• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

Food

  • Print
  • Share
  • E-mail

III. Results And Discussion, Institutional Food Service of the FDA Report on the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility Types (2004)

Table of contents


 The results contained in this report are intended to focus attention on foodborne illness risk factors associated with food preparation procedures and employee behaviors in most need of improvement by industry. If food safety practices within institutional foodservice, restaurants, and retail food store facility types are to be significantly improved, individuals responsible for the management and oversight of food establishments must exercise active managerial control over the risk factors most often implicated as the cause of foodborne illness. Food safety management systems for control of these risk factors must be an integral part of daily operations.

Reducing the occurrence of foodborne illness risk factors should be a goal for all those involved in food safety. If this goal is to be achieved, regulatory retail food program managers need to establish program performance measures that are based on reducing the occurrence of these risk factors. Regulatory inspection programs should use intervention strategies that direct the foodservice and retail food industries' efforts toward attaining active managerial control of those food safety practices and employee behaviors most likely to contribute to foodborne illness. Recommended intervention strategies for both regulatory and industry food safety professionals are presented in Section IV - Recommendations.

Presentation of the data results

The results of the 2003 study are presented in three parts for each of the facility types.

  • Part A. Presents the Percent of observations found Out of Compliance for each risk factor
  • Part B. Presents the Percent of observations found Out of Compliance for individual data items that comprises a risk factor
  • Part C. Summarizes the risk factors and individual data items needing priority attention

The results will be presented separately for each of the facility 9 types.

The figures presented in this section for each of the facility types include only observations from the original forty-two data items used in the 1998 baseline collection. These forty-two data items will be used to measure improvement and/or regression changes in the occurrence of foodborne illness risk factors for the duration of this study. None of the Supplemental data items (Sections 17-23 of the data collection form) are included as part of the data analysis in this section. The results and discussion of the supplemental data items will be addressed later in this report in Section VI, New Areas of Study - Supplemental Data Items.

 Table 7
Data Collection Form - Section Reference for Risk Factors
RISK FACTORNumber of
Data Items
for each
Risk Factor
Referenced Sections
From Data Collection
Form
Food from Unsafe Sources7Sections 1 - 3
Inadequate Cooking12Sections 4 - 5
Improper Holding/Time Temperature10Sections 6 - 9
Contaminated Equipment/Protection from Contamination5Sections 10 - 11
Poor Personal Hygiene5Sections 12 - 15
Other (Chemical Contamination)3Section 16
TOTAL NUMBER OF DATA ITEMS42 

 

A. Percent of Observations found Out of Compliance for each RISK FACTOR

 Table 8
Formula for Calculating RISK FACTOR Out of Compliance Percentages
Percent Out of Compliance =
 Total Number of Out of Compliance Observations for a risk factor
Total Number of OBSERVATIONS (IN and OUT) for the risk factor
X 100%

The Percent Out of Compliance gives an indication of the overall effectiveness of existing food safety management systems for each of the risk factors for the 2003 data collection period. It can be inferred that the higher the Percent Out of Compliance, the weaker the management system for control of the risk factor.

B. Percent of observations found Out of Compliance for each INDIVIDUAL DATA ITEM that comprises a risk factor

 Table 9
Formula for Calculating Out of Compliance Percentages
for each DATA ITEM that Comprises a Risk Factor
Percent Out of Compliance =
 Total Out of Compliance Observations for a Data Item
Total number of OBSERVATIONS (IN and OUT) for the Data Item
X 100%

The Percent Out of Compliance for an individual data item is the proportion of establishments where that data item was Out of Compliance when the practice or procedure could be observed. Each risk factor is comprised of several individual data items based on 1997 FDA Food Code requirements. These individual data items can be used to assess in greater detail the degree of control a facility type had over each risk factor found to have a high Out of Compliance percentage. The greater the Percent Out of Compliance for an individual data item contained In a risk factor, the greater the need for improvement.

The figures in this section contain only those data items with the highest Out of Compliance percentages. In a few cases, there are one or more data items that warrant attention within a risk factor that had a relatively high overall IN Compliance percentage. For these data items, the results of the observations, rather than figures, are used to summarize the discussion points. The results for all data items are available in Appendices A - I.

C. Summary of foodborne illness RISK FACTORS and INDIVIDUAL DATA ITEMS in need of priority attention

Section C summarizes the foodborne illness risk factors and individual data items (i.e., food safety practices and behaviors) in need of priority attention suggested by the data presented in parts A and B. Those risk factors and data items with the most significant Out of Compliance percentages, based on the 2003 data collection are presented in the summary section.

