FOOD SAFETY. Why Are Residents of Long-Term Care Homes at Risk for Food borne Illness?

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1 Why Are Residents of Long-Term Care Homes at Risk for Food borne Illness? There are several factors that may increase the susceptibility of long-term care home residents to foodborne illness such as advanced age, illness, injury and use of antibiotics and antacids. These factors may result in the weakening of their immune system. This leads to an inability to fight off the effects of pathogenic organisms if present in the food they eat. Individuals who use antacids (or other drugs) neutralize the gastric acid in the stomach which inhibits acid secretion which may increase the risk of food or waterborne infections. The secretion of hydrochloric acid by the stomach plays an important role in protecting the body against pathogens ingested with food or water. Foodborne illness that is mild in a healthy individual can be life-threatening to the longterm care home resident. Consequently, food prepared for this population must be prepared in strict accordance with the regulations and guidelines for food premises. Symptoms of Foodborne Illness Common symptoms of foodborne illness are: diarrhea, abdominal cramping, fever, sometimes blood in the stools, headache, vomiting and weakness. However, symptoms will vary according to the type of foodborne illness and the amount of the contaminant consumed. Symptoms of foodborne illness may begin as early as one half-hour after eating the contaminated food or they may not develop for several days or weeks. Symptoms usually last only a day or two, but in some cases can persist. For most healthy people, foodborne illnesses may not be long lasting or life threatening. However, foodborne illness can be severe in high-risk populations including seniors, immuno-compromised individuals and the very young. What to do in case of a suspected foodborne illness: If you suspect a resident has a food borne illness, follow these general guidelines: 1. Seek medical attention for the resident immediately. 2. Institute appropriate infection control measures. This should include contact precautions such as gowns and gloves for contact with resident s feces, dedicated equipment where appropriate, and enhanced hygiene and environmental cleaning. 3. Call Peel Public Health immediately if you suspect food borne illness in your home.

2 food borne outbreak investigations Public Health Inspectors will assist the Outbreak Management Team with an epidemiological investigation of the outbreak. Outbreaks are reported to the Ministry of Health and Long Term Care by Peel Public Health. The Public Health Inspector will coordinate the submission of stool and food samples to the Ontario Agency for Health Protection and Promotion (OAHPP) Toronto Public Health Laboratory. In addition, Public Health Inspectors will advise the home of the results of the samples submitted to the Ontario Agency for Health Protection and Promotion (OAHPP) Toronto Public Health Laboratory. The Public Health Inspector may also conduct a general inspection of the food preparation, storage and service areas of the home. Any ill staff members who are involved in food handling or resident care should be excluded from work while symptomatic. Follow the directive from Peel Health regarding the return to work of ill staff. Peel Health Department Responsibilities Public Health Inspectors are responsible for food safety inspections of food service premises in the Region of Peel. Inspections are conducted under the authority of the Health Protection and Promotion Act. Public Health Inspectors will conduct regular inspections of your home to ensure compliance with Ontario Regulation 562, Food Premises. The Region of Peel has a full disclosure program for all food premises. In addition, Public Health Inspectors conduct Hazard Analysis Critical Control Point (HACCP) food cooking/processing audits in accordance with the Ministry of Health Hazard Analysis Critical Control Point Protocol. Public Health Inspectors investigate foodborne illnesses reported to the Health Department and also inspect other types of public premises and respond to community concerns of a public health nature. Food Handler Education Education of food handlers on an ongoing basis is recommended for all homes. The emphasis on food handler education should be on proper food handling practices and good personal hygiene. Peel Health offers a food safety certification course in accordance with the Ministry of Health Food Handler Training Protocol on an ongoing basis. The course is taught by a Public Health Inspector. Topics include the role of the Public Health Department, legislation, receiving, storing, preparing and serving food safely, introduction to HACCP, food handling hygiene, food allergy, and food premises sanitation, design and maintenance. The food handler certification course can be completed in one day. The course consists of classroom instruction and learning activities followed by an exam. A pass mark of

3 70% must be achieved on the exam in order to obtain the food safety training certificate. A fee is charged for the food handler certification course. A home study course is also available. Groups of 10 or more may be able to organize sessions for their group. For more information call Health Line Peel at Peel Public Heath also offers a refresher in-service.

