1. Fighting BAC!
Food Safety for Older Adults

2. 1 — LOOKING AT THE ENEMY Every year:
48 million people get foodborne illness
128,000 are hospitalized
3000 die
1 in every 6 Americans will get foodborne illness this year.
This information is from the Centers for Disease Control and Prevention. There were about 310 million Americans according to the 2011 U.S. Census Bureau. This is how the estimate of 1 in every 6 Americans was determined.

3. Who is susceptible? Older adults (65 years and older) Pregnant women
Very young children (2 years or younger)
Individuals with compromised immune systems
Individuals who are malnourished
Malnutrition is one of several conditions that can make individuals at high risk for foodborne illness. This is especially important for the population served by the Elderly Nutrition Program. In 2000, it was estimated that 42% of CNS participants are at moderate/high risk for malnutrition and 89% of Meals on Wheels participants are at high risk for malnutrition. Other conditions that increase one's risk for foodborne illness include: stress, taking antacids, and taking certain types of autoimmune drugs.

5. What causes foodborne illness?
Eating unsafe food
Food becomes unsafe primarily because of microorganisms, such as:
Bacteria
Viruses
Parasites
Any food can cause illness if it is not handled safely
There are many types of bacteria -- spoilage, beneficial, and pathogenic. Very few bacteria are pathogenic, which means disease-causing or harmful. Norovirus is the most common cause of reported foodborne illnesses, but bacteria including Salmonella, Clostridium perfringens, Campylobacter, and Staphylococcus aureus are also among the top causes. Bacterial foodborne illnesses are often due to improper cooling and hot-holding temperatures, but also from not cooking food to a safe internal temperature. Viral foodborne illnesses are often due to an infected food handler who does not practice good personal hygiene.

6. Common causes of foodborne illness
Improper cooling/holding of foods
Poor personal hygiene (such as not washing hands properly)
Using food from unsafe sources
Cross-contamination
Improper cooking

7. How do bacteria grow?
Bacteria double under ideal conditions every 20 minutes.
At 12:00 noon you can have 10 bacteria in a food
By 5:00 p.m. there could be 327,680 bacteria.
This is enough to make one sick with foodborne illness
Some microorganisms that cause foodborne illness only require a few organisms to cause illness while others require large numbers. For example, between 1 to 10 virus particles -- the most common cause foodborne illness -- can cause foodborne illness. Remember viruses do not grow in food - they simply contaminate the food.
Small numbers (between 100 to 1000) of E. coli O157:H7 and Listeria monocytogenes bacteria are believed to cause foodborne illness.
Therefore, one should not keep foods in the temperature danger zone for more than two hours.

8. What are ideal conditions for bacteria to grow?
Time and Temperature Control for Safety foods (TCS), which are:
low acid
moist
some protein
Unsafe temperature between 41oF and 135oF
TCS foods at unsafe temperatures for at least four hours
The 2013 Food Code requires foods that are held hot to be at 135F or above. You may see some consumer materials using 140F instead of 135F. This allows for a wider margin for error and extra level of safety, but the science tells us that 135F is a more accurate cutoff temperature for bacterial growth.
There are a few exceptions to this general rule. The 2013 Food Code also specifies that eggs can be held at 45F or below if they haven’t ever gotten above 45F, and roasts that are cooked to a safe time/temperature combination can be held at 130F.
The science also tells us that we have 4 hours to consume TCS foods before bacteria can grow to levels that are likely to make us sick. Many consumer materials give a time limit of 2 hours, which similar to the temperature, allows for a wider margin of error and extra level of safety.
Temperature Danger Zone

9. Activity — TCS Foods
Look at your site’s menu and highlight those foods that are TCS
These foods need to be at 41oF or colder or 135oF or hotter.
The only way to determine if these foods are at the proper temperature is to use a thermometer.
You can coordinate with the County Congregate Nutrition Site Coordinator to receive copies of the menu or you can ask each participant to bring a copy or you can use a template.

10. Viruses and Parasites Norovirus is the top cause of foodborne illness.
Viruses do not grow in food like bacteria do.
Viruses can contaminate any food, not just TCS foods.
Parasites do not cause many cases of foodborne illness in the U.S.
In order for viruses to growth, they need a living host, such as a human, animal, or a plant. They do not grow in food because food is not a living organism.
All foods can be a source of foodborne illness due to viruses. Outbreaks associated with viruses often include foods that most people do not realize can make one sick. They include: baked goods, fruits, chips, and other non-TCS foods. Viruses can also contaminate TCS foods. They just do not grow in these foods.