 

 Institutional Food Service

INSTITUTIONAL FOODSERVICE
HOSPITALS
RESULTS AND DISCUSSION

 

A. Percent of observations found Out of Compliance for each RISK FACTOR

Institutional Foodservice - HOSPITALS
Figure H-1
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each RISK FACTOR
Bar graph of data for foodborne illness risk factors in hospitals
FOODBORNE ILLNESS RISK FACTOR# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle Improper Holding/Time & Temperature21252640.3%
horizontal blue bars Contaminated Equipment/Protection from Contamination8645618.9%
right diagonal teal bars Poor Personal Hygiene8448017.5%
black grid Other/Chemical1712713.4%
vertical dashes Inadequate Cooking162556.3%
  Food From Unsafe Sources11940.5%

Discussion for Figure H-1

Failure to control product holding temperatures and times was the risk factor with the highest Out of Compliance percentage. Contaminated equipment/protection from contamination and poor personal hygiene also had notable Out of Compliance percentages. Management systems that were implemented to ensure foods were adequately cooked and from safe sources appeared to be effective when compared to the other risk factors evaluated during this data collection period. In general, the other/chemical risk factor had a high IN Compliance percentage.

B. Percent of observations found Out of Compliance for each INDIVIDUAL DATA ITEM that comprises a risk factor

For hospitals, the foodborne illness risk factors most in need of attention with their corresponding Out of Compliance percentages are:

  • Improper Hold/Time and Temperature (40.3%)
  • Contaminated Equipment/Protection from Contamination (18.9%)
  • Poor Personal Hygiene (17.5%)

Figures H-2 thru H-4 provide a breakdown of each of these risk factors into data items that represent specific food preparation procedures and employee behaviors in need of attention. These figures provide insight into the relative strengths and weaknesses of the food safety management systems in place in hospitals to control each of the risk factors during the 2003 data collection.

In general, the other/chemical risk factor had a high IN Compliance percentage. There was, however, one data item within this risk factor that warrants attention. A summary of the results of the Out of Compliance observations for the identification, storage, and use of chemicals/toxics data item will be presented.

 

Institutional Foodservice - HOSPITALS
Figure H-2
IMPROPER HOLDING/TIME AND TEMPERATURE
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM
Bar graph of data for out of compliance observations in hospitals
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle PHF cooled to 70 °F in 2 hours/41 °F in total of 6 hours233959.0%
horizontal red bars PHF held cold at 41 °F or below569757.7%
right diagonal red bars Commercially-processed, RTE, PHF date marked418548.2%
red grid PHF held hot at 140 °F or above369537.9%
vertical red dashes RTE, PHF date marked after 24 hours339335.5%
vertical red bars PHF (prepared from ingredients at ambient temperature) cooled to 41 °F or below within 4 hours92931.0%
left diagonal red bars RTE, PHF discarded after 4 days/45 °F or 7 days/41 °F126717.9%
* Foods received at temperatures according to Law are cooled to 41 °F within 4 hours.*2*14**
* Roasts are held at a temperature of 130 °F or above*0*5**
* When time only is used as a public health control, food is cooked and served within 4 hours*0*2**

* These three remaining Improper Holding/Time & Temperature Data Items do not appear
in Figure H-2 due to a low number of total observations (obs.)

Discussion for Figure H-2

The data items, with their corresponding Out of Compliance percentages, for the improper holding/time and temperature risk factor that are most in need of attention include:

  • Cooling of potentially hazardous food (PHF) (59.0%)
  • Maintaining cold holding temperatures for PHF (57.7%)
  • Date marking of open containers of commercially-processed ready-to-eat PHF (48.2%) and ready-to eat PHF made on-site (35.5%)
  • Maintaining hot holding temperatures for PHF (37.9%)
Cooling of PHF

Safe cooling requires the removal of heat from foods quickly enough to prevent the growth of spore-forming pathogens. Hospital foodservice directors and managers need to ensure their practices and procedures are capable of rapidly cooling PHF.

The total number of observations for cooling was substantially less than the total number of observations for other data items. The time of day the data was collected and the length of the time available to spend in a facility were significant factors limiting the number of observations of cooling. For example, as much as six hours may be required on site to document compliance with the FDA Food Code critical limits for cooling. Nonetheless, observations made of cooked or reheated PHF during cooling had the highest Out of Compliance percentage. In addition, the Percent Out of Compliance for cooling PHFs from ambient temperature ingredients is also of interest and procedures for this process should be evaluated to ensure that food safety controls are in place.

