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Regulations Update

Federal Regulation – F371 Sanitary Conditions

F371 had 36 deficiencies cited in South Dakota long-term care facilities in 2009. It ranks number four in the tiop ten deficiencies for long-term care facilities in South Dakota.

Marci Pederson, RN, BSN, Nurse Educator/Consultant

 

F371 states, “The facility must –
Procure food from sources approved or considered satisfactory by Federal, State, or local authorities;
Store, prepare, distribute, and serve food under sanitary conditions.”

The overall intent of F371 is to promote safe food handling to prevent food borne illness.

In the 1950s, when I was a youngster, we had family gatherings on the Fourth of July, Thanksgiving, and Christmas. We all enjoyed a potluck meal at noon, and then the leftovers would sit out on the counter or table until around 5 p.m. Then everyone was invited to eat before they went home to do the farm chores.  Thinking back on this brings an unsettled feeling in the pit of my stomach. Yet, I don’t remember anyone becoming ill with food poisoning although if someone got sick around the holidays we blamed it on the flu even when the symptoms were vomiting and diarrhea. If this would have been in a nursing home setting, chances of a food-borne illness occurring would have been very high. Why is this so? Our nursing home residents are at risk for serious complications from food-borne illness because of their compromised health status.  For this reason alone, sanitary conditions must be adhered to in healthcare food service settings to promote safe food handling. It may seem difficult to believe that our residents could be in potential danger from the food they eat, but I remember one time when some of our health facility surveyors were assigned to do a survey at a facility because there had been deaths relating to food-borne illness. Providing nutritious, safe meals for our residents requires team work and effort. Nutrition is one of the most important aspects of resident care and may even be the most important aspect. A big thank you goes out to all who work in dietary services in nursing homes.

In order to understand food-borne illness we need to know there are three categories of food contaminants:

  • Biological
  • Chemical
  • Physical

Biological Contaminants

  • This category pertains to bacteria, viruses, toxins, and spores. We are not concerned with the good bacteria found in yogurt, which enhances digestion. And normally, Escherichia coli is considered normal bacteria in the intestinal tract, but sometimes it can become pathogenic or cause infectious symptoms resulting in illness or death. Certain foods are more hazardous in relationship to bacterial growth. They are ground beef, poultry, seafood, cut melon, unpasteurized eggs, milk, yogurt, and cottage cheese.  More acidic foods inhibit bacterial growth such as vinegar, pineapple, and lemon juice. Foods which have a high level of water (fruits and vegetables) encourage bacterial growth. Time and temperature play a role in prevention of bacterial growth. Freezing does not kill bacteria, but rapid death of most bacteria occurs at 165 degrees Fahrenheit or above.
  • I have put together a list of helpful hints to keep in mind when working with food to prevent biological contamination. Please take a minute and consider how everyone in your facility who helps with food preparation could explore how to develop a plan for compliance with each one of the bulleted topics. It is well known that when the hands-on staff develop their own improvement plans, there is more success. Focus on one item per month and then evaluate the results at the end of the month’s time period:
  • Although proper reheating will kill most organisms of concern, some toxins, such as those produced by Staphylococcus aureus, cannot be inactivated by reheating food. For this reason, it is important to cook food to the correct temperature the first time. In addition to this, do not allow any food to remain in the danger zone of above 41 degrees Fahrenheit and below 135 degrees Fahrenheit for more than 4 hours.
  • Using the steam table to reheat food is not acceptable since it does not bring the food to the proper temperature within acceptable timeframes.
  • Pasteurized eggs are available. Unpasteurized eggs when cooked to order per resident request need to be eaten promptly after cooking. The unpasteurized eggs should be 145 degrees F for 15 seconds. The white should be completely set and the yolk should be congealed. Waivers to allow undercooked unpasteurized eggs for resident preference are not acceptable.
  • Pooled eggs are raw eggs that have been cracked and combined together. The facility should crack only enough eggs for immediate service in response to a resident’s requests or as an ingredient immediately before baking. Salmonella associated with unpasteurized eggs can be prevented by using pasteurized shell eggs.
  • Raw eggs with damaged shells are also unsafe because of the potential for contamination. Dirty refrigerator door handles and dirty cupboard door handles when touched to obtain an item for food preparation can cause cross-contamination. There must be a consistent cleaning schedule to promote necessary sanitation.
  • The use of gloves is not a substitute for proper handwashing with soap and water. Gloved hands are considered a food contact surface that can get contaminated or soiled. Failure to change gloves and wash hands after doing a dirty task such as working with raw meat and then going to a clean task such as removing clean dishes from the dishwasher contributes to cross-contamination.
  • Antimicrobial gel (hand hygiene that does not require water) cannot be used in place of proper handwashing techniques in a food service setting.
  • Bare hand contact with food is prohibited. The appropriate use of utensils such as gloves, tongs, deli paper, and spatulas is essential to preventing food-borne illness. Do not place the handle of a used tong against the portion of a clean tong which will be touching food.  This actually has happened, and is a potential cross-contamination.
  • Employees who handle food must be free from communicable diseases and infected skin lesions.
  • Any circulating electrical fans that may create a flow of air over the food preparation area need to be on a strict cleaning schedule to prevent dirt and lint from blowing on the food.
    Always store raw meats below fruits, vegetables or other ready-to-eat foods so that meat juices do not drip onto these foods.
  • Labeling, dating, and monitoring refrigerated food, including, but not limited, to leftovers, so it is used by its use-by date is a must.
  • Monitoring internal food temperatures for 15 seconds before serving hot food should be done to ensure microorganisms can no longer survive.
  • Thawing frozen foods must be done in the refrigerator in a drip proof container or thawing can be done by submerging the item under cold water at a temperature of 70 degrees F or below that is running fast enough to agitate and float off loose ice particles.  Thawing as part of the cooking process is acceptable.  Thawing in the microwave, then cooking and serving immediately afterward is acceptable.
  • Work surfaces and food-contact equipment must be clean and sanitized between uses.
  • Cooling foods - place hot foods in shallow containers or pans in the refrigerator which will permit the food to cool more rapidly. Improper cooling is a major factor in causing food-borne illness. Large roasts should be cut into smaller portions for safe chilling.
  • Drying food preparation equipment and utensils with a towel or cloth may increase risks for cross-contamination.