11. To Fight BAC! against foodborne illness:
CLEAN: Wash hands and surfaces often SEPARATE: Don’t cross-contaminate COOK: Cook foods to proper temperatures CHILL: Refrigerate foods promptly
For more information about Fight BAC!, go to the Web site: This site contains other materials that you might find useful for promoting food safety.

12. 2 — RECEIVING Only purchase food from an approved source, such as:
permitted foodservice operation
grocery store
foodservice wholesale supplier
Inspect before you accept to be certain that the food meets your food safety standards.
Permitted foodservice operations should have a permit posted and are inspected quarterly by the county health department.
The only exception to this rule is that whole produce can be purchased from any source -- a roadside vendor, a Farmer's Market, and even a home garden.

13. Activity — Accept or Reject?
Which of these foods would you accept and why?
Individual cartons of milk that are at 48oF
A sheet cake that is uncovered
Turkey and dressing at 132oF
Cooked corn that is at 139oF
Tossed salad that is at 44oF
Reject - The milk must be at 41F or colder
Reject - The turkey and dressing must be at 135F or hotter
Accept - The cooked corn must be at 135F or hotter
Reject - The tossed salad must be at 41F or colder
The sheet cake does not need to be at any given temperature because it is not TCS

14. Develop a Back-up Plan
Many of the foods on the previous slide had to be rejected.
You need a back-up plan in place so that if you have to reject you will still be able to feed the participants.
Share with the group what you would do if you had to reject a shipment of food.
Back-up plans will vary site by site. The NC Division of Aging would like each site to tailor their plan to meet their needs. Therefore, there is no "master" back-up plan available for distribution.
NC Division of Aging, Nutrition Services – Food Preparation and Safety Requirements (effective July 1, 2003):

15. 3 — STORAGE All food must be: covered and clean
in its original packaging or labeled
marked with time and date of receipt
stored at the proper temperature
use a storage chart to determine how long you can keep
The Food Marketing Institute has an excellent fact sheet available online that indicates the shelf-life of various foods. It can be accessed at Go to the section for Consumers.

16. This photograph shows the proper storage of single-use items
This photograph shows the proper storage of single-use items. Single-use service items like plates, bowls, cups, and silverware must be used for patrons.

17. Chemical Storage Store chemicals separate from food.
Keep them close to where they are needed.
While foods need to be at least 6 inches off of the floor, chemicals and cleaning supplies do not.

18. Activity — What’s My Storage Temperature?
At what temperature do each of these
foods need to be stored:
Individual containers of milk
Chocolate chip cookies
Turkey and dressing to be delivered to a home
Tossed salad with carrots and tomatoes
Rolls
Individual containers of milk need to be stored at 41F or below
Turkey and dressing must be at 135F or hotter
Tossed salad with carrots and tomatoes needs to be at 41F or below
Chocolate chip cookies and rolls can be at any temperature because they are not TCS. For best quality, store between 50 and 70F (dry storage temps).

19. 4 — PREPARATION Do not work if you are ill.
Wash hands with soap and water before handling food.
Properly use single-use gloves.
Individuals who have diarrhea, fever, nausea, vomiting should be restricted from handling food, single-use items such as napkins and utensils, and equipment. They might be infected with a highly communicable disease.
Individuals who are diagnosed to have one of these 5 pathogens – norovirus, Salmonella Typhi, E. coli 0157:H7, Shigella, or Hepatitis A -- should NOT be allowed to be on the property until they can provide medical documentation that they are no longer contagious.
The NC Food Code requires that food handlers must wash their hands thoroughly with soap and water and dry with a single use paper towel, clean towel, or approved hand dryer.
Hands must be washed before using single-use gloves and each time gloves are changed. It is recommended that individuals not use latex gloves as there have been a number of reported incidents regarding the development of allergies from overuse of these items.

20. Handwashing Sink Clean Accessible
Stocked with soap and single-use paper towels
Have a separate sink just for handwashing. Make sure it is cleaned regularly, easy to get to, and stocked with soap and single-use paper towels or a hand drying device. Make sure there is a lined trash can that is regularly emptied for disposing of paper towels and trash.

21. The NC Food Code requires that a sign or poster that notifies employees to wash their hands, such as the one shown here, be posted at handwashing sinks used by food employees.