Cold and Hot Holding of PHF

Holding PHF at the proper cold or hot temperatures is critical to preventing the growth of bacteria. Equipment, processes, and monitoring procedures related to maintaining temperature control for PHF need to be assessed and corrective action should be taken if necessary.

Date Marking

Date marking of refrigerated ready-to-eat, PHF foods is an important food safety system component designed to promote proper food rotation and limit the growth of Listeria monocytogenes during cold storage. Discarding ready-to-eat, PHF that has remained in cold storage beyond the parameters described in the FDA Food Code prevents foods with a harmful level of Listeria monocytogenes from being served. The importance of date marking of ready-to-eat, PHF is accentuated in the hospital environment because the meals are primarily served to a highly susceptible population.

Institutional Foodservice - HOSPITALS
Figure H-3
CONTAMINATED EQUIPMENT/PROTECTION FROM CONTAMINATION
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM
Bar graph of data for contamination observations in hospitals
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
blue rectangle Surfaces/Utensils cleaned/sanitized379738.1%
horizontal blue bars Raw/RTE foods, separated229722.7%
right diagonal blue bars Raw animal food, separated149614.6%
blue grid Protected from environmental contamination129712.4%
vertical blue dashes After being served, food is not re-served169 1.4%

Discussion for Figure H-3

The food safety procedures for contaminated equipment/protection from contamination risk factor that are most in need of attention include:

  • Cleaning and sanitizing food contact surfaces and utensils (38.1%)
  • Separating raw animal foods from ready-to-eat foods (22.7%)
  • Separating raw animal foods from each other (14.6%)
Cleaning and Sanitizing

Proper cleaning and sanitization of food contact surfaces is an effective means of preventing cross-contamination. Many different procedures may be involved in the assessment of the management system related to this area. Evaluations should not be restricted to dishwashing procedures but should also include observations on how food preparation tables, cutting boards, and stand-in-place equipment such as slicers and mixers are cleaned and sanitized between uses.

The high Out of Compliance percentage for cleaning and sanitizing food contact surfaces and utensils indicates a weakness in hospital foodservice management systems designed to prevent cross-contamination.

Separation of Raw Animal Foods from Ready-to-Eat Foods

Raw animal foods are a potential source of contamination in any food operation. Storing raw animal foods above or in close proximity to ready-to-eat foods increases the potential for food to become contaminated. To prevent cross-contamination, raw animal foods should also be separated by species based on required minimum cooking temperatures. Required cooking temperatures are based on thermal destruction data and anticipated microbial load. These parameters may vary with different type of raw animal foods. Having organized storage systems that include designated areas for raw animal products will help prevent cross-contamination of foods.

Preventing cross-contamination between raw animal foods and ready-to-eat foods extends to the food preparation area. Designated separate food preparation areas should be provided for raw and ready-to-eat products. If common preparation areas must be used, then procedures must be in place to ensure proper cleaning and sanitizing between uses.

Institutional Foodservice - HOSPITALS
Figure H-4
POOR PERSONAL HYGIENE
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM

Bar graph of data for hygiene observations in hospitals
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
teal rectangle Proper, adequate handwashing329533.7%
horizontal teal bars Good hygienic practices179617.7%
right diagonal teal bars Handwashing facility, convenient/accessible159715.5%
teal grid Handwashing facility, cleanser/drying device119711.3%
vertical teal dashes Prevention of hand contamination995 9.5%

Discussion for Figure H-4

The food safety procedures for the poor personal hygiene risk factor that are most in need of attention include:

  • Proper, adequate handwashing (33.7%)
  • Good hygienic practices (17.7%)
Proper, Adequate Handwashing

Hands may become contaminated when employees engage in activities such as handling raw animal foods, using the restroom or handling soiled tableware. Hands are a common vehicle for the transfer of harmful bacteria and viruses to food products. Effective handwashing is one of the most important measures to minimize the contamination of food by employees. The lack of convenient handwashing facilities and/or supplies of hand cleanser/drying devices may contribute to the lack of proper handwashing. Reinforcing the importance of handwashing should be supported by a management system that includes proper employee training and monitoring of the frequency and effectiveness of handwashing practices.

While handwashing continues to be a primary concern, the results from the 2003 study show a relatively high IN Compliance percentage (90.5%) for preventing direct hand contamination of food in hospitals. Hospital foodservice managers appear to be making a concerted effort to eliminate bare hand contact with ready-to-eat foods.

Good Hygienic Practices

Proper hygienic practices by food employees minimize the possibility of transmitting disease through food. Employee practices such as eating, drinking and smoking in food preparation areas and working while experiencing persistent coughing and sneezing must be prohibited. Elimination of these practices will help prevent the transfer of microorganisms to foods and food contact surfaces.

