The responsibility of a hospital food service — and everyone involved in preparing or serving food to patients — is to provide nutritious and safe food. Although hospital food safety has improved in recent years, outbreaks of hospital-acquired food-borne illnesses (also called “nosocomial gastroenteritis”) continue to occur in Australia and around the world.
Hospitalised patients are often more susceptible to infectious diseases than the average healthy person, and are likely to experience more severe symptoms for a longer length of time — or worse. Patients with reduced or compromised immune systems, like chemotherapy patients or people with autoimmune diseases, are far more likely to die from a bout of food-related illness than a person with a fully-functioning immune system.
A single misstep in hospital food safety control measures could result in a life-threatening outbreak. Safe food handling protocols to prevent food contamination; ongoing food safety training and refresher training; and your Food Safety Supervisor are absolutely essential to protecting the lives of the people in your care, as well as to comply with national food safety laws and regulations.
Preventing food-borne illness in a hospital
Hospitals themselves are sources of infection. Without strict procedures in place, dangerous microorganisms of all kinds (e.g. pathogenic bacteria, viruses) can easily spread among patients, health care staff, administrative staff and visitors. The most common routes of transmission are:
- contaminated food
- person-to-person transmission
- contaminated surfaces or objects
Hospitals typically do a good job of preventing food-borne illness with these three essential strategies:
- Implementing a robust food safety program
- Daily monitoring and recording
- Food safety training and certification
IMPLEMENTING A ROBUST FOOD SAFETY PROGRAM
Like any food service business, foods prepared in hospital kitchens are sourced from outside suppliers. In a perfect world, hospital staff could assume that these food suppliers meet the same stringent hygienic standards and follow the same food safety best practices to prevent food contamination; unfortunately, this is not the case.
In most cases of food-borne illness in hospitals, the origin of the infection can be traced back to procurement, meaning the food or ingredient was contaminated at the time of delivery. For this reason, all incoming food products must be screened for biological, chemical, physical, and allergenic hazards. Failure to follow this essential control measure can have devastating consequences; if the worst happens, the hospital can expect to face intense criticism and scrutiny.
Hospitals are required to have a thorough Food Safety Program based on the seven principles of HACCP. Your Food Safety Program will help you to determine, implement and manage the administrative policies and procedures required to govern food safety operations and to ensure that only safe, healthy food is served to patients. To verify the efficacy of their Food Safety Program, many hospitals schedule routine inspections by local and state regulatory authorities.
Daily inspections of kitchens and all food handling areas should be carried out by catering staff, managers and supervisors. Food service supervisors also audit food temperatures, tray accuracy and tray distribution. In most hospitals, patient satisfaction surveys provide valuable feedback and identify opportunities for improvement.
DAILY MONITORING AND RECORDING
Keeping cold foods cold and hot foods hot is (literally) a matter of life and death in a hospital, because pathogens (e.g. viruses, bacteria) generally live and multiple within a set range of temperatures. Temperature monitoring is a standard — and extremely important — practice in hospitals, and includes monitoring of:
- refrigerator temperatures
- final cooking temperatures
- temperatures of food before and after service
- temperatures in dishwashing machines
Accurate records must be kept and archived using daily checklists. Examples of records may include:
- temperature logs
- patient tray accuracy reports
- quality audits conducted by an outside company
FOOD SAFETY TRAINING AND CERTIFICATION
In most hospitals in Australia, all hospital food service employees need to have completed a nationally recognised food safety training course and at least one Food Safety Supervisor must be on staff and reachable at all times.
In a hospital setting, Food Handlers include nurses or domestic staff who distribute or serve meals, so they also need to be educated about food-borne illnesses, the different types of food contamination, safe food handling practices, personal hygiene and the principles of HACCP. Administrative staff should also be given basic training in safe food handling practices.