22. This photograph shows proper drying of hands after washing.

23. PREPARATION Use safe ingredients.
Wash fresh fruits and vegetables with lukewarm water.
Prevent cross-contamination.
Very few congregate nutrition sites do any food preparation. However, some may host special events or fundraisers. In that case, these rules must be followed to keep the food safe.
Use safe ingredients. Note that food prepared, frozen, or canned in the home cannot be served at the site.
Wash produce to remove dirt and soil. Washing removes some bacteria, but may not remove enough to keep you from getting sick if it is highly contaminated (the best way to kill harmful bacteria is through cooking/heating to safe internal temps). Washing fruits and vegetables with soap, detergent, or commercial produce wash is not recommended. Pre-washed produce does not need to be re-washed, because this can reintroduce contamination.
Prevent cross-contamination by washing hands properly before handling food or after touching contaminated things like trash, dirty rags, or your hair or face; using separate cutting boards for raw and ready-to-eat or cooked foods, and regularly cleaning and sanitizing food contact surfaces.
Sources:
FDA:
NC DHHS:
USDA FSIS:

24. Activity — How well do you wash your hands?
Put a dime-size amount of the Glo-GermTM lotion onto your hands.
Rub all over like you would hand lotion.
Wash your hands with soap and water.
Return to a darkened room and check how well you did by putting your hands under an ultra-violet black light.
The Glo-GermTM lotion will show up as orange under the ultra-violet black light. This illustrates that the more orange that is present the more poorly the hands were washed.

25. 5 — COOKING
Proper cooking kills harmful bacteria and parasites that are naturally present in raw foods.
Cooking will not necessarily destroy toxins or viruses.
Congregate nutrition sites do not cook meals on the property (aside from reheating or otherwise preparing food that does not require cooking). However, many host special events, such as spaghetti dinners, fundraisers, etc.
15A NCAC 18A CONGREGATE NUTRITION SITES
Congregate nutrition sites shall comply with all requirements in Rules through of this Section with the following exceptions:
(1)  Food preparation in a congregate nutrition site shall be limited to reheating food prepared in a food establishment or in a food processing plant or preparation of food that does not require cooking.
(2)  Potentially hazardous food (time/temperature control for safety food) that has been heated or reheated at the congregate nutrition site and remains at the end of the day shall not be served or placed in refrigeration to be used another day.
(3)  Only single-service articles shall be used.
(4)  Equipment in the congregate nutrition site that is not certified or classified for sanitation by an ANSI-accredited certification program that is in good repair and operating properly may be used. At least a two-compartment sink shall be provided. The sink shall be of sufficient size to submerge, wash, rinse, and sanitize utensils. At least one drainboard, table, or counter space shall be provided for air-drying.
(5)  Garbage can liners are required for all garbage receptacles unless the site has receptacle cleaning facilities as specified in Section of the Food Code as amended by Rule of this Section.
(6)  Water used for mop or receptacle cleaning shall not be disposed in the utensil sink. Wastewater from mopping, receptacle cleaning, and other cleaning operations shall be disposed in a service sink or another approved manner in accordance with 15A NCAC 18A or 15A NCAC 02H
The NC Foodservice Rules allow the sites to prepare these meals one day per month without having to meet all of the requirements to be a permitted restaurant.
Nutrition sites with on-site food preparation are inspected like restaurants on a quarterly basis. On the other hand, catered congregate nutrition sites are inspected by local health departments only one time per calendar year. It is possible for more than 12 months to lapse between inspections and perhaps be closer to 2 years if a site is inspected at the beginning of one calendar year and then again near the end of the next. (
Original source:

26. Measuring Food Temperatures
1. Use a digital, tip-sensitive instant read food thermometer that has a temperature range between 0-220oF.
2. Each day check the accuracy of your food thermometer(s) in ice water.
3. Clean and sanitize the thermometer before each use.
Image:

27. Measuring Food Temperatures
4. Insert into the thickest part of the food or into the center of the food, away from fat, bone, or gristle. 5. Test the temperature of each food in multiple places.
Images:
Chicken breast:
Mac n cheese:

28. Activity — What’s My Cooking Temperature?
To what temperature do you cook each of these foods?
Frozen ground beef patties
Turkey roast
Commercially canned spaghetti sauce
Chocolate chip cookies
Vegetable soup
Creamed corn
Frozen ground beef patties must be cooked to 155F for 15 seconds or 160F, or hotter
Turkey must be cooked to 165F or hotter
Commercially canned spaghetti sauce must be cooked to 135F or hotter
Chocolate chip cookies can be baked to 135F or hotter
Vegetable soup must be cooked to 135F or hotter.
Creamed corn must be cooked to 135F or hotter.