4 INSPECTIONS The following pertains to the FoodCheck Peel disclosure system. Food Check Peel a. FoodCheck Peel grading system is based on the Ontario Food Premise Regulation b. Frequency of inspections is based on a risk assessment conducted by the PHI High Risk premise: o Inspected 4x per year o HACCP audit conducted 1x per year Medium Risk premise: o Inspected 2x per year Low Risk premise: o Inspected 1x per year c. The risk rating is dependant on the following criteria: food handler certification, historical level of compliance, history of food poisoning, nature of food prepared, population served, volume of food prepared and water source. FoodCheck Peel Grading System Type Definition Inspection Detail & Time PASS Notice Substantial Compliance with Observed non-compliance is minor and can Food Premise Regulation be followed up during the next scheduled CONDITIONAL PASS Notice CLOSURE Notice Significant non compliance with Food Premise Regulation which may affect food safety Conditions in the food premises are an immediate health hazard to the general public. inspection Immediate threats to food safety will be eliminated at the time of the inspection Follow-up inspection will be conducted within 72 hrs Closure order is issued at time of inspection and would remain in effect until a reinspection determines that the health hazard has been abated. Premise is monitored daily by PHI

5 , SANITATION, DESIGN AND MAINTENANCE The following factors are critical to food safety, sanitation, design and maintenance Refrigerated and Frozen Storage of Hazardous Food a. Keep cold foods cold served at 4 C (40 F) or colder b. Freezing: -18 C (0 F) or less. Freezer items are dated and stamped. c. Cooling of cooked foods: 60 C to 20 C (140 F to 68 F) and refrigerated within two hours (excludes large cuts of meat) d. Any food that remains between 4 C (40 F) and 60 C (140 F) for more than 2 hours must be discarded Cooking/Hot Holding/Reheating of Hazardous Foods a. Thermometers are required to verify food preparation and storage temperatures. b. Thorough cooking to minimum internal food temperatures: Whole poultry 82 C (180 F) Poultry/stuffing/ground and stuffed meat 74 C (165 F) Pork Products (other than ground) 71 C (160 F) Ground meat (other than poultry) 71 C (160 F) Other hazardous foods 74 C (165 F) c. Hot holding: minimum of 60 C (140 F) after cooking/rapid re-heating d. Reheating: to original cooking temperature within four hours. Prevention of Food Contamination a. Food handlers must wash their hands thoroughly before and after handling food. b. Proper utensils e.g. tongs, spoons, forks must be used to minimize direct hand contact with cooked or prepared foods. c. Raw foods must be kept separate from ready-to-eat foods during storage and handling. d. Preparation surfaces and utensils used for ready-to-eat foods must be separate from raw food e. Food must be protected from potential contamination (e.g. food covered, labelled, stored at least 15 cm off floor) f. Chemicals/pesticides are to be stored separately from food.

