FOOD HYGIENE FOR WARD KITCHENS

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					               FOOD HYGIENE
                   FOR
               WARD KITCHENS




APPROVED BY:           Policy & Guideline Committee

TRUST REFERENCE:       B27/2004

DATE (Approved):       14 October 2004

MOST RECENT REVIEW:    13 February 2006
                       Policy & Guideline Committee

NEXT REVIEW:           February 2007

ORIGINATOR (Author):   Infection Prevention and Control Team/
                       Facilities
                       Approved Infection Control Committee April
                       2004 as Chapter 12 of the Infection Control
                       Guide
INDEX



        Subject                                                             Page No

1.0     Introduction                                                                2

2.0     Responsibilities and Use                                                    3

3.0     Design Criteria for Ward Kitchen and Regeneration Areas                    3-5

4.0     Hazard Analysis: Food Safety                                                5

5.0     Training                                                                   5-6

6.0     Cleaning and Washing Up                                                    6-7

7.0     Use of Ward Kitchen: General Provisions                                     7

8.0     Food Storage                                                               7-8

9.0     Food Service                                                               8-9

10.0    Use and Installation of Equipment in Ward Kitchens                     9-12

11.0    Pest Control                                                               12

12.0    Maintenance                                                                12

13.0    Waste Disposal                                                             12

        Bibliography                                                               13

        Appendix 1 Hazard Analysis Ward Kitchens                              14-16

        Appendix 2 Food Hygiene Training for Ward Based Food Handler               17

                       Hygiene Awareness Training for Ward Based Food         18-19
                       Handlers

        Information for Ward Based Food Handlers                              20-22




                                       Page 1                           Dec 2005
1.0      INTRODUCTION

         Managers need to be aware that the Food Safety Act 1990 and the
         regulations relating to food safety legislation apply to all NHS premises
         and sites where food services are provided. They apply to all areas
         where food or drinks are supplied by the hospital for consumption by
         patients, staff and visitors. The standards of food hygiene require the
         need to reflect the nature and activities of the food handling activities
         carried out in the area.

         This code of practice has been prepared to provide all managers and
         staff with consistent advice on the standards of food hygiene practice
         required in ward kitchens. It is appreciated that compliance with the
         elements of the code dealing with the design and fabric of kitchens may
         have resource implications.      It is anticipated that these will be
         accommodated over a period of time.

         The code does not apply to rehabilitation and assessment kitchen areas.
         A separate detailed policy has been prepared for these areas.

         The code contains a number of detailed and specific requirements for
         caterers, service contractors, ward house keeping, nursing and domestic
         service staff.     The Trust expects contractors to comply with the
         requirements of this document.


Guide to terminology used in this document

Food:                                 The definition of food to be applied
                                      includes drink and ice.

Food handler:                         Any person who handles food as part of
                                      their duties. This term encompasses staff
                                      involved in the transportation and service
                                      of foods as well as food production staff.

High risk foods:                      Ready to eat foods that will support the
                                      growth of pathogenic bacteria. These
                                      types of foods include cooked meats,
                                      sandwiches, dairy cream cakes, prepared
                                      salads, meat dishes.

Potable water:                        Safe to drink and acceptable for use in the
                                      preparation of food or drinks.

Ward Manager / Senior Nurse           This term is to be interpreted as the
                                      member of staff who is responsible for
                                      ensuring that operational standards are
                                      maintained on a day to day basis.




                                      Page 2                             Dec 2005
2.0     RESPONSIBILITIES AND USE

2.1     There shall be displayed in every ward kitchen a notice which clearly sets
        out the following key information:-

        *   The name of the Ward Manager who is responsible for the
            maintenance of food hygiene standards in the area;

        *   Who is allowed to use the area;

        *   What activities are permitted in the area;

        *   The cleaning tasks within the area together with a clear statement of
            who is responsible for their satisfactory completion.


3.0     DESIGN CRITERIA FOR WARD KITCHENS AND REGENERATION
        AREAS

3.1     The aim of design of ward kitchen areas should be to provide the
        minimum practicable equipment necessary for the satisfactory operation
        of the area. This will reflect the nature of the activities to be carried out.
        General advice is given below. Specific advice can be obtained from the
        Trusts Environmental Health Adviser and Control of Infection.

3.2     Ward / Department Kitchen

3.2.1   These areas may be used to prepare snacks (e.g. toast, soup), drinks
        and the storage of foods.

        *   All internal finishes must be sound and capable of being cleaned.

        *   All food preparation surfaces must be smooth, impervious, easy to
            clean and durable, e.g. formica, stainless steel.

