by Cindy A. Abole, Public Relations

Food safety success is credited to the teamwork of many departments and staff. It insures continuous food safety at the Medical Center, Institute of Psychiatry and Charleston Memorial Hospital.

“MUSC has had an excellent record for food safety,” said Betty Webster, R.N., infection control practitioner with Medical University Hospital’s Office of Infection Control. To date, there have been no reports of food-borne-related illness or cluster contaminations at MUSC according to Webster.

Today’s food safety standards are governed by federal, state and local regulations. The Food and Drug Administration (FDA), Department of Agriculture and the South Carolina Department of Health and Environmental Control (DHEC) have created, updated and implemented rigorous food guidelines to support consumer protection.

DHEC’s Division of Food Protection oversees quarterly inspections of retail food establishments. These include restaurants, fast food establishments, school cafeterias, grocery and convenience stores, licensed caterers and off-street hot dog vendors. DHEC’s Division of Health Licensing in Columbia handles inspections for health care institutions including hospitals, nursing homes, community residential care areas, rehabilitation centers and other handicap facilities. DHEC also inspects food preparation during large special events like Taste of Charleston, Lowcountry Shrimp Festival, and the Coastal Carolina Fair.

“Working with health care is actually a ‘cut above’ how we work with restaurants,” said Gene Chestnut, assurance program analyst in DHEC’s Division of Health Licensing. “In hospitals, you tend to deal with more qualified people who know and understand the importance of their job. It makes a real difference.”

Chestnut and his team of six inspectors focus their visits on licensing and sanitation within Lowcountry health care settings. Licensing involves a partial or comprehensive review of a facility, sanitation and assessment of fire, life and safety records. The annual sanitation inspections evaluate food storage areas at nursing stations, medical records, census data, staffing documentation, etc. which generally lasts for two days. Results of these inspections are determined by a 100 point grading scale and are posted for public review as DHEC sanitation scores: A is excellent (100-88 points), B is acceptable (87-78 points) and C is marginal (77-70 points).

Similar to retail and the private sector, MUSC’s food services undergoes inspections by DHEC’s Division of Health Licensing and the Joint Commission on Accreditation (JCAHO), an independent and non-profit accrediting body which evaluates over 18,000 health care organizations and programs.

“Good communication is critical in a retail food environment,” said Mike Tierney, Food and Nutrition Services production manager motioning to an array of employee performance posters which randomly dot the kitchen and food production area walls and columns. “There’s no real downtime in our line of business that truly emphasizes the importance of safe food handling habits.”

“Good food preparation is the key for the hospital’s patient services success,” said Joann Howard, R.D. and patient services manager. “A patient usually experiences one cycle of our food menu during an average hospital stay. We’re challenged with the task of creating both an attractive variety and serving our customer something safe and healthy which won’t affect their already compromised and weakened immune systems.”

Howard and the food service staff rely heavily on good kitchen habits for retaining proper food temperatures reflecting National Health Hazard Analysis Critical Control Point Program (HACCP) guidelines for foods outside the designated “temperature danger zone” (between 40 degrees F and 140 degrees F); proper protection utilizing gloves, hairnets and safe handwashing practices; and the prevention of cross contamination featuring custom-colored cutting boards for poultry, beef, seafood, vegetables, etc. All are critical guidelines and practices observed daily by MUSC’s Food and Nutrition staffs.

“People don’t tend to think about food safety,” Webster said. “For patients, the margin for error is so thin. We know as a hospital, we need to be very careful.”

Marriott’s fleet of 120 full-and part-time food personnel—40 food tray workers, 40 internal operations supporters and 40 retail employees, prepares about 1,200 patient meals between 4 a.m. to 8:30 p.m., plus accommodates a retail base of 3,000 customers daily. Sodexho-Marriott is also quick to push its food safety practices beyond the normal DHEC standards. These extras include staff in-service training, local vendor inspections for dairy and produce, hepatitis B vaccinations, and other immunity support.

Howard and several food staff managers are scheduled to attend certification training for food-borne illness practices in Raleigh, N.C., in July and August. The program will certify managers in this topic for the next three years.

Another key to the hospital’s success in managing and controlling food-borne-related illness are surveillance, prevention and control, according to Webster. Primary is surveillance which monitors for evidence among patients, staff and the public. Prevention involves implementing internal policies and education throughout the Medical Center. And finally, control focuses on applying solutions to suspected problems and reports, plus resolving conflicts.

The team of four inspection control practitioners conduct the hospital’s random environmental rounds visiting nursing units, wards and other areas. Since some patient areas provide for patient nourishment, the group inspects blenders, refrigerators and other appliances for cleanliness, food storage violations and other health safety shortcuts.

“We don’t just reprimand staff,” Webster said, referring to these inspections. “Patient issues can create a little work that ultimately benefits both staff and patients. It helps departments to communicate and interact amongst themselves. We serve as liaisons for them regarding any matters with infection control.”

