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DINING PROGRAMS &
FOOD SAFETY Attracting Residents and Keeping them Healthy
Ruth L. Petran, Ph.D. VP, Food Safety & Public Health
Ecolab
#ALFA2014
Carlos C. Villarreal Divisional Director of Dining Services
Emeritus
FOOD IS EVERYONE'S HERITAGE
#ALFA2014
• Food is central to most important, emotional
moments throughout our lives
• Food serves as a means of connection
#ALFA2014
IT SHOULDN’T BE A SURPRISE
Dining is a key factor in resident satisfaction and occupancy*
http://www.seniorliving.net/categories/senior-nutrition/senior-living-industry-sees-dining-services-leading-growth/
• Our favorite spots offer relaxation, safety,
friendliness and laughter
• Spaces designated for eating are critically important
• Three or more impressions every day
#ALFA2014
DINING EXPECTATIONS ARE INCREASING
• The Baby Boomer generation is all about choice and customization
• They will expect to: • Order their favorite meals
• Request meal delivery service
• Have access to on-site coffee bars, grab-and-go dining options and fine dining
• Access in-room WiFi
#ALFA2014
AUDIENCE POLL
How many of you are including the following in your
communities today?
• All-day Dining
• Regional Food
Specialization
• Bistro/Grab & Go • Fresh Salad Bar
• Coffee Bar/Bakery
• Bar/Happy Hour • Special Dietary Requests
• FRESH Made Food
(Never frozen)
More than eight in ten (82%) expect to have access to
a fresh salad bar during meal times*
* Conducted by Anderson Robbins Research
BRING RESIDENTS LASTING SATISFACTION –
WITH EVERY MEAL
• Resident feedback • Satisfaction surveys
• Comments/criticisms
• Resident’s family insights
• Nutritionally balanced
and safe meals • Weekly in-house audits
• Monthly recognition of
best practices
• Monthly newsletters and
webinar trainings
#ALFA2014
#ALFA2014
DINING IS A BIG DEAL TO US –
AND TO OUR SENIORS
• Residents and families are looking for the BEST care, by people they TRUST
• Strive to go beyond the right offering and atmosphere
• Standard protocol and training to ensure consistent dining results
It is important that it is all done SAFELY
FOOD SAFETY: HELPING TO KEEP RESIDENTS HEALTHY
• Lots of data available about food safety
• Pay attention - illnesses happen
• Adopt a risk reduction mindset
• Everyone has a role in promoting food safety
#ALFA2014
This will enhance your business!
TOP 15 ATTRIBUTES CONSUMERS LOOK FOR*
Attribute Top Response % Rank
Taste and flavor of the food 66.5% 1
Quality of the food 65.3% 2
Dishware/glassware/silverware is clean 64.5% 3
Restaurant interior is clean 59.6% 4
Kitchen/food prep area (if visible) is clean 58.4% 5
Order accuracy 56.9% 6
Bathroom is clean 50.7% 7
Service is pleasant and friendly 48.9% 8
Staff pays attention to fundamentals 47.5% 9
Food served is visually appealing 45.5% 10
#ALFA2014
*Top 10 out of 60 attributes. Source: Technomic Inc. Consumer Brand Metrics Study cumulative results from Q4 2010 through Q1 2013
Clean dishes and restaurant environment
are at the top of the list
#ALFA2014
In a recent survey, 93% agreed that if a community isn’t
clean, it suggests that the staff might not take good care of the
residents either.*
WHAT IT MEANS TO YOU
Similarly, 86% agreed that clean, healthy spaces provide
reassurance that a senior living community is a safe,
comfortable place to live.*
* Conducted by Anderson Robbins Research, 2014
First impressions are critical
FOODBORNE ILLNESS ESTIMATES 11
United States
48 million cases
120,000 hospitalizations
3000 deaths
Europe
45.5 million cases
China/Asia
Surveillance beginning
Australia
5.4 million cases
120 deaths
Canada
4 million cases
#ALFA2014
Global food & water illness estimates:
1 billion cases, 2.2 million deaths
AGE MAKES A DIFFERENCE!