        *   Splash backs should be provided to the rear of sinks, work surfaces
            and wash hand basins.

        *   A double sink with double drainer is preferable for washing up.

        *   A wash hand basin for hand washing.

        *   A waste bin with a lid for the disposal of waste.

        *   A refrigerator with a thermometer. The refrigerator should be
            capable of maintaining food temperatures below 5ºC during normal
            usage. A larder unit should normally be used.

        *   Any equipment which does not stand on work surfaces shall be
            mobile to facilitate cleaning or wall mounted.

        *   A supply of potable water shall be provided to the sink. The drinking
            water supply tap shall be marked “Drinking Water”.



                                       Page 3                                Dec 2005
        *   A means of heating milk for drinks, e.g. microwave or two ring hob.

        *   The area should be large enough to accommodate a beverage
            vending trolley.

        *   Cupboards and base units should be kept to a minimum.

        *   A toaster of a design approved by the Trusts Fire Safety Adviser.

        *   A conventional cooker is not permitted.

        *   An ice making machine of a design approved by Infection Control.

3.3     Regeneration Point

3.3.1   The siting of regeneration points needs to be carefully considered.
        Normally they will be in ward kitchens, specific ward regeneration areas
        or main kitchen areas. Where this is not practicable the area must be
        agreed with the Trusts’ Fire Safety Adviser and Environmental Health
        Adviser / Officer. It may also be necessary to consult with Building
        Control in certain circumstances.

3.3.2   The regeneration area should not be sited next to toilets, bathrooms or
        dirty utility rooms or other potential sources of contamination.

        The regeneration area must have the following facilities:

        •   A wash hand basin must be provided in the area complete with soap
            dispenser and paper hand towels.
        •   The area must be ventilated.
        •   Cleanable/impervious wall surfaces must be provided.
        •   Splash backs to the WHB must be provided.
        •   A waste bin must be provided.
        •   A non slip easy to clean floor must be provided.
        •   Electrical supply to facilitate food trolley regeneration and service
            supplies.

3.4     Drinks / Beverage Point (When this is not possible in a Ward
        Kitchen)

        This type of area is to be used only for the preparation of drinks and the
        storage of foods.

        *   All internal finishes must be sound and capable of being cleaned.

        *   All food preparation surfaces must be smooth, impervious, easy to
            clean and durable, e.g. formica, stainless steel.

        *   Splash backs should be provided to the rear of sinks, work surfaces
            and wash hand basins.

        *   A double sink with double drainer is preferable for washing up.



                                      Page 4                             Dec 2005
      *   A wash hand basin for hand washing.

      *   A waste bin with a lid for the disposal of waste.

      *   A refrigerator with a thermometer. The refrigerator should be
          capable of maintaining food temperatures below 5ºC during normal
          usage. A larder unit should normally be used.

      *   Any equipment which does not stand on work surfaces shall be
          mobile to facilitate cleaning.

      *   A supply of potable water shall be provided to the sink. The drinking
          water supply tap shall be marked “Drinking Water”.

      *   A means of heating milk for drinks, e.g. microwave or two ring hob.

      *   The area should be large enough to accommodate a beverage
          vending trolley.

      *   Cupboards and base units should be kept to a minimum.


4.0   HAZARD ANALYSIS : FOOD SAFETY

4.1   Food safety legislation require the operators to food businesses to:-

      *   Identify potential food safety hazards;

      *   Identify measures that may be used to control these hazards;

      *   Identify critical control points;

      *   Implement monitoring and recording systems to assess the
          effectiveness of critical controls.

      A model hazard analysis system for ward kitchen areas is included as
      Appendix 1. It is intended that this model would be adapted for local use,
      printed, laminated and displayed in each area for reference.


5.0   TRAINING

5.1   The Food Safety (General Food Hygiene) Regulations 1995 require that
      all “food handlers” are trained and/or supervised and instructed in food
      hygiene commensurate with the needs of their post. All Managers /
      Senior Nurses shall carry out an objective assessment of the training
      needs of non catering food handling staff and ensure that these training
      needs are fulfilled. The training given to staff shall include practical
      instruction of hygiene practices and use of equipment.

5.2   It is not intended that all food handlers undergo a Chartered Institute of
      Environmental Health Foundation Course in Food Hygiene. However this
      course is appropriate for staff who are involved with high risk food



                                       Page 5                            Dec 2005
      preparation. A guide to the training needs of other staff is included as
      Appendix 2.

