Dietary Infection Prevention

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Dietary Infection Prevention

• Presented by Julie Lesemann, RN IP

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YOU have a big role in decreasing the risk for
infection!!

• 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

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Foodborne illnesses

• 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

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Campylobacter Jejuni

• 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

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Listeria

• 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

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Salmonella

• 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.

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Shigella

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

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Staphylococcus Aureus

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

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Hepatitis A

• Symptoms
• Sudden fever
• Malaise
• Abdominal cramps
• Anorexia
• Jaundice
• Sources
• Food contaminated with Human feces
• Most often restaurants

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Norovirus

• 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!

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How do you PREVENT these illnesses?

• 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

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4 Steps to Food Safety

1. Clean-Wash hands and surfaces often!
2. Separate- DONT Cross Contaminate
3. Cook- To the Right temp! These bacteria multiple
   very quickly in that danger zone (40-140 F.)
4. Chill- Refrigerate promptly!

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Environmental Surfaces

• C. Difficile gt 5-10 Months
• Staphylococci 7 months
• Norovirus 4 months
• Adenovirus 5 months
• Rotavirus 3 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?

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Testing and teaching

• 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.

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What infection prevention means in the kitchen?

• 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.

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Food Preparation workers ill?

• 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

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HANDWASHING.. The single most effective measure
of protection.

• 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 ?

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Hand washing and minimizing bare hand contact

• 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.

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Poor hand washing examples

• 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.

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Bare hand contact

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

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Personal hygiene

• 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.

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Examples cont.

• 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

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In the dining room

• 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.

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Infection Prevention is all of our business..

• 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.

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Kitchenettes

• 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?

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In summary

• 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!

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More thoughts on IP.

• Comments
• Questions
• Thank you!!!!!!

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Resources

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