Exhibit 09B - GSA_FOH Food Safety Manager Training Manual 1.pdf

U.S. General Services Administration Property Management Division

Presented by:

U.S. General Services Administration Property Management Division, and U.S. Department of Health and Human Services, Federal Occupational Health

FOOD

SAFETY

MANAGER

TRAINING

EXHIBIT 9B-

FOOD SAFETY

MANAGER TRAINING

MANUAL

Food Safety Manager Training

Table of Contents

Forward…………………………………………… 4 Section 1 – Definitions …………………………. 8

Focus Areas Section 2 – Adult Learning Principles ……… 14 Section 3 – Understanding Food Safety ……… 18

Human Impact ………………….. 18 Areas of Responsibility ……………. 19 Foodborne Illness ………………….. 24 Potentially Hazardous Foods ……… 31 Food Safety Hazards ……………. 33 Recognizing and Responding to a Foodborne Outbreak ………………. 36 Section 4 – Personal Hygiene …………………… 42 Section 5 – Food Handling …………………… 47 Section 6 – Cleaning vs. Sanitizing…………….. 57

Types of Sanitizers ……………….. 57 Manual and Machine Warewashing ……………………… 60 Wiping Cloths …………………………. 64

Section 7 – Facility Maintenance ………………….. 66 Floors, Walls Ceiling ………………. 66 Lighting …………………………….. 67 Pest Control ……………………… 68 Plumbing …………………………….. 72 Immediate Health Hazards ………….. 74 Workplace Safety …………………… 75

Section 8 – Implementing Learned Skills……… 78

Summary Section 9 – Summary and Review …………….. 80 Section 10 – Instructions and Post-Test ………. 82

Food Safety Manager Training

Forward

Once again, the General Services Administration (GSA), along with the U.S. Public Health Service (USPHS), Federal Occupational Health (FOH) has produced a food service training program. The first training, produced in 2005, focused on the food service employee. The training highlighted important food safety techniques as indicated by the most frequently cited violations from the FOH inspector’s reports.

The training presented here is designed to provide GSA food service managers with the knowledge and ability to effectively communicate food safety issues to their employees.

It is designed to review fundamental food safety procedures as well as provide managers with an understanding of how to effectively communicate the information to their employees. The objectives of both trainings are similar in that they are both aimed at reducing the number of deficiencies that may be found during a food inspection and ultimately at reducing the likelihood of any foodborne illness occurring in GSA food facilities.

More than 200 known diseases are transmitted through food.

The causes of foodborne illness include viruses, bacteria, parasites, toxins, and metals. The symptoms of foodborne illness range from mild gastroenteritis (inflammation of the gastrointestinal tract) to life-threatening neurologic, hepatic (liver-related), and renal (kidney-related) syndromes. In the United States, the annual occurrence of foodborne diseases has been estimated at 76 million cases, up to 325,000 hospitalizations, and up to 5,000 deaths. However, because milder cases may go unreported, the incidence may be significantly higher. In addition, some proportion of foodborne illness is caused by pathogens or agents that have not yet been identified and thus cannot be diagnosed.

For example, just 20 years ago, many of the pathogens that cause the most concern, including Escherichia coli (E-coli), had not been identified as causes of foodborne illness.

As a manager, you have an obligation to provide the safest food possible to the individuals that you serve. You have a responsibility to inform staff on all aspects of food safety.

However, obstacles may exist that could potentially impede on an employee’s willingness or ability to follow procedures.

The manager must be aware of these obstacles and seek out ways to overcome them. This training focuses on providing techniques and tools that the manager can utilize to better understand their employees and to ultimately improve their employees’ food service skills. The training is broken down into the following 7 sections:

1. Adult Learning Principles,

2. Understanding Food Safety,

3. Personal Hygiene,

4. Food Handling,

5. Cleaning/Sanitizing,

6. Facility Maintenance and

7. Effectively Transferring Learning and Skills to Employees.

This training is designed to supplement the food service training that managers require. Supervisors should also participate in existing training as indicated by state and federal requirements. This comprehensive training consists of viewing the enclosed DVD, reading this manual and completing the post-test at the end of this book. All managers and supervisors who operate food service facilities on GSA property (excluding facilities with vending machines only) are expected to participate.

Participants must achieve a score of 80% or greater in order to receive a Manager Certificate of Completion, which should be displayed prominently at your facility. The FOH Food Inspectors will be looking for the Manager Certificate of Completion displayed at every qualifying facility during the current inspection year. After viewing the DVD and reading this manual, please refer to page 82, for instructions on submitting the post-test to FOH for grading.

Section 1

DEFINITIONS

Accredited Program –

(a) “Accredited Program” – means a protection manager certification program that has been evaluated and listed by an accrediting agency as conforming to national standards for organizations that certify individuals.

