IC in Care Series: Hospital Food Service and Infection Control

By Kelly Teal
 
Hospital food service infection control experts have a lot on their plates, as it were, when it comes to ensuring patients’ well-being. That responsibility has not let up in 2016; the Centers for Disease Control and Prevention (CDC) keeps pushing medical institutions to offer healthier fare – think fresh, not prepackaged, salads; Chipotle’s produce-linked food poisoning outbreak lingers in recent memory; and the Zika virus’s entrance into the United States raises questions about its impact on areas including food safety. Each of these issues should reinforce to hospital food infection control experts the need to stay mindful of industry best practices. Doing so will continue to help protect patients, says Marisa Pinchas, MPH, CIC, the infection preventionist at Children’s Hospital Los Angeles.

“Many of these outbreaks can be linked back to poor hand hygiene or to sick food service employees,” Pinchas says of incidents including those incurred by Chipotle. “The national spotlight on these food safety issues serves as an important reminder to hospital food services of the consequences of not following infection control policies.”
The 115-year-old CHLA takes that counsel to heart. The institution, Southern California’s first pediatric hospital, admits 11,000 inpatients every year, a number that speaks to the need and desire to ensure food storage, preparation and serving all remain pristine. CHLA’s food infection control experts do this by adhering to the latest standards set by associations and government agencies. To that point, FDA last updated its Food Code in 2013 when it enforced new regulations for lettuce, tomatoes, salads, celery, coleslaw and some fruits. Those measures stand out as the CDC encourages hospitals to provide more of the foods included in that FDA scrutiny. All told, there is zero room for relaxed oversight.

“Food service programs must ensure that their new food options are subject to the same rigorous infection control standards and requirements” as before, Pinchas says.
Amid the ongoing activity by the CDC and FDA, though, comes the question of whether the dangerous Zika virus, which now has infected dozens of pregnant women in the United States, will force any changes to hospitals’ food safety practices. The short answer? No. Pinchas says to follow existing infection prevention standards until or unless circumstances shift.

“We have no reason to believe at this time that Zika would ever be transmitted through the ingestion of contaminated food or water,” she says.  That’s because the Aedes species mosquito that carries Zika lays its eggs in and around standing water. 

“The food purchased for use in hospitals should always be obtained from a certified buyer who adheres to FDA-approved food safety standards, which would prevent food from being prepared, packaged, or delivered in the vicinity of standing or pooled water,” Pinchas pointed out.

In sum, says Pinchas, “there are no extra precautions that hospital food service providers need to take at this time to prevent the transmission of Zika virus.”

That advice applies to any patient-supplied food as well, she says, as long as the risk for Zika stays outside of the realm of nutrition. Yet that doesn’t mean hospitals cannot or should not help patients and their families think about preventing food contamination in general.

“Educating our patients and families about food safety best practices, such as proper food preparation and storage, and having strict policies in place about what may or may not be brought from outside into the hospital environment, will help mitigate the risk of food contamination and exposure to common foodborne pathogens,” Pinchas says.
However, should conditions change, and an emerging foodborne infectious disease become prominent in the United States, “it will be imperative for infection preventionists to closely monitor what food is brought in from outside the hospital and put interim measures or restrictions into place if necessary,” she says.

On that note, infection control experts “should always be prepared for any emerging infectious disease, with active emergency preparedness plans in place to be able to react quickly to any new threat,” Pinchas says. “In general, infection preventionists must always remain vigilant and actively prepared for all new emerging infectious diseases, and adjust all of our practices accordingly. Of the past few emerging infectious diseases which made headlines, such as MERS-CoV, Enterovirus D-68, Ebola and Zika virus, none have been transmitted through food or contaminated food, so our food services plans have not been directly impacted.”

Still, emergency strategies should include contingencies for food services, in case an emerging infectious agent is transmitted through food or water, she adds.

