1. Safe Plates for Home Food Handlers Module 3: Personal Hygiene and Health

2. Case Study

3. What Happened February 2016, Raleigh, NC
Guests at a potluck Super Bowl party brought homemade buffalo chicken dip
Dip was left out for hours without any type of temperature control
Party host ate dip late at night while cleaning up and then woke up with stomach cramps and vomiting hours later

4. What They Found Illness was caused by Staphylococcus aureus toxin
Party guests were seen “double dipping” and using their fingers to scoop dip onto chips
Dip was left out at room temperature for over four hours before the host ate it

5. Discussion
How do you think the Staph bacteria got into the buffalo chicken dip? How could that have been prevented?

6. Learning Objectives
Identify the role of clean outer clothing, fingernails and jewelry in preventing food contamination and allergen cross-contact
Recognize where eating, drinking and tobacco use is allowed
Identify when, where and how to wash hands

7. Learning Objectives
Identify instances when bare hand contact with food is allowed
Identify adequate barriers to bare hand contact and how to use single-use gloves
Identify symptoms and illnesses that must be reported to a manager
Describe how to correctly cover an infected wound on the hands or forearms

8. Key Terms
Excluded food handler – symptoms or diagnosis dictate that food handler can’t work in food establishment
Reinstated food handler– symptoms have cleared so food handler is approved to work
Restricted food handler – symptoms dictate that food handler can’t work with or around food

9. Personal Hygiene

10. Clothing and Hair
Wear clean clothing to prevent contamination of food and food-contact surfaces
Wear a clean apron and remove when leaving the kitchen
Remove all jewelry, with exception of a plain ring, from hands and arms while working
Hair shoulder length or longer should be pulled up
When preparing food in community settings, wear a hat or other hair covering
Why do you think these rules are in place?
You never know what could get on your or your clothes at home, so bathing and wearing clean clothes prevents bringing in contamination
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.
Have you seen people wear their aprons in the bathroom, or home at the end of a shift? Aprons protect your clothes, but also protect FROM your clothes
It is very hard to get detailed rings clean. Not only can jewelry fall out into food, they have the potential to transfer pathogens
Hair restraints help keep hair out of food and help prevent people from touching their faces/hair

11. Hands Hands transfer hazards very easily
Best practices for hand hygiene include: 
Keeping fingernails clean and cut short
Covering cuts and sores on hands with a bandage
Washing hands frequently and properly will also prevent contamination 

12. Taste Testing Preventing contamination while tasting food is important
Food should not be tasted over pots, pans or serving containers
Methods
Use a disposable utensil to taste a dish or place a tasting portion in a small dish
Always take a step away to taste
Do not reuse tasting utensils
Have you seen a cooking show and the cook tastes with the stirring spoon and then dribbles back into the pot?
Tasting should be done so that there is no way for tasters to contaminate

13. Other Hygiene Concerns
Avoid eating, drinking, chewing gum or using tobacco while preparing food
Keep personal items away from food while cooking
Chewing while preparing food increases the chances of spitting into food
Drinks should be in covered containers, preferably with straws. This is so that liquid doesn’t spill out, and so that when the cup is picked up hands don’t touch a part that the mouth touches
As the manager, are you checking to make sure these rules are being followed?
Too many people in the kitchen can create a problem with flow of food (and people)

14. Proper Handwashing

15. How to Wash Hands
Wet hands and exposed parts of arms with warm water and soap
Rub soap into hands and arms for seconds
Rinse hands and arms with warm water Whole process should take 20 seconds
Dry hands and arms on disposable paper towel or electric dryer
Highlight that handwashing sinks must have running potable water, soap, hand drying. Foot pedals are ideal. If your sink has handles, make sure to not recontaminate your hands on the handle after washing.
Handwashing is a critical factor in reducing fecal-oral pathogens that can be transmitted from hands to ready-to-eat (RTE) food as well as other pathogens that can be transmitted from environmental sources.
Research has shown a minimum second scrub is necessary to remove transient pathogens from the hands and when an antimicrobial soap is used, a minimum of 15 seconds is required. Soap is important for the surfactant effect in removing soil from the hands and a warm water temperature is important in achieving the maximum surfactant effect of some soap.
Every stage in handwashing is equally important and has an additive effect in transient microbial reduction.
Handwashing done properly can result in a 2-3 log reduction in transient bacteria and a 2-log reduction in transient viruses and protozoa. With heavy contamination of transient microbial pathogens, (i.e., > 104 microbes, as found on hands contaminated with bodily wastes and infected bodily fluids) handwashing may be ineffective in completely decontaminating the hands. Therefore, a further intervention such as a barrier between hands and ready-to-eat food is necessary.

