# Presentation: 480518

## Reducing Foodborne Illness Risk Factors in Food Service and Retail Establishments

## Agency initiative to provide information about risk factors insufficiently controlled in:
 Institutions
 Restaurants
 Retail food  

-  Institutions
-  Restaurants
-  Retail food

** ****Introduction**

##  Introduction

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

##  Introduction

- 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.

##  Introduction

- 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.

## Introduction

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

**Notes:**
Improper -Holding/Time & Temperature
Hospitals surveyed were out of compliance 40.3%
Nursing Homes surveyed out of compliance 30.7%

## Institutions 

- Hospitals and Nursing Homes
- Elementary Schools
- Risk factors needing priority attention
- Recommendations
- Summary

## Risk factors needing priority attention 

- Hospitals and Nursing Home
- Improper Holding, Time and Temperature
- Contaminated Equipment
- Poor Personal Hygiene
- Schools
- Improper hot and cold holding
- Date marking

**Notes:**
Cooling safely and in a timely manner is essential for preventing the growth of bacteria. 
PHF cooled to 70°F in 2 hours/41°F in total of 6 hours.
PHF held cold at 41°F or below  
Date marking is important to ensure proper rotation and limit the growth of bacteria during storage. 

## Recommendations 

- Regulators
- Provide
- Policy
- Technical training
- Operator guidance
- Operator compliance evaluation

## Recommendations

- Operators
- Provide
- Procedures
- Staff training
- Monitoring
- Corrective action

## Recommendations

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

## Recommendations

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

## Recommendations

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

## Recommendations

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

## Recommendations

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

## Recommendations 

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

## Recommendations 

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

## Summary

- Institutional Food Service
- Review impact areas
- Practice safe procedures
- Provide training
- Monitor compliance
- Adhere to safe practices like those in the 2005 FDA Food Code

**Notes:**
Take corrective action for out of compliance observation
Review previous inspection reports 
Be aware of employee training program
Address food safety concerns

## Restaurants

- Full Service
- Risk factors needing priority attention
- Recommendations
- Summary

## Risk factors needing priority attention 

- Full Service
- Improper Holding, Time and Temperature
- Improper cooling Potentially Hazardous Food (PHF) / Time-Temperature Control for Safety (TCS) Food
- Poor Personal Hygiene
- Improper hand washing

## Risk factors needing priority attention

- Full Service
- Improper Holding, Time and Temperature
- 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

**Notes:**
Safe cooling requires the removal of heat from foods quickly enough to prevent the growth of spore-forming bacteria.

 Excessive time for cooling of potentially hazardous food has been consistently identified as one of the leading contributing factors to foodborne illness 

## Risk factors needing priority attention

- Full Service
- Poor Personal Hygiene
- 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

## Recommendations for Operators

- Full Service
- Implement standard operating procedures for cooling
-  Pay special attention to large food items such as turkeys, roasts, soups, sauces, chili, refried beans and rice
- 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

## Recommendations for Operators

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

## Recommendations for Operators

- Full Service
- Document the corrective action and prevent the problem from reoccurring
- Avoid the need to cool large batches by preparing smaller batches
- Include a cooling step in your recipes

## Recommendations for Operators

- Full Service
- Implement monitoring procedures
- Monitoring provides a way to identify when there is  loss of control of the cooling process

**Notes:**

Monitoring Cooling;
Will help you determine if your cooling limits are being met.
Will identify when there is a loss of control and you can take the corrective action needed. 
Monitoring procedure should include, who, what when and how.
Should be simple and easy to follow. 
Will  ensure that the food is getting cooled within the correct time frame to control the growth of bacteria. 

## Recommendations for Operators

- Full Service
- Monitoring procedures should include:
- what you will monitor
- how you will monitor
- when and how often
- who is the person responsible for the monitoring

## Recommendations for Operators

- Full Service
- Conduct ongoing verification
- 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

## Recommendation for Operators

- Full Service
- Hand washing
- Establish a hand washing standard operating procedure (SOP)
- Provide interactive employee training
- Conduct follow-up training as needed
- Emphasize the importance of hand washing
- Evaluate hand sink placement

## Recommendation for Operators

- Full Service
- Hand washing
- 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

## Recommendation for Operators

- Full Service
- Hand washing
- 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

## Recommendations for Operators

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

## Recommendations for Regulators

- Full Service
- Maintain an open dialog with operators
- Understand the establishment’s training program
- During inspections include time to observe hand washing behaviors
- Target long term behavior change

## Recommendations for Regulators

- Full Service
- Verify hand wash sink use and placement
- Role model “Good Practices”
- Take corrective action and conduct training demonstrations when improper hand washing is observed

## Recommendations for Regulators

- Full Service
- When arranging an inspection visit:
- It is important to have an understanding of a facility’s operation and to consider the processing schedule.

