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

#4 INADEQUATE COOKING Organisms of Concern

• Salmonella

• E. coli O157:H7

#ALFA2014

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

RISK REDUCTION MINDSET

#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

QUESTIONS?

#ALFA2014