Friday, November 26, 2010
Happy Day After Thanksgiving!
I hope that you did not eat too much yesterday and can still function today! Or if, like me, you have multiple days of giving thanks with extended families, enjoy all of them!
Wednesday, November 24, 2010
Happy Thanksgiving!
Tomorrow, take a few minutes out of your day and think about all the things for which you are thankful. Sometimes we are so stressed about the day-to-day activities that we forget how much we really do have.
And keep the food safe!! :)
And keep the food safe!! :)
Friday, November 19, 2010
LTC Regulations: Survey Preparedness
There are several things that a facility can do to improve its chances for a good survey. One is to be "survey ready every day." In other words, know the regulations and follow the regulations, every day.
I have worked with facilities that "geared up" for survey. I have had managers tell me, when I have pointed out violations during a mock survey, that the employees know what to do and will do it when the surveyors are there.
This defeats the whole purpose of regulations and surveys. We should all be doing the right things because they are the right things to do for the residents, not just to please the surveyors.
And following the regulations is the right thing to do for the residents. F371 is based on the FDA Food Code. This is what needs to be followed to be sure food is safe.
We should be following F371, not because we will be surveyed on it, but because it is the right thing to do for the residents, everyday.
I have worked with facilities that "geared up" for survey. I have had managers tell me, when I have pointed out violations during a mock survey, that the employees know what to do and will do it when the surveyors are there.
This defeats the whole purpose of regulations and surveys. We should all be doing the right things because they are the right things to do for the residents, not just to please the surveyors.
And following the regulations is the right thing to do for the residents. F371 is based on the FDA Food Code. This is what needs to be followed to be sure food is safe.
We should be following F371, not because we will be surveyed on it, but because it is the right thing to do for the residents, everyday.
Wednesday, November 17, 2010
LTC Regulations: F441, Infection Control
Any nursing employee preparing or serving food must follow F371, including the portion about no bare hand contact with food.
However, when nursing employees are assisting residents with meals, F441, Infection Control, comes into play. The important aspects of F441 related to meal service concern hand hygiene.
The SOM states: "Hand hygiene is a general term that applies to washing hands with water and either plain soap or soap/detergent containing an antiseptic agent; or thoroughly applying an alcohol-based hand rub (ABHR).
It also states: "Hand washing refers to washing hands with plain (i.e. nonantimicrobial) soap and water."
F441 specifies when hand hygiene must occur. It also specifies when hand hygiene must include hand washing.
For example, hand washing must occur when hands are visibly soiled. Hand washing must also occur before and after eating or handling food. Hand hygiene can include using an ABHR.
F441 defines when nursing employees must wash their hands and when they can use an ABHR.
According to F371, they still cannot touch food with bare hands. If they use gloves, the gloves become contaminated as soon as they touch anything else, just as if they were dining service employees.
Nursing employees using gloves in the dining room really is not practical. They would be changing gloves and washing hands almost constantly. A better approach is a combination of completing as much food handling as possible in the kitchen by dining service employees and using utensils in the dining room.
For example, if toast is buttered in the kitchen as it is being made, that saves a step in the dining room. A fork can then be used to hold the toast in place while a knife is used to spread the jelly in the dining room. Deli papers can also be used, but they are a single use item.
What are you doing to avoid bare hand contact with food while residents are being assisted?
However, when nursing employees are assisting residents with meals, F441, Infection Control, comes into play. The important aspects of F441 related to meal service concern hand hygiene.
The SOM states: "Hand hygiene is a general term that applies to washing hands with water and either plain soap or soap/detergent containing an antiseptic agent; or thoroughly applying an alcohol-based hand rub (ABHR).
It also states: "Hand washing refers to washing hands with plain (i.e. nonantimicrobial) soap and water."
F441 specifies when hand hygiene must occur. It also specifies when hand hygiene must include hand washing.
For example, hand washing must occur when hands are visibly soiled. Hand washing must also occur before and after eating or handling food. Hand hygiene can include using an ABHR.
F441 defines when nursing employees must wash their hands and when they can use an ABHR.
According to F371, they still cannot touch food with bare hands. If they use gloves, the gloves become contaminated as soon as they touch anything else, just as if they were dining service employees.
Nursing employees using gloves in the dining room really is not practical. They would be changing gloves and washing hands almost constantly. A better approach is a combination of completing as much food handling as possible in the kitchen by dining service employees and using utensils in the dining room.
For example, if toast is buttered in the kitchen as it is being made, that saves a step in the dining room. A fork can then be used to hold the toast in place while a knife is used to spread the jelly in the dining room. Deli papers can also be used, but they are a single use item.
