Infection Control Assessment and Oversight of Food Services at

Infection Control Assessment and Oversight
of Food Services at
Children’s Hospital Los Angeles
Mary Virgallito
Manager of Infection Prevention and Control
March 2012
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
• 317 beds, 85 percent of
which are private rooms.
• 35 pediatric critical care
• Affiliated with the Keck
School of Medicine,
University of Southern
• 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
Regulatory Requirements For Infection
Control in Food Services
Governing Agency
The Joint Commission
CA Law: Title22
Infection Control Oversight
of Safety in Food Handling
Risk Assessment
Infection Control
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
– 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
• 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
• 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
• 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
• 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
– 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
Food Services Documentation
• 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

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