INTRODUCING A FOOD MANAGEMENT SYSTEM FOR HOSPITALS (HACCP)

1. INTRODUCING A FOOD MANAGEMENT SYSTEM FOR HOSPITALS (HACCP)

2. Principle Behind HACCP SAFE INGREDIENTS + SAFE PROCESS = A SAFE PRODUCT

3. Definitions – Important to Understand • HAZARD – Anything that may cause a food to become unsafe for humans to eat • RISK – The probability of that hazard occurring CONTROL

4. HAZARD = Risk of serving uncooked chicken to Patients / Customers CONTROL RISK = What is the likelihood of this occurring ? Definitions

5. BIOLOGICAL PHYSICAL HAZARDS CHEMICAL WHAT TYPE OF HAZARDS CAN EXIST IN A CATERING FACILITY… PRODUCE SAFE FOOD FIT TO EAT

6. Existing Essentials RequirementsBefore the implementation of HACCP - See Annex A - • High standards of design & maintenance MUSTalready exist in the kitchen & ancillary areas • Staff MUST already be suitably trained and be receiving regular good in-house food hygiene training • Senior Management MUST fully support the HACCP concept with equal support given to the Food Services Manager in provision of time & resources

7. Understand the 4 C’s Concept • C – Good Hygiene practice prevents CrossContamination • C – Effective Cleaning removes harmful bacteria and stops them spreading • C – Effective Chilling prevents harmful bacteria multiplying • C – Thorough Cooking kills bacteria

8. TASK The HACCP Team Should: • Give a description of the food, ingredients, processing methods and delivery to their customers. • Include all possible menu Items & special occasion menus • Similar foods group them together e.g. raw meat to be chilled, placed in a heated servery or trolley then served Assemble a HACCP Team 1. • Food Services Supervisor • Dietician • Head Chef • Infection Control Nurse • External Advisors 1. The purpose of this is to provide a clear outline of the steps involved in the process • These will be visitors, staff and patients. • Some patients may have specific dietary needs e.g. low sugar (diabetics), or specific allergies e.g. nuts Describe Food & Distribution 2. RECEIVING STORING The Team should perform an onsite review of the operation to verify the accuracy of the flow diagram PREPARING 3. Describe the Consumers COOKING Create Flow Diagrams SERVIING 4. 5. Verify the Flow Diagrams STAGE 1 – DEVELOPING A HACCP PLAN

9. PURCHASE DELIVERY DRIED GOODS STORAGE CHILLED FOOD STORAGE FREEZER STORAGE & DEFROSTING FOOD PREPERATION COOKING COOLING RE-HEATING Serving PLATING UP TROLLY & DELIVERY SERVERY EXAMPLE FLOW PLAN Purchase of Raw Chicken & Ingredients Storing (Freezer) Producing Curry Chicken Defrosting (Fridge) Prep (Cleaning, portioning,) Cooking Hot – Holding (Bain Marie) Plating Line Trolley Delivery

10. PURCHASE RECEIPT CHILLED STORAGE SERVE COLD FROZEN PREPERATION CHILL DRY COOKING HOT HOLD COLD HOLD RE-HEAT SERVE HOT SERVE HOT SERVE COLD SERVE HOT EXAMPLE FLOW PLAN

11. There Are 7 Stages of HACCP • Conduct a hazardanalysis i.e. look for hazards • Determine the Critical Control Points (CCP’s) • Implement effective controls at the CCP’s • Implement monitoring systems at the CCP’s • Establish Corrective Actions • Verify & Review Procedures • Establish record keeping and documentation procedures

12. PURCHASE RECEIPT CHILLED STORAGE SERVE COLD FROZEN PREPERATION CHILL DRY COOKING HOT HOLD COLD HOLD RE-HEAT SERVE HOT SERVE HOT SERVE COLD SERVE HOT WHAT AREA DO YOU THINK IS MOST IMPORTANT TO MAINTAIN FOOD SAFETY??

13. PHYSICAL BIOLOGICAL CHEMICAL STAGE No1: - Carry out a Hazard Analysis of the Catering Operation REMINDER: WHAT HAZARDS MAY EXIST IN A CATERING OPERATION

14. Example of a Hazard Analysis Form: (See Form A)

15. Example of a Hazard Analysis Form: (See Form A) Biological: - growth of bacteria. - cross contamination of bacteria from raw to ready to eat food. Physical - Pest contamination - Mold Chemical - Cleaning agents contamination - Pesticides

16. STAGE No2 : - Determine the Critical Control Point (CCP’s) Critical..??

17. STAGE No2 : - Determine the Critical Control Point (CCP’s) • A CCP is an identifiable point in a process whereby a control or safety measure MUST be applied to remove a hazard from a food or a step which is required to make the food safe e.g.: • Example 1:Cooking A Burger From Raw. If the burger is undercooked, any harmful bacteria present in the meat will not be destroyed and the surviving bacteria could give your customer food poisoning. In this example, ‘cooking’ is a Critical Control Point (CCP) in the food preparation process.

18. STAGE No2 : - Determine the Critical Control Point (CCP’s) Example 2:Cooling Rice. If recently cooked rice is cooled too slowly, it could give your customer food poisoning. In this example, ‘cooling’ in a food processis a Critical Control Point (CCP).