(b) “Accredited Program” – refers to the certification process and is a designation based on an independent evaluation of factors such as the sponsor’s mission;

organizational structure; staff resources; revenue sources;

policies; public information regarding program scope, eligibility requirements, re-certification, discipline and grievance procedures; and test development and administration.

(c) “Accredited Program” – does not refer to training functions or educational programs.

Approved – means acceptable to the regulatory authority based on a determination of conformity and principles;

practices; and generally recognized standards that protect public health.

Bacteria – a germ with only one cell. There are many kinds and they can cause illness when they are allowed to grow and multiply.

Contaminated Food – food containing agents, including chemicals, which are capable of causing illness when consumed.

Cross Contamination - occurs when bacteria is spread between food, surfaces, or equipment. Cross contamination is most likely to happen when:

• Raw food touches or drips into other foods

• Raw food touches or drips onto equipment or surfaces

• People touch raw food with their hands and fail to wash their hands before touching other foods.

Dial Stem Thermometer – measures the temperature of food. It has a round top with a long pointed sensor made of stainless steel to insert into food. This is the recommended thermometer to be used to check the temperature of food.

Food – means a raw, cooked, or processed substance, ice, beverage or ingredient used or intended for use or for sale in whole or in part for human consumption, or chewing gum.

Food Contact Surfaces – consist of the surfaces of equipment or utensils with which food normally comes into contact. It also includes the surface of a utensil from which food may drain, drip, or splash onto or into a food, or onto a surface normally in contact with food. These surfaces are normally thought of as pans, spoons, countertops, and cutting boards, but may also include refrigerator shelving, steamers, or cooking appliances.

Foodborne Disease – is caused by consuming contaminated foods or beverages. Many different disease-causing bacteria or pathogens can contaminate foods, so there are many different foodborne diseases.

In addition, poisonous chemicals, or other harmful substances can cause foodborne diseases if they come in contact with or are otherwise present in food.

Food Employee – means individual working with unpackaged food, food equipment or utensils, or food-contact surfaces.

Formal Setting – training environment that fosters learning and where real-life scenarios can be discussed.

Garbage – refuse that is wet or contains food matter.

Germ – refer to bacteria.

HACCP - Hazard Analysis Critical Control Points plan is a written document that explains the formal procedures for following the HACCP principles developed by the National Advisory Committee on Microbiological Criteria for Foods.

Hazard – is a biological, chemical, or physical property that may cause an unacceptable consumer health risk.

Microorganism – refer to bacteria.

Person-in-charge – means the individual present at the food establishment who is responsible for its operation at the time of inspection.

Poisonous or Toxic Materials – means substances that are not intended for ingestion and are included in the following four (4) categories:

1. Cleaners and sanitizers, including cleaning and sanitizing agents such as caustics, acids, drying agents, polishes, and other chemicals.

2. Pesticides, except sanitizers, which includes insecticides and rodenticides.

3. Substances necessary for the operation and maintenance of the establishment such as nonfood grade lubricant and personal care items that may be harmful to health.

4. Substances that are not necessary for the operation and maintenance of the establishment and are on the premises for retail sale, such as petroleum products and paints.

Potentially Hazardous Food –

a) Food that is natural or synthetic and requires temperature control because it is in a form capable of supporting the rapid and progressive growth of infectious or toxigenic microorganisms.

b) Includes an animal food that is raw or heat-treated; a food of plant origin that is heat-treated or consists of raw sprouts; cut melons; and garlic-in-oil mixtures that are not modified in a way that results in mixtures that do not support growth.

Ready-to-eat-foods – includes the following:

• Raw animal food that is cooked or frozen.

• Raw fruits and vegetables that are washed.

• Fruits and vegetables that are cooked for hot holding.

• All potentially hazardous food that is cooked to the temperature and time for the specific food and cooled.

• Plant food for which further washing, cooking, or other processing is not required for food safety and from which rinds, peels, husks, or shells – if naturally present – are removed.

• Substances derived from plants such as spices, seasonings and sugar.

• Bakery item such as bread, cakes, pies, fillings, or icing for which further cooking is not required.

• Dry salami or pepperoni; salt cured meat and poultry product, such as prosciutto ham; and country cured ham and Parma ham.

• Dried meat and poultry such as jerky or beef sticks.

Refuse – means waste materials that are clean and dry such egulatory Authority – means the local, state, or federal isk – means the likelihood that an adverse health effect will anitization – means the application of cumulative heat or are ervice animal – means an animal such as a guide dog, or ewage – means liquid waste containing animal or include arewashing – means the cleaning and sanitizing of as cardboard or glass recyclables.

R enforcement body or authorized representative having jurisdiction over the food establishment.

R occur within a population as a result of a hazard in a food.

S chemicals on cleaned food contact surfaces that when evaluated reduces the presence of microorganisms that capable of producing illness.

