1. 1 November 2006 Reducing Foodborne Illness Risk Factors in Food Service and Retail Establishments

2. 2 n Agency initiative to provide information about risk factors insufficiently controlled in: u Institutions u Restaurants u Retail food Introduction

3. 3 n To remind operators and regulators about safe practices used to control risk factors.

4. 4 Introduction n The following slides contain “food safety messages” provided for use in foodservice, retail food stores and retail regulatory programs for training, refresher sessions and inspection related activities.

5. 5 Introduction n These “food safety messages” were adapted from the findings of the FDA 2004 report on the occurrence of foodborne illness risk factors and those most commonly found to be out of compliance in nine (hospitals, nursing homes, elementary schools, fast food and full service restaurants, deli’s, meat and poultry, seafood and produce) facility types.

6. 6 Introduction n These “food safety messages” also include recommendations that were created based on guidance in the FDA Food Code 2005.

7. 7 Institutions n Hospitals and Nursing Homes n Elementary Schools u Risk factors needing priority attention u Recommendations u Summary

8. 8 Risk factors needing priority attention n Hospitals and Nursing Home n Improper Holding, Time and Temperature u Contaminated Equipment u Poor Personal Hygiene n Schools u Improper hot and cold holding F Date marking

9. 9 Recommendations n Regulators u Provide F Policy F Technical training F Operator guidance F Operator compliance evaluation

10. 10 Recommendations n Operators u Provide F Procedures F Staff training F Monitoring F Corrective action

11. 11 Recommendations n Hospitals and Nursing Homes u Cool foods from 135°F to 70 °F in 2 hours and then to 41°F in a total of 6 hours. u Hold Potentially Hazardous Foods (PHF) /Time-Temperature Control For Safety (TCS) Food cold at 41°F or below

12. 12 Recommendations n Hospitals and Nursing Homes u Hold hot food at 135°F or above u If held for more than 24 hours, date mark ready-to-eat, Potentially Hazardous Foods (PHF) /Time-Temperature Control For Safety (TCS) Food u Discard after 7 days if held at 41°F; and after 4 days if held at 45°F

13. 13 Recommendations n Hospitals and Nursing Homes u Clean and sanitize surfaces, equipment and utensils u Keep raw animal food separate from ready-to-eat foods u Train employees and enforce a good personal hygiene program u Promote hand washing u Exclude ill workers

14. 14 Recommendations n Elementary Schools u Holding, Time and Temperature F Keep hot foods at 135°F or above F Pre-heat steam table, soup warmers, etc. before adding food F Reheat leftovers quickly to 165°F (in less than 2 hours) F Reheat commercially prepared foods in intact packages to 135°F

15. 15 Recommendations n Elementary Schools u Holding, Time and Temperature F Keep cold foods at 41°F or colder F Provide all hot and cold holding units with thermometers F Cool hot foods from 135°F to 70° in 2 hours and then to 41°F in a total of 6 hours F Cool foods made from room temperature ingredients (canned tuna, bean salad, etc.) to 41°F in 4 hours

16. 16 Recommendations n Elementary Schools u Date mark ready-to-eat, Potentially Hazardous Food (PHF) /Time- Temperature Control For Safety (TCS) Food F If prepared on-site and held more than 24 hours F If commercially processed, date mark when opened

17. 17 Recommendations n Elementary Schools u Date mark ready-to-eat, Potentially Hazardous Food (PHF) /Time- Temperature Control For Safety (TCS) Food F Discard after 7 days if held at 41°F F Discard after 4 days if held at 45°F

18. 18 Summary n Institutional Food Service u Review impact areas u Practice safe procedures u Provide training u Monitor compliance u Adhere to safe practices like those in the 2005 FDA Food Code

19. 19 Restaurants n Full Service u Risk factors needing priority attention u Recommendations u Summary

20. 20 Risk factors needing priority attention n Full Service u Improper Holding, Time and Temperature F Improper cooling Potentially Hazardous Food (PHF) / Time-Temperature Control for Safety (TCS) Food u Poor Personal Hygiene F Improper hand washing

21. 21 Risk factors needing priority attention n Full Service u Improper Holding, Time and Temperature F Improper Cooling Failure to cool food properly is unsafe and can allow bacteria to grow Poor cooling practices in your establishment can lead to foodborne illness for your customers

22. 22 Risk factors needing priority attention n Full Service u Poor Personal Hygiene F Improper Hand washing Failure to wash hands properly is unsafe and can contribute to the spread of viruses Poor hand washing practices in your establishment can lead to customer illness Improper hand washing is a leading risk factor for foodborne illness commonly found to be out of control