With so much on hospital food infection preventionists’ minds, then, it seems imperative to review the rules that have proven effective in protecting patient health. Consult and save the following topical aids, extracted from a March 2012 presentation given by CHLA’s Mary Virgallito, director of infection prevention and control, to the Association for Professionals in Infection Control and Epidemiology (APIC), for a refresher.
 
Preventing Infections in Food Measures - Purchasing and Receiving
 - Buy food from a reputable dealer to take an essential first step in preventing foodborne illness from intrinsic contamination.
- Work with the director of food services to ensure documentation of food purchased.
- Ensure food stays free from extreme alterations in temperature; schedule shipments to maintain proper freezer or cold storage.
 - Put proper receiving procedures in place.
 - Inspect and approve food when it arrives.
 - Keep testing logs and validate that staff know how to accept and reject product, preventing problems from intrinsic contamination.
 
Preventing Infections in Food Measures - Common Pathogens Associated with Intrinsic Contamination
 
- Campylobacter spp., Escherichia coli, and Salmonella spp. all have been associated with beef, pork, poultry, eggs and peanut butter.
 - Hepatitis A is associated with shellfish.
 - Trichinella spiralis is associated with pork.
 - Enterohemorrhagic E. coli 0157:H7 has been associated with undercooked beef.
 - Listeriamonocytogenesis is associated with ready-to-eat foods such as luncheon meats, and soft and imported cheeses.
 
Preventing Infections in Food Measures – Food Storage
 
- Properly monitor refrigerators and freezers, and keep complete records.
 - If temperatures go out of range, document what was done to correct the problem and keep that information accessible.
 - Store cooked foods above raw foods.
 - Separate raw animal foods from raw ready-to-eat foods during storage, preparation, holding and display.
 - Keep all foods properly wrapped or covered.
 
Preventing Infections in Food Measures – Food Preparation, Staff Knowledge
 
- 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.
 - Discard individual portions of food once served.
 - Protect unwrapped foods with sneeze guards.
 - Discard single-service articles after one use.
 
Preventing Infections in Food Measures – Serving Food
 
- Transport prepared foods to other areas in closed food carts or covered containers (use separate carts for serving clean trays and collecting dirty trays).
 - Serve food with clean tongs, scoops, forks, spoons, spatulas or gloves to avoid direct contact with food.
 - Observe all HACCP guidelines for heating, cooling and handling foods that are cooked, cooled and reheated for service.
 - Clean thermometers appropriately before and after checking food temperatures.
 - 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
 
- Have staff use rubber cutting boards; the boards must be washed and sanitized between uses.
 - Dispose of china or plastic ware that is chipped or has lost its glaze.
 - Make sure all food grinders, choppers and mixers are cleaned, sanitized, completely dried and reassembled after each use.
 - Drain and flush dishwashers daily. Make sure the dishwasher maintains a final sanitizing rinse of 180 degrees Fahrenheit and wash water of 150 degrees Fahrenheit.
 - Clean the exterior of the ice machines daily.
 - Sanitize all serving carts, including those for collecting soiled trays.
 
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 these conditions or are out ill for five days or more, they must have clearance from their personal physician before they may return 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.
 
Preventing Infections in Food Measures – Education
 
- Food services staff require infection prevention education upon hire, annually and as needed based on survey or assessment results.
 - Infection prevention education must be tailored specifically to food services staff – focus on why and how to prevent contamination.
 - Education must incorporate information on health and safety regulations for food preparation and handling.
 - Discuss basic general principles of infection control such as hand hygiene, cleaning and disinfection, and transmission-based precautions as they relate to patient food services.
  - Food services staff must receive a one-hour lecture on the principles of infection control in foods services biannually, and take a post-instruction test that will identify areas that will require more intensive focus and instruction.
 - Infection control and food services management must work together closely to provide the staff with information on infection control processes and cleaning and disinfection.
 - Infection control must conduct an annual inspection that is reported to the hospital infection control committee.

Kelly Teal is a freelance writer.