5.3   All training given to staff shall be validated and recorded by their
      manager.


6.0   CLEANING AND WASHING UP

6.1   It is recommended that where possible, should be carried out centrally. If
      washing of crockery or utensils is carried out at ward level suitable
      facilities for washing up shall be provided. Beverage vending trolleys
      shall be emptied, cleaned and refilled in the ward kitchen.

6.2   Dishwashers

      If a dishwasher is available or used it must be capable of providing a
      disinfecting rinse of 82ºC for two minutes or 71O C for three minutes.
      Detergents selected for use with the dishwashing machine should be of a
      type formulated for that use.

6.3   Final rinse temperatures should be high enough to ensure that items are
      dry as they are taken out of the machine or air dry by evaporation within
      four minutes.

6.4   Users of dishwashers should be trained to follow the manufacturers
      instructions concerning:-

      *   Loading and unloading the machine, measuring detergents, etc,
          setting the required programme and switching on and off.

      *   Cleaning of dishwasher.

6.5   A maintenance service agreement must be in place.

6.6   If a dishwasher is not provided a double bowl stainless steel sink with
      double draining boards should be provided. Crockery and other utensils
      or equipment should be washed in the first sink in hot water (45ºC-55ºC)
      with a suitable detergent. They should be rinsed in the second sink in hot
      water at a temperature of 77ºC-82ºC for two minutes or 65ºC for 10
      minutes.

6.7   Whatever the method of washing used it is essential that crockery, etc, is
      adequately dried after use. Normally it shall be allowed to air dry. Where
      this is not possible crockery shall be dried with a disposable paper towel.
      Fabric tea towels are not permitted.

6.8   A cleaning schedule shall be prepared for each ward kitchen.            This
      document shall clearly identify:-

      *   Who or what group of staff is responsible for each cleaning task;



                                    Page 6                              Dec 2005
      *   The frequency of every cleaning task including high level cleaning of
          walls and ceiling;

6.8   Separate cleaning equipment must be used for the ward kitchens. These
      materials should be stored separately from general purpose cleaning
      materials used in the ward. The use of disposable cleaning materials is
      recommended.        All cleaning materials shall be colour coded in
      accordance with the Trusts Control of Infection Policies. Unless specified
      the colour of cleaning clothes, scourers, gloves and buckets to be used
      for kitchen areas is yellow.


7.0   USE OF WARD KITCHENS : GENERAL PROVISIONS

7.1   Patient / relative access to ward kitchen must be controlled by the Ward
      Manager.

7.2   Patients and patients’ relatives may only use the ward kitchen for the
      preparation of food after obtaining authorisation from the Ward Manager.
      The practice of patients and their relatives preparing food in ward
      kitchens needs to be very strictly regulated as does the nature of their
      activities they carry out. Raw meats, raw eggs and raw unwashed
      vegetables shall not be brought into the ward kitchen. The Ward
      Manager must ensure that this advice is followed.

7.3   Eating of food or drinking of beverages by staff and visitors in ward
      kitchens is strictly forbidden.

7.4   Any equipment used in ward kitchens shall be provided or approved by
      the Trust and safety tested accordingly. No unauthorised equipment
      shall be provided and redundant condemned equipment shall be
      disposed of in accordance with Trust policies.

7.5   No one should ever sit on worktops in the ward kitchens.

7.6   Animals should not be allowed in kitchen areas and separate facilities for
      the storage of pet food and for the cleaning of feeding bowls, etc, should
      be provided.

7.7   No plants or flowers are allowed in kitchen areas.

7.8   Staff food in the ward refrigerator must be in date and stored in a sealed
      clean container, labelled with their name and date to be consumed. The
      storage of staff food within ward kitchens should be restricted to food
      intended for consumption at work that day


8.0   FOOD STORAGE

8.1   All foods shall be stored in appropriate storage conditions in accordance
      with their manufacturers recommendations. All high risk foods shall be




                                   Page 7                              Dec 2005
      stored in the refrigerator. Under no circumstances shall their storage at
      room temperature be permitted.

8.2   All foods shall be subject to good stock rotation. New stock shall be
      checked for their expiry date and placed below or behind older stock. All
      foods shall be checked to ensure they remain within their expiry date.
      Any food which has passed the manufacturers expiry date shall be
      discarded.

8.3   The contents of open packets of dry goods shall be transferred to clean,
      suitable storage containers with a tight fitting lid the date code on the
      original container should be marked on the container.

8.4   The stock levels within ward kitchen must be kept to the minimum
      practicable levels.

8.5   Foods and food contact equipment shall be stored in separate cupboards
      / units to cleaning chemicals.

8.6   Chemicals shall be stored in their original container. On no account shall
      they be stored in food containers.