S other animal trained to provide assistance to an individual with a disability.

S vegetable matter in suspension or solution and may liquids containing chemicals in solution.

W utensils and food contact surfaces of equipment.

Section 2

ADULT LEARNING PRINCIPLES1

Part of being an effective teacher involves understanding how adults learn and understanding what may prevent adults from learning. Teaching adults is simply communicating ideas and information. An effective teacher knows what will work with a particular audience. Here are some ideas to consider as you prepare to teach your employees about the principles of food safety.

• When preparing your training, remember to keep the information simple and practical. By focusing on the elements that are most relevant to employees at your location you can individualize the message. By communicating information in a clear and concise manner you increase the likelihood that employees will retain and implement what has been presented to them.

• Adults are self-directed; they need to feel free to govern themselves. Whenever possible you should involve your employees in the learning process. One way to achieve this is to ask your employees if they have any confusion regarding a specific task or duty that is expected of them. The employees need to recognize you as the facilitator and the source of information.

Your job is to guide employees and, whenever possible, assist them in determining the answer to problems or situations on their own. It should be made clear to employees that by participating in training that they will not only keep themselves safe on the job, they will also protect the customer from a potential foodborne illness.

• Adults have accumulated a foundation of life experiences and knowledge that may include work-related activities and previous education. Encourage employees to relate experiences to the class. This can prove to be a valuable instructional tool. Real life scenarios with resolutions may assist the employee in remembering what is expected of them on the job.

• Adults learn best in a comfortable, non-threatening environment. As do all learners, adults need to be shown respect. Remember that all members of your staff are valuable resources. The best learning environment is that in which participants feel that their ideas and contributions are valued.

• Employees must recognize the need for the information. Consider what might be the motivation for the employee to listen to what is presented? As a presenter you will need to find the ways to communicate information that your employee will want to listen to, learn and implement.

• Reinforcement is a very necessary part of the teaching/learning process. Keep in mind that there are two types of reinforcement, positive and negative.

Positive reinforcement is normally used by instructors who are teaching participants new skills. As the name implies, positive reinforcement is “good” and reinforces good behavior. Negative reinforcement is useful in trying to change modes of behavior. The instructor uses negative reinforcement until the “bad” behavior disappears, or becomes extinct. When trying to change behavior you should consider applying both positive and negative reinforcement

• After training, employees must retain and apply information in order to benefit from the learning. As an instructor you need to use the information presented in training as part of how you communicate with your employees on a daily basis. Be aware of teachable moments which are opportunities for you to demonstrate desired practices and behaviors. Make note of the training posters that FOH will provide to you.

Make sure to hang these posters in a conspicuous location so that they may serve as a continual reminder to employees on how to properly wash their hands and properly execute manual warewashing in a three compartment sink. These posters are designed to solidify information that should have already been communicated to your employees. Employees should also be reminded to pay attention to existing posters that serve as reminders for desired procedures and practices.

• Become aware of barriers that may prevent your employees from benefitting fully or participating in your training. Even if the employee is present at your training is there anything that is happening with him or her that may be interfering with their ability to focus and retain what is being taught? Some barriers that may exist include lack of interest, ability, language differences, and lack of confidence regarding the information being presented. You as instructor must keep in mind that people learn at different speeds and that it is natural for participants to feel anxious or nervous when faced with a learning situation. You must be sensitive to these barriers and individualize the message so that your employees will be more inclined to pay attention and implement desired practices. Positive reinforcement by you can enhance the learning experience.

• Learning is enhanced from sensory stimulation. Some people favor one sense over others to learn or recall information. You should present information that stimulates as many senses as possible in order to increase the chance of learning success. For example, auditory learners are comfortable in a lecture modality, but physical learners learn by doing; encourage participation and include tactile and hands-on activities for them. Visual learners prefer media and demonstrations; be engaging and provide visual aids to help maintain interest.

Stephen Lieb, Principles of Adult Learning, Adults as Learners

Section 3

UNDERSTANDING FOOD SAFETY

Human Impact

As previously discussed, foodborne illness is a serious public health concern and the cost to American society is high. With 76 million cases of foodborne illness occurring each year, virtually all Americans will experience some form of foodborne illness over the course of their lifetime. For most individuals the impact may not even be noticeable, resulting in only mild, temporary discomfort. For others, especially pre-school age children, pregnant women, older adults, and those with impaired immune systems, foodborne illness may have serious or long-term consequences, and for some, may be life threatening.

