1. Module 6: Personal Hygiene

2. Work Party with the Staph …

3. Morbidity and Mortality Weekly, December 20, 2013, Vol.62, No.50
What Happened?
Military hospital Emergency Department received 13 people with gastrointestinal illness.
Symptoms:
Nausea, vomiting, abdominal cramps or pain, diarrhea, headache
Symptoms appeared 2-3 hours after a lunch party
Everyone ate Perlo (a chicken, sausage, and rice dish)
Morbidity and Mortality Weekly, December 20, 2013, Vol.62, No.50

4. The Recipe
Frozen chicken thighs and sausage defrosted in the microwave
Defrosted chicken thighs cooked in stock pot of boiling water
Thighs cooled, meat removed and placed back in stock pot
Sausage cooked and added to the stock pot

5. The Recipe (continued)
Onions and other seasonings sautéed in sausage oil and added to stock pot
Rice added to stock pot and cooked until all water absorbed
Cooked Perlo placed in unheated oven for approximately 8 hours (overnight)
Perlo transferred to slow cooker and reheated for 1 hour on high setting before transport and consumption
Ask participants what points are concerning in the recipe.

6. Likely Cause Food contained Staphylococcus aureus
Could have been introduced in handling of cooked chicken or taste testing.
Overnight storage of Perlo in oven (not refrigerated) allowed growth and toxin production
Rewarming in slow cooker would not destroy toxin (food in TDZ)
May have increased toxin production

7. DISCUSSION
There were 2 major slip ups that caused this case. First handling of food likely contaminated it with Staph, a bacteria normally present on our skin and mouth/nose area.
This may not of been a big problem, but it was also subject to temperature abuse. This allowed the staph to grow and produce toxins. These toxins got everyone sick pretty quickly (3 hours).

8. Learning Objectives
Describe best practices to reduce or eliminate the risk of Staphylococcus toxin forming
Identify the symptoms and foods associated with Staph
Explain the difference between a restricted and excluded employee
List reasons for exclusion or restriction of employee

9. Key Terms Toxin – Poison produced by microorganism
Heat stable toxin – Not destroyed by cooking (165°F)
Temperature Danger Zone (TDZ) - Above 41°F and below 135°F
Excluded employee - Can’t work in food establishment
Restricted employee - Can’t work with or around food
Reinstated employee - Approved to work

10. Staphylococcus aureus
Termed “staph”
Common in the environment
Lives in humans and animals
Present in nasal passages and throats
Hand or arm sores (especially pus)
Transmitted via cough or sneeze
Can be destroyed by proper cooking
Can produce toxin that is not destroyed by cooking

11. Toxin
Staph toxin can cause nausea, stomach cramps, vomiting, and diarrhea
Symptoms usually last for a few hours to a day
Fast acting
Causes symptoms 1-7 hours after eating contaminated foods
Controlled by good personal hygiene and avoiding holding in temperature danger zone

12. Foods Linked to Staph Meat and meat products Poultry and egg products
Salads
egg, tuna, chicken, potato, macaroni
Bakery products
cream-filled pastries, cream pies, chocolate éclairs
Milk and dairy products
Any food product handled after cooking

13. From Our Case Study

14. Corrective Action and Prevention
Main contributing factors:
Poor food handling practices (human contamination)
Inadequate refrigeration of foods
Using clean food preparation, storage and equipment surfaces
Immediately cooling using proper techniques

15. Remember From Before? Temperature Danger Zone
Store TCS food at or below 41°F
Hot hold at 135°F or above if stored for more than 2 hours
Check temperature
Do you document it?
Store food in small portions in shallow containers
TDZ: Properly cool food (Cooling 2 hours for 135 to 70, 4 hours for 70 to 41)
Log Temperature- have a check sheet,

16. Corrective Action and Prevention Personal Hygiene
Staph is naturally present on our skin, around the mouth and nose.
Open sores and cuts are problematic
Proper hand washing for 20 seconds
No bare hand contact
Exclude employees with wounds on hands or arms (unless covered)
Cover open wounds with appropriate bandages and gloves

17. FDA Food Code
Reinstate restricted employee if skin, infected cut or boil is covered with:
Impermeable cover (finger cot or stall) and single use glove if it is on hand, finger, or wrist
An impermeable cover on the arm if infected wound or boil is on the arm
Dry, durable, tight fitting bandage on body

18. Corrective Action/Prevention Personal Hygiene
Hand washing, glove use
Limit bare hand contact (utensils)
Bathing
Clean uniforms and clothes
No jewelry (plain wedding band only)
Hair restraint
Proper taste testing practices
Cough and sneeze
A restaurant in South Carolina was involved in a foodborne disease investigation. They tested all the employees and food but didn’t find the cause. A week later the investigator saw a new employee and a kind of pungent smell. They asked, the new employee worked from time to time when they got busy. His full time job… drove a septic tank pump truck.

19. When Gloves are Required
Handling ready to eat foods (except washing produce)
Slash resistant gloves for carving/cutting
Change gloves between raw and RTE
Open cut or sore - remember regular hand washing

20. Case Study How It Happened What They Found
Perlo was stored in the oven for 8 hours
Poor personal hygiene
13 military personnel ill
Everyone ate same meal

21. Case Study What Went Wrong Prevention Proper cooling and reheating
Proper personal hygiene
Temperature abuse allowed Staph to grow and produce toxins

22. Activity
Write down a list of best practices to minimize the risk of Staphylococcus aureus.
Remember:
Personal hygiene
Cross contamination
Temperature Danger Zone

23. Quiz
You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should:
Have them start preparing the salad anyway
Move them to the meat slicing area
Send them to see the doctor, then home for the day
Have them put on a watertight bandage over the cut and wear gloves
Answer: d)

24. Quiz
You see that the food handler you assigned to prepare the salad has a small cut on their hand. You should:
Have them start preparing the salad anyway
Move them to the meat slicing area
Send them to see the doctor, then home for the day
Have them put on a watertight bandage over the cut and wear gloves
Answer: d)

25. Quiz
When an individual is made sick by a toxin present in the food, it is called:
Toxin mediated infection
Foodborne infection
Foodborne intoxication
None of these
Answer: c)

26. Quiz
When an individual is made sick by a toxin present in the food, it is called:
Toxin mediated infection
Foodborne infection
Foodborne intoxication
None of these
Answer: c)

27. Summary Proper handling Proper and immediate cooling Personal hygiene
Approved coverings for infected cuts, wounds
Restriction and reinstatement for employees