`Food Safety Matters’:
Work Pack
2013
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bettertogether
Contents
Page
Introduction
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What the Law says
4
The history of food safety
5
What is food safety?
6
Importance of Food Safety
6
What is food poisoning?
6
Food Safety Hazards
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Microbiological hazards
Chemical hazards
Allergenic hazards
Physical hazards
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The main causes of food poisoning
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Visual signs of poor hygiene conditions
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The Four C’s
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Cleaning
Cooking
Chilling
Cross-Contamination
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Food safety in the community
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Food at work and you
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Overview of strategies to prevent food poisoning
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Summary: Prevention of Food Poisoning
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References
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Introduction
It has been suggested that in the UK 5.5 million people contract food-borne illnesses each year.
Most of us experience food poisoning when we are in a fit and healthy state and so, by and large,
we manage to survive. This is not always the case for vulnerable and ill people who are at a higher
risk of contracting food-borne illnesses and becoming seriously unwell. Food hygiene and food
safety is therefore an area of extreme importance. The potential risk for food poisoning is
enormous, and when things do go wrong the consequences can lead to serious illness and deaths,
possibly involving large numbers of people. People receiving healthcare and requiring food want to
be assured that what they are eating is safe and not contaminated. Food Hygiene is therefore
about measures taken to ensure food is wholesome and safe.
It is a requirement under the Food Hygiene Regulation 2006 (Regulation (EC) No. 852/2004 on
hygiene of food stuffs and The Food Hygiene (England No. 2) Regulations Great Britain 2006) that
all ‘food handlers’ are either supervised, instructed and/or trained in food hygiene practices
commensurate with their work. A ‘food handler’ is defined as anyone involved in the food service
operation including storage, preparation, transportation and serving of food and drink whether open
(unwrapped) or packaged. Food includes drinks, ice infant feeds including artificial formula and
expressed breast milk.
As a student, you may be responsible for the preparation, cooking/reheating or serving of food
eaten by service users. Failure to handle food correctly can result in legal action being taken
against the organisation and the individual member(s) of staff concerned. As a food handler, you
must maintain a high standard of personal hygiene. Also, remember that you have a legal duty to
ensure that this food is safe to eat and free from contamination.
All people working in a food handling area must wear suitable protective clothing. The standards of
clothing may differ depending upon the duties being carried out. However, the following are
considered as a minimum requirement:
 Personnel preparing open food must wear a clean, uniform or similar, plus a disposable
apron
 Do not wear uniforms when travelling to work
As a ‘food handler’ you must also practice good personal and hand hygiene. This includes:
 Ensuring they have clean hands when handling food.
 Wearing aprons as per NPSA (2007) colour coding for handling and distributing food.
 No smoking – many health and social care organisations are smoke-free.
 No eating or drinking whilst handling food.
 Not wearing jewellery (a plain band ring is acceptable), false nails or nail varnish.
 Covering wounds likely to cause risk of contamination of foods. Staff who report for duty
with a dressing on should have it changed before they enter a food area.
 Any loss of dressings must be reported immediately.
 Employees with open wounds must be excluded from food handling areas e.g. production
kitchen/ward kitchen.
 Food handlers known or suspected of having or carrying, any food transmitted disease
must be prohibited from practising if there is a risk of cross-contamination with pathogenic
micro-organisms.
Personal illness MUST be reported because food poisoning bacteria can be carried on/in the body
and thereby passed to food. Students must always report immediately illnesses to the relevant
Clinical Team Leader, Practice Support Line (PPO) and the Occupational Health Department.
These include:
 Diarrhoea
 Vomiting
 Septic conditions
 Skin infections
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This work package begins with a discussion regarding various organisms that cause foodborne
illness in humans and their epidemiology. It will also explore how organisms are transmitted and
address prevention and control measures to assure food safety. This work package is designed to
outline the practical methods of handling food in order to minimise risk of contamination and
therefore food borne illness. Throughout this work package, you will be asked to think about how
this information can be used when you are handling food, and to identify situations that reflect the
topic being discussed. These will be found in shaded boxes. You are required to complete these
activities and put your completed book and print out from your MCQ into your practice portfolio.
Once you have completed the MCQ, please print two copies of your MCQ results (you must gain
85% to pass). Please give one print out to your Academic Personal Tutor and show your practice
mentor your completed workbook and your print out of attaining 85% for your MCQ. You can
access the MCQ from the Clinical Skills pages at http://learntech.uwe.ac.uk/cs/food-hygiene.aspx
you will need to log in with your password. The test is found in the MCQ file on the left hand menu.
Studying and completing the exercises will help you to:
– comply with the law
– demonstrate safe standards of practice
– Maintain the safety and well-being of service users
– protect your organisation and Profession’s reputation
What the Law Says
Keeping food safe is a legal requirement and failure to do so can lead to prosecution. It is essential
that food and drink provided in the community and hospital health care environment is managed
and handled in a manner that it does not pose any risk to children, families, visitors or staff. All staff
involved in working with food must ensure good food hygiene practices at all times. Under the
Food Safety Act (GB 1990), water and ice are classed as food and therefore must be handled with
the same good food hygiene practices as food. Failure to do so could result in a serious outbreak
of food poisoning and potential loss of life.
Following the food poisoning outbreak at Stanley Royal Hospital in August 1984, Crown Immunity
was lifted from NHS hospitals in February 1987. Consequently ALL ASPECTS of hospital catering
are now subject to control under the Law. Under the Health and Social Care Act (GB 2008), The
Code of Practice for the NHS on the prevention and control of healthcare associated infections it is
a requirement that there is a food hygiene policy within Hospitals and Community HealthTrusts.