Discussion for the Other/Chemical Risk Factor
Table 10
Assessment of the Other/Chemical Category - HOSPITALS
Poisonous or Toxic Materials are Properly Identified, Stored, and Used
# Observations
OUT
TOTAL Observations
(IN & OUT)
% Observations
OUT
179717.5%

All of the Out of Compliance observations relating to the other/chemical risk factor are attributed to one data item. The proper identification, storage, and use of cleaners, sanitizers, and other chemicals in hospitals are in need of attention. Food safety procedures related to the identification, storage, and use of cleaners, sanitizers, and other chemicals need to be reviewed and revised, if necessary, to address any gaps in the program that may be contributing to the Out of Compliance observations made of this data item.

C. Summary of Foodborne Illness RISK FACTORS and INDIVIDUAL DATA ITEMS in need of priority attention.

Table 11
Institutional Foodservice - HOSPITALS
Summary of Foodborne Illness RISK FACTORS and
DATA ITEMS in Need of Priority Attention
FOODBORNE ILLNESS
RISK FACTOR
in need of Priority Attention
(From Section A)
INDIVIDUAL DATA ITEM
in need of Priority Attention
(From Section B)
Improper Holding/
Time & Temperature
PHF cooled to 70 °F in 2 hours/41 °F in total of 6 hours
PHF held cold at 41 °F or below
Commercially-processed RTE, PHF date marked
PHF held hot at 140 °F or above
RTE PHF date marked after 24 hours
PHF (prepared from ingredients at ambient temperature) cooled to 41 °F or below within 4 hours
RTE, PHF discarded after 4 days/45 °F or 7 days/41 °F
Contaminated Equipment/
Protection from Contamination
Surface/Utensils cleaned/sanitized
Raw animal foods separated from RTE foods
Raw animal foods separated from each other
Poor Personal HygieneProper, adequate handwashing
Good hygienic practices
Other/ChemicalPoisonous or toxic materials are properly identified, stored, and used


 

INSTITUTIONAL FOODSERVICE
NURSING HOMES
RESULTS AND DISCUSSION

 

Institutional Foodservice - NURSING HOMES
Figure NH-1
PERCENT (%) of OBSERVATIONS found
OUT OF COMPLIANCE for each RISK FACTOR

Bar graph of data for foodborne illness risk factors in nursing homes
FOODBORNE ILLNESS RISK FACTOR# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle Improper Holding/Time & Temperature14246330.7%
horizontal blue bars Contaminated Equipment/Protection from Contamination8642120.4%
right diagonal teal bars Poor Personal Hygiene9145020.2%
black grid Other/Chemical2111618.1%
vertical dashes Inadequate Cooking8161 5.0%
  Food From Unsafe Sources6190 3.2%

Discussion For Figure NH-1

Failure to control product holding temperatures and times was the risk factor with the highest Out of Compliance percentage. Contaminated equipment/protection from contamination, poor personal hygiene, and chemical contamination also had notable Out of Compliance percentages. Management systems that were implemented to ensure foods were adequately cooked and from safe sources appeared to be effective when compared to the other risk factors evaluated during this data collection period.

B. Percent of observations found Out of Compliance for each INDIVIDUAL DATA ITEM that comprises a risk factor

For nursing homes, the foodborne illness risk factors in most need of attention with their corresponding Out of Compliance percentages are:

  • Improper Holding/Time and Temperature (30.7%)
  • Contaminated Equipment/Protection from Contamination (20.4%)
  • Poor Personal Hygiene (20.2%)
  • Other/Chemical (18.1%)

Figures NH-2 thru NH-4 provide a breakdown of each of these risk factors into data items that represent specific food preparation procedures and employee behaviors in need of attention. These figures provide insight into the relative strengths and weaknesses of the food safety management systems in place in nursing homes to control each of the risk factors during the 2003 data collection.

In general, the other/chemical risk factor had a high IN Compliance percentage. There was, however, one data item within this risk factor that warrants attention. A summary of the results of the Out of Compliance observations for the identification, storage, and use of chemicals/toxics data item will be presented.