Chemical Contaminants

The most common chemicals that can be found in a food system are cleaning agents and insecticides. Three principles should be followed when preventing chemical contamination:

  • Make sure we store all chemicals in their original containers. We do this to prevent using a chemical which could look like a food item such as sugar or salt. Another reason to store chemicals in their original containers is the original containers have the label information we need to use the product as safely as possible according to manufacturer’s recommendations.
  • Make sure we use chemicals only according to the manufacturer’s recommendations. If this is not done, we risk making the cleaning product too weak to sanitize the area being cleaned or too strong which will leave a toxic residue on a food contact surface.
  • Chemical products should be stored separately from food items. Insecticides should be used only according to the manufacturer’s instructions to prevent toxic contact with food.

Physical Contaminants

Physical contaminants are foreign objects which may inadvertently enter the food.  Examples include but are not limited to staples, fingernails, jewelry, hair, glass, metal shavings from can openers, and pieces of bones.

  • Fingernails should be kept trimmed and clean. Artificial fingernails are not acceptable in the food preparation area. Research has shown artificial fingernails harbor bacteria.
  • Jewelry should be kept to a minimum. Studies have shown jewelry such as rings, watches, and bracelets harbor microorganisms.
  • Hair – hair restraints are required in the food preparation area.

There is always plenty to learn in order to safely store, prepare, and serve food to our residents.  When this is not done safely, serious consequences can occur.  When your facility is fully compliant with this regulation, your residents are safe from food-borne illness.

Contact me at mapederson@avera.org  for all of your Regulatory Compliance and Survey Preparation needs.

Do the math! The facility bottom line improves when resident care continually improves.

As a former health facilities senior surveyor, Marci worked at the Department of Health Office of Licensure and Certification for eight years. Marci provides Survey Preparedness Consulting designed to create a culture of constant survey preparedness by helping staff understand regulatory requirements, not just comply with them.

Read more Regulations Updates.  The Avera Solutions’ Blog contains writings from Marci and other Avera Education & Staffing Solutions staff and consultants.


 

 

Marci Pederson, RN, BSN

Marci Pederson, RN, BSN

As a former health facilities senior surveyor, Marci served a variety of health care facilities. Her experience includes nursing education, medical/surgical nursing, psychiatric nursing, infection control, utilization review and quality assurance.

Have a question for Marci? A topic idea for her next column? Need more information on having a mock survey at your facility? Send her an email at mapederson@avera.org.