The risk of foodborne illness is of increasing concern due to changes in our global market, the aging of our population, increasing numbers of immunocompromised and immunosuppressed individuals, changes in consumer eating habits, and changes in food production practices. According to one U.S. Department of Agriculture (USDA) Economic Research Service (ERS) report, just five foodborne illnesses:

Camploybacter, Salmonella, E. coli O157:H7, Listeria monocytogenes, and Toxoplasma gondii - cause $6.9 billion in medical costs, lost productivity, and premature deaths. For some, the acute stage of foodborne disease may be only the start of the problem. The Food and Drug Administration (FDA) estimates that two to three percent of foodborne illness victims develop secondary long-term medical complications resulting in over 1.5 million lingering health problems per year.

The above figures are estimates that relate to the overall economy, but the costs to individual business can be even more overwhelming. If a food service establishment is investigated and/or implicated in a foodborne outbreak, its reputation, employee morale, revenue, and customer base can be grossly damaged beyond recovery. If the same facility is conclusively shown to have caused a foodborne outbreak, the financial, insurance and legal costs will be even higher.

Areas of Responsibility

Food safety is a responsibility that involves everyone in the food supply chain. As a manager of a food service facility located within a GSA building you have a unique set of responsibilities to the employees you hire and to the public to which you serve your food. Your first responsibility is to ensure that the food you provide is safe. Your company, management team, and the individuals that work for you are all legally responsible for providing a safe food product. If a person becomes sick as a result of an error that was made in your establishment, you could be held liable.

According to the U.S. Food and Drug Administration’s (FDA) Food Code, you also have a responsibility to participate in a certified food protection manager training course in which you have shown proficiency of required information by passing an exam as part of an accredited program.

As a manager you must ensure that the foods that enter your facility are from an approved source. An approved source is defined as one that has been found acceptable by the regulating authority based on recognized standards that protect the health of the public.

As a manager you must teach safe food handling practices of potentially hazardous food to your employees. The information provided to your employees must be aimed at inhibiting, restricting, and otherwise minimizing the growth of pathogenic organisms. Training can occur on a daily basis in the form of on-site reminders to individual employees, or it can be formal training that involves all employees. Formal training must be documented and should occur on a regular basis throughout the year.

It is your responsibility, as the manager of a food service facility, to ensure that a person-in-charge is present at your facility during all hours of operation. According to the FDA Food Code, the permit holder shall be the person-in-charge or shall designate a person-in-charge. The person-in-charge must comply with all critical Food Code items

As a manager, you should work with the regulating authority that has jurisdiction during a sanitation inspection. This includes your local county or state inspector as well as the FOH inspector. During your inspection you may be asked questions by the inspector and your full cooperation is expected.

If a certified manager is not available during an inspection, or anytime the certified manager is not present at the facility, then the person-in-charge at the time must either have no violations of the Food Code or be able to demonstrate subject area knowledge and answer all of the following questions correctly:

• Describe the relationship between a food employee’s personal hygiene and the prevention of foodborne illness.

• Explain the responsibilities of the person-in-charge if a food employee has a disease or medical condition that may cause a foodborne illness.

• Describe specific foodborne illnesses and their symptoms.

• Describe the relationship between the holding time and temperature of potentially hazardous foods and the prevention of foodborne illness.

• Explain the hazards when raw or undercooked eggs, poultry, fish, or meat are consumed.

• State the required food temperatures and cooking times associated with the safe cooking of potentially hazardous foods.

• Understand the required minimum and maximum temperatures and times associated with safe refrigerated storage, hot food holding, cooling, and reheating of potentially hazardous foods.

• Describe the relationship between prevention of foodborne illness and each of the following:

• Controlling cross contamination.

• Minimizing the handling of ready-to-eat foods.

• Frequent handwashing.

• Maintaining the cleanliness and good repair of the establishment.

• Describe the relationship between food safety and each of the following:

• The provision of food equipment sufficient in number and capacity for the food operation.

• The provision of food equipment that is designed, constructed, located, installed, operated, maintained, and cleaned in a sanitary manner.

• Explain procedures for cleaning and sanitizing food contact surfaces of food equipment and utensils.

• Understand the source of potable water used in the food establishment and how it is to be protected from contamination.

• Identify all poisonous or toxic materials used in the food establishment and describe the correct procedures for storage, dispensing, use, and disposal as required by law.

• Identify critical control points in the flow of food through the food establishment and describe the preventative measures taken at each critical control point to ensure that hazards are minimized.

• Describe in detail how the person-in-charge and employees comply with a Hazard Analysis and Critical Control Point (HACCP) plan (if required by law), the FDA Food Code, or any other applicable local food sanitation regulations.

Inspectors have the unique opportunity to see many different food establishments within the same community. Being open to the ideas the inspector presents and implementing these suggestions will bring about desired outcomes and positive change to your facility. Keep in mind that the FOH inspector is conducting the inspection not only to identify potential hazards in your facility, but also to assist you in understanding the ways in which these hazards can be eliminated or reduced.

