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

• 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


• 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.

• 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

APIC Text of Infection Control and Epidemiology. Chapter 58: Food and
Nutrition Services, 2009