Food safety training workshops should be part of the onboarding process for all hospital staff before entering a kitchen or serving patients. Workshops should cover:
- proper refrigeration, freezing, thawing and reheating of foods
- effective cleaning and sanitising practices
- symptoms of food-borne illness and how it can occur
- pathogens most commonly associated with food-borne illness
- high-risk foods and the risks associated with each of them
- common allergens and how they affect the body
It’s important that hospital food service workers understand the why behind the food safety tasks they are required to perform, so that they know why the task is necessary for food safety. If food service workers know that cooking foods to a specific temperature will destroy bacteria, then they can understand why it’s important to check a food’s final temperature before serving it to a patient.
Understanding how food contamination can happen — by physical objects, chemicals, bacteria, viruses, parasites and people — requires not only initial training, but refresher courses as well, until food safety becomes second nature.
Food Handler health and hygiene
All hospital Food Handlers — and Food Handlers in any industry — must be aware that high standards of personal hygiene are important. General rules for food workers in a hospital setting include (but are not limited to):
- Food Handlers must wear clean outer clothing and hair restraints, such as hats, hairnets and/or beard restraints.
- Food Handlers should keep their fingernails short and should clean under the nails frequently with soap and water (longer fingernails can harbour more dirt and bacteria than short nails).
- Food Handlers should use gloves, bakery tissue paper or food handling utensils to handle ready-to-eat food. (Never use your bare hands.)
- If possible, Food Handlers should use touchless or hands-free faucets and paper towel dispensers to reduce the risk of cross-contamination.
- Food Handlers who are experiencing symptoms such as vomiting, diarrhoea, sore throat or fever must stop working immediately and report to their manager and to the hospital’s Occupational Health Department.
- Food Handlers must cover any cuts, wounds or open sores on their hands or arms with a good-quality waterproof bandage (or bandages).
- Food Handlers must practise frequent hand washing using the correct method; soap and water; and paper towels or a hand dryer. Alcohol-based hand sanitisers are not effective against some viral pathogens (e.g. Norovirus) or C. difficile spores.
Compliance with Australia’s food safety laws and regulations
Hospital food service facilities have a responsibility to ensure that the food they provide is safe and suitable. The requirements that apply to each food service facility within a hospital or community organisation are determined by the type of food being handled, and the number and type of customers of the food service facility.
To protect patients in Victoria, Queensland and the Australian Capital Territory, all hospital food service facilities must comply with Food Safety Standard 3.2.2 and Food Safety Standard 3.2.3 of the Australia New Zealand Food Standards Code, which contain specific rules and requirements for food safety training and Food Handler certification.
Class 2 and 3 organisations must also comply with Food Safety Standard 3.3.1 and they must have at least one Food Safety Supervisor on staff at all times.
A Class 2 organisation:
- provides unpackaged food to patients, staff or the public; or
- produces or packages food for distribution to patients, staff or the public
A Class 3 organisation:
- meets the description of a Class 2 facility; and
- provides potentially hazardous or high-risk food to vulnerable persons; or
- conducts catering
Many hospital and community organisations in New South Wales are also required to have a Food Safety Supervisor. In all other provinces or territories, it is strongly recommended that you arrange for Food Safety Supervisor training to ensure your organisation is in compliance with food safety laws and requirements.
What are Food Safety Supervisors responsible for in a hospital?
A Food Safety Supervisor must be “reasonably available” at all times the facility is operating and must:
- know how to recognise, prevent and alleviate food safety hazards of the food service facility
- have skills and knowledge in matters relating to food safety relevant to the food service facility
- have the authority to supervise and give directions about matters relating to food safety to persons who handle food in the food service facility
To become a Food Safety Supervisor in Australia, you are required to complete a nationally recognised training course. Many people choose to complete the course online because it’s more convenient than attending in-class sessions.
The Australian Institute of Food Safety offers a nationally recognised Food Safety Supervisor online course for all recognised industries in Australia. The online Food Safety Supervisor course can be done in as little as eight hours and meets all legislative requirements for each of the states and territories.