Institutional Foodservice - NURSING HOMES
Figure NH-2
IMPROPER HOLDING/TIME AND TEMPERATURE
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM

Bar graph of data for foodborne illness risk factors in nursing homes
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle PHF cooled to 70 °F in 2 hours/41 °F in total of 6 hours172665.4%
horizontal red bars Commercially-processed, RTE, PHF date marked327542.7%
right diagonal red bars PHF held cold at 41 °F or below349436.2%
red grid RTE, PHF date marked after 24 hours268729.9%
vertical red dashes PHF held hot at 140 °F or above177024.3%
vertical red bars Foods received at temperatures according to Law are cooled to 41 °F within 4 hours.32810.7%
left diagonal red bars RTE, PHF discarded after 4 days/45 °F or 7 days/41 °F561 8.2%
* PHF (prepared from ingredients at ambient temperature) is cooled to 41 °F within 4 hours*7*14**
* Roasts are held at temperature of 130 °F or above*1*6**
* When time only is used as a public health control, food is cooked and served within 4 hours*0*2**

* These three remaining Improper Holding/Time & Temperature Data Items do not appear
in Figure NH-2 due to a low number of total observations (obs.)

Discussion for Figure NH-2

For the improper holding/time and temperature risk factor, there is a need to review food safety systems related to:

  • Cooling of potentially hazardous food (PHF) (65.4%)
  • Date marking of open containers of commercially-processed ready-to-eat PHF (42.7%) and ready-to-eat PHF made on site (29.9%)
  • Maintaining cold holding temperatures for PHF (36.2%)
  • Maintaining hot holding temperatures for PHF (24.3%)
Cooling of PHF

Safe cooling requires the removal of heat from foods quickly enough to prevent the growth of spore-forming pathogens. Nursing home foodservice directors and managers need to ensure their practices and procedures are capable of rapidly cooling PHF.

The total number of observations for cooling was substantially less than the total number of observations for other data items. The time of day the data was collected and the length of the time available to spend in a facility were significant factors limiting the number of observations of cooling. For example, as much as six hours may be required on site to document compliance with the FDA Food Code critical limits for cooling.

Date Marking

Date marking of refrigerated ready-to-eat, PHF is an important food safety system component designed to promote proper food rotation and limit the growth of Listeria monocytogenes during cold storage. Discarding ready-to-eat, PHF that has remained in cold storage beyond the parameters described in the FDA Food Code prevents foods with a harmful level of Listeria monocytogenes from being served. The importance of date marking of ready-to-eat, PHF is accentuated in the nursing home environment because the meals are primarily served to a highly susceptible population.

Cold and Hot Holding of PHF

Holding PHF at the proper cold or hot temperatures is critical to preventing the growth of bacteria. Equipment, processes, and monitoring procedures related to maintaining temperature control for PHF need to be assessed and corrective action should be taken if necessary.

Institutional Foodservice - NURSING HOMES
Figure NH-3
CONTAMINATED EQUIPMENT/PROTECTION FROM CONTAMINATION
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM

Bar graph of data for contamination observations in nursing homes
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
blue rectangle Surfaces/Utensils cleaned/sanitized359437.2%
horizontal blue bars Raw/RTE foods, separated238826.1%
right diagonal blue bars Raw animal food, separated148815.9%
blue grid Protected from environmental contamination139413.8%
vertical blue dashes After being served, food is not re-served1571.8%

Discussion for Figure NH-3

The food safety procedures for contaminated equipment/protection from contamination risk factor that are most in need of attention include:

  • Cleaning and sanitizing food contact surfaces and utensils (37.2%)
  • Separating raw animal foods from ready-to-eat foods (26.1%)
  • Separating raw animal foods (15.9%)
Cleaning and Sanitizing

Proper cleaning and sanitization of food contact surfaces is an effective means of preventing cross-contamination. Many different procedures may be involved in the assessment of the management system related to this area. Evaluations should not be restricted to dishwashing procedures but should also include observations on how food preparation tables, cutting boards, and stand-in-place equipment such as slicers and mixers are cleaned and sanitized between uses.

The high Out of Compliance percentage for cleaning and sanitizing food contact surfaces and utensils indicates a weakness in nursing home foodservice management systems designed to prevent cross-contamination.

Separation of Raw Animal Foods from Ready-to-Eat Foods

Raw animal foods are a potential source of contamination in any food operation. Storing raw animal foods above or in close proximity to ready-to-eat foods increases the potential for food to become contaminated. To prevent cross-contamination, raw animal foods should also be separated by species based on required minimum cooking temperatures. Required cooking temperatures are based on thermal destruction data and anticipated microbial load. These parameters may vary with different type of raw animal foods. Having organized storage systems that include designated areas for raw animal products will help prevent cross-contamination of foods.

Preventing cross-contamination between raw animal foods and ready-to-eat foods extends to the food preparation area. Designated separate food preparation areas should be provided for raw and ready-to-eat products. If common preparation areas must be used, then procedures must be in place to ensure proper cleaning and sanitizing between uses.