The Food Hygiene (England) Regulations 2006 provide the framework for the EU legislation to be
enforced in England. There are similar regulations in Wales, Scotland and Northern Ireland. The
Food Safety (General Food Hygiene) Regulations 1995 and the Food Safety (Temperature
Control) Regulations 1995 do not apply anymore. Many of the requirements of these regulations
are included in the new EU legislation. The main new requirement is to have 'food safety
management procedures' and keep up-to-date records of these.
The Food Hygiene (England) Regulations (GB 2006) requires that all food business operators shall
put into place, implement and maintain a permanent procedure based on the principles of Hazard
Analysis Critical Control Points (HACCP). The HACCP principles referred to consist of the
following;
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Penalties under the Act
 Unlimited fines or up to 2 years imprisonment or both, could be imposed on the
responsible employee and his or her superiors. It is therefore vital for all concerned that
every effort is made to avoid an offence.
Defence to Charges under the Act
 To properly defend a possible charge under the Act, we must be able to prove ‘due
diligence’.
The three basic EU food hygiene regulations are:
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Regulation (EC) 852/2004 on the hygiene of foodstuffs (EU 2004)
Regulation (EC) 853/2004 laying down specific hygiene rules for food of animal origin (EU 2004)
Regulation (EC) 854/2004 laying down specific rules for the organisation of official controls on
products of animal origin intended for human consumption (EU 2004)
Managers must put in place ‘food safety management procedures’ based on the principles of
HACCP (hazard analysis and critical control point). HACCP is a way of managing food safety. It is
based on putting in place procedures to control hazards. In practice, this means that you must
follow the procedures that have been put in place to manage food safety ‘hazards’ in your Trust.
The Local Authority Environmental Health Officer has open access to all Trusts and can inspect
these areas at any time. All ward kitchens and ward refrigerators are bound by legal requirements
and therefore are subject to, and must conform to Food Hygiene Regulations. Documented
systems must be in place such as the ‘Safer Food Better Business Package’ (FSA
2010)
The History of Food safety
During the early 20th century, contaminated food, milk and water caused many foodborne
infections. The ‘sanitary revolution’ began in an attempt to eliminate disease organisms before they
reached consumers. Public health departments or sanitation boards helped institute sewage and
water treatment facilities in the early 1900’s in many cities throughout the UK (figure 1). The
sanitary revolution included;
 Sewage and water treatment
 Hand-washing, sanitation
 Pasteurization of milk was developed in 1864 and used in milk in 1908 to decrease
pathogen load
 Refrigeration became available for household use in 1913 which helped decrease the
growth of foodborne pathogens in the home
Before vaccines or antibiotics were discovered, these were the prevention methods taken. Once
microbiology methods were improved, the etiology, characteristics, and sources of foodborne
diseases were able to be identified.
 Animals identified as a source of foodborne pathogens
 Improved animal care and feeding
 Improved carcass processing
Improvements were made regarding healthier animal care, feeding and carcass processing. These
measured improved the quality of the food supply. Improved surveillance, research and outbreak
investigations have helped discover mechanisms of contamination and led to new control
measures through Laws and policies regarding food handling
The various laws and policies that have been implemented to improve food handling that you were
introduced to in the last section, will be discussed further in the epidemiology and
prevention/control sections of this work package.
Figure 1: Early 1900 Sanitation Boards
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What is Food safety?
Food Safety is the action of keeping food free from harm. It is the process of storing, preparing,
cooking and serving ‘safe’ food.
Who Cares and Why?
Saves organisations money in the long run
Avoids you poisoning your service users
Food safety standards increase
Ensures you are compliant with the Law
Food quality standards increase
Organises your process to produce safe food
Organises staff promoting teamwork/efficiency
Due diligence defence in court
Importance of Food Safety
Every year thousands of people experience food borne illness often described as food poisoning,
which can be extremely unpleasant and in some cases life threatening. Particular care needs to be
taken when preparing, cooking and serving food to service users as they are vulnerable to harmful
microorganisms and other hazards. This may be because they are either;
 Neonates
 Under 2 years of age
 Immuno-compromised
 Acutely ill
 Receiving antibiotics and/or steroid medication
Of course anyone can become ill from contaminated food; you might have had food poisoning at
some time in your life. Food poisoning is easy to prevent.
What is Food Poisoning?
Food borne illness or food poisoning is an illness caused from consuming food that contains a
harmful substance, harmful micro-organisms or their toxins. This normally results in some of the
following symptoms:
 Abdominal pain/cramps
 Diarrhoea
 Nausea
 Vomiting
 Fever
 Dizziness
 Headaches
 Flu-like symptoms
These normally occur between 2-48 hours after eating contaminated food. However, some viruses
and bacteria may multiply and symptoms may take days or even weeks to show. Most often food
poisoning results in symptoms which pass reasonably quickly, within a few days. Sometimes the
symptoms result in more acute illness which can be very unpleasant, even leading to long-term
illness. There are approximately 5.4 million cases per year in UK, and death occurring in 200
severe cases per year.
One of the unique factors of foodborne diseases is the variability in incubation times (period from
exposure to the pathogen to the demonstration of clinical signs) of the organisms – see figure 2
below.
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Figure 2: Usual incubation period ranges for select foodborne diseases
Food Safety Hazards
A hazard is something that could be dangerous. And there are lots of different hazards. When we
are talking about hazards in relation to food, a hazard is something that could mean that food will
not be safe to eat. The four main food safety hazards that can make food potentially harmful are;
 Microbiological & Toxins
 Chemical
 Allergenic
 Physical
Microbiological Hazards
Some micro-organisms are used to make foods such as yoghurt and bread. These microorganisms are not harmful. The micro-organisms that can make us sick include:
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Viruses e.g. Rotavirus, Caliciviruses (better known as Norovirus or Norwalk viruses)
Bacteria e.g. Salmonella, E. coli, Listeria
Parasites e.g. Toxoplasma gondii, Trichinella spiralis
Mould e.g. Aspergillus flavus
Micro-organisms such as viruses and bacteria are the most common causes of food poisoning.