## Recommendations for Regulators

- Full Service
- Establish Inspection Priorities for Cooling
- Flex hours to accommodate verification of cooling practices
- Take corrective action during inspection

**Notes:**
Open Dialog:
Important and gives the inspector an opportunity to learn the operations and how cooling is done. 
With the operator and food facility staff shows interest in their operation and leads to a good relationship.
Is helpful to convey information and promote public health. 

Having an open dialog can provide valuable information that may not be discovered by observing the activities going on during the inspection. 

An open dialog can provide information as to what activities are currently occurring which might otherwise be missed. 

Understanding the operational procedures and training programs gives the inspector the opportunity to provide feedback to the operator and give the operator a chance to discus issues related to food safety. 

## Recommendations for Regulators

- Full Service
- Establish solution for long term control
- Maintain an open dialog with operators
- Understand the operation procedures and employee training programs

## Summary 	

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

## Restaurants

- Fast Food
- Risk factors that need extra attention
- Safe Practices
- Summary

## Risk Factors that need extra attention	

- Fast Food
- Improper Holding, Time and  Temperature
- Poor Personal Hygiene
- Chemicals

## Recommendations

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

## Recommendations

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

## Recommendations 

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

## Recommendations  

**Hard Cooked Eggs**

- Fast Food
- Date** **Marking** **

## Recommendations

- Fast Food
- Date** **Marking

**Cooked Noodles**

## Recommendations 

- Fast Food
- Personal Hygiene
- 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

## Recommendations 

- Fast Food
- Personal Hygiene
-  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
- Practice no bare hand contact when handling ready-to-eat foods

## Recommendations 

- Fast Food
- Single-Use Gloves for Salad Preparation

## Recommendations 

- Fast Food
- Chemicals
- Ensure that chemicals are clearly labeled
- Store chemicals separate from food
- Use chemicals for the intended use
- Do not mix any chemical with another chemical

## Recommendations 

- Fast Food
- Chemicals
- Proper labeling and storage

## Summary 

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

## Summary

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

## Retail Food Stores

- Departments
- Deli
- Meat and Poultry
- Seafood
- Produce
- Risk factors needing extra attention
- Safe practices
- Summary

## Risk factors needing extra attention 

- Deli Departments
- Improper Holding, Time and Temperature
- Poor Personal Hygiene
- Prevention from Contamination

## Recommendations 

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

## Recommendations 

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

## Recommendations  

- Deli Departments
- Personal Hygiene
- 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

## Recommendations

- Deli Departments
- Personal Hygiene
- 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

## Recommendations 

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

## Recommendations

- Deli Departments
- Personal Hygiene

**Accessible hand wash sink**** **
** **

## Recommendations 

- Deli Departments
- Personal Hygiene

**Hand wash signage**** **

## Recommendations 

- Deli Departments
- Protection from Contamination
- Avoid Sources of Contamination

**Blood from meat **

## Recommendations  

- Deli Departments
- Protection from Contamination
-  Be sure that all food contact surfaces are  clean and sanitized before use, between use, and as needed

## Summary 

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

## Risk factors needing extra attention

- Meat and Poultry Departments
- Improper time, and temperature
- Prevention from contamination
- Poor personal hygiene
- Chemical

## Recommendations  

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

## Recommendations 

- Meat and Poultry Departments
- Date marking
-  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.

## Recommendations 

- Meat and Poultry Departments
- Prevention from contamination
- Keep all areas clean and sanitized
- Clean and sanitize food contact surfaces and utensils frequently

## Recommendations 

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

## Recommendations

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

## Recommendations  

- Meat and Poultry Departments
- Personal Hygiene
- 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

## Recommendations

- Personal Hygiene
- 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
- Wear proper attire including hair restraints and protective garment covers such as coats

## Summary

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

## Summary

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

## Risk factors needing extra attention 

- Seafood Departments
- Improper holding, time and temperature
- Prevention from contamination
- Poor personal hygiene
- Food from unsafe source

## Recommendations  

- Seafood Departments
- Holding Time and Temperature
- 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
- Maintain cold holding temperatures for PHF/TCS at 41°F or below

## Recommendations 

- Seafood Departments
- Holding Time and Temperature
- Discard ready-to-eat, PHF/TCS as required for date marking

## Recommendations 

- Seafood Departments
- Date Marking

**Food Product Date Marked**

## Recommendations 

- Seafood Departments
- Prevention from Contamination
- Properly clean and sanitize all food contact surfaces and utensils

- 3 compartment sink

## Recommendations 

- Seafood Departments
- Prevention from Contamination
- Separate raw animal foods from ready-to-eat foods and from other raw animal foods

**Notes:**
The storage of raw animal meat above ready-to-eat items was identified as being out of compliance 23.5% of the time. An example of this would be storing raw bloody ground beef over salad.