Institutional Foodservice - NURSING HOMES
Figure NH-4
POOR PERSONAL HYGIENE
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM

Bar graph of data for hygiene observations in nursing homes
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
teal rectangle Proper, adequate handwashing348540.0%
horizontal teal bars Prevention of hand contamination188920.2%
right diagonal teal bars Handwashing facility, convenient/accessible169417.0%
teal grid Handwashing facility, cleanser/drying device129412.8%
vertical teal dashes Good hygienic practices118812.5%

Discussion for Figure NH-4

The food safety procedures for the poor personal hygiene risk factor that are most in need of attention include:

  • Proper, adequate handwashing (40.0%)
  • Prevention of hand contamination (20.2%)
Proper, Adequate Handwashing

Hands may become contaminated when employees engage in activities such as handling raw animal foods, using the restroom or handling soiled tableware. Hands are a common vehicle for the transfer of harmful bacteria and viruses to food products. Effective handwashing is one of the most important measures to minimize the contamination of food by employees. The lack of convenient handwashing facilities and/or supplies of hand cleanser/drying devices may contribute to a lack of proper handwashing. Reinforcing the importance of handwashing should be supported by a management system that includes proper employee training and monitoring of the frequency and effectiveness of handwashing practices.

Prevention of Hand Contamination

Handwashing alone may not prevent the transmission of pathogens to foods via hand contact, therefore, preventing bare hand contact with ready-to-eat foods is a major control measure for limiting the spread of harmful bacteria and viruses from the hands to ready-to-eat food. Reinforcing the importance of preventing bare hand contact with ready-to-eat foods should be supported by a management system that includes proper employee training and monitoring of practices to identify to what extent procedures are being followed.

Discussion of the Other/Chemical Risk Factor
Table 12
Assessment of the Other/Chemical Category - NURSING HOMES
Poisonous or Toxic Materials are Properly Identified, Stored, and Used
# Observations
OUT
TOTAL Observations
(IN & OUT)
% Observations
OUT
219422.3%

All of the Out of Compliance observations relating to the other/chemical risk factor are attributed to one data item. The proper identification, storage, and use of cleaners, sanitizers, and other chemicals in nursing homes is in need of attention. Food safety procedures related to the identification, storage and use of cleaners, sanitizers, and other chemicals need to be reviewed and revised, if necessary, to address any gaps in the program that may be contributing to the Out of Compliance observations of this data item.

 

C. Summary of foodborne illness RISK FACTORS and INDIVIDUAL DATA ITEMS in need of priority attention

Table 13
Institutional Foodservice - NURSING HOMES
Summary of Foodborne Illness RISK FACTORS and
DATA ITEMS in Need of Priority Attention
FOODBORNE ILLNESS
RISK FACTOR
in need of Priority Attention
(From Section A)
INDIVIDUAL DATA ITEMS
in need of priority attention
(From Section B)
Improper Holding/
Time & Temperature
PHF cooled to 70 °F in 2 hours/41 °F in total of 6 hours
Commercially-processed RTE, PHF date marked
PHF held cold at 41 °F or below
RTE PHF date marked after 24 hours
PHF held hot at 140 °F or above
Contaminated Equipment/
Protection from Contamination
Surface/Utensils cleaned/sanitized
Raw animal foods separated from RTE foods
Raw animal foods separated from each other
Poor Personal HygieneProper, adequate handwashing
Prevention of hand contamination
Other/ChemicalPoisonous or toxic materials properly identified, stored, and used


 

INSTITUTIONAL FOODSERVICE
ELEMENTARY SCHOOLS
RESULTS AND DISCUSSION

A. Percent of observations found Out of Compliance for each RISK FACTOR

Institutional Foodservice - ELEMENTARY SCHOOLS
Figure ES-1
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each RISK FACTOR

Bar graph of data for foodborne illness risk factors in elementary schools 
FOODBORNE ILLNESS RISK FACTOR# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle Improper Holding/Time & Temperature11838330.8%
black grid Other/Chemical2411322.2%
horizontal teal bars Poor Personal Hygiene7847816.3%
blue grid Contaminated Equipment/Protection from Contamination4634013.5%
  Food from Unsafe Sources9199 4.5%
vertical dashes Inadequate Cooking399 3.0%

Discussion for Figure ES-1

Failure to control product holding temperatures and times was the risk factor with the highest Out of Compliance percentage. Chemical contamination, poor personal hygiene, and contaminated equipment/protection from contamination also had notable Out of Compliance percentages. Management systems that were implemented to ensure foods were adequately cooked and from safe sources appeared to be effective when compared to the other risk factors evaluated during this data collection period.