But, parasites, natural and manufactured chemicals, and toxins from organisms can also cause
food poisoning. However, bacteria are the most common cause. These micro-organisms include;
Food spoilage bacteria: may cause food to smell or taste ‘off’ or change texture or colour. This
results in food being inedible. See figure 3 below.
Figure 3:
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Food borne virus: these may use food as a mode of transfer, once inside the body, they multiply
and cause illness. For example, Norovirus (Norwalk) is a common virus which can be transferred
of food and food surfaces. Remember, viruses do not require food or moisture to survive, but are
controlled by good hygiene techniques outlined in this work package.
Moulds and yeasts: may grow in food and change its appearance or taste. These contaminate food
and can make it unusable.
Pathogenic bacteria are the main concern of food safety. There are an estimated 250 pathogens
that can cause foodborne related illnesses. Foodborne illness is defined as two or more cases of a
similar illness resulting from ingestion of a common food. It can result from consuming foods
contaminated with various pathogens. In most cases bacteria are the major pathogen followed by
viruses, then parasites. The most commonly recognized foodborne infections are caused by
Campylobacter, Salmonella, E. coli O157:H7. This is because they cause food poisoning without
changing the food taste or appearance.
Transmission
Food safety problems are often caused by these pathogenic bacteria (figure 4),
because they can;
 Spread from hands, equipment or surfaces that have not been
thoroughly cleaned
 Survive in food that is not properly cooked
 Grow and multiply in food that is left out at room temperature or is not
properly chilled
 Spread from raw food to ready-to-eat food if they are not kept separate
Figure 4: Transfer of micro-organisms by hands
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Activity
Think about the food handling tasks you might be required to carry out on your first placement.
This may include:
 Serving food and feeding
 Preparing formula feeds
 Assisting mothers with breast feeding/breast expressing
 Making drinks and working in staff food areas
Identify how individuals, families and colleagues could acquire food borne illness from the food
and drinks you will handle
Important Organisms
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Norovirus (Norwalk) like viruses
Campylobacter
Salmonella
E. coli O157:H7
Clostridium botulinum
Shigella spp
Toxoplasma
Emerging organisms
Although many pathogens can cause foodborne illnesses, we will briefly cover those of greatest
impact. These may also be potential bioterrorism agents for food sources. The pathogens we will
discuss include Norwalk viruses, Campylobacter, Salmonella, E. coli O157:H7, Clostridium
botulinum, Shigella, and recently emerging organisms such as Norovirus (Table 1).
Norovirus (Norwalk)
An outbreak of nausea and vomiting in Norwalk, Ohio in 1968 led to the discovery of Norwalk virus.
Later, other small round structured viruses were identified as causing a similar disease and named
Norwalk-like viruses. They are all members of the Caliciviridae family and have recently been
renamed Norovirus. They are an important cause of sporadic gastrointestinal disease outbreaks
throughout the world. It is considered the most common foodborne infectious agent and an
estimated 23,000 cases occur each year. It is transmitted in the stool and vomit of infected persons
and can be shed for up to 2 weeks. Raw shellfish, such as clams and oysters that are harvested
from sewage contaminated waters may also induce a norovirus infection. Food-handlers who do
not adequately wash their hands may contaminate food or water and spread this disease.
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Small infectious dose; very contagious and can take as small as 10 viral particles to infect
someone
o Signs
 12-48 hours post-exposure
 Nausea, vomiting, diarrhoea, abdominal cramps
 Headache, low-grade fever
 Duration: 2 days
This organism can be shed in the faeces and vomit for up to two weeks, but typically it is
recommended that food-handlers not return to work for 3 days after symptoms subside to prevent
further spread.
Campylobacteriosis
Develops 2- 4 weeks after the Campylobacter infection when, diarrhea signs and symptoms
disappear. Foodborne related illnesses due to campylobacteriosis is increasing in incidence. It is
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caused primarily by Campylobacter jejuni, but also C. fetus and C. coli. It is considered the leading
bacterial cause of foodborne related diarrhoea affecting 2.4,000 people in the UK each year (514% of all diarrheal illnesses worldwide). Usually these are children under the age of 5 and young
adults (15-29 years of age). Very few deaths are caused by this organism. Recently Guillain-Barré
Syndrome has been associated with a small number of Campylobacter cases. This syndrome is
the leading cause of acute paralysis and develops 2-4 weeks after a Campylobacter infection again
that is once diarrhea signs and symptoms disappear.
o
Sources
 Raw or undercooked poultry
 Non-chlorinated water
 Raw milk
 Infected animal or human faeces: Poultry, cattle, puppies, kittens, pet birds
o
Clinical signs
 Diarrhoea, abdominal cramps,
fever, nausea
 Duration: 2-5 days
Salmonellosis
This is a gram negative bacteria, which has many serotypes that can cause foodborne related
illnesses. The ones we most commonly associated with human foodborne illness are S.
typhimurium and S. enteritidis in the UK. They account for about 41% of all human cases reported.
