1. Firefly owner John Simmons poses at his restaurant at 3824 Paradise Road in Las Vegas on Monday Nov. 18, 2013. (Bill Hughes/Las Vegas Review-Journal) NC Safe Plates Module 6

2. 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) What Happened? Morbidity and Mortality Weekly, December 20, 2013, Vol.62, No.50

3. 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 & placed back in stock pot Sausage cooked and added to the stock pot

4. The Recipe (continued) Onions and other seasonings sautéed in sausage oil & added to stock pot Rice added to stock pot & cooked until all water absorbed COOKED PERLO PLACED IN UNHEATED OVEN FOR APPROXIATELY 8 HOURS (OVERNIGHT) PERLO TRANSFERRED TO SLOW COOKER & REHEATED FOR 1 HOUR ON HIGH SETTING BEFORE TRANSPORT AND CONSUMPTION

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

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

8. Key Terms Toxin – poison produced by microorganism Heat stable toxin – not destroyed by cooking (165 o F) Temperature Danger Zone (TDZ)- Above 41 o F and below 135 o F Excluded employee- can’t work in operation Restricted employee- can’t work with or around food Reinstated employee- approved to work

9. Staphylococcus aureus – a bacteria Termed “staph” Common in the environment Lives in humans and animals –Present in nasal passages & throats –Hand or arm sores (especially pus) –Cough or sneeze Can be destroyed by proper cooking Can produce toxin that is not destroyed by cooking

10. Toxin Can cause nausea, stomach cramps, vomiting, and diarrhea Symptoms usually last for a few hours to a day Fast acting –Causes symptoms within 1-7 hours after eating contaminated foods –Controlled by good personal hygiene and avoid temperatures in temperature danger zone

11. 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

12. From Our Case Study

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

14. Remember from before? Temperature Danger Zone –Store TCS food at or below 41 o F –Hot hold at 135 o F or above if stored for more than 2 hours Check temperature –Do you document it? Store food in small portions in shallow containers

15. Corrective Action / 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

16. 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 on arm Dry, durable, tight fitting bandage on body

17. Corrective Action / Prevention Personal Hygiene Hand washing, glove use Limit bare hand contact (utensils) Bathing Clean uniforms and cloths Jewelry- maybe plain wedding band Hair restraint Proper taste testing practices Cough and sneeze

18. 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

19. Case Study 13 military personnel ill Everyone ate same meal How it happened Perlo was stored in the oven for 8 hours Poor personal hygiene What they found

20. Case Study Temperature abuse allowed Staph to grow and produce toxin What went wrong Proper cooling and reheating Proper personal hygiene Prevention

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

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

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

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