8.7   No food or materials shall be stored on the floor.

8.8   Patient snacks shall be stored in clean, lidded suitable containers and be
      refrigerated if recommended in the manufacturer’s storage instructions.


9.0   FOOD SERVICE

9.1   The service of food supplied by the catering department must be carried
      out as quickly and efficiently as possible. This requires the co-operation
      of the catering department and ward staff.             To facilitate clear
      communication and co-ordination the following is recommended:-

      *   A clear schedule of ward service times and arrangements should be
          agreed between the catering department and ward staff;

      *   Ward staff should sign to acknowledge receipt of the trolley.

9.2   The catering department shall ensure that the food service trolley or
      regeneration trolleys they use are capable of:-

      *   Regeneration trolleys must be capable of reheating food to a
          minimum of 75ºC at the slowest heating point;

      *   Regeneration trolleys and hot line food service systems must maintain
          hot food temperatures above 63ºC upon delivery and service;

      *   Regeneration trolleys and food service systems must maintain cold
          food service temperatures below 5ºC upon delivery and service.




                                    Page 8                                Dec 2005
9.3    Foods should be served as quickly as possible after accepting
       responsibility for the food trolley.

9.4    Patients who require assistance with eating should have their meal kept
       hot in the food trolley until a ward staff member is available to assist the
       patient.

9.5    Hot foods may be consumed up to one hour after service to
       accommodate slow eaters and patients who need assistance. After this
       period any remaining hot food shall be thrown away.

9.6    Cold foods should be consumed within one hour or dated and labelled
       and placed in the refrigerator. They must be thrown away after 24 hours.

9.7    Ice cream shall always be served frozen and never refrozen once it has
       started to thaw. Ice cream shall be eaten within one hour or shall be
       thrown away.

9.8    Where patients require a liquid / puree diet. This shall be provided via
       the central production kitchen and not at ward level.

9.9    The communal use of preserves is to be discouraged. These should be
       provided in individual portion packs.

9.10   Staff involved in the service of food to patients shall wear a clean yellow
       disposable plastic apron dedicated solely for food service. They shall
       thoroughly wash their hands before putting on the apron prior to
       commencing food handling activities.

9.11   Where there are feeding difficulties at ward level, e.g. where patients are
       away from the ward at meal times undergoing routine, non emergency
       tests etc., the Catering Manager shall ensure that adequate
       arrangements are made for the provision of late meals. The ward should
       use provisions at ward level and / or organise an alternative meal with the
       catering department.

9.12   Patients should be issued with disposable hand wipes or offered
       opportunity to wash their hands prior to food services.

9.13   Ward staff member should ensure the patients bed table is clean and
       clear of any obstructions prior to any food and beverages services.


10.0   USE AND INSTALLATION OF EQUIPMENT IN WARD KITCHENS

10.1   The selection of equipment for use in ward kitchens should be carefully
       considered. It is recommended that no electrical equipment is provided
       without prior consultation with the Trusts Estates Department and Control
       of Infection. All equipment to be installed in the kitchen must be mobile
       or wall mounted to facilitate cleaning.




                                     Page 9                               Dec 2005
10.2     Equipment shall be installed and used in accordance with the
         manufacturers instructions. A copy of the manufacturers instruction
         manual shall be kept in a conveniently accessible position in the kitchen.
         Specific advice is given below on the use of equipment that may be
         expected to be provided in a ward kitchen.

10.3     Kitchen Equipment

         Microwave Ovens

10.3.1   Microwaves shall not be used for reheating or boosting the heat of
         patient’s meals.

10.3.2   Microwaves are acceptable for heating drinks and cereal for patients.

10.3.3   The microwave oven manufacturer’s instructions must be followed at all
         times in use, cleaning and maintenance.

10.3.4   Microwave ovens are provided for use for patient service. If staff are
         allowed access to them for their use they must clean the equipment
         afterwards.

10.4     Ice making machines / water coolers

10.4.1   Ice making machines and water coolers must be installed and used in
         accordance with their manufacturers instructions.

10.4.2   It is recommended that ice making machines and water coolers are
         plumbed in. Machines requiring manual filling should not be purchased.
         Machines shall be plumbed in to a suitable source of potable water.

10.4.3   Ice Making Machines

         The equipment must be maintained and cleaned in accordance with the
         manufacturers instructions. A plastic scoop shall be provided for serving
         the ice. This shall be stored in a clean lidded plastic box between uses.
         The scoop and the storage box shall be cleaned and disinfected daily.

10.4.4   Staff shall use the scoop provided to remove ice from the machine. They
         shall wash their hands prior to collecting ice.

