Hospital kitchens play a critical role in infection prevention, focusing on safe food handling from receiving to serving. Proper vetting of food vendors, temperature control, storage, and hygiene are essential to prevent contamination and ensure patient safety.
Hospital kitchens tend to be overlooked or absent regarding infection prevention, but readers may be surprised by the role infection prevention plays in the kitchen. The kitchen has many different tentacles to observe daily, monthly, quarterly, and yearly to safely store and serve food items to staff, patients, and families. The goal is to prevent biological (bacterial, fungal, parasites), chemical (cleaners, sanitizers), and physical (metal shavings, dust and dirt, staples) contamination of the food. To identify some of those tentacles and why they should be monitored to prevent foodborne illness, this article will follow the food.
Food vendors must be properly vetted to ensure that they are a safe source before the food is ordered and delivered to facilities. Delivery takes place on a dock. Most docks also receive and deliver other items that are not ingestible. For this reason, food should have a dedicated clean area for shipment. The area should be easily identified for the drivers delivering the food. The staff receiving the food items are trained to receive cold, frozen, and room temperature items. They would ensure the items received were shipped with the appropriate temperature by checking the temperatures and keeping a log. They will reject any items that do not meet the requirements. This is referred to as time and temperature-controlled safety (TCS).
While all foods can grow bacteria, some foods are more likely to grow bacteria at temperatures in the danger zone. These are referred to as TCS foods. TCS foods include dairy products, shell eggs, poultry, meat (beef, pork, lamb), fish, baked potatoes, tofu, sliced melon, cut tomatoes, cut leafy greens, sprouts, heat-treated plant foods (rice, beans, and vegetables).
If frozen food defrosts in the shipping process, there is a potential for bacteria, yeast, and molds present in the food to begin growing. If the shipping is too warm for those items that are to be cold-shipped, such as dairy, cut tomatoes, greens, etc, this will also offer a suitable medium for pathogens to grow. Food must be kept out of the danger zone of 41 degrees to 135 degrees F to prevent microbial growth.
Damaged packages are also a concern when delivered. If the packaging of crates is crushed, the items within the crates could have been exposed to the environmental elements of the crate, pallets, or other unclean items. Introducing environmental pathogens and mechanical contaminants into or on the food items.
Once food has been shipped and has passed the shipment inspection, the food should be delivered directly to the dedicated storage areas. Frozen items should go directly to the freezer, cold items should go to the refrigerators, and any items that require room temperature, such as canned goods, should be stored appropriately.
Once these items have been delivered, the unpacking of these items is just as important as they were being shipped. The temperature, the cleanliness of the areas, staff knowledge, and monitoring and maintenance of the facility and systems are all important. This prevents physical and chemical contamination of the food.
Unpacking meat items or items with the potential to thaw and drip should be stored so they would not cross-contaminate other items if they thaw. Cross-contamination of foods can cause foodborne illness or allergic reactions. The food storage hierarchy is as follows (from top to bottom): ready-to-eat foods, seafood, whole cuts of meats like beef and pork, ground meats and seafood, and whole and ground poultry.
Canned goods and shelf-stable items should be stored in a clean, cool, dry area to prevent physical and chemical contamination. This includes infant and adult formulas. Items should be stored at least 6 inches off the floor. Care should ensure no dust or dirt accumulates on the items. The temperature should be below 85 degrees F. Items should not be stored under sinks or near stoves. Cans should be free from dents. Dents may cause breeched-in seams and allow pathogens to enter the can. Chemicals such as cleaners and sanitizers should be stored in a designated place away from food items.
Food should be prepared safely. This includes personnel and how food is handled. Personnel should have good personal hygiene, starting with hand hygiene. Hands should be washed only in a hand-washing sink with water at 110 degrees for 20 seconds. Nails should be kept short and natural, with no nail polish or fake nails. Hair should always be covered. Bracelets and watches may not be worn. One plain band ring may be worn. Aprons must be removed before emptying the trash or using the restroom. All these actions prevent bacterial and physical contamination of food.
Frozen food should be thawed in a refrigerator following the food storage hierarchy. If foods need to be thawed quickly, a microwave may be used, or the food may be placed in cold running water. Frozen foods that are thawed quickly must be cooked immediately.
What is the final temperature for cooked TCS foods? Poultry: 165 F; ground meat: 160 F; seafood: 145 F; whole beef, pork, lamb: 145 F for at least 3 minutes; plant-based foods (pasta, fruit, vegetables): 135 F. Final cooking temperatures should be recorded in a log.
Foods held hot should stay at 135 F or higher. Foods stored cold should be at 41 F or lower. If foods do not maintain temperature outside the danger zone, they should be removed. Products held hot or cold for serving should be temped every 2 hours.
Care must be taken to prevent cross-contamination during serving. Hands should never come into contact with the food, or the food should never come into contact with surfaces. This means that plates should be handled by the bottom or the edge. Glassware should be handled by the middle or bottom. Utensils should be touched only by the handle. Utensils should be stored and used to serve handle up to prevent touching the food contact surface.
The infection prevention team must know food safety. In addition, they must look at the condition of equipment and plumbing to ensure the kitchen is functional. Thousands of meals are served daily to patients, staff, and families. Close partnerships with dietary services will prevent food-borne outbreaks and the breakdown of operations. Always follow the food!