Foodborne Illness

A foodborne illness is any infection or illness that is transferred to humans by the food they consume. There are five risks factors for foodborne illness, they are as follows:

1. Improper food temperatures. Potentially hazardous foods must be maintained at or below 41° Fahrenheit

(F) if cold, and above 135° F if hot, in order to prevent the significant growth of pathogenic bacteria.

That is not to say that all growth stops. Bacteria will continue to grow through cell mitosis (reproduction through cell division/splitting) even at these temperatures, but they grow much more slowly and take many more hours to become a problem.

2. Undercooked or uncooked foods. Many foods already contain pathogenic bacteria. These include meats, poultry, and fish that if not cooked thoroughly and to specified time and temperatures, may provide pathogenic bacteria the opportunity to grow.

3. Contaminated food equipment. Food that is prepared with equipment that has not been cleaned and sanitized has the potential to become contaminated with pathogenic bacteria. If this equipment is used without being properly cleaned and sanitized the risk of cross contamination greatly increases.

• Food-to-food cross contamination occurs when a raw food – such as meat – which contains harmful bacteria, comes into contact with ready-to-eat-foods. For example, if juices from raw contaminated chicken come into contact with salad ingredients that are not washed, cross contamination occurs. This can be avoided by using separate refrigerator space to store ready-to-eat-foods away from raw meat.

• Equipment-to-food cross contamination occurs when raw foods – such as meat – that contains harmful bacteria, is cut by a knife and then the same knife is used to cut raw salad ingredients without having being cleaned and sanitized. This type of cross contamination can be prevented by washing equipment after each food operation, i.e.

cutting vegetables then cutting raw meats.

• People-to-food cross contamination occurs when people directly contaminate food by not washing their hands after using the bathroom or sneezing into their hands, then resume food preparation or cooking. Good personal hygiene is the best method of prevention to avoid this type of cross contamination. The recommended handwashing technique should be taught and enforced for all food service employees. Sneeze guards and other mechanical devices used in the customer area also prevent contamination possibilities.

4. Food from an unsafe source. There have been foodborne illnesses linked to the receipt of food from an unapproved source such as a non-approved supplier. If food procured in this manner is used at the facility, the manager assumes the risk that the food may not have been handled according to standard practices that an approved supplier must follow.

5. Poor hygienic practices. Employees that handle or prepare food are given the public’s trust that they will practice sound personal hygiene procedures. This trust includes the assumption that they will wear clean clothes, use hair restraints, wash their hands when needed, and not work when they are sick.

The causes of foodborne illnesses are classified into three categories; foodborne intoxication, foodborne infection, and toxin-mediated foodborne infection. Descriptions of each, as well as examples of the associated illnesses, are provided below.

Foodborne intoxication - is caused by eating food that contains either a chemical hazard or a toxin. Biological toxins are present when microorganisms produce waste.

Unlike the living organism, these wastes may or may not be destroyed or chemically altered by heating the food.

Foodborne intoxications occur even if the food is thoroughly cooked. Paying attention to compromised foods is essential to preventing intoxications. Some of the pathogenic bacteria associated with foodborne intoxication are:

• Botulism - is a rare but serious illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. Foodborne botulism is caused by eating foods that contain the botulism toxin. Botulism is considered a medical emergency and foodborne botulism is especially dangerous because many people can be poisoned simultaneously by eating contaminated food. Symptoms of Botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness.

Foodborne infection - is an illness that is caused by eating foods that contain live pathogenic microorganisms that reproduce in the gut. The organisms continue to reproduce and may cause the infected person to become ill. Some of the major bacteria associated with foodborne infections include the following:

• Salmonellosis - is an infection with bacteria called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most people recover without treatment.

However, in some cases, the diarrhea may be so severe that the patient requires hospitalization. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to suffer the most severe illness.

• Campylobacteriosis - is an infectious disease caused by the Campylobacter bacteria. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

• Listeriosis - a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes. Listeriosis has recently been recognized as an important public health problem in the United States. The disease primarily affects the elderly, pregnant women, newborns, and adults with weakened immune systems. However, persons without these risk factors can sometimes be affected.

• Vibrio parahaemolyticus - is a bacterium in the same family as those that cause cholera. It lives in brackish saltwater and causes gastrointestinal illness in humans.

V. parahaemolyticus naturally inhabits coastal waters in the United States and Canada and is present in higher concentrations during summer; it is a salt-requiring organism.

Toxin-mediated foodborne infection – is an infection that is very severe because it is a combination of pathogens and toxins. The person ingests the pathogens and then the infection produces toxins that begin to affect and/or damage organs in the body. Major bacteria associated with toxin-mediated foodborne outbreaks include:

• Shigellosis - is an infectious disease caused by a group of bacteria called Shigella. Most individuals who are infected with Shigella develop diarrhea, fever, and stomach cramps that begin a day or two after they are exposed to the bacteria. The diarrhea is often bloody.