23. 23 Recommendations for Operators n Full Service u Implement standard operating procedures for cooling u Pay special attention to large food items such as turkeys, roasts, soups, sauces, chili, refried beans and rice u Use safe methods that work best for the foods you are cooling: reducing the quantity, using an ice bath and stirring, using commercial equipment like a blast chiller

24. 24 Recommendations for Operators n Full Service u Implement corrective action procedures when cooling practices are not followed u Make sure employees understand when to apply corrective action u Advise employees of the different options for corrective action such as discarding or reheating

25. 25 Recommendations for Operators n Full Service u Document the corrective action and prevent the problem from reoccurring u Avoid the need to cool large batches by preparing smaller batches u Include a cooling step in your recipes

26. 26 Recommendations for Operators n Full Service u Implement monitoring procedures u Monitoring provides a way to identify when there is loss of control of the cooling process

27. 27 Recommendations for Operators n Full Service u Monitoring procedures should include: F what you will monitor F how you will monitor F when and how often F who is the person responsible for the monitoring

28. 28 Recommendations for Operators n Full Service u Conduct ongoing verification F Verify to ensure that the procedures related to cooling are being carried out properly Observe tasks related to cooling and monitoring activities Review monitoring records and check frequency, accuracy and consistency

29. 29 Recommendation for Operators n Full Service u Hand washing F Establish a hand washing standard operating procedure (SOP) F Provide interactive employee training F Conduct follow-up training as needed F Emphasize the importance of hand washing F Evaluate hand sink placement

30. 30 Recommendation for Operators n Full Service u Hand washing F Keep hands and arms clean, and wash: during food preparation as often as necessary to remove soil when switching between working with raw food and working with ready-to-eat food after touching anything that can contaminate hands

31. 31 Recommendation for Operators n Full Service u Hand washing F Keep hands and arms clean, and wash: after touching bare body parts after using the toilet after touching soiled equipment or utensils before putting on gloves to work with food

32. 32 Recommendations for Operators n Full Service u Provide detailed training for employees u Train employees in their specific roles for the success of your food safety program u Give the employees the necessary tools and knowledge needed to be successful

33. 33 Recommendations for Regulators n Full Service u Maintain an open dialog with operators u Understand the establishment’s training program u During inspections include time to observe hand washing behaviors u Target long term behavior change

34. 34 Recommendations for Regulators n Full Service u Verify hand wash sink use and placement u Role model “Good Practices” u Take corrective action and conduct training demonstrations when improper hand washing is observed

35. 35 Recommendations for Regulators n Full Service u When arranging an inspection visit: F It is important to have an understanding of a facility’s operation and to consider the processing schedule.

36. 36 Recommendations for Regulators n Full Service u Establish Inspection Priorities for Cooling F Flex hours to accommodate verification of cooling practices F Take corrective action during inspection

37. 37 Recommendations for Regulators n Full Service F Establish solution for long term control F Maintain an open dialog with operators F Understand the operation procedures and employee training programs

38. 38 Summary u Restaurants F Full Service Implement standard operating procedures (SOP’s) for hand washing and cooling Conduct interactive employee training Monitor Verify safe procedures Take Corrective action

39. 39 Restaurants n Fast Food u Risk factors that need extra attention u Safe Practices u Summary

40. 40 Risk Factors that need extra attention n Fast Food u Improper Holding, Time and Temperature u Poor Personal Hygiene u Chemicals

41. 41 Recommendations n Fast Food u Holding, Time and Temperature F Date mark ready-to-eat, Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food F If prepared on-site and held more than 24 hours

42. 42 Recommendations n Fast Food u Holding, Time and Temperature F If commercially processed, date mark when opened F Discard after 7 days if held at 41°F F Discard after 4 days if held at 45°F

43. 43 Recommendations n Fast Food u Holding, Time and Temperature F Ensure foods that require refrigeration are maintained at 41°F or below F Maintain hot food at 135°F or above

44. 44 Recommendations Hard Cooked Eggs n n Fast Food n n Date Marking

45. 45 Recommendations n Fast Food u Date Marking Cooked Noodles

46. 46 Recommendations n Fast Food u Personal Hygiene F Keep hands and arms clean and wash: during food preparation as often as necessary to remove soil when switching between working with raw food and working with ready-to-eat food after touching anything that can contaminate hands

47. 47 Recommendations n Fast Food u Personal Hygiene F Keep hands and arms clean and wash: after touching bare body parts using the toilet after touching soiled equipment or utensils before putting on gloves to work with food u Practice no bare hand contact when handling ready-to-eat foods

48. 48 Recommendations n Fast Food u Single-Use Gloves for Salad Preparation

49. 49 Recommendations n Fast Food u Chemicals F Ensure that chemicals are clearly labeled F Store chemicals separate from food F Use chemicals for the intended use F Do not mix any chemical with another chemical