B. Percent of observations found Out of Compliance for each INDIVIDUAL DATA ITEM that comprises a risk factor

For elementary schools, the foodborne illness risk factors most in need of attention and their corresponding Out of Compliance percentages are:

  • Improper Holding/Time and Temperature (30.8%)
  • Other/Chemical (21.2%)
  • Poor Personal Hygiene (16.3%)
  • Contaminated Equipment/Protection from Contamination (13.5%)

Figures ES-2 thru ES-4 provide a breakdown of each of these risk factors into data items that represent specific food preparation procedures and employee behaviors in need of attention. These figures provide insight into the relative strengths and weaknesses of the food safety management systems in place in elementary schools to control each of the risk factors during the 2003 data collection.

The Out of Compliance percentage noted for the other/chemical risk factor was attributed to one specific data item that warrants attention. A summary of the results of the Out of Compliance observations for the identification, storage, and use of chemicals/toxics data item will be presented.

Institutional Foodservice - ELEMENTARY SCHOOLS
Figure ES-2
IMPROPER HOLDING/TIME AND TEMPERATURE
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each Data Item

Bar graph of data for compliance observations in elementary schools
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
red rectangle Commercially-processed, RTE, PHF date marked326450.0%
horizontal red bars RTE, PHF date marked after 24 hours225143.1%
right diagonal red bars PHF held cold at 41 °F or below289828.6%
red grid PHF held hot at 140 °F or above218225.6%
vertical red dashes RTE, PHF discarded after 4 days/45 °F or 7 days/41 °F84318.6%
vertical red bars Foods received at temperatures according to Law are cooled to 41 °F within 4 hours.1263.8%
* PHF cooled to 70 °F in 2 hours/41 °F in total of 6 hours *5*8**
* PHF (prepared from ingredients at ambient temperature) is cooled to 41 °F or below within 4 hours*1*7**
* When time only is used as a public health control, food is cooked and served within 4 hours*0*4**
* Roasts are held at a temperature of 130 °F or above*0*0**

* These four remaining Improper Holding/Time & Temperature Data Items do not appear in
Figure ES-2 due to a low number of total observations (obs.)

Discussion for Figure ES-2

For the improper holding/time and temperature risk factor, there is a need to review food safety systems related to:

  • Date marking of open containers of commercially-processed, ready-to-eat PHF (50.0%) and ready-to eat, PHF made on site (43.1%)
  • Maintaining cold holding temperatures for PHF (28.6%)
  • Maintaining hot holding temperatures for PHF (25.6%)
Date Marking

Date marking of refrigerated ready-to-eat, PHF is an important food safety system component designed to promote proper food rotation and limit the growth of Listeria monocytogenes during cold storage. Discarding ready-to-eat, PHF that has remained in cold storage beyond the parameters described in the Food Code prevents foods with a harmful level of Listeria monocytogenes from being served. The importance of date marking of ready-to-eat, PHF is accentuated in elementary schools because the meals are primarily served to a highly susceptible population.

Cold and Hot Holding of PHF

Holding PHF at the proper hot or cold temperatures is critical to preventing the growth of bacteria. Equipment, processes, and monitoring procedures related to maintaining temperature control for PHF need to be assessed and corrective action should be taken if necessary.

Discussion for the Other/Chemical Risk Factor
Table 14
Assessment of the Other/Chemical Category - ELEMENTARY SCHOOLS
Poisonous or Toxic Materials are Properly Identified, Stored, and Used
# Observations
OUT
TOTAL Observations
(IN & OUT)
% Observations
OUT
249824.5%

All of the Out of Compliance observations relating to the other/chemical risk factor were attributed to one data item. The proper identification, storage, and use of cleaners, sanitizers, and other chemicals in elementary schools is in need of attention. Food safety procedures related to the identification, storage, and use of cleaners, sanitizers, and other chemicals need to be reviewed and revised, if necessary, to address any gaps in the program that may be contributing to the high Out of Compliance percentage.