Shigellosis usually resolves in 5 to 7 days. Persons with shigellosis in the United States rarely require hospitalization. A severe infection with high fever may be associated with seizures in children less than two years old. Some people who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others.

• Escherichia coli (E. coli) - are a large and diverse group of bacteria. Although most strains of E. coli are harmless, others can make you sick. Some kinds of E.

coli can cause diarrhea; while others cause urinary tract infections, respiratory illness and pneumonia, and other illnesses. Still other kinds of E. coli are used as markers for water contamination. You might hear about E. coli being found in drinking water, which are not themselves harmful, but indicate the water is contaminated. Some kinds of E. coli cause disease by making a toxin called Shiga toxin. The bacteria that make these toxins are called “Shiga toxin-producing” E. coli, or STEC for short. The most commonly identified STEC in North America is E. coli O157:H7 (often shortened to E. coli O157 or even just “O157”). When you hear news reports about outbreaks of “E. coli” infections, they are usually talking about E. coli O157.

A properly functioning immune system can fight a small number of bacteria and prevent them from reproducing or producing harmful levels of toxins. However, bacteria can reproduce rapidly and in larger numbers, bacteria can cause illness. It is understandable why a person with a compromised immune system is particularly at risk.

To effectively reduce the occurrence of foodborne illness, managers must focus their attention on achieving active managerial control. The term “active managerial control” describes the industry’s responsibility for developing and implementing a food safety management system designed to prevent, eliminate, or reduce the occurrence of foodborne illness risk factors. This approach stresses food safety prevention as opposed to reaction by implementing a continuous system of monitoring and verification. Elements of an effective food safety management system may include the following:

• Implementation of recipe cards that contain specific steps for preparing a food item and food safety critical limits, such as final cooking temperatures, that require monitoring and verification.

• Standard operating procedures (SOPs) for performing critical procedures, such as cooling techniques.

• Equipment and facility design and maintenance.

• Employee health policy for restricting or excluding ill employees.

• On-going quality control and assurance.

The principles listed above are included in a Hazard Analysis and Critical Control Point (HACCP) system. HACCP system is comprised of seven principles that are meant to be applied to a written food safety program. Managers that participate in a HACCP program greatly increase the likelihood a operating a safe food service facility.

Potentially Hazardous Foods

Just as there are segments of our population that are considered high risk for developing a foodborne illness, there are also certain foods that are in the high risk category for causing a foodborne outbreak. These foods are called Potentially Hazardous Foods (PHFs). These foods have one or more of the following characteristics:

• High protein. Pathogenic bacteria depend on proteins, which are the building blocks of life.

• Moisture. All pathogenic bacteria require water to survive and to thrive. This is called the Active Water

(aw) of a food.

• Chemically neutral or slightly acidic. On the pH scale, low numbers are said to be acid and high numbers are said to be base (or alkaline). The pH scale ranges from 0 to 14 with 7 being neutral (water is slightly acidic because of the polar nature of the material).

• Food processing procedures (e.g., slicing melons).

When a food is sliced, or opened, more surface area is exposed to potential contamination.

• Examples of Potentially Hazardous Foods include the following:

• Milk and milk products

• Meats:

Poultry Beef Pork Fish

• Cooked carbohydrates (rice and spaghetti)

• Eggs

• Garlic and oil mixtures

• Sliced melons

• Shellfish

• Ready-to-eat foods

Potentially hazardous food requires strict time and temperature controls to stay safe. Efforts should be taken so that PHF do not enter into the Temperature Danger Zone (TDZ), 41°F (cold foods) to 135°F (hot foods). PHF must be checked often to make sure that they stay safe using a properly calibrated, cleaned and sanitized thermometer.

Food Safety Hazards

There are three major hazards that may be introduced into the food supply any time during harvesting, processing, transporting, preparing, storing, and serving food. These hazards may be chemical, biological, or physical.

Chemical Hazards - Chemicals are used throughout food establishments. These chemicals include pesticides, personal care items, cleaning products, food additives, and toxic metals. These chemicals can leach into food from canning or cooking utensils. All chemicals used in the food establishment must be labeled and stored in a separate location from food preparation areas. This separate space must not be stored above food, equipment, utensils, linens, and single-service or single-use articles. The only exception to this rule is for sanitizers that may be stored above warewashing equipment. Chemicals that are transferred from their original containers must be placed in containers that are not also used for food storage. All spray bottles, buckets and working containers must be clearly labeled with the common name of the chemical.

Only chemicals used for facility operation or maintenance are permitted at food service facilities. Chemicals used must comply with recommended handling procedures as outlined on the manufacturer’s label. As required by law, Material Safety Data Sheets (MSDS) must be maintained for all chemicals used onsite. MSDS must be accessible to all employees of the facility. Pesticides must be specifically labeled as being allowed in a food establishment.