50. 50 Recommendations n Fast Food u Chemicals u Proper labeling and storage

51. 51 Summary n Restaurants u Fast Food F Review the risk factors that need extra attention F Follow safe practices to ensure proper Holding, Time and Temperature of Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food

52. 52 Summary n Restaurants u Fast Food F Wash hands regularly and as needed F Practice no bare hand contact when handling ready-to eat foods F Ensure the proper usage, storage and labeling of all chemicals

53. 53 Retail Food Stores n Departments u Deli u Meat and Poultry u Seafood u Produce F Risk factors needing extra attention F Safe practices F Summary

54. 54 Risk factors needing extra attention n Deli Departments u Improper Holding, Time and Temperature u Poor Personal Hygiene u Prevention from Contamination

55. 55 Recommendations n Deli Departments u Holding Time, Temperature F Date mark ready-to-eat, Potentially Hazardous Food (PHF) Time/Temperature Control For Safety Food (TCS). F If prepared on-site and held more than 24 hours F If commercially processed, date mark when opened

56. 56 Recommendations n Deli Departments u Holding Time, Temperature F Discard after 7 days if held at 41°F F Discard after 4 days if held at 45°F F Hold food that requires refrigeration cold at 41°F or below

57. 57 Recommendations n Deli Departments u Personal Hygiene F Make certain that food workers wash their hands properly, adequately and as necessary Keep hands and arms clean and wash: during food preparation as often as necessary to remove soil when switching between working with raw food and working with ready-to-eat food after touching anything that can contaminate hands

58. 58 Recommendations n Deli Departments u Personal Hygiene F Keep hands and arms clean and wash: after touching bare body parts using the toilet after touching soiled equipment or utensils before putting on gloves to work with food

59. 59 Recommendations n Deli Departments u Personal Hygiene Have hand washing sinks convenient and accessible for use Have hand washing sinks stocked with soap, single-use towels or drying device

60. 60 Recommendations n Deli Departments u Personal Hygiene Accessible hand wash sink

61. 61 Recommendations n Deli Departments u Personal Hygiene Hand wash signage

62. 62 Recommendations n Deli Departments u Protection from Contamination F Avoid Sources of Contamination Blood from meat

63. 63 Recommendations n Deli Departments u Protection from Contamination F Be sure that all food contact surfaces are clean and sanitized before use, between use, and as needed

64. 64 Summary n Deli Departments u Follow safe practices for holding time, temperature u Ensure proper hand washing and that hand sinks are accessible and fully stocked u Protect food from contamination

65. 65 Risk factors needing extra attention n Meat and Poultry Departments u Improper time, and temperature u Prevention from contamination u Poor personal hygiene u Chemical

66. 66 Recommendations n Meat and Poultry Departments  Ensure proper temperatures F Keep food cold for safety and an enhanced shelf life F Maintain food 41º F or below in storage and while on display F Keep frozen food frozen F Keep hot food at 135°F or above

67. 67 Recommendations n Meat and Poultry Departments u Date marking F Label all ready-to-eat foods and food products that are prepared on the premises or that are commercially produced and held for more than 24 hours with a disposal date as described in the FDA Food Code.

68. 68 Recommendations n Meat and Poultry Departments u Prevention from contamination F Keep all areas clean and sanitized F Clean and sanitize food contact surfaces and utensils frequently

69. 69 Recommendations n Meat and Poultry Departments u Prevention from contamination F Clean and sanitize all food contact surfaces and equipment especially after changing from poultry to red meat F Watch for buildup beneath cutting table top surfaces and on other equipment

70. 70 Recommendations n Meat and Poultry Departments u Chemical F Avoid chemical hazards F Keep all sanitizers, pesticides and other chemicals separate from food F Identify chemicals with a legible label F Use chemicals only as directed by the manufacturer’s label

71. 71 Recommendations n Meat and Poultry Departments u Personal Hygiene F Wash your hands frequently and after any change in operations Keep hands and arms clean and wash: during food preparation as often as necessary to remove soil when switching between working with raw food and working with ready-to-eat food after touching anything that can contaminate hands

72. 72 Recommendations u Personal Hygiene F Keep hands and arms clean and wash: after touching bare body parts using the toilet after touching soiled equipment or utensils before putting on gloves to work with food F Wear proper attire including hair restraints and protective garment covers such as coats

73. 73 Summary n Meat and Poultry Departments u Follow the safe practices to ensure that proper time and temperature is maintained when handling meat and poultry u Take measures to protect food from contamination

74. 74 Summary n Meat and Poultry Departments u Make sure that employees have good personal hygiene at all times and wash hands regularly especially in between handling raw poultry and red meat u Make sure that all chemicals are properly stored, labeled and always follow the manufacturers instructions for use

75. 75 Risk factors needing extra attention n Seafood Departments u Improper holding, time and temperature u Prevention from contamination u Poor personal hygiene u Food from unsafe source