S. newport has been on the rise since 1996. Salmonellosis causes an estimated 1.4 million
reported cases annually with 580 deaths. Salmonellosis is most severe in elderly, infants and
persons with chronic diseases. People with AIDS are particularly vulnerable and often suffer
recurring episodes.
o Sources
 Raw poultry and eggs
 Raw milk
 Raw beef
 Unwashed fruit, vegetables, alfalfa sprouts
 Reptile pets: Snakes, turtles, lizards
o Clinical signs
 Onset: 12-72 hours
 Diarrhoea, fever, cramps
 Duration: 4-7 days
Escherichia coli O157:H7
Escherichia coli, is a pathogen of foodborne related illnesses. Harmless strains of E. coli are found
in nature, including the intestinal tracts of humans and animals. Diarrhoeal disease is caused by
several different strains of harmful E. coli. The most dangerous type is entero-haemorrhagic E. coli
(EHEC). It gets its name because it can cause bloody diarrhoea and can lead to kidney failure in
children or immune-compromised persons. E. coli O157:H7 is the most common EHEC and its
entero-haemorrhagic toxin is what actually causes the disease.
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Surface proteins; toxin
o Sources
 Undercooked or raw hamburger; salami
 Alfalfa sprouts; lettuce
 Unpasteurized milk, apple juice or cider
 Well water
 Animals: Cattle, other mammals
o Clinical signs
 Watery or bloody diarrhoea, nausea, cramps
 Onset: 2-5 days
 Duration: 5-10 days
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o
Sequela
 Haemolytic Uraemic Syndrome (HUS)
 Acute kidney failure in children
 Life threatening
Clostridium botulinum
Botulism is caused by a neurotoxin from Clostridium botulinum. Fortunately cases are limited, but
can be very severe when they do occur. This toxin causes flaccid paralysis and cranial nerve
deficits, and can lead to death. Infants are at greatest risk. Approximately 10-30 outbreaks and
110 cases are reported each year.
 Neurotoxin leads to flaccid paralysis
o Sources
 Home-canned foods
 fermented meats
 honey
o Clinical signs
 Double vision, drooping eyelids, difficulty speaking and swallowing
 Onset: 18-36 hours
 If botulism is suspected, medical attention should be sought immediately.
For more information, please refer to the specific botulism PowerPoint
and fact sheet.
Shigellosis
Shigellosis is also known as bacillary dysentery. Most cases are caused by Shigella sonnei.
However, S. dysenteriae, S. flexneri and S. boydii can also cause foodborne related illnesses.
Approximately 9,000 cases are reported every year in the UK. It is most commonly transmitted by
sick or asymptomatically infected food service workers.
o Sources:
 Human faecal contamination of food, beverages, vegetables, water
o Clinical signs:
 Watery or bloody diarrhea, nausea, vomiting, cramps, fever
 Onset: 2 days
 Duration: 5-7 days
Toxoplasmosis
Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii, which can infect all
species of mammals, including humans. As mentioned previously, it is one of the three leading
causes of death from a foodborne disease; the others were Salmonella and Listeria. It causes an
estimated 1,125 cases of foodborne illness each year and 37 foodborne related deaths. Pregnant
women and immuno-compromised individuals, especially HIV positive service users, are at the
greatest risk of toxoplasmosis.
 Toxoplasma gondii- intracellular protozoan
o Sources
 Infected cats (shedding in their faeces and soil
 undercooked meat
 mechanical vectors such as cockroaches and flies
o Clinical signs
 Fever, headache, swollen lymph nodes
 If the protozoan cysts develop in tissue, other more severe clinical signs can be
observed.
Cyclospora (Protozoan)
There have also been increases in the number of cases caused by the protozoan Cyclospora
implicated in a 1996 epidemic from imported raspberries.
Listeria monocytogenes
Listeriosis is one of the 3 most common causes of foodborne related death.
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o
o
Sources
 Ready-to-eat meats such as hot dogs, lunch meat soft cheeses
Clinical signs
 Human abortions and stillbirths
 Septicaemia in young or low-immune
Activity
Using information within this work pack and your own research; complete table 1
Table 1: Common food vehicles for certain food-borne related illness pathogens
Pathogen
Campylobacter jejuni or
coli
Food sources
Symptoms
Onset time
Clostridium perfringens
Escherichia coli 0157:H7
Listeria monocytogenes
Salmonella spp. (nontyphoid)
Staphylococcus aureas
Vibrio sp.
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Chemical hazards
Chemical hazards include;
 Naturally Occurring
 Intentionally added
 Unintentionally added
Naturally Occurring
Natural or manufactured chemicals and toxins from organisms can
also cause foodborne illnesses. Toxins are poisonous substances
produced by some micro-organisms, plants and animals. Most
toxins that cause food poisoning are tasteless and remain
dangerous when cooked. Toxins form in:
 potatoes when they are exposed to light and turn green
 fish and other seafood when they feed on algae or other fish that contain toxins.
Intentionally and unintentionally added chemical hazards
Chemicals in the hospital and the community include those used:
 to clean kitchen surfaces and equipment; degreasers,
detergents, disinfectants, descalers
 as pesticides.
Chemicals can be very harmful if they are:
 spilt on or near food
 mistaken for food or drink
Be careful when using chemicals around food areas and always follow the COSHH Regulations
(The Control of Substances Hazardous to Health, 2002). Remember to;
 Keep chemicals well away from food
 Keep them in their original clearly marked container
 Dilute correctly
 Wipe them away thoroughly before preparing food on surfaces
 Read the safety directions before using a chemical to identify how to use it safely and use
according to instructions
 Never put chemicals in food containers or drink bottles
 Always label chemicals clearly
Allergenic hazards
These are food ingredients that cause individuals to have an allergic reaction to food when eaten.
You must take care to ensure that vulnerable service users are not exposed to these allergens.