What are you doing to avoid bare hand contact with food while residents are being assisted?
Friday, November 12, 2010
LTC Regulations: Facility Tags
In the past, regulations were grouped by discipline. There were "dietary" tags and "nursing" tags and neither discipline paid much attention to the others. Some facilities still have this philosophy. A better approach is to consider all regulations as facility regulations.
Any employee, regardless of department, must follow F371 if she is handling food. This applies to dining service employees, of course. It also applies to employees in activities/life enrichment, social services, nursing, department managers and anyone else that prepares or serves food, even if it is just for special events.
It is necessary that the dining service manager take responsibility for seeing that all employees who work with food are properly trained. It is also necessary to monitor that they are actually using the knowledge they were given.
Any employee, regardless of department, must follow F371 if she is handling food. This applies to dining service employees, of course. It also applies to employees in activities/life enrichment, social services, nursing, department managers and anyone else that prepares or serves food, even if it is just for special events.
It is necessary that the dining service manager take responsibility for seeing that all employees who work with food are properly trained. It is also necessary to monitor that they are actually using the knowledge they were given.
Wednesday, November 10, 2010
LTC Regulations: F371 and No Bare Hand Contact with Food, Serving Considerations
Remember, gloves are not magic. Anytime an employee touches the glove with anything that would contaminate his hands, the gloves have just been contaminated. This applies to service as well as production.
Often I see an employee wearing gloves on trayline to pick up food, rolls for example, and place them on the plate. However, the employee is also touching serving utensils, plates, rearranging the plate lowerator, putting trays in a cart, etc. Often, the employee is also opening the oven door, handling dirty potholders, taking food out of the oven, etc. Those gloves are no longer clean for handling food. Whatever contaminates were on the lowerator, carts, oven handles, potholders, etc., are now on the food and the residents will consume the contaminates when they eat the food. This is classic cross-contamination. And in this case, classic is not good!
A safer approach is to use utensils to handle food. (Be sure to use a different utensil for each food. If one food contains contaminates, such as bacteria, using the same utensil will contaminate all the food items.) Use tongs, spatulas, scoops, ladles, or whatever utensil is appropriate for the task.
If utensils are used for handling the food, gloves are not necessary for serving. Gloves create a barrier between hands and food. If the hands are not touching the food, gloves are not necessary. A major disadvantage of using gloves during service is that employees will touch food with contaminated gloves without thinking about it when they would not touch food with their bare hands.
Inappropriate use of gloves is often the cause of contaminating food during service.
Often I see an employee wearing gloves on trayline to pick up food, rolls for example, and place them on the plate. However, the employee is also touching serving utensils, plates, rearranging the plate lowerator, putting trays in a cart, etc. Often, the employee is also opening the oven door, handling dirty potholders, taking food out of the oven, etc. Those gloves are no longer clean for handling food. Whatever contaminates were on the lowerator, carts, oven handles, potholders, etc., are now on the food and the residents will consume the contaminates when they eat the food. This is classic cross-contamination. And in this case, classic is not good!
A safer approach is to use utensils to handle food. (Be sure to use a different utensil for each food. If one food contains contaminates, such as bacteria, using the same utensil will contaminate all the food items.) Use tongs, spatulas, scoops, ladles, or whatever utensil is appropriate for the task.
If utensils are used for handling the food, gloves are not necessary for serving. Gloves create a barrier between hands and food. If the hands are not touching the food, gloves are not necessary. A major disadvantage of using gloves during service is that employees will touch food with contaminated gloves without thinking about it when they would not touch food with their bare hands.
Inappropriate use of gloves is often the cause of contaminating food during service.
Friday, November 5, 2010
LTC Regulations: F371 and No Bare Hand Contact with Food, Kitchen Considerations
A major emphasis with the revised F371 is no bare hand contact with food. The purpose of this is to help keep food safe.
Several items cans be used to create a barrier between hands and food including disposable gloves, utensils, and deli sheets.
A critical aspect to remember is that gloves are not magic. Anytime gloves touch something that would have contaminated the hands, the gloves have just been contaminated and must be changed.
For example, an employee's task is to make cold sandwiches. She washes her hands, puts on gloves properly, and opens up the cooler door to get the ingredients. STOP!!! She has just contaminated her gloves on the cooler door!
