Infection Control Assessment and Oversight of Food Services at

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Infection Control Assessment and Oversight of Food Services at

Children’s Hospital Los Angeles

Mary Virgallito

Manager of Infection Prevention and Control

March 2012

Objectives

Upon completion of this presentation the audience will:

Briefly discuss experience with opening new patient tower

Review requirements of TJC, CMS, and CA State Law Title 22 as they relate to Infection Control oversight of Food Services

Describe the key areas of focus for Infection Control Oversight of

Food Services recommended by APIC

Discuss employee health issues specific to food services.

Identify Infection Control issues specific to the process of food preparation, handling, and service in the hospital setting.

Identify key points in performing a comprehensive Food Service

Risk Assessment

Children

s Hospital Los Angeles

Founded in 1901;first pediatric hospital in

Southern California

Admits 11,000 inpatients per year

317 beds, 85 percent of which are private rooms.

35 pediatric critical care beds

Affiliated with the Keck

School of Medicine,

University of Southern

California

Magnet Hospital by the

American Nurses

Credentialing Center

The New Patient Tower -

Marion and John E. Anderson Pavilion

Preparation for Licensing – Mock Survey Experience

Focused heavily on

Environment of Care

New equipment and associated processes

New workflow

Cleaning and disinfection

Infection Prevention and Control

New facility had a completely new kitchen and cafeteria

Mock licensing survey demonstrated the need for a greater focus on IC principles in Food Services

LA County DPH licensing survey team would include a Registered

Dietician

Regulatory Requirements For Infection

Control in Food Services

Requirement

Infection Control Oversight of Safety in Food Handling

The Joint Commission

Governing Agency

CMS

 

CA Law: Title22

Risk Assessment

Infection Control

Education

 

Employee Health Services

APIC: Preventing Infections in Food Services

Purchasing and receiving food

Maintaining clean and functional work areas

Oversight of policies and procedures

Example: Managing and cleaning ice and vending machines

Cleaning, disinfection, and sanitation practices

Compliance with local health department regulations

Infection Prevention and Control education of staff

Preventing Infections in Food Measures -

Purchasing and Receiving

Purchasing food from a reputable dealer, an essential first step in preventing food borne illness from intrinsic contamination

Work with the Director of Food Services to ensure documentation of food purchased

Food should be free from extreme alterations in temperature; shipments need to be scheduled to ensure proper freezer or cold storage is maintained.

Ensure proper receiving procedures are in place

Food needs to be inspected and approved when it is brought into the facility.

Ensure logs of testing are kept and staff know criteria for accepting and rejecting product to prevent problems from intrinsic contamination.

Preventing Infections in Food Measures - Common Pathogens

Associated with Intrinsic Contamination

Campylobacter spp., Escherichia coli, and

Salmonella

spp. have all associated with beef, pork, poultry, eggs, and peanut butter

Hepatitis A associated with shellfish

Trichinella spiralis

associated with pork

Enterohemorrhagic E. coli 0157:H7 has been associated with undercooked beef

Listeriamonocytogenesis

associated with ready to eat foods like luncheon meats, soft cheeses, and imported natural cheeses.

Preventing Infections in Food Measures –

Food Storage

Ensure steps are taken to prevent cross contamination of food during storage:

Ensure the facility refrigerators and freezers are at properly monitored with complete logs.

Make sure that if the temps are out of range that documentation of what was done to correct it is present.

Cooked foods must be stored above raw foods

Raw animal foods should be separated from raw ready to eat foods during storage, preparation, holding, and display

All foods should be properly wrapped or covered

Preventing Infections in Food Measures –

Food Preparation

Ensure staff know appropriate steps for food preparation:

Thoroughly wash all raw unprocessed fruits and vegetables under running water before use

Discard any food that comes out of broken packages or swollen cans.

Discard any food that has an abnormal appearance or odor.

Individual portions of food once served will be discarded.

Protect unwrapped foods with sneeze guards.

Single service articles are discarded after one use.