10.4.5   A record of cleaning and routine maintenance must be recorded.

10.5     Refrigerators

10.5.1   The operating temperatures of ward refrigerators shall be monitored
         daily. If the unit does not have a digital temperature display a
         thermometer is to be placed in the refrigerator to facilitate this
         requirement. The operating temperature of the refrigerator should be 1ºC
         to 4ºC. If the operating temperature is outside this range the unit should
         be checked again in one hour. If the unit is back in range the
         temperature should be entered on the record. If the refrigerator


                                      Page 10                             Dec 2005
         temperature reaches 10ºC all food and perishable goods should be
         discarded. Refrigerators that are not operating within the required
         temperature range following the follow up check shall be reported to the
         Estates department. If the unit is incapable of achieving the required
         temperature criteria it shall be replaced by the directorate.

10.5.2   All foods stored in the refrigerator shall be in sealed labelled containers
         (also refer to section 8 – Food Storage)

10.5.3   Only staff food to be consumed on site, that day shall be stored in the
         ward refrigerator. Raw meats, raw eggs and raw unwashed vegetables
         shall not be brought into the ward kitchen. Any staff food must be in a
         sealed container labelled with the member of staffs name and date to be
         consumed.      Any food not complying with this requirement shall be
         discarded.

10.5.4   Any chilled foods provided for patients should be labelled with the date
         and patients name (the label must not obstruct the best before / use by
         dates). Foods shall not be stored in the ward refrigerator for longer than
         24 hours. Food in the refrigerator should be systematically checked and
         food that has been stored over 24 hours shall be discarded.

10.5.5   No drugs, blood or cold compresses shall be stored in the ward
         refrigerator.

10.5.6   No raw unprepared foods other than fruit shall be stored in the ward
         refrigerator.

10.5.7   Where space is limited in the ward refrigerator, patients food must take
         priority.

10.6     Freezers

10.6.1   The use of freezers in ward areas shall be restricted to those areas with
         a clearly defined need.

10.6.2   The operating temperatures of ward freezers shall be monitored daily. A
         thermometer is to be installed in the freezer to facilitate this requirement.
         The operating temperature of the freezer should be below -18ºC.
         Freezers that are not operating within the required temperature range
         shall be reported to the Estates Department. If the unit is incapable of
         achieving the required temperature criteria it shall be replaced.

10.6.3   No drugs, blood or cold compresses shall be stored in the ward freezer.

10.6.4   The storage of frozen foods shall be kept to minimum practicable levels.
         Foods shall be subject to stock rotation.

10.7     Beverage Vending Trolleys and Manual Beverage Systems

10.7.1   This type of equipment shall be used, cleaned and maintained in
         accordance with the manufacturers instructions. They shall be filled and


                                       Page 11                               Dec 2005
         cleaned either in the main catering department or ward kitchen. Water
         used to fill them must be drawn from a suitable potable water supply. (not
         from a wash hand basin)

10.7.2   Milk provided for use with a beverage vending trolley or a manual
         beverage system should be set out in minimum quantities. The aim
         should be that milk be left out at room temperature for a maximum of one
         hour and then disposed of. Small jugs or containers should be used for
         the provision of milk. These should be changed rather than refilled. They
         should be thoroughly washed prior to re use. Plastic disposable spoons
         provided for use with drinks should be discarded after use.

10.7.3   A dedicated water jug must be made available to fill beverage machines
         where automatic water filling is not possible. The jug must not be used
         for any other purpose. This jug must be washed after use and stored dry
         between use.


11.0     PEST CONTROL

11.1     Any signs of pests or sightings of pests must be reported immediately to
         the Ward Manager for that area. The Ward Manager shall then inform
         the nominated pest control officer in the Facilities Department.

11.2     On no account should ward staff attempt to treat a pest infestation or
         problem without the nominated pest control officers express agreement.

11.3     The eradication and control of pests at ward level shall be carried out as
         part of the service contract for the hospital site.


12.0     MAINTENANCE

12.1     Defects in kitchen equipment or fabric should be reported to the Estates
         Department utilising the Trusts normal works requisition procedures.

12.2     Essential planned preventative maintenance of key kitchen equipment,
         e.g. ice machines, ducts, vents and grills shall be carried out by the
         Estates Department. This work should be included in a planned
         preventative maintenance programme.


13.0     WASTE DISPOSAL

13.1     All food waste will be disposed of in accordance with the Trusts waste
         disposal policy. Normally plate waste will be returned to the catering
         department for disposal. Waste in waste bins in ward kitchen must be
         disposed of at least once a day.