16. Proper Handwashing
Wet hands and exposed parts of arms with warm water and soap
Rub soap into hands and arms for seconds
Rinse hands and arms with warm water Whole process should take 20 seconds
Dry hands and arms on disposable paper towel or electric dryer
The greatest concentration of microbes exists around and under the fingernails of the hands.

17. When to Wash Hands Before Starting to cook Handling food When
Switching between raw and cooked or RTE food
As frequently as required to maintain clean hands and prevent cross-contamination
After
Handling raw food
Using bathroom
Coughing, sneezing, blowing nose
Touching tissue, hair, face
Cleaning and sanitizing
Removing garbage
Touching money, phones and pets

18. Hand Sanitizers
Hand sanitizers are not a replacement for thorough and effective handwashing
Can be used after handwashing as a second step to decontaminate hands
Hand sanitizers do not remove dirt and soil, they just spread it around
Commonly-available, alcohol-based hand sanitizers are not effective against all pathogens, including Norovirus

19. Bare Hand Contact

20. Preventing Bare Hand Contact
When preparing food in community settings it is important to take extra steps for food safety
Preventing bare hand contact with ready-to-eat foods is one way to keep food safe when preparing for large groups
Methods to prevent bare hand contact include:
Single-use gloves
Serving utensils such as spoons, ladles and tongs
Single-use deli or bakery papers

21. Glove Use
Wear single-use gloves when handling all ready-to-eat foods, except washing produce
Always cover a bandaged wound with a single-use glove
Change gloves whenever switching from raw to ready-to-eat foods or switching from allergen to non-allergen foods

22. Reporting Illness and Injury

23. Reporting Symptoms and Illness
Sick people can very easily contaminate food and spread illness to other people
People shouldn’t prepare food for others when they have certain symptoms and illnesses

24. Restricted
If a food handler has the following symptoms they should not prepare food for others:
Sore throat with fever
Uncovered, infected cuts, wounds or lesions containing pus on the hand, wrist or other exposed body part
Persistent sneezing, coughing or runny nose that causes discharges from the eyes, nose or mouth
Food handlers can still be in the kitchen but shouldn’t handle food or food-contact surfaces

25. Covering Cuts and Wounds
Waterproof cover and single use glove if wound is on hand, finger or wrist
A waterproof cover on the arm
Dry, durable, tight fitting bandage on body

26. Excluded
If a food handler has the following symptoms they should not be around food:
Diarrhea
Vomiting
Jaundice
Sore throat and fever*
Symptoms from non-infectious conditions do not apply (e.g., pregnancy, gastrointestinal syndromes, medications, etc.)
*excluded if serving highly susceptible population

27. HENSS Reportable Illnesses
Food handlers must be excluded if diagnosed with:
Hepatitis A virus
Shiga-toxin producing E.coli (STEC)
Norovirus
Salmonella species (Typhoidal and non-typhoidal)
Shigella species
HENSS
HENSS can be used as an acronym for the exclusion diseases
These may show up on the exam. It isn’t necessary to know all the disease details about them, but know that diagnoses with these illnesses require exclusion

28. Reportable Illnesses Food handlers must also be excluded if:
Have had a recent illness from or lives in household with someone who has a reportable illness
Traveled within last 50 days to an area outside U.S. with an epidemic from a reportable illness
Food handler is suspected of causing or being exposed to confirmed illness outbreak
In restaurant and community settings, managers must report jaundice and/or diagnoses of the 5 illnesses to the regulatory authority

29. Returning to Food Handling
Must be symptom free for 24 hours
Need written clearance from a healthcare professional after diagnosis with reportable illness
Cuts and wounds must be healed or properly covered

30. Summary RESTRICT EXCLUDE REINSTATE Sore throat and fever*
RESTRICT
Sore throat and fever*
Open, infected cut/wound/boil
Persistent sneezing, coughing or runny nose with discharge
EXCLUDE
Vomiting
Diarrhea
Jaundice
Confirmed diagnosis of: Hepatitis A, STEC, Norovirus, Salmonella species (typhoidal and non-typhoidal), Shigella species
REINSTATE
Properly covered cut/wound/boil
Symptom-free for 24 hours
Confirmed cased of required reported illnesses require a doctor’s note

31. Why do you think these things are so hard to get right?
Discussion
Proper personal hygiene and staying home when sick are the biggest ways to prevent spread of foodborne illness.
Why do you think these things are so hard to get right?

32. Review Personal hygiene best practices Proper handwashing
Methods to prevent bare hand contact
Reporting illness symptoms and diagnoses