29. This photograph shows the accuracy of a thermometer being checked in ice water. The stove is NOT on!!

30. Activity — Calibrating Thermometers
Divide the group into teams.
Give each team a thermometer and a glass filled with crushed ice and water.
Have each team check the accuracy of their thermometer.
If not at 32oF, then have them calibrate.

31. 6 — SERVING Keep hot foods at 135oF or hotter.
Keep cold foods at 41oF or colder.
Use cleaned and sanitized serving utensils.
Use single-service patron serving pieces, like plates, bowls, cups, and silverware.
Wear clean clothes and keep hair restrained.
Only single-service articles, like disposable plates, bowls, silverware, and cups, should be used for patrons at congregate nutrition sites. However, minimal washable utensils can be used for serving and preparing meals.
Hair must be restrained with a hair net or if pulled back one can use a visor or a ball cap.
15A NCAC 18A CONGREGATE NUTRITION SITES
Congregate nutrition sites shall comply with all requirements in Rules through of this Section with the following exceptions:
(1)  Food preparation in a congregate nutrition site shall be limited to reheating food prepared in a food establishment or in a food processing plant or preparation of food that does not require cooking.
(2)  Potentially hazardous food (time/temperature control for safety food) that has been heated or reheated at the congregate nutrition site and remains at the end of the day shall not be served or placed in refrigeration to be used another day.
(3)  Only single-service articles shall be used.
(4)  Equipment in the congregate nutrition site that is not certified or classified for sanitation by an
ANSI-accredited certification program that is in good repair and operating properly may be used. At least a two-compartment sink shall be provided. The sink shall be of sufficient size to submerge, wash, rinse, and sanitize utensils. At least one drainboard, table, or counter space shall be provided for air-drying.
(5)  Garbage can liners are required for all garbage receptacles unless the site has receptacle cleaning facilities as specified in Section of the Food Code as amended by Rule of this Section.
(6)  Water used for mop or receptacle cleaning shall not be disposed in the utensil sink. Wastewater from mopping, receptacle cleaning, and other cleaning operations shall be disposed in a service sink or another approved manner in accordance with 15A NCAC 18A or 15A NCAC 02H

32. This photograph shows proper serving of foods.

34. 7 — LEFTOVERS
Congregate nutrition site should not be cooling hot foods or reheating them because:
the sites do not have commercial equipment to properly cool foods.
Review the leftover policy
TCS foods that have been heated or reheated at the site and are left over at the end of the day cannot be refrigerated and used again another day.
If using Time as a Public Health Control (which means temperatures are not monitored during holding/serving), food must be consumed or discarded within 4 hours. Label foods with date and time to be consumed by.
Review the leftover policy at the site.
15A NCAC 18A CONGREGATE NUTRITION SITES
Congregate nutrition sites shall comply with all requirements in Rules through of this Section with the following exceptions:
(1)  Food preparation in a congregate nutrition site shall be limited to reheating food prepared in a food establishment or in a food processing plant or preparation of food that does not require cooking.
(2)  Potentially hazardous food (time/temperature control for safety food) that has been heated or reheated at the congregate nutrition site and remains at the end of the day shall not be served or placed in refrigeration to be used another day.
(3)  Only single-service articles shall be used.
(4)  Equipment in the congregate nutrition site that is not certified or classified for sanitation by an
ANSI-accredited certification program that is in good repair and operating properly may be used. At least a two-compartment sink shall be provided. The sink shall be of sufficient size to submerge, wash, rinse, and sanitize utensils. At least one drainboard, table, or counter space shall be provided for air-drying.
(5)  Garbage can liners are required for all garbage receptacles unless the site has receptacle cleaning facilities as specified in Section of the Food Code as amended by Rule of this Section.
(6)  Water used for mop or receptacle cleaning shall not be disposed in the utensil sink. Wastewater from mopping, receptacle cleaning, and other cleaning operations shall be disposed in a service sink or another approved manner in accordance with 15A NCAC 18A or 15A NCAC 02H

35. Participants taking home leftovers
Stress safe handling when taking home leftovers. Leftovers should be consumed or refrigerated within 4 hours, or they must be thrown out (as is the guideline for using TPHC). As said earlier, the science also tells us that we have 4 hours to consume TCS foods before bacteria can grow to levels that are likely to make us sick. Many consumer materials give a time limit of 2 hours, which similar to the temperature, allows for a wider margin of error and extra level of safety. The total time food is in the TDZ matters – it’s cumulative, and refrigeration only slows bacterial growth – it doesn’t stop it.