                                      Page 12                             Dec 2005
BIBLIOGRAPHY


     The Food Safety Act 1990         ISBN 0-10-541690-8
     The Food Safety (General Food    ISBN 0-11-053227-9
     Hygiene) Regulations 1995
     The Food Safety (Temperature     ISBN 0-11-053383-6
     Control ) Regulations 1995
     NHS Catering : Health Service    ISBN 0-11-321095-7
     Catering - Hygiene
     Industry Guide to Good hygiene   ISBN 0-11-321899-0
     practice: Catering Guide
     HSG (92)35 Pest Control          NHS Executive: Copies from DoH
     Management for the NHS           Distribution Centre
     HSG (96) 20 Management of food   NHS Executive: Copies from DoH
     hygiene in the NHS               Distribution Centre




                                Page 13                          Dec 2005
        APPENDIX 1 : HAZARD ANALYSIS WARD KITCHENS


      HAZARDS                        CONTROLS                         MONITORING




PURCHASE
• Food may already be        • Buy from R.D.C. or via Catering      • Senior Nurses, Ward
  contaminated.                Department.                            Manager and Ward Staff.

                             • Guidance on patients and
                               relatives food should be
                               observed.
• Cross contamination from   • Staff and patients are not allowed   • Responsibility of all staff.
  raw to cooked foods.         to bring in raw foods such as
                                                                    • Checks by Ward
                               meat, poultry, eggs and fish into
                                                                      Manager.
                               ward kitchen.
           /


                                          Page 14                                  Dec 2005
       HAZARDS                             CONTROLS                         MONITORING
FOOD SERVICE




• Bacteria may grow if food is     • Serve food as soon as possible       • Senior Nurses, Ward
  left at room temperature after     after arrival. Hot food not served     Manager and Ward Staff.
  delivery to the ward.              within 1hour must be discarded.
                                     If it is to be eaten hot keep it
                                     piping hot above 63°C
                                   • Serve cold food as soon as           • Senior Nurses, Ward
                                     possible. If the time delay to         Manager and Ward Staff.
                                     service from trolley arriving is
                                     more than 1 hour food must be
                                     put in the ward refrigerator.
• Contamination of food.           • Serve food with clean utensils       • Senior Nurses, Ward
                                     and maintain good standards of         Manager and Ward Staff.
                                     personal hygiene. Wash hands
                                     before food service and put on
                                     yellow apron.
                                   • Ward service points should not
                                     be in close proximity to toilets,
                                     bathrooms or dirty utility rooms.
                                   • Handle crockery and cutlery by
                                     the handle part only.

STORAGE

• Cross contamination from         • Raw foods shall not be accepted      • Senior Nurses, Ward
  raw to cooked foods.               into ward kitchens.                    Manager and Ward Staff.


• Growth of bacteria due to        • Store high risk foods in the         • Daily temperature check
  chilled/perishable food            refrigerator working below 5ºC.        of refrigerator.
  storage at too high a
  temperature.


• Growth of bacteria due to        • All food and fluids are rotated.     • Senior Nurses, Ward
  shelf life abuse.                  Food and fluids are discarded by       Manager and Ward Staff.
                                     the ‘Use by Date’.




                                                Page 15                               Dec 2005
       HAZARDS                              CONTROLS                       MONITORING
PREPARATION




• Bacteria may grow in high         • Do not keep foods at room         • Senior Nurses, Ward
  risk foods if they are kept at      temperature for more than 1 hour.   Manager and Ward Staff.
  room temperature.


• Contamination of food.            • Handle food with clean hands       • Senior Nurses, Ward
                                      and equipment. Handle crockery       Manager and Ward Staff.
                                      and cutlery by the handle part
                                      only.


                                    • Maintain good standards of
                                      personal hygiene.


• Bacteria growth in porridge if    • Prepare just before service in     • Senior Nurses, Ward
  left at room temperature.           accordance with the                  Manager and Ward Staff.
                                      manufacturers instructions.
                                      Serve within 1 hour or discard.

   Keep animals and pests out of kitchen. If you think you have a
   problem with pests contact the Facilities Pest Control Officer for
   advise.

   Wash you hands regularly and wear clean over clothing when
   preparing food e.g. disposable apron.

   People who are ill with a tummy upset should not prepare foods for
   others.

   Keep kitchen clean and tidy.

   Guidance for patients and relatives on food to be brought into
   hospital should be observed

If in doubt throw it out. Discard food, which have not been purchased,
prepared, cooked and served properly.