Source: CDC 2011. http://www.cdc.gov/foodnet/factsandfigures.htm
2011 US FOODBORNE ESTIMATES
CDC RISK FACTORS FOR FOODBORNE ILLNESS USA 1998-2008
Adapted from CDC 2013. Appendix MMWR 62(SS02);1-34
Poor Personal Hygiene,
25%
Other, 4%
Inadequate Cooking,
9%
Improper Holding,
31%
Contaminated equipment/
environment, 20%
Unsafe Source,
10%
FOCUS ON TOP CONTRIBUTING FACTORS CAN DRIVE ILLNESSES DOWN
1. Improper Holding Temperatures
2. Contaminated Equipment
3. Poor Personal Hygiene
4. Inadequate Cooking
5. Unapproved Source
#ALFA2014
#1 IMPROPER HOLDING TEMPERATURES
• Proper hot and cold holding are crucial
to food safety
– Keep food out of the Temperature
Danger Zone
– Monitor proper temperature control
with a calibrated thermometer
– Use equipment designed for keeping
food at the proper temperature
#ALFA2014
Allows pathogens to persist and in some cases,
Increase to harmful levels
#1 IMPROPER HOLDING TEMPERATURES Organisms of Concern
• Clostridium perfringens
• Bacillus cereus
• Salmonella
• Staphylococcus aureus
• Histamine
#ALFA2014
#1 IMPROPER HOLDING TEMPERATURES Organisms of Concern
Clostridium perfringens
• Frequent contaminant in meats
• Cells grow in food with poor temperature control
• Illness caused by ingestion large numbers of cells
• Symptoms - relatively mild, but can include intense
abdominal pain, diarrhea
#ALFA2014
#1 IMPROPER HOLDING TEMPERATURES Real Life Outbreak
#ALFA2014
• Outbreak in Cooked Beef
– 156 cases all had eaten cooked beef sandwiches
from same food service preparation
– Beef was boiled, then refrigerated until service a
couple days later.
– Was held at 49ºC, sliced & served through the
day
– Found high levels of cells in leftover beef
#2 CONTAMINATED EQUIPMENT
• Understand the flow of food through your establishment
• Understand where there is a possibility of cross-
contamination
• Set up barriers and procedures to block pathogen
transfer and growth
• Use proper sanitization procedures and chemicals,
following the label instructions
• Make sure your kitchen is free of pests
#ALFA2014
Cross-contamination is a major hazard in the flow of food
#2 CONTAMINATED EQUIPMENT Organisms of Concern
• Salmonella
• Listeria monocytogenes
• Campylobacter
• Norovirus
#ALFA2014
Camplybacter jejuni
• Symptoms – diarrhea, fever, cramps, nausea,
vomiting & visible blood in stools.
#ALFA2014
#2 CONTAMINATED EQUIPMENT Organisms of Concern
Lettuce contaminated with raw chicken
• 14 patrons at a food service event became ill
• Two hospitalizations. – Camplybacter jejuni isolated from all patients
• Investigation revealed multiple sources of contamination – Countertop too small to separate raw poultry and other foods
– Cook cut up raw chicken before preparing salads
– Lettuce for salads was shredded with a knife
– Cook wore a towel around her waist, frequently used to dry hands
– Uncertain whether the cook had cleaned the countertop after cutting up the chicken
#ALFA2014
#2 CONTAMINATED EQUIPMENT Real Life Outbreak
#3 POOR PERSONAL HYGIENE
• Avoid unsanitary habits
• Maintain and monitor their
personal health
• Report illness and wounds
• Follow hygienic hand practices:
good hand washing and
proper glove use
#ALFA2014
Food handlers can contaminate food and
cause consumers to become ill
#3 POOR PERSONAL HYGIENE Organisms of Concern
• Foodborne viruses – Norovirus and Hepatitis
• Staphylococcus aureus
• Shigella
#ALFA2014
NOROVIRUS OUTBREAKS
Source: Vega, et al. 2014 J. Clin Micro 52:147.