This is increasingly common in children. Common allergens include;
 Peanuts
 Tree nuts
 Milk
 Egg
 Fish
 Shellfish
Physical
hazards
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Soya products
Gluten; wheat, rye, barley flour
Sesame seeds
Celery
Mustard
Activity
Go to: http://tna.europarchive.org/20120419000433/allergytraining.food.gov.uk/english/
This will give you access to the Food Standards Agency's food allergy online training
programme. It has been developed by the Agency for Law enforcement officers but it is a
useful resource for anyone needing to learn more about food allergy.
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Physical hazards
Any potentially harmful extraneous matter not normally found in food which
might physically injure people and/or introduce harmful bacteria into food.
Examples include;
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Glass
Wood
Stones
Metal
Plastic
Dead insects
Hair
Jewellery
Activity
View ‘Bacteria Bite Business’ online video;
http://www.flyonthewall.com/FlyBroadcast/FSA/BacteriaBiteBusiness/
This 8-minute video has been produced by the Food Standards Agency (FSA). It demonstrates
the importance of good food hygiene, focusing on the 4 Cs (Cleaning, Cooking, Chilling and
Cross-contamination).
The main causes of food poisoning
Includes;
 Undercooked food
 Food cooked too far in advance
 Poor temperature control of food
 Food contaminated by food handlers
 Cross contamination of ready to eat food from raw food
NB. Food poisoning is often caused by food that looks, smells and tastes normal.
Figure 5: Factors contributing to food poisoning outbreaks in UK
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Visual signs of poor hygiene conditions
You have an important role to play in protecting your service users from food borne illness. You
should be able to spot the signs of poor hygiene either in the hospital environment or the service
user’s home. Some of these indicators might include:
 Dirty cutlery, glasses and other food equipment
 Unwashed dishes left for long periods
 Food in fridges that is mouldy, smelling, uncovered, or out of date
 Dirty toilets
 Chemicals left around food
 Dirty dishcloths
 Signs of pest infestations such as mouse droppings
 Food being served at the wrong temperature
 General unsatisfactory levels of dirt and food debris
The Four C’s
There are 4 main things to remember for good food hygiene;
1. Cleanliness
2. Cooking
3. Chilling
4. Cross-contamination
1. Cleanliness
Cleaning is the process of removing dirt and grease particles and debris,
and is often followed by the disinfection process, which then reduces microorganisms to a low safe level. Cleaning and disinfection should be
integrated into a work routine and should be formalised in cleaning
schedules.
Cleaning schedules ensure that cleaning is carried out;
 At the appropriate frequency
 In the correct manner
 Using correct products and materials
 Using the correct protective equipment
Cleanliness will:
 Ensure a pleasant, safe and attractive environment
 Promote a favourable image to the service user
 Reduce materials that would provide food for, or harbour pests
 Reduce the risk of food poisoning
 Reduce the risk of physical contamination from foreign matter
Remember to:
 Remove and store food away before cleaning and disinfection
 Clean as you work, before, between and after food handling tasks
 Use detergents with hot water to clean surfaces
 Use sanitisers or other food safe disinfectants to make surfaces and items safe to
use
 Pay particular attention to food contact and hand contact surfaces
 Make sure that cloths and other cleaning materials are regularly replaced and are
not a source of contamination
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You can prevent the spread of harmful pathogens by observing good personal hygiene and
keeping work surfaces, utensils etc clean. It is important to wash your hands regularly,
especially:
 After visiting the toilet
 After handling raw foods
 Before touching ready-to-eat food
And remember:
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Don’t handle food when you are ill with stomach problems, such as diarrhoea or
vomiting
Don’t touch food if you have sores or cuts, unless they are covered with a
waterproof dressing
2. Cooking
Cooking food to a high temperature will kill harmful pathogens such as
listeria, salmonella, E. col 0157 and campylobacter. Above 630C most
bacteria die and by 800C even most heat tolerant bacteria are dead.
Temperature is a way of ensuring food is safe to eat:
 Check that the middle/core temperature of food when cooked is at least 700C and
ideally 750C or hotter
 Reheat food, only once, to at least 750C (in Scotland the Law states 820C)
 When serving food it must be at or above 630C
 Use a temperature probe as a sure method of testing temperature or check for signs
of undercooking such as pinkness of flesh and cooking juices or signs of blood. This
applies especially to minced meat and poultry.
3. Chilling
Bacterial growth slows down as the temperature drops. Below 5 0C, they
only multiply very slowly and when food is frozen they become dormant.
Therefore, it is very important to keep certain foods at the right
temperature to prevent bacteria growing or toxins forming. Always look
at the label on the packaging. If it says that the food needs to be refrigerated, make sure
that you keep it in the fridge. If food needs to be chilled is left standing at room temperature,
food poisoning bacteria can grow and multiply to dangerous levels (figure 6). Some
important temperatures to remember are;
 Keep chilled ready-to-eat food at or below 80C to comply with the Law
 Keep food stored in a fridge below 50C. ideally between 1-40C
 Keep frozen at -180C or colder
 Cooked leftovers should be cooked quickly and then put in the fridge.
 Putting food in shallow containers and dividing it into smaller amounts will speed up
the cooling process.
4. Cross-contamination
Cross-contamination is the transfer of bacteria from foods (usually raw)
to other foods. The bacteria can be transferred directly when one food
touches (or drips onto) another, or indirectly, for example from hands,
equipment, work surfaces or knives and other utensils. Crosscontamination is one of the major causes of food poisoning.
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To prevent cross-contamination:
 Always wash your hands thoroughly after touching raw food
 Keep raw and ready-to-eat foods separate
 Store raw meat in sealable containers at the bottom of the fridge, so it cannot drip
onto other foods
 Use different chopping boards/work surfaces for raw food and ready-to-eat food
 Clean knives and other utensils thoroughly after use with raw food
Activity
We need to control these possible routes of contamination.