                                                  Page 16                            Dec 2005
Appendix 2

FOOD HYGIENE TRAINING FOR WARD BASED FOOD HANDLERS


Induction

All staff shall receive induction training.     Induction training shall include
communication to new starters. This shall include the Essentials of Food Hygiene
as a minimum.

Staff or volunteers who solely prepare hot beverages should receive written
instruction on induction covering the food hygiene aspects of their duties. Their
understanding of these written instructions shall be assessed by the supervisor
inducting them into the organisation.

Practical Instruction

All staff shall receive training and or instruction in the practical competencies their
post requires. This training shall include the food hygiene aspects of the tasks they
are required to perform.

Hygiene Awareness

Staff who serve food and prepare beverages but do not prepare any high risk foods
shall receive hygiene awareness training. This shall comprise of a structured
training session covering the food hygiene issues and relevant Trust Polices and
procedures. A copy of the syllabus to be covered is attached. Staff shall undergo
a short test at the end of the course.

Foundation in Food Hygiene Certificate

All staff who prepare high risk foods or are involved in rehabilitation kitchen
assessment sessions with patients shall undergo this course or its equivalent.




                                        Page 17                               Dec 2005
HYGIENE AWARENESS TRAINING FOR WARD BASED FOOD HANDLERS


Introduction

This course has been developed for ward based food handlers. The course is
intended to provide candidates with an underpinning knowledge of food hygiene.
The objective is that at the end of the course they will be aware of the importance
of good standards of food hygiene and their own obligations.

It is anticipated that the course contact time will be a minimum duration of 4 hours.

The course shall be delivered by a trainer who is registered with the Chartered
Institute of Environmental Health as a tutor for the Foundation in Food Hygiene
Certificate.


Module 1 - Introduction to food hygiene

Aims:          The expected outcome is that the candidate knows the symptoms
               and main causes of food poisoning. The candidate understands the
               cost of poor food hygiene to themselves, patients and the Trust.

Objectives:    Candidate is able to state names and characteristics of bacteria and
               requirements for their growth.

               Candidate is able to explain what is meant by the terms food
               hygiene, food poisoning, food borne disease and contamination.

               Candidate is able to list the possible consequences of poor
               standards of food hygiene in a healthcare environment.


Module 2 - Basic bacteriology

Aims:          The expected outcome is that the candidate is aware of the potential
               for pathogenic bacteria and viruses to cause food poisoning or food
               borne illness in a healthcare environment

Objectives:    Candidate is able to list the key growth requirements of bacteria,
               method of multiplication and timescale of that process. Explain the
               terms bacteria spore and toxin and their relevance to food poisoning
               bacteria in the health care environment.




                                        Page 18                               Dec 2005
Module 3 - Prevention of contamination and food poisoning

Aims:         Candidate is aware of the potential for pathogenic bacteria or viruses
              to cause food poisoning or food borne illness within the healthcare
              environment. Candidates need to be aware of their role in the
              transmission of these illnesses and the importance of maintaining high
              standards of food handling practice.

Objectives:   Candidate is able to explain the mode of transmission of pathogenic
              bacteria that are capable of causing food poisoning or food borne
              illness in the health care environment. State the importance of high
              standards of food hygiene.

Module 4 - Personal hygiene

Aims:         Candidate is aware of the importance of high standards of personal
              hygiene in the prevention of food poisoning, food borne illnesses and
              food contamination.

Objectives:   Candidates will be able to list the potential sources of pathogenic
              bacteria or potential foreign body contamination from their own person
              or personal effects. They will be able to list key personal hygiene
              measures.


Module 5 - Cleaning and Pest Control

Aims:         Candidates will recognise the need for high standards of cleanliness
              and pest control within the health care environment. They will be
              aware of the correct methodology of cleaning food equipment. They
              will be aware of the procedures within the Trust relating to pest control.

Objectives:   Candidates will be able to state the needs for high standards of
              cleanliness and pest control in the healthcare environment. Candidate
              will be able to list the main food pests, signs of their activity and the
              procedure to be adopted in the event of their detection. Candidate will
              be able to explain the difference between cleaning and disinfection and
              state methods to achieve them.

Module 6 - Legislation

Aims:         Candidate is aware of the legal framework governing food safety.

Objectives:   The candidate will be able to state the key requirements of the Food
              Safety Act 1990. List the requirements of the Food Safety (General
              Food Hygiene) Regulations 1995 relating to personal hygiene, food
              handling and cleanliness of food premises and equipment. List the
              requirement of the Food Safety (Temperature Control) Regulations
              1995.




                                        Page 19                              Dec 2005
             INFORMATION FOR WARD BASED FOOD HANDLERS

Hand Washing

Hands should be routinely washed when entering the kitchen.