Preventing Infections in Food Measures –

Serving Food

Prepared food is transported to other areas in closed food carts or covered containers (use separate carts for serving clean trays and collecting dirty trays).

Food is served with clean tongs, scoops, forks, spoons, spatulas, or gloves to avoid direct contact with food.

All HACCP Guidelines are observed for heating, cooling, and handling foods that are cooked, cooled and reheated for service.

When checking temperatures on foods for quality control ensure that thermometers are cleaned appropriately before and after checking the food.

Ensure that foods prepared to be served at a later time are cooked, chilled, and reheated at appropriate temperatures to prevent contamination or microbial growth.

Preventing Infections in Food Measures –

Kitchen Equipment and Maintenance

Staff use rubber cutting boards and make sure they are washed and sanitized in between uses

Staff dispose of china or plastic ware that is chipped or has lost its glaze.

All food grinders, choppers, and mixers should be cleaned, sanitized, completely dried, and reassembled after each use.

Dishwashers should be drained and flushed daily. Make sure it maintains a final sanitizing rinse of 180

°

F and wash water of

150

°

F

The exterior of the ice machines should be cleaned daily.

All serving carts must be sanitized. Ensure carts that collect soiled trays are sanitized as well.

Preventing Infections in Food Measures - Food Service Staff

All food services employees must be free of active or communicable diseases (skin lesions, boils, gastrointestinal or respiratory infection)

If staff are ill with the se conditions or out ill for 5 or more days they need to have clearance from their personal physician prior to returning to work.

Food Handlers with diarrhea must be removed from duty until they are asymptomatic.

Individuals identified as chronic carriers of salmonella or shigella are not permitted to work in food services.

Ensure that your facility and/or contracted service has an Infection

Control Employee Health Services Policy that defines which illnesses prohibit staff from working and the process for returning to work.

Preventing Infections in Food Measures -

Education

Food Services Staff require Infection Prevention education

Upon Hire

Annually

As needed based on survey or assessment results

Infection Prevention education must be tailored specifically to

Food Services Staff – focus on what preventative steps are and why they are taken

Education must incorporate information on health and safety regulations for food preparation and handling.

Discuss basic general principles of IC such as Hand Hygiene,

Cleaning and Disinfection, and Transmission Based Precautions as they relate to patient food services.

Preventing Infections in Food Measures -

Education

Food Services staff received a one hour lecture on principles of Infection Control in Food Services.

Repeated biannually

Included a post-test to identify areas that require more intensive focus and instruction.

IC and Food Services Management work closely together to provide the staff with information on Infection

Control processes and cleaning and disinfection requirements

Infection Control conducts an annual inspection which is reported to the hospital infection Control Committee

Preventing Infections in Food Measures –

Policy and Procedures

Infection Control policies should:

Incorporate food services specific issues

Care and Maintenance of Vending Machines / Ice Machines

Infection Prevention and Control policies for Contracted

Services

Ensure consistency with IC principles and policies

Ensure policy for restriction of ill staff is in place

Ensure facilities has proper policy for care and maintenance of food services equipment

Ongoing IC Risk Assessment -

Comprehensive Food Safety Inspections

A comprehensive Food Safety Inspection should be completed

Accurately assess risk for food borne illness

Allows for specific risks to be identified and appropriate action plans developed

At CHLA Infection Control completes a comprehensive food safety inspection annually in Food Services.

Any items found to be out of compliance on this unannounced inspection are placed on an action plan and presented to the hospital Infection Control

Committee.

Food Services Documentation

“Toolkit”

Review of Regulatory Compliance Requirements

Infection Control Food Service Worker Education Powerpoint

Infection Control Food Service Worker Assessment Test

Food Services Infection Control Risk Assessment

Blank Action Plan for Follow up of Items Identified in

Risk Assessment

Sample Policies and Procedures

References

APIC Text of Infection Control and Epidemiology. Chapter 58: Food and

Nutrition Services, 2009

QUESTIONS….

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