Think about the areas you work in and how efficiently this control of potential crosscontamination is carried out. It may be by;
 Using disposables
 By colour coding equipment
 Thorough cleaning and disinfection between tasks
Figure 6: Important Food Safety temperatures to remember
Food Safety in the Community
When working on placement in the community environment, particularly in the individuals own
home, you may be presented with particular food safety issues. These often result from the fact
that the home environment is not regulated under food safety legislation and standards of hygiene
and equipment being used may not always be seen as adequate.
Particular issues may be:
 Poor standards of refrigeration due to inefficient and/or unclean fridges
 Lack of safe, easy to clean work surfaces
 Food being past its use by date or best before dates
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Unmarked uncovered food left in the fridge or on work surfaces
Lack of cleaning materials
Unclean or damaged crockery and cutlery
Poor lighting
Pest contamination
Inefficient or dirty cooking or reheating equipment
Lack of food temperature probes and sanitising materials
Activity
Think about how you might overcome some of the difficulties faced in the community as listed
above. You might be doing some of the following;
 Bring your concerns to the attention of the individual
 Cleaning before using kitchen without upsetting the individual
 Checking for signs of pests and reporting any concerns
 Check use by dates of food in the fridge
 Throw away unsafe food with prior permission from the individual
 Cover, label and date anything you leave in the fridge for subsequent use
Food at work and you
Staff food
Food brought in by staff must be stored in a designated staff fridge rather than the service users’
refrigerator. Where a staff fridge is not available, the service users’ fridge may be used provided
there is adequate storage space. Staff food must be labelled with the staff members name and
date. Any cartons of juice must be dated with the date of opening. A nominated person must
ensure that the food beyond the use by date is discarded.
Kitchens in your placement area
All ward/care home kitchens and refrigerators are bound by legal requirements and therefore are
subject to, and must conform to Food Hygiene Regulations. The Local Authority Environmental
Health Officer has open access to the Trust and can inspect these areas at any time The Support
Service Manager is responsible for ensuring that the following controls are maintained within
kitchens:
 Clean daily and as spills occur
 Check fridge / freezer door seals regularly for mould splits and general repair state
 Defrost freezer monthly and use only for short-term storage – fridges/freezers
 Service users’ personal food must be wrapped or sealed and labelled with the person’s
name and date it was placed in the refrigerator.
 A nominated member of staff must check expiry dates daily. Any food found to be out of
date must be discarded (including service user food).
 Under no circumstances must raw meat, fish or poultry be stored in the ward refrigerator
 Refrigerators must be used for food storage ONLY. Blood, drugs and specimens are not to
be stored in the ward/Kitchen fridge.
 The refrigerator temperature must be checked and recorded in the morning and evening.
 The refrigerator must operate below 50C. Where there is a rise in temperature, the door
must not be opened for 15 minutes when a second reading must be taken. If the
temperature consistently rises above 80C the Support Service Manager should be informed
immediately so that alternative storage arrangements or a replacement can be arranged
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All new appliances must be fitted with a digital temperature display, and be designed to
operate between +1 C and +8 C.
Microwaves: only dishes designed specifically for microwave use are to be used.
Medicine dispensing containers
These should be washed in the kitchen sink, NOT in the hand wash basin, and thoroughly dried.
Disposable medicine containers must be discarded following use.
Service users/Relatives
 Must not be permitted into hospital ward kitchen under any circumstances. This may not be
applicable in a care or nursing home.
 Service user’s food should never be re-heated.
 Any low risk food belonging to the service user, such as dried fruit, should be kept in the
service user’s locker or room in a labelled plastic sealable container, box or bag
 Take away food, once in the healthcare setting is the responsibility of the Trust. Any take
away food should be piping hot on arrival and eaten straight away. Any left-over should be
discarded.
Temperature Control
 Ensure that heated meal trolleys are plugged in immediately on arrival.
 Ensure that food is served immediately and never reheated.
 Confirmation that the food has reached the required temperature is made using the
appropriate temperature probe by kitchen staff. This must be documented.
 Food must be removed immediately after the meal with the exception of ‘red food trays’ (if
used) which identify service users with nutritional needs.
 If service users are away at meal times the hot meal must never be retained for longer
than 30 minutes. If the service user is likely to be away for longer, then a meal will need to
be arranged for them on their return
 All frozen food should be stored at or below -18°C. Frozen food when arriving must not be
above -12°C.
 All chilled foods should be stored between 0°C and 8°C.
 Chilled food must not be left outside of chilled storage for more than 4 hours. Any food left
out for more than 4 hours must be disposed of appropriately.
 All hot food must be cooked to a core temperature of above 75°C and should be served
before the temperature drops below 63°C.
 Hot food can be kept for 4 hours if the temperature remains above 75°C, or 2 hours if
between 63°C and 75°C (FSA 2007)
 Ice Creams supplied by the Catering Department are provided in insulated tubs. These
must be consumed within one hour of the meal time for which they are provided for. If not
consumed within this time, they should be discarded.
Preparation of Specialised Formula Feeds, Supplement Drinks and Enteral feeding
 If required, it is the responsibility of the nursing staff for these to be prepared and
distributed in a safe manner that prevents contamination.
 The following recommendations therefore apply:o Formula Feeds, Supplement Drinks, Single fluid cartons;
 These need not be refrigerated before use if they are in a sealed container
 Check that the date on the bottle/carton has not expired before opening
 Once a bottle/carton has been opened they should be consumed within 4
hours or refrigerated. They should be labelled with the date and time
opening before placing in the refrigerator
 After 24 hours of refrigeration they must be discarded.
