Food-borne bugs can kill the frail, elderly
Teach aides safe food-prep methods
Preparing meats, poultry, and eggs has become risky business in recent years as some previously harmless bacteria have turned deadly.
Foods Americans used to enjoy without a thought now can make them terribly ill or even kill them: rare hamburger, raw or runny eggs, raw oysters, and homemade mayonnaise are a few examples.
Experts advise home care agencies to make sure their aides are aware of basic safe food preparation skills and the dangers of certain food-transmitted bacteria. More than 30 million Americans suffer from some type of food-borne illness each year.
A home care inservice on food safety could help your staff prevent food-borne illness and the spread of the disease through cross contamination.
Pat Trapp, RN, staff educator at Hillside Home Care/Hospice in Beaver Dam, WI, gave her staff a 1.5 hour inservice on food safety and nutrition, with help from Teresa Wolf, RD, CDE, a dietitian with Beaver Dam Community Hospital in Beaver Dam, WI.
Hillside Home Care is a nonprofit organization that’s affiliated with the 120-bed hospital. The home care agency serves five counties in southcentral Wisconsin.
"We gave a quiz on what things are unsafe in your refrigerator," Trapp says. (See 10 common food safety mistakes, p. 29.)
The elderly and sick are more susceptible to food-borne illnesses, Wolf says.
"In the home care setting, people have illnesses where their immune systems are not up to par or are already compensated," she explains. "I think they’re going to be more at risk because of that, and it’s more critical for them to use food precautions."
The danger of unsafe foods recently was highlighted in a case in Greenville, SC, in which an elderly woman died shortly after eating a sandwich that allegedly was contaminated with Salmonella. The woman, who had been treated in home care, was in the hospital when a caregiver brought her a sandwich from a local restaurant.
The patient’s private duty nurse also was given a sandwich from the same place. Both women became seriously ill with Salmonella, and it was reported by the local newspaper that a batch of homemade mayonnaise, which was made with raw eggs, at the restaurant might have caused an outbreak affecting hundreds of people. The elderly woman died within two weeks of becoming ill.
Wolf and Trapp offer the following tips on setting up your inservice on food safety:
• Teach aides what some of the more common bacteria are and how they can contaminate food.
"I gave the staff a handout with the infamous five bacteria: Salmonella, Staphylococcus aureus, clostridium perfringens, clostridium botulinum, and campylobacter jejuni," Wolf says.
Salmonella is one of the most common of the five, and government officials say it might have contaminated thousands of chickens in the United States. They believe it can be transmitted directly into eggs.
Escherichia coli, also known as E. coli, is one bug that used to be considered benign until the 1980s when a killer strain emerged. Now because of potential E. coli contamination, restaurants and other food preparation services cook all hamburgers well done. (See chart of bacteria-causing food-borne illnesses, inserted in this issue.)
• Review the proper handling, hand washing, and food preparation methods.
"For example, you should use separate knives and cutting surfaces when you prepare raw vs. cooked food," Wolf advises.
The U.S. Department of Agriculture in Washington, DC, recommends food preparers take the following precautions:
— Wash hands in hot soapy water for at least 20 seconds before handling food.
— Wear bandages over any cuts or sores on your hands or wear plastic gloves.
— Constantly clean the counter tops, stove, cutting boards, and other surfaces that might touch food.
— Keep the juices in raw meat, poultry, and fish from oozing out and touching other foods during preparation.
— Never cut vegetables or salad ingredients on a cutting board that was used for raw meat unless it was washed with hot soapy water and sanitized with bleach.
— Regularly clean refrigerator surfaces with hot soapy water.
— Thaw foods only in the microwave or refrigerator and never leave out at room temperature.
— Check poultry and seafood for stale odors before cooking, and make sure they’re thoroughly rinsed before cooking.
— Marinate meats in the refrigerator, and discard the leftover marinade.