“People have a right to expect a safe product,” said Pam Fogle, infection control practitioner with the Medical Center’s Infection Control. “People have to learn to accept some responsibility when it comes to how you handle, fix and eat foods at home. Here, the hospital is responsible for food safety for all our patients.”

The Hazard Analysis Critical Control Point (HACCP) is an internationally recognized, science-based system designed to prevent the occurrence of food safety problems. First developed to support America’s space program in the 1960s, this food safety program focuses on preventing hazards that could cause food-borne illnesses under science-based controls.

Today, the Food and Drug Administration (FDA) uses HACCP regulations in various food industries from meat and poultry to canned foods manufacturing. HACCP has been endorsed by the National Academy of Sciences, the Codex Alimentarius Commission (an international food standard-setting organization), and the National Advisory Committee on Microbiological Criterial for Foods.

The HACCP approach is based on seven principles for identifying hazards in food production, controlling the hazards at critical points in the process and verification that the system works properly.

Seven HACCP Principles

1) Analyze hazards. Confirm that potential hazards associated with a food are properly identified. A food hazard can be classified as biological, chemical or physical.

2) Identify critical control points. These include points in a food’s production—from its raw state through processing, shipping to consumption by consumer—at which the potential hazard can be controlled or eliminated. (Eg: cooking, chilling, handling.)

3) Establish preventive measures with critical limits for each control point.

4) Establish corrective actions to be taken when monitoring shows that a critical limit has not been met. (Eg: reprocessing or disposing of food if the minimum cooking temperature is not met.)

5) Establish effective actions to be taken when monitoring shows that a critical limit has not been met. (Eg: reprocessing or disposing of food if the milium cooking temperature is not met.)

6) Establish effective record keeping to document the HACCP.

7) Establish procedures to verify that the system is working consistently. (Eg: testing time-and-temperature recording devices to verify that a cooking unit is working properly.)

Source: FDA Consumer Reprint: HACCP: A State-of-the-Art Approach to Food Safety, 1995. For information on the Internet about HACCP and the USDA Food Safety Inspection Service, <http://www.fsis.usda.gov>

Take precautions against food-borne bacteria

by Cindy A. Abole, Public Relations

Sitting on a plate is a heaping scoop of homemade banana pudding. Although the dish sits untouched for the past hour, a silent, invisible war rages on. The opponents in this strange battle are identified by names like salmonella, campylobacter and cyclospora. These microscopic enemies or food pathogens are examples of small but potentially dangerous risks people take when they prepare or handle food.

Each year, food-borne illness are responsible for more than 9,000 deaths in the United States. Millions, additionally, are sickened and affected by food tainted by pathogens, microorganisms which cause infections and disease. But according to government statistics, the U.S. food supply is among the world’s safest. Or is it?

This past spring, the Clinton administration unveiled an ambitious program aimed at reducing and controlling food-borne illnesses through the Food and Drug Administration’s (FDA) Food Safety Initiative, a nationwide plan aimed at improving the safety of the nation’s food supply through consumer education, food service workers training, enhanced food safety inspections, monitoring and continued research.

“People need to take responsibility for themselves,” said Joann Howard, R.D., and patient services manager, referring to America’s changing eating habits. “Today’s public needs to be more aware about recognizing and diagnosing food-borne illnesses.”

Howard, who works with MUSC’s Food and Nutrition Services which is managed by Sodexho-Marriott Services, cites how typical social events featuring people and food can also be dangerous. Gatherings like family dinners, reunions and other celebrations should require individuals to practice safe food handling habits. For example, people at picnics leave foods unrefrigerated for long periods of time. Improper storage or holding temperature of foods are the most common practice associated with food-borne disease. That’s because some microorganisms present in food may reproduce causing food-related infections or poisoning.

Often, individuals are unaware about cross contamination practices in the kitchen during the food preparation process. Consumers should take the time to wash hands, utensils or thaw meats properly, Howard said.

Howard can’t emphasize enough about the importance of temperature control when dealing with foods. The Medical Center’s Food and Nutrition staffs are required to check and log refrigerator temperatures at least twice a day. National Health Hazard Analysis Critical Control Point Program (HACCP) temperature guidelines require that food temperatures be checked at every stage or critical point where contamination may occur. This includes food delivery, storage, preparation, holding, serving, cooking and storage of leftovers and reheating.

During the storage process, HACCP temperature guidelines require that refrigerated foods retain the same temperature for at least four hours. Foods stored outside the “temperature danger zone” of 40 degrees F to 140 degrees F are at risk for harmful bacteria growth. Thicker sauce foods like gravies, chili and stews are especially prone to bacteria because they hold temperatures and take longer to chill, Howard said. Studies have proven that even the choice of food containers is vital to cooling foods during storage. Howard recommends small, shallow containers as a good choice for breaking down foods into safer, convenient units.