Hands must be washed before accessing the following:-

   •   Ice / Ice Machine
   •   Ice Scoop
   •   Refrigerator
   •   Toaster
   •   Microwave
   •   Preparing Snacks
   •   Preparing Beverages

Ward Kitchen

   •   Kitchen code of practice, food safety notice, model code of practice for ward
       kitchens, kitchen responsibilities and cleaning information must be adhered
       to whilst working in the ward kitchen.
   •   Only authorised staff allowed to use ward kitchen area.
   •   Waste must be disposed of in accordance with the hospital waste policy.
   •   Do not leave cardigans, coats, and handbags in kitchen.
   •   Do not attend to your hair in the kitchen.
   •   Do not sit on work surfaces.
   •   Do not eat your lunch or drink in a ward kitchen.

Ward Refrigerator

   •   Store all perishable foods in the refrigerator.
   •   Staff food placed in the refrigerator should be kept to a minimum as the
       priority is for patients food.
   •   Staff food should be kept in clean lidded container with name, date to be
       consumed advised on a label. No food wrapped in shopping bags is
       permitted. The space in refrigerators is limited therefore only food for
       consumption on that day is allowed in the refrigerator. Refrigerator
       temperatures are recorded and monitored daily. Refrigerator operating
       temperatures are between 1ºC to 4ºC, if the reading is outside this range,
       the unit should be checked again in one hour. If the unit is back in range the
       temperature should be entered on the record. If the refrigerator temperature
       reaches 10ºC all food and perishable goods should be discarded.
       Refrigerators that are not operating within the required temperature range
       following the follow up check shall be reported to the Estates department. If
       the unit is incapable of achieving the required temperature criteria it shall be
       replaced by the directorate.

   •   Daily, weekly cleaning regimes to be implemented and maintained.



                                        Page 20                               Dec 2005
  •     Rotate all food and fluids and discard as appropriate.

Microwaves

  •     Patients food must not be reheated.
  •     Should only be used to heat patients milk.
  •     Staff to clean microwaves after their own use.

Beverage Trolley

  •     Only a small amount of milk should be left in the milk jug on the trolley and
        for no more than one hour. The jug should be washed and dried in between
        use.
  •     Sugar and beverages to be stored in sealed containers on the trolley.
  •     A dedicated water replenishment jug should be used to fill up the water tank
        if this is not automatic.

Ice Machine

  •     Only ‘plumbed in’ ice machines are acceptable.
  •     Hands must be washed before accessing ice.
  •     Ice scoop must be stored in a clean lidded container.
  •     Daily and weekly cleaning regimes to be implemented and maintained.

Water

  •     Drinking water should not be obtained via wash hand basins.
  •     Water should be drawn from taps marked ‘drinking water only’

Food Service

  •     Wash hands and wear a clean disposable yellow apron, prior to service and
        wash hands, change apron as required throughout service.
  •     Serve food to patients as soon as the food trolley has been handed over to
        the ward (at required temperature).
  •     Interruptions to service for patient handling assistance – wash hands, wear a
        new disposable apron before returning to food service.
  •     Serving food to patients with an infection – follow the precautions as required
        prior to entering the room, serve food and then wash hands, wear a new
        disposable apron before returning to food service.
  •     Do not allow food trolley service to be in close proximity to bathrooms and
        toilets.
  •     Handle crockery and cutlery by the handles.
  •     Do not assist with food service if you are suffering from diarrhoea and/or
        vomiting (and review the need to be on duty).
  •     Food waste should be returned to the main kitchen for disposal.



                                         Page 21                              Dec 2005
Food Safety

   •   No raw foods allowed in ward kitchens.
   •   Food should be purchased via reputable source i.e. RDC, Catering
       Contractors.
   •   Follow guidance for food allowed to be brought in by relatives.
   •   Follow model code of practice for ward kitchens.
   •   Adhere to all ward kitchen policies and procedures.
   •   Follow the requirements of the ‘Foundation Food Hygiene Certificate’.


Kitchen Colour Coding

The Trust operates a cleaning colour coding policy to assist with the prevention of
cross contamination.

   •   Yellow cleaning cloths, scourers, gloves and buckets must only be used in
       ward kitchens.
   •   Staff shall wear a clean disposable yellow apron whilst working in the kitchen
       or serving food.

Pest Control

   •   Any signs of pests shall be reported immediately to the ward manager who
       will inform the nominated estates pest control officer.
   •   Ward staff should not attempt to treat a pest infestation without the express
       permission of the estates pest control officer.




                                       Page 22                              Dec 2005