76. 76 Recommendations n Seafood Departments u Holding Time and Temperature F Date mark open containers of commercially- processed, ready-to-eat, Potentially Hazardous Foods (PHF) Time /Temperature Control For Safety Food (TCS) and ready-to- eat, PHF/TCS prepared on site F Maintain cold holding temperatures for PHF/TCS at 41°F or below

77. 77 Recommendations n Seafood Departments u Holding Time and Temperature F Discard ready-to-eat, PHF/TCS as required for date marking

78. 78 Recommendations n Seafood Departments u Date Marking Food Product Date Marked

79. 79 Recommendations n Seafood Departments u Prevention from Contamination F Properly clean and sanitize all food contact surfaces and utensils 3 compartment sink

80. 80 Recommendations n Seafood Departments u Prevention from Contamination F Separate raw animal foods from ready- to-eat foods and from other raw animal foods

81. 81 Recommendations n Seafood Departments u Personal Hygiene F Wash your hands often, especially after handling raw animal foods, using the restroom, or handling soiled equipment Hand washing

82. 82 Recommendations n Seafood Departments u Personal Hygiene F Make sure all hand wash sinks are supplied with soap and single use towels or hand drying devices

83. 83 Recommendations n Seafood Departments u Food from Unsafe Sources F Make sure that all food items are purchased from approved sources such as licensed seafood processors or vendors

84. 84 Recommendations n Seafood Departments u Food from Unsafe Sources F Keep and maintain shell stock tags for 90 days from the dates of harvest Shellstock tag

85. 85 Recommendations n Seafood Departments u Chemical F Make sure all spray bottles or chemical storage containers are properly identified F Keep all cleaners, sanitizers or other chemicals in the seafood department or market properly stored

86. 86 Recommendations n Seafood, Seafood Departments u Chemical F Make sure to use cleaners or other chemicals as intended F Always read the label for chemical type and instructions for use

87. 87 Summary n Seafood Departments u Keep seafood at proper temperatures. u Use good sanitation practices u Wash your hands often

88. 88 Summary n Seafood Departments u Store seafood properly to prevent contamination u Purchase seafood from approved sources u Maintain shell stock tags

89. 89 Risk factors needing extra attention n Produce Departments u Improper holding, time and temperature u Poor personal hygiene

90. 90 Recommendations n Produce Departments u Holding, time and temperature F Hold Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food at 41º or below Cut melonsSprouts

91. 91 Recommendations n Produce Departments u Holding, time and temperature F Hold Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food at 41º or below salad bar

92. 92 Recommendations n Produce Departments u Holding, time and temperature F Use proper storage to reduce the chances of customers becoming ill after eating foods

93. 93 Recommendations n Produce Departments u Holding, time and temperature F Pay special attention to cut melon, sprouts, and salad bar items that need refrigeration because microorganisms can grow and multiply easiest in these kinds of foods

94. 94 Recommendations n Produce Departments u Holding, time and temperature F Check refrigeration on a frequent basis to ensure that it is working properly and holding food at 41°F or below F Chill whole fruits before cutting or slicing F Make sure that ice levels are adequate and checked regularly when using ice to hold cut melon

95. 95 Recommendations n Produce Departments u Holding, time and temperature F Pre-chill unopened cans or jars of food products that will be served on the salad bar F Make sure that Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food that are displayed on “reduced for quick sale” rack are at held at 41°F or below

96. 96 Recommendations n Produce Departments u Holding, time and temperature F Use a thermometer and check the temperatures of Potentially Hazardous Food (PHF)/ Time-Temperature Control For Safety (TCS) Food in your produce department

97. 97 Recommendations n Produce Departments u Personal Hygiene F Make sure to wash your hands before handling produce F Use the designated hand washing sink

98. 98 Summary n Produce Departments u Maintain food at the proper temperature u Wash hands properly and as often as needed: F Refer to Chapter 2 in the 2005 FDA Food 2-3 Personal Cleanliness 2-301.14 When to Wash

99. 99 References n FDA Report in the Occurrence of Foodborne Illness Risk Factors in Selected Institutional Food Service, Restaurant and Retail Food Store Facility Types (2004) u www.cfsan.fda.gov/~dms/retrsk2.html www.cfsan.fda.gov/~dms/retrsk2.html n Food Code, U.S Public Health Service, Food and Drug Administration, 2005 u http://www.cfsan.fda.gov/~dms/fc05-toc.html http://www.cfsan.fda.gov/~dms/fc05-toc.html

100. 100 FDA Contacts FDA Regional Food Specialists Retail Food Protection Team Center for Food Safety and Applied Nutrition Food & Drug Administration College Park, MD PH: 301-436-2350 Email: Bedwards@cfsan.fda.gov