36. Improperly cooled food = unsafe food
Improperly cooled food must be discarded.
During cooling, spores could grow.
Some form toxins.
Reheating, even to boiling temperatures, will not necessarily destroy these toxins.
When in doubt, throw it out!

37. 8 — CLEANING AND SANITIZING
CLEANING = removing dirt and debris
SANITIZING = killing % of harmful bacteria that might still be on the surface.
99.999% (within 30 seconds) is for food contact surfaces
99.9% (within 30 seconds) is for non-food contact surfaces
Source:

38. Cleaning and Sanitizing Steps
1. Wash surface with soapy water. 2. Rinse with clean water. 3. Immerse rinsed item into a properly prepared sanitizing solution. 4. Let soak for 2 minutes. 5. Remove and air-dry. 6. Store item in clean location.
Sanitizing solutions:
Hot water at 171F or above; contact time = at least 30 sec
Quats at 75F or above; contact time = at least 30 sec
Chlorine of 50 mg/L concentration at 100F (pH=10 or less) or 75F (pH=8 or less); contact time = at least 7 sec
Iodine (uncommon) at 68F; contact time = at least 30 sec

39. Chlorine sanitizing solution
1 teaspoon unscented chlorine bleach + 1 gallon, warm not hot water = Sanitizing solution at 50 ppm
Chlorine of 50 mg/L (ppm) concentration at 100F (pH=10 or less) or 75F (pH=8 or less); contact time = at least 7 sec

40. Equipment for cleaning and sanitation that is NOT certified or classified for sanitation by an ANSI-accredited certification program CAN be used if it’s in good repair and operating properly.
Congregate meal sites must at least have a 2-compartment sink that’s big enough to submerge, wash, rinse, and sanitize utensils. There should also be at least one drainboard, table, or counter space for air drying.
Make sure garbage cans have liners (see exception below).
Dump dirty mop bucket and other cleaning wastewater into a service or waste sink, not into a sink used for washing utensils or preparing food.
15A NCAC 18A CONGREGATE NUTRITION SITES
Congregate nutrition sites shall comply with all requirements in Rules through of this Section with the following exceptions:
(1)  Food preparation in a congregate nutrition site shall be limited to reheating food prepared in a food establishment or in a food processing plant or preparation of food that does not require cooking.
(2)  Potentially hazardous food (time/temperature control for safety food) that has been heated or reheated at the congregate nutrition site and remains at the end of the day shall not be served or placed in refrigeration to be used another day.
(3)  Only single-service articles shall be used.
(4)  Equipment in the congregate nutrition site that is not certified or classified for sanitation by an ANSI-accredited certification program that is in good repair and operating properly may be used. At least a two-compartment sink shall be provided. The sink shall be of sufficient size to submerge, wash, rinse, and sanitize utensils. At least one drainboard, table, or counter space shall be provided for air-drying.
(5)  Garbage can liners are required for all garbage receptacles unless the site has receptacle cleaning facilities as specified in Section of the Food Code as amended by Rule of this Section.
(6)  Water used for mop or receptacle cleaning shall not be disposed in the utensil sink. Wastewater from mopping, receptacle cleaning, and other cleaning operations shall be disposed in a service sink or another approved manner in accordance with 15A NCAC 18A or 15A NCAC 02H

41. Make sanitizing solution fresh daily and test each batch for the right concentration.

42. Activity — Preparing sanitizing solution
Divide the group into teams.
Give each team a spray bottle and bleach.
Have them prepare sanitizing solution.
Have each group measure the concentration.
Demonstrate the proper procedure for preparing sanitizing solution.
The proper way to prepare sanitizing solution in a spray bottle is to pour a cap of bleach into the bottle. Close and swish around until it covers all surfaces. Pour out the remaining solution. Fill with warm, not hot water. Measure with a chlorine test strip. The test strip should register at 50 ppm.

43. 9 — HOME DELIVERED MEALS Securely package and seal each food.
Hold food at 135oF or hotter or 41oF or colder.
Use food delivery carriers that meet NSF standards.
Deliver meal within two hours from the time the meal was placed in carrier.
Clean and sanitize carriers after each use.
Cambro-like containers are the only approved carriers for storing hot foods.
Igloo-type containers can only be used for the transporting of cold foods.

44. Insulated carriers

46. “Foodborne illness is nearly 100% preventable if food is handled safely from the time it is received until the time it is served.”

47. Garner Senior Center Garner, NC
Photos taken at:
Garner Senior Center
Garner, NC