Institutional Foodservice - ELEMENTARY SCHOOLS
Figure ES-3
POOR PERSONAL HYGIENE
PERCENT (%) of OBSERVATIOS found
Out of Compliance for each Data Item

Bar graph of data for foodborne illness risk factors in elementary schools
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
teal rectangle Proper, adequate handwashing309431.9%
horizontal teal bars Prevention of hand contamination159216.3%
right diagonal teal bars Good hygienic practices139613.5%
teal gridHandwashing facility, convenient/accessible 139813.3%
vertical teal dashesHandwashing facility, cleanser/drying device 7987.1%

 

Discussion for Figure ES-3

The food safety procedures for the poor personal hygiene risk factor that are most in need of attention include:

  • Proper, adequate handwashing (31.9%)
  • Prevention of hand contamination (16.3%)
Proper, Adequate Handwashing

Hands may become contaminated when employees engage in activities such as handling raw animal foods, using the restroom or handling soiled tableware. Hands are a common vehicle for the transfer of harmful bacteria and viruses to food products. Effective handwashing is one of the most important measures to minimize the contamination of food by employees. The lack of convenient handwashing facilities and/or supplies of hand cleanser/drying devices may contribute to a lack of proper handwashing. Reinforcing the importance of handwashing should be supported by a management system that includes proper employee training and monitoring of the frequency and effectiveness of handwashing practices.

Prevention of Hand Contamination

Handwashing alone may not prevent the transmission of pathogens to foods via hand contact, therefore, preventing bare hand contact with ready-to-eat foods is a major control measure for limiting the spread of harmful bacteria and viruses from the hands to ready-to-eat food. Reinforcing the importance of preventing bare hand contact with ready-to-eat foods should be supported by a management system that includes proper employee training and monitoring of practices to identify to what extent procedures are being followed.

Institutional Foodservice - ELEMENTARY SCHOOLS
Figure ES-4
CONTAMINATED EQUIPMENT/PROTECTION FROM CONTAMINATION
PERCENT (%) of OBSERVATIONS found
Out of Compliance for each DATA ITEM

Bar graph of data for foodborne illness risk factors in elementary schools
DATA ITEM# OUTTotal Obs.
(IN & OUT)
% OUT
blue rectangle Surfaces/Utensils cleaned/sanitized259425.5%
horizontal blue bars Raw/RTE foods, separated74814.6%
right diagonal blue bars Protected from environmental contamination119811.2%
blue grid After being served, food is not re-served2613.3%
vertical blue dashes Raw animal food, separated1352.9%

 

Discussion for Figure ES-4

The food safety procedures for contaminated equipment/protection from contamination risk factor that are most in need of attention include:

  • Cleaning and sanitizing food contact surfaces and utensils (25.5%)
  • Separating raw animal foods from ready-to-eat foods (14.6%)
Cleaning and Sanitizing

Proper cleaning and sanitization of food contact surfaces is an effective means of preventing cross-contamination. Many different procedures may be involved in the assessment of the management system related to this area. Evaluations should not be restricted to dishwashing procedures but should also include observations on how food preparation tables, cutting boards, and stand-in-place equipment such as slicers and mixers are cleaned and sanitized between uses.

The high Out of Compliance percentage for cleaning and sanitizing food contact surfaces and utensils indicates a weakness in elementary school foodservice management systems designed to prevent cross-contamination.

Separation of Raw Animal Foods from Ready-to-Eat Foods

Raw animal foods are a potential source of contamination in any food operation. Storing raw animal foods above or in close proximity to ready-to-eat foods increases the potential for food to become contaminated. To prevent cross-contamination, raw animal foods should also be separated by species based on required minimum cooking temperatures. Required cooking temperatures are based on thermal destruction data and anticipated microbial load. These parameters may vary with different type of raw animal foods. Having organized storage systems that include designated areas for raw animal products will help prevent cross-contamination of foods.

Preventing cross-contamination between raw animal foods and ready-to-eat foods extends to the food preparation area. Designated separate food preparation areas should be provided for raw and ready-to-eat products. If common preparation areas must be used, then procedures must be in place to ensure proper cleaning and sanitizing between uses.

 

C. Summary of foodborne illness RISK FACTORS and INDIVIDUAL DATA ITEMS in need of priority attention

Table 15
Institutional Foodservice - ELEMENTARY SCHOOLS
Summary of Foodborne Illness RISK FACOTRS and
DATA ITEMS in Need of Priority Attention
FOODBORNE ILLNESS
RISK FACTOR
in need of Priority Attention
(From Section A)
INDIVIDUAL DATA ITEMS
in need of Priority Attention
(From Section B)
Improper Holding/
Time & Temperature
Commercially-processed RTE, PHF date marked
RTE, PHF date marked after 24 hours
PHF held cold at 41 °F or below
PHF held hot 140 °F or above
RTE, PHF discarded after 4 days/45 °F or 7 days/41 °F
Other/ChemicalPoisonous or toxic materials properly identified, stored, and used
Poor Personal HygieneProper, adequate handwashing
Prevention of hand contamination
Contaminated Equipment/
Protection from Contamination
Surfaces/Utensils cleaned/sanitized
Raw animal food separated from ready-to-eat foods