6 Establishment Sanitation, Design and Maintenance Equipment and Utensils Proper storage of clean utensils. Disposable (single-service) utensils properly stored and dispensed. Thermometers to verify food preparation and storage temperatures. Food contact surfaces properly designed, constructed, installed, located, maintained (smooth, non-absorbent, cleanable, corrosion resistant and non-toxic). Non-food contact surfaces and equipment properly designed, constructed, installed, maintained (accessible for cleaning). Food Handler Hygiene and Activities Clean outer garments. Prohibited use of tobacco/smoking while preparing food. Hair confined. Washing hands thoroughly before and after handling food. Hands must be washed at a separate handwashing basin. The handwashing basin must be in a location convenient for employees and be located in each processing and preparation area. The handwashing basin must be supplied with hot and cold potable running water and soap or detergent in a dispenser. Hands must be dried with clean single-service towels (paper towels) or by use of a continuous cloth roller towel in a mechanical device. Equipment and Utensils Mechanical dishwashing (temperature, time, sanitizing). Washing temperature is 60 C to 71 C (140 F to 160 F). The sanitizing rinse water temperature is not lower than 82 C (180 F) for a minimum of 10 seconds for a high temperature dishwasher. The sanitizing rinse water temperature is not lower than 24 C (75 F) for a minimum of 45 seconds for a low temperature dishwasher that uses chemical sanitizers.

7 Manual dishwashing: wash-rinse-sanitize technique. 2-compartment sink method: Step 1: Pre-scrape and pre-rinse Step 2: Wash and Rinse in sink #1 using a clean detergent solution and clean water Step 4: Sanitize in Sink #2 (see table below for sanitizing options) Step 4: Air dry Note: A 2-compartment sink can only be used for the cleaning and sanitizing of pots, pans and cooking/preparation utensils. 3-compartment sink method Step 1: Pre-scrape and pre-rinse Step 2: Wash in sink #1 using a clean detergent solution and clean hot water Step 3: Rinse in sink #2 using clean hot water at 43 C (110 F) Step 4: Sanitize (see table below for sanitizing options) in sink #3 Step 5: Air dry

8 Sanitizing Options for Dishwashing Agent Water temperature Concentration Contact time Chlorine not less than 24 C (75 F) 100 ppm 45 seconds Quaternary ammonium not less than 24 C (75 F) Iodine not less than 24 C (75 F) Hot Water: Manual Dishwashing Not less than 77 C (170 F) 200 ppm 45 seconds 25 ppm 45 seconds N/A 45 seconds Mechanical Dishwashing Not less than 82 C (180 F) N/A 45 seconds Sanitizer test kit available to determine the concentration of the sanitizing agent. Thermometer available to verify wash and rinse temperatures Food contact surfaces washed, rinsed and sanitized after each use and following any operations when contamination may have occurred. Refer to the table below for a chlorine sanitizing solution recipe. Wiping cloths handled properly (sanitizing solution used) Sanitizing Solution using Household Bleach (5.25% bleach) Task Concentration Recipe Contact time 1 tsp of bleach with ppm cups of water or 45 seconds 5ml of bleach with 2½ L of water 2 or 3 compartment dishwashing / sanitizing surfaces Sanitizing large utensils/equipment unable to be cleaned and sanitized by means of sink or other machines 200 ppm 2 tsp of bleach with 10 cups of water or 10 ml of bleach with 2½ L of water 45 seconds Sanitary Facilities Every sanitary facility shall be equipped with: a constant supply of hot and cold running water a supply of soap in a dispenser a supply of toilet paper a durable easy-to-clean receptacle for used towels and other waste material a continuous cloth roller towel in a mechanical device, a supply of paper towels, a supply of clean single service towels or hot air dryer

9 Garbage and Waste Management Insect and vermin-proof containers provided where required. Frequency of garbage removal adequate to maintain the premises in a sanitary condition. Liquid wastes handled and collected in a sanitary manner. Pest Control Adequate protection against the entrance of insects, vermin, rodents, dust and fumes. Sanitary Maintenance and Construction of Establishment Floors, walls, and ceiling clean and in good repair. General housekeeping satisfactory. Exclusion of live animals on the premises, subject to exemptions. Lighting is adequate for food preparation and cleaning. References: Ministry of Health and Long Term Care. Food Safety Protocol, October 2008 Canadian Food Inspection Agency. The Canadian food safety system: food recall. Ottawa, ON: Canadian Food Inspection Agency; APIC Text of Infection Control and Epidemiology 3 rd edition. APIC 2009; Vol. II: 97:2-5