Storing raw animal foods above each other was identified out of compliance 18.2%. An example of this would be storing raw chicken above a pork roast.

Proper storage of raw animal food/meats is very important in reducing the amount of potential cross contamination or illness.

## Recommendations 

- Seafood Departments
- Personal Hygiene
- Wash your hands often, especially after handling raw animal foods, using the restroom, or handling soiled equipment

- Hand washing

**Notes:**
Proper and adequate hand washing was identified out of compliance over 37% of the time.

We need to work harder on keeping our hands clean, especially after visiting the restroom, after smoking or eating, after handling trash or soiled equipment, and as often as necessary.

We also need to make sure there is always soap and proper hand drying devices at the hand washing sinks at all times.

## Recommendations 

- Seafood Departments
- Personal Hygiene
- Make sure all hand wash sinks are supplied with soap and single use towels or hand drying devices

## Recommendations 

- Seafood Departments
- Food from Unsafe Sources
-  Make sure that all food items are purchased from approved sources such as licensed seafood processors or vendors

**Notes:**
For Seafood Facilities, the in compliance rate was very high for this risk factor.  

The exception to this general observation was the “retention of shellstock tags for 90 days” This items was out of compliance over 44% of the time.

Shellfish harvested from contaminated water can harbor harmful bacteria and viruses. Shellfish tags are part of an overall monitoring program. Tags must be maintained for 90 after the shellstock has been consumed or sold.

## Recommendations 

- Seafood Departments
- Food from Unsafe Sources
- Keep and maintain shell stock tags for 90 days from the dates of harvest

- Shellstock tag

## Recommendations 

- Seafood Departments
- Chemical
- Make sure all spray bottles or chemical storage containers are properly identified
- Keep all cleaners, sanitizers or other chemicals in the seafood department or market properly stored

**Notes:**
The proper identification, storage, and use of cleaners, sanitizers, and other chemicals was out of compliance in (19%) of the observation made. 

A good storage, labeling and use of chemical program is necessary to address any gaps the may be contributing to the out of compliance rate for this risk factor. 

## Recommendations 

- Seafood, Seafood Departments
- Chemical
- Make sure to use cleaners or other chemicals as intended
- Always read the label for chemical type and instructions for use

## Summary

- Seafood Departments
- Keep seafood at proper temperatures.
- Use good sanitation practices
- Wash your hands often

## Summary

- Seafood Departments
- Store seafood properly to prevent contamination
- Purchase seafood from approved sources
- Maintain shell stock tags

## Risk factors needing extra attention

- Produce Departments
- Improper holding, time and temperature
- Poor personal hygiene

## Recommendations  

- Produce Departments
- Holding, time and temperature
- Hold Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food at 41o or below

**Cut melons**

**Sprouts**

## Recommendations  

- Produce Departments
- Holding, time and temperature
- Hold Potentially Hazardous Food (PHF) Time/Temperature Control For Safety (TCS) Food at 41o or below

**salad bar**

## Recommendations 

- Produce Departments
- Holding, time and temperature
- Use proper storage to reduce the chances of customers becoming ill after eating foods

**Notes:**
Microorganisms can grow in these foods if their temperature remains above 41o.
These microorganisms can make people sick.

Sometimes MANY people can become ill after eating certain foods that were stored or held warmer than 41°. When many people become sick, it is called a Foodborne Illness Outbreak.
History shows us that often, when an OUTBREAK occurs:
 - people are ill, and sometimes people may even die, because of eating this food
 - law suits may be filed
 - radio and television news will cover the story 
 - your local/state Health department must conduct inspections to investigate the problem
 - the produce department staff may be restructured as a result of this event
 - the store may undergo serious changes

## Recommendations 

- Produce Departments
- Holding, time and temperature
- 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

## Recommendations

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

## Recommendations 

- Produce Departments
- Holding, time and temperature
- Pre-chill unopened cans or jars of food products that will be served on the salad bar
- 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

## Recommendations 

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

## Recommendations  

- Produce Departments
- Personal Hygiene
- Make sure to wash your hands before handling produce
- Use the designated hand washing sink

## Summary 

- Produce Departments
- Maintain food at the proper temperature
- Wash hands properly and as often as needed:
- Refer to Chapter 2 in the 2005 FDA Food 2-3 Personal Cleanliness 2-301.14 _When to Wash_

## References 

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

## FDA Contacts

- FDA Regional
- Food Specialists

- Retail Food Protection TeamCenter for Food Safety and Applied NutritionFood & Drug AdministrationCollege Park, MD
- PH: 301-436-2350
- Email: Bedwards@cfsan.fda.gov