Child Care Centers
1%
Correctional facilities
1%
Cruises, Vacation
3%
Hospitals 4%
Long term care
facilities 62%
Parties & events
5%
Restaurants 10%
Schools 6%
Unknown 8%
US, 2009-2013 (n=3960)
TRANSMISSION MODES IN NOROVIRUS OUTBREAKS
66.1
25.9
7.5 0.3 0.2
0
20
40
60
80
100
Percent
2009-2010 (N=1908)
Source: Hall. 2013 Emerg Infec Dis. 19(8):135
#3 POOR PERSONAL HYGIENE Real Life Outbreak
– Guests at different events received sandwiches
from common source
– > 100 people estimated to be affected
– Illness associated with sandwiches containing
lettuce
– Employee with norovirus symptoms returned to
work the same day his symptoms ended
– Was still excreting Norovirus in his stool
– Food prep sink used to wash lettuce also used for
hand washing
– Michigan issued guidelines that food service
workers with suspected norovirus not return to
work until they are asymptomatic for 48-72 hours
Photo courtesy: Dr. B.V.V. Prasad, Baylor College of Medicine
#ALFA2014
#4 INADEQUATE COOKING
• Final cooking temperatures for various products
depend on the type of microorganisms
associated with that food type
• Since not all pathogens and toxins are destroyed
by heat, proper handling before and after
cooking are crucial
• Surviving pathogens can cause illness
#ALFA2014
Cooking to proper final cooking temperatures for a specified
time reduces microorganisms
E. coli O157:H7 Outbreaks
• Hamburger – 1st major outbreak in 1993 – Hamburger restaurants implicated
– >500 people ill; 45 HUS; 3 deaths
– Attributed to under cooked contaminated hamburger patties
– Other eventual outcomes of the outbreak: • Increased temperature to 155°F minimum
for restaurant cooked hamburgers
• Safe-food-handling labels on meat
• E. coli O157:H7 declared an adulterant in raw ground beef
• Irradiation of hamburger patties gained favor
#ALFA2014
#4 INADEQUATE COOKING Real Life Outbreak
#5 UNAPPROVED SOURCE
• What is an Approved Source?
– Has been inspected
– Is in compliance with local, state and federal law
– Known source or point of origin
– Good reputation
• What can cause issues?
– Contingency plans/Need to use a back up vendor
– Spot purchase/local vendors
– Not being specific enough in required criteria – e.g.,
Growing conditions for produce and seafood, Production
conditions for meat & seafood
#ALFA2014
#5 UNAPPROVED SOURCE: Organisms of Concern
• Vibrio species
• Seafood toxins - Histamine
• Norovirus
• Salmonella
• Campylobacter
#ALFA2014
#5 UNAPPROVED SOURCE: Organisms of Concern
Salmonella has contaminated produce
• Tomatoes
– 2007 Tomato Safety Initiative – FDA/Fla/Va
• Cantaloupe
– 2008 FDA import alert for Honduran grower/packer
• Raw almonds
– 9/1/07 – USDA requires pasteurization
#ALFA2014
Know how your produce is handled
• Produce is frequently consumed raw
• Cross-contamination opportunities are prevalent
• Treatments to destroy pathogens are limited
• Global sourcing leads to inconsistent controls
#ALFA2014
#5 UNAPPROVED SOURCE: Factors Contributing to Produce Outbreaks
More people are eating fresh produce
1. Improper Holding Temperatures
2. Contaminated Equipment
3. Poor Personal Hygiene
4. Inadequate Cooking
5. Unapproved Source
#ALFA2014
FOCUS ON TOP CONTRIBUTING FACTORS CAN DRIVE ILLNESSES DOWN
Consider… what can you do to help
prevent another outbreak from being
attributed to one of these factors?
#ALFA2014
THINKING WITH A RISK REDUCTION MINDSET
• Process
– Identify all relevant hazards
– Focus on prevention to address all identified hazards
• Preventive controls must be effective, addressing
the hazards of concern
– Do they work?
– Do they achieve the intended control?
#ALFA2014
Must be effectively implemented
RISK REDUCTION: Plan for Norovirus
• Hands should be washed frequently with soap
and water
• Do not permit infected workers to prepare food
for at least 3 days after recovery
• Review current cleaning and hygiene plan
• Discard food that may have been contaminated
by an ill person
#ALFA2014
RISK REDUCTION: Have a Spill Kit Available
• Procedures
• Registered disinfectant
• Personal protective
equipment
• Absorbent beads
• Wipes
• Scoop
• Bag
#ALFA2014
RISK REDUCTION: Constant Attention
• Procedures with three levels of action:
– LEVEL GREEN • Standard procedures – maintaining hygiene when norovirus poses
no direct threat
– LEVEL YELLOW • Risk reduction – a heightened defensive response to an outbreak in
your area/industry
– LEVEL RED • Remediation – a focused response to an outbreak in your facility,
designed to break the chain of infection or illness
– INCIDENT CLEAN-UP • How to clean an incident of vomitus or stool contamination
#ALFA2014
FOOD SAFETY SOLUTIONS Consider Interventions at Multiple Sites
42
Food Service
Retail
Agricultural
Production
Processing
Your Community
#ALFA2014