19. STAGE No2 : - Determine the Critical Control Point (CCP’s) Example 3:Preparing Raw Vegetables for Cooking. A person is preparing raw vegetables by peeling and washing them. Is this a critical control point? Example 4:Preparing Raw Vegetables For A Salad. A person is preparing raw vegetables for inclusion into a salad bar. Is this a critical Control Point

20. THE CCP DECISION TREE:

21. Setting Of Critical Limits at Identified CCP’s • You’ve identified a area in the food process which needs to controlled to ensure food is prepared safely. • You now need to set a “Critical Limit” i.e. what factor needs to be measured and / or controlled to ensure food is safe to eat e.g. time/temperature, concentration of chlorine • An example of a critical limit, may be that already set by law or regulation (such as in the SASC "Poultry must be cooked so that all parts reach a minimum of 165oF (74oC))"

22. Record what CCPs you have introduced onto your HACCP Record Sheet STAGE No3: - Implement Effective Controls at the Identified CCP’s • In setting any critical limit it must be based on common sense and recognized as • a control which will prevent, eliminate or reduce a hazard to an acceptable level. • A critical limit maybe based upon factors such as: • - Time • - Temperature • - Physical parameters • - Available Chlorine e.g. used to disinfect ready to eat fruit & vegetables • - Preventing Cross- Contamination

23. And / or you can use technical equipment: Can be very simple from using your human senses: Monitoring: Whatever method you use to have a successful HACCP program you must physically record the results of your monitoring.

24. Monitoring Must Be: • Accurate - Be aware of false or same readings • Representative – Batch monitoring / product size • Unbiased – Staff should not change results • Competently Done – Conducted by competent / trained staff who know what they are doing and can implement corrective action. • Timely – Carried out regularly and in a timely manner • Supervised – Check the records. Enforce the checks

25. HAZARD STAGE No5: -Establish Corrective Action So you’ve identified a PROBLEM or potential failure in one of your food processes – What are you going to do to correct it? 1st response – Protect the consumer and deal with the Food 2nd response – Deal with the cause. Investigate & identify the cause of the problem & correct it.

26. Chicken is undercooked Return it to the oven Until core temp >75oC (165oF) min 30sec WHAT DO YOU THINK ? By Master chef who: 1st - Protects the consumer by not allowing the undercooked poultry to be served to patients. 2nd - Corrects the cause of non-compliance e.g. returns the chicken to the oven for a longer time Examples of Corrective Actions: In any Corrective Action scenario, you need to ask yourself the following questions: Example 1. Chicken probed on removal from oven is 69oC (156oF) core temp • What is the problem? • Where / how can it be dealt with? • When will it be dealt with? • Who can deal with it?

27. Milk, yogurts and cream all warm to touch Prior to receipt of food by the catering unit Reject delivery & return it to supplier WHAT DO YOU THINK ? By Master chef who: 1st - Protects the consumer by not allowing the potentially high risk un-refrigerated dairy products to be used for catering purposes. 2nd - Corrects the cause of non-compliance e.g. rejects delivery & reassess competency of supplier Examples of Corrective Actions: As before In any Corrective Action scenario, you need to ask yourself the following questions: Example 2. Delivery of dairy food from local supplier in an un-refrigerated vehicle • What is the problem ? • Where can it be dealt with ? • When can it be dealt with ? • Who can deal with it ?

28. HAZARD STAGE No5: - Establish the Corrective Actions Your Corrective Actions must be written into your HACCP plan. It is essential that staff are trained accordingly on all these Corrective Actions and know what to do.

29. VERIFICATION HAZARD STAGE No6: - Verify & Review Procedures “…checking that the safety measures that you have implemented are working correctly..” i.e. correct temp & time visual checks etc

30. Check It & Review It? What else can you see that may be wrong here?…..look…

31. Consider reviewing the HACCP plan when: • Operations Change e.g. new equipment • Consumer Groups Change e.g. new patients, diabetics • Indication of HACCP plan failure e.g. insect found in food or complaints of food being cold

32. HAZARD STAGE No7: - Establish Records and Documentation Procedures Use the Hazard Plan & Examples Template Forms (A-N) Located in the Safer Food Better Business Folder A. Hazard Analysis Forms B. Approved Hospital Suppliers List C. Delivery Check Record D. Fridge Temperature Checks E. Freezer Temperature Checks F. Defrosting Temperature/Time Checks G. Cooking Temperature Records H. Servery Temperature Records I. Trolley Temperature Records J. Training Records K. Cleaning Schedule L. Pest Control Records M. Probe Thermometer Maintenance Records N. Internal Audit O. HACCP Diary Planner

33. ANNEX PAGES IN FOOD SAFETY GUIDANCE NOTES • A – Essential Programs Needed Before The Implementation of HACCP • B – Useful Guidelines For Typical Hospital • C – Tips on the Correct Use of Thermometers • D – Food Safety Training Programs

34. HAZARD STAGE No7: - Establish Records and Documentation Procedures Questions that you constantly need to ask….. Check your records every daily or weekly. Are your control adequate Are all your employees trained? Do they understand your recording procedures and what to do if something goes wrong? Periodically review your HACCP system – any changes needed? Physically check potentially hazards. Do not assume… Any new chemicals being used? Any customer complaints?

35. FINALLY……. ANY QUESTIONS?

36. WHAT NOW! • Complete the Hazard Analysis Form • Amend your Policies & Procedures • Amend Monitoring / check forms • Train Your Staff • Revisit Date…….

37. Assignment • Hend Ahmed Ibrahim.

38. Recommended text book • Janet Brown