1. Presented by Julie Lesemann, RN IP

2.  My goal today is to remind each of you of how vital all of your efforts are and the impact they have on Infection Prevention for those whom we serve each day.  We will discuss Foodborne illnesses that we try to avoid every day.  Preventative measures to take within the Preparation and distribution process. Including delivery of food- not only by dietary, but by the nursing assistants and nurses who assist within your settings.  Alternative food service areas: kitchenettes, NH and Hospital…. Potential concerns involved with patient/resident/ staff/ visitor within those areas.  What you can do to help decrease the risks

3. E Coli  Produces a toxin that causes sever damage in the lining of the intestines Symptoms:  Diarrhea  Potential loss of kidney function  Death Sources:  Meat: particularly undercooked hamburger  Raw Milk  Leafy greens

4.  The Leading cause of bacterial diarrheal illness in the US  2-4 MILLION cases per year Source:  Raw/undercooked Poultry and beef  Raw milk  Untreated water

5.  Causes septicemia, meningitis, encephalitis and intrauterine or cervical infections  In pregnant woman can cause stillbirths Sources:  Deli Meats  Raw milk  Soft cheeses  Ice cream  Raw vegetables  Undercooked meat, poultry and seafood

6.  Symptoms:  Diarrhea, fever, abdominal cramps 12- 72 hrs after infection.  Lasts 4-7 days  42,000 cases/year Sources:  Raw or undercooked eggs  Undercooked poultry  Dairy products  Seafood  Fruits, vegetables.

7. Symptoms:  Diarrheal illness  Fever  Vomiting 300,000 cases / yr Sources:  Potato  Tuna, shrimp salads  Milk and dairy products  Poultry  Raw vegetables

8. Symptoms:  Nausea, vomiting  Abdominal cramps Sources:  Cooked foods high in protein i.e. ham, tuna, chicken, macaroni, potato salad  Cream filled bakery  Dairy

9. Symptoms:  Sudden fever  Malaise  Abdominal cramps  Anorexia  Jaundice Sources:  Food contaminated with Human feces  Most often restaurants

10.  Affects the stomach and intestines “gastroenteritis”  Many of those eating the contaminated food become ill- causing an outbreak. *Food Providers/Preparers who are sick with Norovirus are a particular risk to others!!!! A sick food handler can easily contaminate the food!

11.  Educate STAFF- Empower staff-upon hire and annually  MONITOR/ AUDIT!! Wkly, monthly, qrtly, peer  QA programs  Review policies  Look at every part of the “Chain of Infection”  Receiving, Storage, Food contamination (Prep, washing, thawing, mixing, cutting, slicing, cooking, blending, cooling, reheating, etc.  Distribution- the process of getting that food out to the patient/resident/staff. Holding foods on steam tables, dispensing the food, delivery of food by staff  Is education documented?  Monitor and teach USING: The 4 STEPS to food safety

12. 1. Clean-Wash hands and surfaces often! 2. Separate- DON’T Cross Contaminate 3. Cook- To the Right temp! These bacteria multiple very quickly in that danger zone (40-140 F.) 4. Chill- Refrigerate promptly!

13.  C. Difficile > 5-10 Months  Staphylococci7 months  Norovirus4 months  Adenovirus5 months  Rotavirus3 months  It is essential to perform audits regarding environmental surfaces! Involve staff!  What products are used for cleaning your environment? Are cleaning buckets emptied daily? Wash rags changed daily?

14.  Work with your IP and Lab – have employees assist taking “swabs” monthly or quarterly.  Before and after cleaning is complete.  Remember High touch areas!  Handles/ ice machines, utensils, etc.

15.  The majority of regulations that pertain to Dietary are infection control related….  Cleanliness of kitchen, refrigerators, walk ins etc  Cooler and freezer temps  Food storage, prep and sanitation  Date marking  Dish machine  The “Flow” in the kitchen (clean to dirty)  Utilization of gloves, aprons, hairnets, etc.  Cleaning of equipment- is it on a schedule- who monitors?  Cleaning of light fixtures, drains, vents, etc.

16. Employee health (your health)  Observe for employees with the symptoms food establishments should be most concerned about.. Vomiting Diarrhea Sore throat and fever Infected cuts or burns with drainage Pink eye

17.  The single most effective measure against the spread of infection!!!  Organisms are spread most often via healthcare workers hands!  Are employees audited? Taught on hire ?

18.  When entering a food prep area  Before putting on clean gloves and between glove changes  Before engaging in food preparation  When changing tasks, esp. between handling raw and RTE food.  After handling soiled dishes, equipment or utensils  After touching bare human body parts  After using the restroom  After coughing, sneezing, blowing nose, breaks, eating or drinking.  Minimize bare hand contact as much as possible.

19.  Staff member entered kitchen, obtained a pitcher of milk from refrigerator, proceeded to the dining room to pour milk for residents. Staff member did not wash hands when entering the kitchen.  Staff member did not wash hands after working with soiled dishes, before stacking clean dishes, with fingers touching the eating surfaces.

20.  Staff member sliced potatoes with bare hands  Staff member served hamburger buns at tray line with bare hands.

21.  Aprons, hair restraints, jewelry  Bad example: staff handles sprayer to rinse a soiled utensil, no apron on then handles the clean dishes and served food.  Staff member used sprayer to rinse soiled dishes, the front of the staffs shirt wet, then handled clean dishes.

22.  Staff serving food at the tray line with hair not restrained in hairnets, including staff member with chin length hair dropping forward as leaning over the food.  Staff preparing sandwiches with hair not restrained in forehead region

23.  Insure that staff are washing their hands prior to serving, when they get up to assist a resident and come back to help serve or feed!!!!  Residents hands soiled and they are serving themselves at the table- talk to staff immediately.  Residents sticking food in their baskets! Please notify staff or assist them to take it out of their baskets.

24.  Staff placing food in front of a resident- should they tie their hair up if long?  Staff assisting 2 residents eat… they should wash their hands in between.  Take opportunities to educate as they arise..  Cleaning of tables/ bleaching environmental surfaces, etc.

25.  What do you see? How do refrigerators look? Are they clean, no food items / crumbs spilled..  Are they checked for dates, etc.  Are families bringing food to residents ? If so what are the rules on this?  Are families / visitors digging in the refrigerators? Are they touching snacks, etc.? Helping themselves in the ice machines? How are we dealing with this?

26.  It is all of our responsibility to ensure Infection prevention exists and is monitored within each department.  Take time to build your Infection prevention practices within your dietary departments!

27.  Comments  Questions  Thank you!!!!!!

28.  http://www.foodsafety.gov/keep/basics/chill /index.html http://www.foodsafety.gov/keep/basics/chill /index.html  http://www.cdc.gov/24-7/pdf/food-safety- factsheet.pdf http://www.cdc.gov/24-7/pdf/food-safety- factsheet.pdf  CDC  MDH