DINING PROGRAMS & FOOD SAFETY Attracting Residents and Keeping them Healthy Ruth L. Petran, Ph.D.
Carlos C. Villarreal
VP, Food Safety & Public Health Ecolab
Divisional Director of Dining Services Emeritus
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FOOD IS EVERYONE'S HERITAGE • Food is central to most important, emotional moments throughout our lives • Food serves as a means of connection
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IT SHOULDN’T BE A SURPRISE
• Our favorite spots offer relaxation, safety, friendliness and laughter • Spaces designated for eating are critically important • Three or more impressions every day
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/
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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
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AUDIENCE POLL How many of you are including the following in your communities today? • All-day Dining • Regional Food Specialization
• Coffee Bar/Bakery • FRESH Made Food (Never frozen)
• Bistro/Grab & Go
• Fresh Salad Bar
• Special Dietary Requests
• Bar/Happy Hour
More than eight in ten (82%) expect to have access to a fresh salad bar during meal times* * Conducted by Anderson Robbins Research
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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
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
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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
This will enhance your business!
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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
*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
WHAT IT MEANS TO YOU 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.* Similarly, 86% agreed that clean, healthy spaces provide reassurance that a senior living community is a safe, comfortable place to live.* First impressions are critical * Conducted by Anderson Robbins Research, 2014
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FOODBORNE ILLNESS ESTIMATES Europe Canada
4 million cases
United States
China/Asia
48 million cases 120,000 hospitalizations 3000 deaths
45.5 million cases
Surveillance beginning
Australia
5.4 million cases 120 deaths
Global food & water illness estimates: 1 billion cases, 2.2 million deaths #ALFA2014
AGE MAKES A DIFFERENCE! 2011 US FOODBORNE ESTIMATES
Source: CDC 2011. http://www.cdc.gov/foodnet/factsandfigures.htm
CDC RISK FACTORS FOR FOODBORNE ILLNESS USA 1998-2008 Unsafe Source, 10%
Poor Personal Hygiene, 25%
Contaminated equipment/ environment,
20% Other, 4%
Improper Holding, 31%
Inadequate Cooking, 9%
Adapted from CDC 2013. Appendix MMWR 62(SS02);1-34
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
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#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 Allows pathogens to persist and in some cases, Increase to harmful levels #ALFA2014
#1 IMPROPER HOLDING TEMPERATURES Organisms of Concern • • • • •
Clostridium perfringens Bacillus cereus Salmonella Staphylococcus aureus Histamine
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#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
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#1 IMPROPER HOLDING TEMPERATURES Real Life Outbreak • 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
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#2 CONTAMINATED EQUIPMENT • Understand the flow of food through your establishment • Understand where there is a possibility of crosscontamination • 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 Cross-contamination is a major hazard in the flow of food
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#2 CONTAMINATED EQUIPMENT Organisms of Concern • • • •
Salmonella Listeria monocytogenes Campylobacter Norovirus
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#2 CONTAMINATED EQUIPMENT Organisms of Concern Camplybacter jejuni • Symptoms – diarrhea, fever, cramps, nausea, vomiting & visible blood in stools.
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#2 CONTAMINATED EQUIPMENT Real Life Outbreak 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
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#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 Food handlers can contaminate food and cause consumers to become ill #ALFA2014
#3 POOR PERSONAL HYGIENE Organisms of Concern • Foodborne viruses – Norovirus and Hepatitis • Staphylococcus aureus • Shigella
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NOROVIRUS OUTBREAKS US, 2009-2013 (n=3960)
Unknown 8% Schools 6%
Child Care Centers Correctional facilities 1% 1%
Cruises, Vacation 3% Hospitals 4%
Restaurants 10%
Parties & events 5%
Long term care facilities 62%
Source: Vega, et al. 2014 J. Clin Micro 52:147.
TRANSMISSION MODES IN NOROVIRUS OUTBREAKS 2009-2010 (N=1908) 100 80
66.1
60 40 20 0
25.9 7.5
0.3
0.2
Percent 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 #ALFA2014 Photo courtesy: Dr. B.V.V. Prasad, Baylor College of Medicine
#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 Cooking to proper final cooking temperatures for a specified time reduces microorganisms #ALFA2014
#4 INADEQUATE COOKING Organisms of Concern • Salmonella • E. coli O157:H7
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#4 INADEQUATE COOKING Real Life Outbreak 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
#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
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#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
Know how your produce is handled
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#5 UNAPPROVED SOURCE: Factors Contributing to Produce Outbreaks • • • •
Produce is frequently consumed raw Cross-contamination opportunities are prevalent Treatments to destroy pathogens are limited Global sourcing leads to inconsistent controls
More people are eating fresh produce
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FOCUS ON TOP CONTRIBUTING FACTORS CAN DRIVE ILLNESSES DOWN 1. 2. 3. 4. 5.
Improper Holding Temperatures Contaminated Equipment Poor Personal Hygiene Inadequate Cooking Unapproved Source
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Consider‌ what can you do to help prevent another outbreak from being attributed to one of these factors?
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RISK REDUCTION MINDSET
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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?
Must be effectively implemented
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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
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RISK REDUCTION: Have a Spill Kit Available • Procedures • Registered disinfectant • Personal protective equipment • Absorbent beads • Wipes • Scoop • Bag
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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
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FOOD SAFETY SOLUTIONS Consider Interventions at Multiple Sites Food Service
Retail Agricultural Production
Processing
Your Community #ALFA2014
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QUESTIONS?
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