In the June 1998 edition of the American Journal of Infection Control, Public Health specialists Hala Fawal of the University of Alabama-Birmingham and Lynn Steele, EPI Center of San Francisco General Hospital, shared results from a meeting relating to the steady increase of food-borne-related illness at the first International Conference on Emerging Infectious Diseases held in Atlanta this past spring. Guest speaker Michael Osterholm, M.D., Minnesota Department of Health, attributes five factors which have led to the public increase of food-borne illness:

1) The American diet has changed. Because of a greater demand for fresh produce, the United States has increased imported products from developing countries. Produce consumed uncooked can be contaminated anywhere during the process from “farm to table.”

2) Americans are dining more outside of the home (27 percent in 1970 compared with 40 percent in 1996). The use of commercial food service has increased the public’s risk for exposure due to poor food handling.

3) The development and reliance on new methods of food production may have resulted in a false sense of security. For example, a recent study of the pasteurization process that is used for egg products revealed a small portion (one percent) still containing the bacteria, salmonella.

4) Both newer generations of food pathogens and reemerging agents cause food-borne illness. Examples are the Norwalk virus, Toxoplasma gondii and other new strains of E. Coli.

5) A growing number of high-risk populations, particularly the elderly and immunocompromised, are at increased risks when exposed to food pathogens. Osterholm and other food safety experts agree that increased awareness, development of standardized surveillance systems and improved communication between laboratories are keys to better public education of food-borne illness.

On the July 4 segment of President Clinton’s weekly radio address, the president unveiled several ambitious projects which focus on improving the nation’s food supply for the 21st century based on the Food Safety Initiative. The USDA and Health and Human Services’ Food Safety Research Institute will join forces to develop and coordinate strategy for improving and conducting food safety research. He also related new improvements for the safety of fruit and vegetable juices by incorporating warning labels to help consumers identify unpasteurized products. He concluded his show by confirming full passage of the FY 1999 budget which appropriates $101 million towards improved food inspection techniques, additional personnel and effective educational outreach.

“There’s always room for improvement,” Howard said, referring to better ways of improving food safety at MUSC. “We’re always looking for ways to make foods better, while at the same time considering people’s health.”

HACCP safe food practices at home

Purchasing

• Purchase meat and poultry products last and keep packages of raw meat and poultry separate from other foods, particularly foods that will be eaten without further cooking.
• Make sure meat and poultry products are refrigerated when purchased.
• Canned goods should be free of dents, cracks or bulging lids.

Home Storage

• Verify temperature of your refrigerator and freezer with an appliance thermometer. Refrigerators should run at 40 degrees F or below. Freezers at 0 degrees F.
• At home, refrigerate or freeze meat and poultry immediately.
• To prevent raw juices from dripping on other foods inside the refrigerator, use plastic bags or place meat and poultry on a plate.
• Wash hands with soap and water for 20 seconds before and after handling any raw meat, poultry or seafood products.
• Store canned goods in a cool, clean dry place. Avoid extreme heat or cold which can be harmful to canned goods.

Pre-Preparation

• Wash hands with soap and water for 20 seconds before beginning preparation after handling raw meat, poultry, eggs; after touching animals; after using the bathroom; after changing diapers, after blowing the nose.
• Thaw and marinate foods in the refrigerator.
• Wash hands, counters, equipment, utensils, and cutting boards with soap and water immediately after use. Equipment can be sanitized with a chlorine solution of 1 teaspoon of household bleach per quart of water.

Cooking

• Always cook foods thoroughly.
• Use a meat thermometer to determine if your meat, poultry or casserole has reached a safe internal temperature. Check the product in several spots to assure a safe temperature throughout the product.
• Avoid uninterrupted cooking. Never refrigerate partially cooked products to later finish cooking on the grill or oven. Meat and poultry products must be cooked thoroughly the first time.
• When microwaving foods, carefully follow manufacturer’s instructions. Use microwave-safe containers, cover, rotate and allow for standing time, which contributes to thorough cooking.

Serving

• Wash hands with soap and water before serving or eating food.

• Hold hot foods above 140 degrees F and cold foods below 40 degrees F.
• Never leave foods, raw or cooked, at room temperature longer than two hours. On a hot day with temperatures at 90 degrees F or warmer, this decreases to one hour.

Handling Leftovers

• Divide leftovers into small units and store in shallow containers for quick cooling. Refrigerate within two hours of cooking.
• Discard anything left out too long.
• When reheating leftovers, reheat thoroughly to a temperature of 165 degrees F or until hot and steamy. Bring soups, sauces and gravies to a rolling boil.
• Finally, if in doubt, throw it out.

Source: HACCP in the Kitchen, USDA Food Safety and Inspection Service