A restricted use pesticide shall only be applied by a certified applicator.

Chemical hazards can also occur from chemical reactions between food and food equipment containing metals such as copper, lead, zinc, brass, and cadmium. Acidic foods can leach these metals from the equipment and contaminate food. Backflow prevention devices are required on carbonated beverage dispensers specifically for this reason.

Carbonated water is acidic, and if it backflows into a copper water line, the copper or lead from the solder can be leached into the water and dispensed to the next serving causing copper or lead poisoning. Acidic foods, such as canned tomato or pineapple juice, left in the can for storage can leach tin into the food. Acidic foods can also leach metals from pewter pitchers, copper pots, and galvanized utensils.

There have also been foodborne illnesses associated with cadmium leaching from food being cooked on refrigerator shelving racks. It is important to only use “approved” food grade equipment in the food service establishment and to use the equipment as intended to prevent chemical hazards.

Biological Hazards –occur when food becomes contaminated by microorganisms found in the air, food, water, soil, animals, and the human body. Microorganisms are, by far, the most common type of food contamination and pose the greatest risk for humans. Because of this, microorganisms are considered the single greatest threat to food safety. Microorganisms commonly associated with foodborne illnesses include bacteria, viruses, and parasites.

Bacteria – the majority of biological hazards are bacteria that can be controlled through time, temperature, acidity, and water activity. Some bacteria form spores that are highly resistant and may not be destroyed by cooking and drying.

Viruses – can exist in food without growing, but they can rapidly reproduce once they are on or in a living host – typically a human being. Viruses can be controlled by practicing good personal hygiene, because that limits the possible transmission of viruses from one source to another via human contact.

Hepatitis A, norovirus, and rotavirus are directly related to contact with contaminated human feces. The spread of viruses can be prevented by forbidding bare-hand contact with food, practicing proper hand washing, and not allowing ill employees to work at your facility.

Parasites – are organisms that require a host. Parasites may be transmitted from animals to humans, from humans to humans, or from humans to animals.

Several parasites have emerged as significant causes of foodborne and waterborne disease. These organisms live and reproduce within the tissues and organs of infected human and animal hosts, and are often excreted in feces. Special attention should be given when preparing foods such as fish and pork since they are known to carry parasites.

Physical Hazard – is any physical material or foreign object not normally found in a food that can cause illness or injury.

These physical hazards may be the result of contamination, carelessness, mishandling or poor practices at any point in the food chain from harvest to consumer, including within the food facility. These hazards are the easiest to identify because the consumer usually finds the foreign object and reports the incident.

Recognizing and responding to a foodborne outbreak.

A foodborne outbreak is an incident in which two or more individuals experience a similar illness after the ingestion of a common food. Epidemiological evidence implicates the food as the source of the illness. The only exceptions are a single case of botulism or a single illness caused by the ingestion of a chemical. In these examples one case constitutes an outbreak. Knowing that you have the ultimate responsibility to prevent such outbreaks means that you also need to know how to detect and react to an outbreak if one should occur.

Consider the following scenario. A regular customer comes into your facility for lunch. The customer decides to have the lunch special. About 10 minutes later two other customers come in and order the same item. All three customers take their lunches back to their office. One hour later the first customer returns back to your facility and tells you that her stomach is upset and she feel nauseous. She has returned to get something to drink. At the same time another one of the three original customers who ate the special returns and he too complains to you that his stomach is upset and he in fact just got sick in the men’s room. He informs you of this because he believes it is your special that made him sick.

At this point, as the manager, you must assume the complaints from the customers are related and are true.

You should immediately remove the suspect item from your food service line. It is recommended that you do not destroy this item because testing of the item may be required. Next, you should begin gathering information from the affected customers. You should collect the following information.

1. Name, address and telephone number(s).

2. Who else may have become ill in the office?

3. Has the person sought medical attention for the illness (if so, who was the doctor)?

4. What foods or drinks were consumed?

5. What time was the food consumed?

6. Who was the server, if any?

7. Other information that may seem important at the time.

Let the customer know that the complaint is being taken seriously and that it will be investigated immediately. Give the customer a timeframe to indicate when they can expect a follow-up phone call with the results.

The following people should be contacted immediately:

1. The food establishment’s owner.

2. The GSA Building Manager.

3. The local health department (as a courtesy only).

4. Your company’s attorney.

5. Your company’s insurance agent.

The Investigation

The GSA Building Manager has the ultimate responsibility in assuring that all operations that occur in his/her building are done safely. With this authority the GSA Building Manager may decide to call FOH or the local health department to conduct an emergency inspection of the facility. The inspector will help to identify the problem and will outline the specific steps required to rectify the situation.

This will be achieved by implementing several activities.