The proper way to do this is for her to wash her hands and set up her work area. She is not touching food so she does not need to wear gloves. She gets out the cutting board, knife, other utensils she may need, pans to put the sandwiches in, food wrap to cover the pans, labels and pen for labeling and dating the pans, the containers of food, etc. While she is doing this, she is careful not to touch the food or any surface that will come into contact with food. Then she washes her hands, properly puts on gloves, and can begin to make sandwiches.
When she has a pan of sandwiches made, or needs to get more food from the cooler, she needs to take off her gloves, wash her hands, cover and label the pans of sandwiches, put them in the cooler, get more containers of food, etc. Before she touches the food again, she needs to wash her hands and put on a new pair of gloves.
Employees must be monitored closely to be sure they understand and do this properly. Too often, they do believe that once they put on gloves they can touch anything they want and still touch food. This is not true! Gloves can cause cross-contamination just as easily as hands.
What success stories can you share in training employees on proper glove use?
Several items cans be used to create a barrier between hands and food including disposable gloves, utensils, and deli sheets.
A critical aspect to remember is that gloves are not magic. Anytime gloves touch something that would have contaminated the hands, the gloves have just been contaminated and must be changed.
For example, an employee's task is to make cold sandwiches. She washes her hands, puts on gloves properly, and opens up the cooler door to get the ingredients. STOP!!! She has just contaminated her gloves on the cooler door!
The proper way to do this is for her to wash her hands and set up her work area. She is not touching food so she does not need to wear gloves. She gets out the cutting board, knife, other utensils she may need, pans to put the sandwiches in, food wrap to cover the pans, labels and pen for labeling and dating the pans, the containers of food, etc. While she is doing this, she is careful not to touch the food or any surface that will come into contact with food. Then she washes her hands, properly puts on gloves, and can begin to make sandwiches.
When she has a pan of sandwiches made, or needs to get more food from the cooler, she needs to take off her gloves, wash her hands, cover and label the pans of sandwiches, put them in the cooler, get more containers of food, etc. Before she touches the food again, she needs to wash her hands and put on a new pair of gloves.
Employees must be monitored closely to be sure they understand and do this properly. Too often, they do believe that once they put on gloves they can touch anything they want and still touch food. This is not true! Gloves can cause cross-contamination just as easily as hands.
What success stories can you share in training employees on proper glove use?
Wednesday, November 3, 2010
LTC Regulations
At one time, it was said that the only industry that was more regulated than LTC was nuclear power plants! I'm not sure if that is still true, but we are very heavily regulated!
When it comes to food service, there are many sets of regulations that must be followed. The federal government, through CMS, has its set of regulations. These are in the State Operations Manual (SOM). The link for the latest version, October 2010, is http://www.cms.gov/transmittals/downloads/R66SOMA.pdf.
In addition, state long-term care regulations must also be followed. If there is a discrepancy, follow the most stringent.
Although not always enforced by state long-term care surveyors, another set of regulations that also need to be followed are state food service regulations, often call the state food code. Depending upon the city or county where a facility is located, there may be county and/or city regulations that must be followed. Again, follow whatever regulation is most stringent.
The FDA Food Code contains recommendations, not regulations. However, most regulations, including the SOM, are based on the FDA Food Code.
The FDA Food Code is an excellent reference. It can help greatly in developing your policies for those gray areas that the regulations do not address. If a surveyor questions what you are doing, and it is is not spelled out in detail in any regulation, if you can show in the FDA Food Code that what your are doing is acceptable, it is difficult for a surveyor to cite you.
If anyone wants o share survey stories, please do! Everyone is always interested in specifics!
When it comes to food service, there are many sets of regulations that must be followed. The federal government, through CMS, has its set of regulations. These are in the State Operations Manual (SOM). The link for the latest version, October 2010, is http://www.cms.gov/transmittals/downloads/R66SOMA.pdf.
In addition, state long-term care regulations must also be followed. If there is a discrepancy, follow the most stringent.
Although not always enforced by state long-term care surveyors, another set of regulations that also need to be followed are state food service regulations, often call the state food code. Depending upon the city or county where a facility is located, there may be county and/or city regulations that must be followed. Again, follow whatever regulation is most stringent.
The FDA Food Code contains recommendations, not regulations. However, most regulations, including the SOM, are based on the FDA Food Code.
The FDA Food Code is an excellent reference. It can help greatly in developing your policies for those gray areas that the regulations do not address. If a surveyor questions what you are doing, and it is is not spelled out in detail in any regulation, if you can show in the FDA Food Code that what your are doing is acceptable, it is difficult for a surveyor to cite you.
If anyone wants o share survey stories, please do! Everyone is always interested in specifics!
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