue with ongoing education?

Questions?

Thank You!

Elaine Farley-Zoucha, RD, LMNT

EZ Nutrition Consulting, PC