— Wash all fresh fruits and vegetables with cold water.
— Turn your face away, or cover your mouth and nose with a tissue if you sneeze or cough, and then wash your hands again.
• Explain which foods should be avoided, and tell staff how to cook and store certain risky foods properly.
The Beaver Dam area of Wisconsin is rural with many farmers, so it’s not uncommon for people to still drink milk straight from the cow, Wolf says.
But there’s a great risk of bacteria in unpasteurized milk, so people should avoid the raw milk, she emphasizes. "Also, we don’t recommend eating raw eggs, especially for people who are compromised in their health."
Wolf says it’s a good practice to store leftovers in small sealed containers because the food will chill faster and there’s less chance of promoting bacteria growth.
Wolf’s other advice is for chefs to make sure they do not leave high-risk foods at room temperature for more than two hours.
"Watch how you’re reheating the foods, and make sure you’re getting the temperature high enough to prevent bacteria from growing," Wolf adds.
The American Dietetic Association of Chicago, IL, makes the following recommendations for cooking and storing food:
— Keep foods purchased frozen in their original wrapping.
— Keep all foods wrapped or in covered containers, and make sure the containers are shut tight.
— Organize the freezer with oldest foods in front, and label each package with item, date, and number of servings.
— Keep food colder than 40 degrees or hotter than 140 degrees.
— Cook chicken well done, and stuff the turkey or chicken just before roasting.
— Don’t use a cracked egg.
— Boil home-canned foods, and discard any moldy canned fruits and fruit jams.
— Cook eggs until the yolk and white are firm, and modify recipes that call for uncooked eggs, such as homemade Caesar salad dressing, which could use pasteurized eggs as a substitute.
— Don’t eat raw cookie dough or taste any meat or chicken before it’s cooked.
— Use a meat thermometer to make sure beef, veal, and lamb reach 160 degrees, pork reaches 160-170 degrees, poultry reaches 165-180 degrees, and ham is cooked to 160 degrees.
— Never partially heat foods and then set aside to finish later.
— Stir, rotate, and cover foods when microwaving for even cooking.
— Cook ground beef until it’s no longer pink.
— Roast meat or poultry at 325 degrees or above.
• Create a food-safety case study to illustrate what techniques should be followed.
Wolf created the following case study:
Judy Jejuni was throwing a dinner party for many of her friends. She was serving roasted chicken with all the accouterments on Thursday evening. In order to plan ahead, Judy took the chicken from the freezer to thaw at room temperature Wednesday evening.
Judy’s friend Buddy Botulinum offered to help her with the meal preparation. Buddy’s job was to clean and de-bone the chicken. He took out his chef’s knife and cutting board and finished this task in record time. Judy gave Buddy another task of chopping lettuce for the salad, which he did using the same cutting board and knife. "No sense in wasting time washing extra dishes."
Buddy was surprised to feel so energetic since he was just getting over a cold. He still had a few sniffles, but he always carried his handkerchief with him tucked neatly under his apron.
Thursday evening finally arrived, and the party was a success! Judy had more than enough food. She told Buddy to place the leftovers in large deep pans and to let them cool on her kitchen counter overnight before refrigerating. Four days later, Judy’s friend Earl E. Coli came to visit. Judy was sure glad she had the leftover chicken. Good eating Judy and Earl!
Questions:
1. What are some major food safety hazards practiced by Judy and Buddy?
2. How could they improve on their food safety practices?
There could be a variety of answers to the second question. But the key points to watch for when staff answer the first question are as follows:
• The chicken should be thawed in the refrigerator or microwave, not at room temperature;
• Buddy should use different cutting boards and counter tops for the salad because by using the same surface and utensils, he’s promoting cross contamination.
• Food preparers who have a cold or illness should be sure to sneeze or cough into a tissue and away from the food. Then they should wash their hands;
• Leftovers should not be left out for more than two hours before being refrigerated and stored.
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