Infection Control Assessment and Oversight of Food Services at Children’s Hospital Los Angeles

1. Infection Control Assessment and Oversight of Food Services at Children’s Hospital Los Angeles Mary Virgallito Manager of Infection Prevention and Control March 2012

2. Objectives 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

3. Children’s Hospital Los Angeles Founded in 1901;first pediatric hospital in Southern California Admits 11,000 inpatients per year 317 beds, 85 percent of which are private rooms. 35 pediatric critical care beds Affiliated with the Keck School of Medicine, University of Southern California Magnet Hospital by the American Nurses Credentialing Center

4. 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 Dietician

5. Regulatory Requirements For Infection Control in Food Services

6. 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

7. 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.

8. 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 • Trichinellaspiralisassociated with pork • EnterohemorrhagicE. 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.

9. 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 present. • 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

10. 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.

11. 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.

12. 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 glaze. • 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 150°F • 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.

13. 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.

14. 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.

15. 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 requirements • Infection Control conducts an annual inspection which is reported to the hospital infection Control Committee

16. 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 Services • 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

17. Ongoing IC Risk Assessment - Comprehensive Food Safety Inspections • A comprehensive Food Safety Inspection should be completed • 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 Committee.

18. Food Services Documentation “Toolkit” • Review of Regulatory Compliance Requirements • Infection Control Food Service Worker Education Power-point • 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

19. References APIC Text of Infection Control and Epidemiology. Chapter 58: Food and Nutrition Services, 2009

20. QUESTIONS….