`Food Safety Matters’:

WorkPack

2013

ContentsPage

Introduction3

What the Law says4

The history of food safety5

What is food safety?6

Importance of Food Safety6

What is food poisoning?6

Food Safety Hazards7

-Microbiological hazards7

-Chemical hazards13

-Allergenic hazards13

-Physical hazards14

The main causes of food poisoning14

Visual signs of poor hygiene conditions15

The Four C’s15

-Cleaning15

-Cooking16

-Chilling16

-Cross-Contamination16

Food safety in the community17

Food at work and you18

Overview of strategies to prevent food poisoning20

Summary: Prevention of Food Poisoning22

References23

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

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 copiesof 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 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;

  • 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:

  • 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 milkwas developed in 1864 and used in milk in 1908 to decrease pathogen load
  • Refrigeration became available for household use in 1913which 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 throughLaws and policies regarding food handling

The various laws and policiesthat 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


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

Duediligence 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.

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 micro-organisms are not harmful. The micro-organisms that can make us sick include:

  • 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:

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

Important Organisms

•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.

  • Small infectious dose; very contagious and can take as small as 10 viral particles to infect someone
  • 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.