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o
Powdered Sachets
 Before preparing, ensure that hands are washed well and implements used
for mixing are clean and dry before use
 Sachets should be mixed according to the manufacturer’s instructions with
cold freshly drawn tap water, freshly boiled water, or cold milk directly from
the refrigerator
 Milk can be heated in the microwave
 Sachets should be supplied from catering/dietician for single use only, a
sachet which has already been opened should not be used
 The preparation of these drinks should be made in the designated kitchen
 Once mixed, any drink should be consumed within 4 hours, if not it must be
discarded
 No open packets from home to be brought in
Enteral Feeding
The National Institute for Health and Clinical Excellence found that 30% of feeds were
contaminated with a variety of micro-organisms, with the highest rates of contamination in home
settings (NICE 2003). The risk of infection is associated with three main interventions;
 The preparation and storage of feeds
 The administration of feeds
 Care of the insertion site and enteral feeding tube
Individuals undertaking enteral feeding must ensure that their hands are decontaminated before;
 preparing feeds
 assembling feeding systems
 any manipulation of the feeding system
A clean disposable apron should be worn each time the enteral system is manipulated (NICE
2003).
Flushing the feeding tube
Sterile water for irrigation is to be used for service users with enteral tube feeding in hospitals and
cooled boiled water in the service users’ home. The feeding tube must be flushed with water
 Before and after feeding
 Before and after administration of each medicine.
 Additional flushes may be needed to meet the service users’ daily fluid requirements as
specified in their feeding regimen.
Feed handling times
Hanging times are influenced by the risk of microbial contamination in different circumstances
 Sterile feed in pre-filled containers can hung for up to 24 hours.
 Once opened sterile feed must be used within 24 hours or discarded.
 Giving sets are to be used for one feeding episode and discarded
Feed pumps
Feeding pumps should be cleaned daily with detergent wipes. Any spillage in between is to be
removed with a detergent wipe.
Overview of Strategies to prevent food poisoning
The main strategies to prevent food poisoning are:
 Ensure food does not become contaminated
 Kill or slow down the growth of micro-organisms.
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o
To ensure food does not become contaminated keep hands and nails clean and wash
hands and nails thoroughly with warm, running water and soap before:
 eating, preparing or handling food;
 between handling raw meat, poultry and seafood, and handling cooked food or food
that will be eaten raw
 after coughing, sneezing, using a handkerchief etc.
 after going to the toilet
 after handling rubbish
 after touching animals
 after handling chemicals (e.g. cleaning products)
o
Dry hands thoroughly
o
Cover cuts and infections on hands
o
Keep the kitchen clean
o
When cleaning plates and equipment;
 scrape and rinse off surface food
 wash in clean, soapy water
 rinse in clean water
 air dry where possible
 if drying immediately, use only a clean, dry towel
o
Pest control and animals
 stop pests such as cockroaches and mice coming into the area where food is kept
 discourage pests by not leaving food or dirty dishes out on the benches
 keep animals out of the kitchen
o
Handle food safely.
 avoid preparing food when sick or feeling unwell
 keep raw meats, poultry and seafood separated from cooked food and food to be
eaten raw
 protect food in the refrigerator by placing in covered containers or covering with
plastic wrap
 use clean equipment, plates or containers to prevent contamination of cooked food
(or food that will be eaten raw) with traces of raw food
 use clean equipment, rather than hands, to pick up food
 wear clean clothes or a clean apron
 wash fruit and vegetables to be eaten raw under running water.
o
To kill or slow down the growth of micro-organisms:
 Cook high-risk foods thoroughly such as; mince, burger patties, sausages, rolled
roasts, stuffed meats, rabbit, seafood, poultry
o
Keep hot food hot and cold food cold:
 Avoid keeping food in the temperature danger zone of 5°C - 60°C
 keep cooked food at 60°C or above until served
 refrigerate or freeze food that is to be prepared well in advance and reheat until
steaming hot before serving
 cook or reheat packaged food strictly in accordance with any directions on the label
 Place hot food in the refrigerator once it has stopped steaming.
 Divide large quantities of food into small shallow containers for faster cooling.
 When reheating for use, heat as quickly as possible until steaming hot.
o
Keeping cold food cold
 Avoid keeping food in the temperature danger zone of 5°C - 60°C
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take cold groceries home to the refrigerator quickly as possible
keep chilled and frozen food cold if it will be a long time before it can be placed in a
refrigerator or freezer
store cold food at 5°C or less
keep cold food in the refrigerator as much as possible
thaw frozen food in the refrigerator or microwave
store and handle cold food according to any directions on the label
check the temperature of the refrigerator regularly
Animal products are not the only food that can be contaminated. Various foodborne
disease outbreaks have occurred due to fruits and vegetables. The table below
indicates the many possible sources for contamination during the processing of
produce.
Event
Production and harvest
- Growing, picking, bundling
Contamination sources
Irrigation water, manure, lack of field sanitation
Initial processing
- Washing, waxing, sorting, boxing
Wash water, handling
Distribution
- Trucking
Ice, dirty trucks
Final processing
- Slicing, squeezing, shredding, peeling
Wash water, handling, cross-contamination
Summary: Preventing food poisoning
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References
European Parliament (2004) The General Food Regulations 2004, Regulation (EC) 854/2004
London: TSO, [online]. Available from: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2002:031:0001:0024:EN:PDF [Accessed 30th
August 2012].
European Parliament (2004) Hygiene of Foodstuffs, EU Regulation 852/2004, London: TSO,
[online]. Available from: http://ec.europa.eu/food/food/biosafety/hygienelegislation/index_en.htm
[Accessed 30th August 2012].