The first will be to conduct a series of interviews with the involved parties including the affected customers, employees who served the food, food service management, and medical staff who cared for the affected customers. The objective of the interviews is to determine (a) what foods were involved in the outbreak/illness, and (b) what went wrong to cause the outbreak/illness.

When an outbreak occurs, the primary concern is preventing further cases. Some control measures that may need to be implemented immediately are:

1. Pinpointing employees that are ill, or who may have caused the outbreak to be excluded from the food establishment (only if they are ill).

2. Recommending alternative food processes or preparation methods.

3. As a last resort, closing the establishment.

Food samples may be collected at this point in the investigation. The investigator will collect samples for laboratory analysis to include microbial matching from the foods and customers. This involves asking the customers and/or employees for stool, vomit and/or blood samples.

This is a key to the overall success or failure of the investigation. The laboratory will confirm or deny the connection between the suspect food and the customer’s illness.

Once a food or food stock is suspected, the inspector may tag it for holding until the results of the investigation are finalized. Only the inspector can release the hold of the foods.

There are certain investigations and reporting requirements of foodborne outbreaks according to the FDA food code.

The possible outcomes of an investigation may be as follows:

1. The outbreak was associated with the food from the establishment or a supplier.

2. The outbreak was not associated with the food from an establishment, or a supplier, and no cause was found.

3. The outbreak was not associated with the food from the establishment or a supplier and another cause was found. Sometimes the cause can be a common outside influence such as a pool or water supply that is completely out of the manager’s control.

What happens next?

The follow-up phase of the outbreak is dependent upon what the inspectors have found. The inspector attempts to find the food that caused the outbreak, why it caused the outbreak, the severity or number of individuals involved in the outbreak, and other applicable factors. All of this information helps to better understand how to prevent it from ever happening again. Reports may also be sent to the state health department or a federal authority such as the Centers for Disease Control and Prevention (CDC) for tracking purposes.

In the end, all of the information collected helps to prevent future outbreaks by pointing out the details of how the event unfolded. The cause of the outbreak can be a simple or a very complex chain of events that can be used to teach other managers and employees how to prevent an outbreak in the future.

Section 4

PERSONAL HYGIENE

The habits and hygienic practices of the food service employee have the most direct impact on food quality and safety of the food they prepare and handle. Poor personal hygiene is one of the most common ways to contaminate food and increase the risk of a foodborne outbreak. In this section you will learn what constitutes good personal hygiene and how to teach this information to your staff. The consequences of not teaching and enforcing these basic practices are too great to ignore.

Hands touch every part of the body and every part of the food being prepared. Good handwashing technique is a requirement to prevent the contamination and spread of disease. If an employee who handles ready-to-eat food has a gastrointestinal illness and neglects to wash their hands after using the bathroom, the employee can easily spread the disease onto surfaces that he/she touches, including plates and silverware. Infected lesions on the hands or forearms can contaminate foods by introducing pathogenic bacteria onto foods and utensils. Sometimes a seemingly healthy employee is actually a carrier of a disease such as

Hepatitis A. These are all examples of why proper handwashing is so important in the food service industry.

In addition to making others ill, a food service employee with poor personal hygiene may be a risk to themselves as well.

If employees do not wash their hands before eating they may be exposed to pathogenic bacteria if they were handling raw meats or other potentially hazardous foods prior to eating. Employees who wipe their hands on their aprons may be allowing a huge amount of bacteria to grow on their soiled apron. Bacteria can be spread from surface to surface and food to food throughout the kitchen. Sometimes people will spread bacteria without realizing it by touching a pimple that has pus oozing from it, scratching their scalp, sneezing, rubbing their nose or coughing into their hands. Smoking, drinking, and eating also are hand-to-mouth activities that should only be conducted in designated areas and never in food storage or preparation areas. There is only one exception to drinking in food preparation areas and that is if the drink container has a tightly fitting lid and a straw that will not allow the contents to spill.

Handwashing:

Even though handwashing seems like a routine task, the FDA Food Code actually specifies how you should wash your hands if you are working in a food service establishment. According to the Food Code, it should take at least 20 seconds to execute the following:

1. Wet the hands with warm running water;

2. Apply soap;

3. Rub the hands together for at least 20 seconds, (about the time it takes to sing “Happy Birthday” to yourself twice), making sure to get soap to all exposed surfaces including in between fingers and forearms;

4. Clean under fingernails;

5. Rinse all soap;

6. Dry hands using single-use paper towels or a warm-air hand dryer.

Here is a partial list that outlines when an employee is required to wash their hands:

1. After using the restroom.

2. After touching their face.

3. After touching their clothes.

4. After eating, smoking, and drinking.

5. After taking out the garbage.

6. After using cleaning compounds or any type of chemical.

7. After clearing tables or handling dirty utensils.

8. After coughing, sneezing, or…