European Parliament (2004) Specific Hygiene Rules for Food of Animal Origin, EU Regulation
853/2004, London: TSO, [online]. Available from:
www.fsai.ie/.../food.../food_hygiene/specific_hygiene_rules_for_foo... [Accessed 28th August 2012].
European Parliament (2007) Guidance for Food Business Operators on Microbiological Criteria for
Foodstuffs, EU Regulation No. 1441/2007, London: TSO, [online]. Available from:
http://tna.europarchive.org/20120419000433/http://www.food.gov.uk/foodindustry/regulation/europ
eleg/eufoodhygieneleg/microbiolreg [Accessed 30th August 2012].
Food Standards Agency (2006) Food Hygiene: A Guide for Businesses, London: TSO, [online].
Available from:
http://webarchive.nationalarchives.gov.uk/20120206100416/http://food.gov.uk/multimedia/pdfs/publ
ication/hygieneguidebooklet.pdf [Accessed 30th August 2012].
Food Standards Agency (2006) Food Law Inspections and Your Business, London: TSO, [online].
Available from: www.food.gov.uk/multimedia/pdfs/.../foodlawinspec0310.pdf [Accessed 30th August
2012].
Food Standard Agency (2007) Guidance on Temperature Control Legislation in the United
Kingdom EC Regulation 852/2004, London: TSO, [online]. Available from:
www.food.gov.uk/multimedia/pdfs/tempcontrolguiduk.pdf [Accessed 30th August 2012].
Food Standard Agency (2007) Bugs Like it Hot, London: TSO, [online]. Available from:
http://www.food.gov.uk/multimedia/pdfs/publication/bugslikeithot0607.pdf [Accessed 30th August
2012].
Food Standard Agency (2007) Guidelines for Making up Special Feeds for Infants and Children in
Hospital, London: TSO, [online]. Available from:
www.food.gov.uk/multimedia/pdfs/.../babypowdertoolkit1007[Accessed 30th August 2012].
Food Standards Agency (2009) Hazard Analysis Critical Control Points (HACCP), London: TSO,
[online]. Available from: http://www.food.gov.uk/business-industry/meat/haccpmeatplants/
[Accessed 28th August 2012].
Food Standard Agency (2010) Safer Food Better Business, London: TSO, [online]. Available from:
www.food.gov.uk/multimedia/pdfs/fsactguide.pdf [Accessed 30th August 2012].
Great Britain (1990) Food Safety Act 1990, London: TSO, [online]. Available from:
www.legislation.gov.uk/ukpga/1990/16/contents [Accessed 30th August 2012].
Great Britain (1999) The Food Standards Act 1999, London: TSO, [online]. Available from:
http://www.food.gov.uk/enforcement/regulation/foodstandardsact [Accessed 30th August 2012].
Great Britain (2006) The Food Hygiene Regulations 2006 (as amended), London: TSO, [online].
Available from: www.food.gov.uk/enforcement/regulation/ [Accessed 30th August 2012].
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Great Britain (2006) Food Hygiene (England) Regulations 2006, London: TSO, [online]. Available
from: http://tna.europarchive.org/20120419000433/legislation.gov.uk/uksi/2006/14/contents/made
[Accessed 30th August 2012].
Great Britain (2008) Health and Social Care Act 2008, London: TSO.
National Institute for Clinical Excellence (2003) Guidelines for the Management of Enteral Tube
Feeding in Adults, London: NICE, [online]. Available from:
www.nice.org.uk/nicemedia/live/10978/29981/29981.pdf [Accessed 30th August 2012].
National Patient Safety Agency (2007) Colour Coding Hospital Cleaning Materials and Equipment,
London: TSO, online]. Available from: www.nrls.npsa.nhs.uk/Home/Patient safety resources
[Accessed 30th August 2012].
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Table 1: Common food vehicles for certain food-borne related illness pathogens
Pathogen
Campylobacter jejuni or
coli
Clostridium perfringens
Escherichia coli 0157:H7
Listeria monocytogenes
Salmonella spp. (nontyphoid)
Staphylococcus aureas
Vibrio sp.
Food sources
Major: poultry
Minor: milk, mushrooms,
clams, hamburger, water,
cheese, pork, shellfish,
eggs, cake icing
Major: meat, meat strews,
meat pies, beef, turkey,
chicken gravies
Minor: beans, seafood
Major: beef particularly
ground beef
Minor: poultry, apple cider,
raw milk, vegetables,
cantaloupe, hot dogs,
mayonnaise, salad bar items
Major: soft cheese, pate,
ground meat
Minor: poultry, dairy
products, hot dogs, potato
salad, chicken, seafood,
vegetables
Major: poultry, meat, eggs
and their products
Minor: vegetables, fruit,
chocolate, peanuts, shellfish
Major: workers handling
foods: meat (especially
sliced meat), poultry, fish,
canned mushrooms
Minor: dairy products,
prepared salad dressing,
ham, salami, bakery items,
custards, cheese
Major: oysters
Minor: other seafood
Symptoms
Diarrhoea, abdominal
cramps, headache
Onset time
2-5 days
Paralysis, diarrhoea
12-36 hours
Watery or bloody
diarrhoea, nausea
cramps, haemolytic
uraemic syndrome
2-5 days
Fever, muscle aches,
and sometimes with
nausea and vomiting.
Can lead to Meningitis
Variable, can
be a few
days, or
occasional 2
monmths
Diarrhoea, fever
cramps
12-36 hours
Vomiting, abdominal
pain, low temperature
1-7 hours
Vomiting, diarrhoea,
abdominal pain. In very
vulnerable people it can
lead to septic shock
1-7 days
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