{Therapeutic Nutrition in Egypt} Critical Report on the Management and Policies of Al-Nas Hospital
Creators: name: Mohamed Fathy Abdelhamid‬‏, ‪Merna
Publisher: name: Merna Mohamed Fathy Abdelhamid
Year: 2025
Subjects: subject: Nutrition Policy
subject: Nutrition Assessment
subject: Applied nutrition
subject: therapeutic nutrition
subject: Food Insecurity
subject: Food Safety
subject: Food safety
subject: Food Safety/methods
subject: Clinical nutrition
subject: Nutritionists
subject: Thesis
subject: Research
subject: Health
subject: Health Promotion
subject: Hospital
subject: Hospital Departments
subject: Hospital Units
subject: Hospitals

description: Faculty of Home Economics 

Food Science and Nutrition Department 

Undergraduate Dietetics Program (UDP)

Therapeutic Nutrition Major 

 

Title

Critical Report for the Management and policies of 

(Al-Nas Hospital)

By

Merna Mohamed Fathy Abdelhamid

Undergraduate Student in Level four at Dietetics Program, Therapeutic Nutrition Major, Food Science and Nutrition Department, Faculty of Home Economics,

Helwan University, Cairo, Egypt

This Thesis is part of an Internship (1) course

Under Supervision of

Prof. Dr. Haggag M. Hamdy

Professor of Nutrition, Nutrition and Science Department,

Faculty of Home Economics, Helwan University

Level 4

2022\2023

 

Great thanks and gratitude for the efforts

Of

Prof. Dr. Haggag M. Hamdy

Professor of Nutrition, Nutrition and Science Department,

Faculty of Home Economics, Helwan University.

&

Prof. Dr. Naeem Rabeh

Vice Dean of the Faculty of Home Economics.

&

Prof. Manal K Abdel-Rahman 

Prof. of Nutrition

 &

Prof. Dr. Khaled El-Qady

Dean of the College of Home Economics.

 

This project required a considerable time and effort to make it perfect, and I saw the fruit of my labor and effort with pride and determination, so I would like to extend my full thanks and sincerity to Prof. Dr. Haggag M. Hamdy, as he was patient with my questions and gave his guidance and support, which made me complete this project in the best way.

All appreciation and respect to Prof. Dr. Naeem Rabeh and Prof. Dr. Khaled El-Qady for allowing us to gain the practical experience by giving us the opportunity to obtain training in the Al-Nas Hospital, where we found respect and good treatment in addition to practical experience. I would like to thank my parents and friends who helped me a lot in finishing this project within the limited time. Just because of them, I was able to overcome the difficulties and create my project and make it a good and enjoyable experience.

List of Contents






Title



Page NO.





Hospital



7





Types of Hospitals



7





Hospital Departments



11





Department of Clinical Nutrition



15





Job description



16





Food Safety in Hospitals



17





General Food safety hazards



18





Food Safety Hazards Agents



26





The Obligations of Food Business



33





The Hazard Analysis Critical Control Point



34





HISTORY OF HACCP



35





Terms of HACCP System



37





Scope of HACCP



39





Seven principles of HACCP



39





Development of the HACCP Plan



42





Measures To Control Hazards



44





Hazard Analysis



47





Management Of The HACCP Program



49





Benefits of Implementing the HACCP System        



50





Application Of HACCP



51





Purchasing



52





What is a Hospital Purchasing Agent?



52





How Hospital Purchasing Works



53





 

 

 

 

List of Contents






Title



Page NO.





What Impacts Decisions in Hospital Buying?



53





Food Receiving



56





Storage



59





Storage Temperatures and Procedures



59





Inventory Control



67





Difference Between Inventory Control and Inventory Management



68





Types of Inventory Control Systems



70





Inventory Control Techniques



71





General Safety Measures in Hospitals



73





Safety and Health Management Systems in Hospitals: Best Practices and Examples



75





Food Safety Guidelines Throughout A Foodservice Operation



76





Food Safety in Production and Service



79





Personal Hygiene Guidelines for Employees



86





Hand Washing Guidelines



87





Emergency Policies: Incident, Injury and Hazard Reporting



89





TIME / TEMPERATURE CONTROL



96





What is a safe temperature?



96





The 2 hour/4 hour guide



97





Thermometers



98





Al-Nas Hospital



100





Al-Nas Hospital Departments



102





Stages of food safety in Al-Nas Hospital



110





Receiving and Storing Processes



110





 

 

List of Contents






Title



Page NO.





Preparation Process



113





Cooking Process



114





Bain Marie Stage



114





Washing Process



115





References



116





 



 





 



 





 

 

 

List of Tables

 






Title



Page NO.





Methods to Measure How to Control Hazards



44





Critical Control Point for Refrigerated Products



62





Critical Control Point for Refrigerated Fresh Meats, Poultry, and Seafood



65





Critical Control Point for Frozen Foods



66





Difference Between Inventory Control and Inventory Management:



69





The 2 hour/4 hour Table Guide



97





 



 





 



 





 



 





 



 





 

 

Introduction

Hospital:

Hospital is an organization of public health. It is an institution which takes care of the health and diseases of people with the help of sophisticated equipment and instruments, by a group of specially trained people. As many people think, hospital is not only a place where sick people are taken care off; it also looks after the health or well-being of the people and maintains it. It tries to keep them in good health and disease free by undertaking immunization, educational program and by teaching personal and social hygienic practices.

Types of hospitals:

Hospitals are usually funded by the public sector, by health organizations (for-profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Hospitals may fall into one of three categories based on their funding:

Publicly owned hospitals, Nonprofit hospitals and For-profit hospitals.

Hospitals can be further classified based on the treatment provided by them (indicative) or in terms of facilities offered by, as:

General Medical & Surgical Hospitals, Specialty Hospitals, Teaching Hospitals, Clinics, Psychiatric Hospitals, Family Planning & Abortion Clinics, Hospices & Palliative Care Centers, Emergency & Other Outpatient Care Centers, Sleep Disorder Clinics, Dental Laboratories and Blood & Organ Banks.

General Medical & Surgical Hospitals:

The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health.

Specialty Hospitals:

Specialty hospitals provide care for a specific specialty and tailor their care and facilities to fit the chosen type of condition, patient, or procedure on which they focus. Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth.

 

Teaching Hospitals:

Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school, or university.

 

 

Clinics:

The medical facility smaller than a hospital is generally called a clinic and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Psychiatric Hospitals:

Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. This industry includes establishments licensed to provide diagnostic, medical treatment, and monitoring services for inpatients who suffer from mental illness or substance abuse disorders.

Family Planning & Abortion Clinics:

Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. This industry includes freestanding centers with medical staff primarily engaged in assisting pregnant women and families in making various decisions regarding family planning.

Hospices & Palliative Care Centers:

This industry provides programs that offer symptom relief and pain management for patients with life-terminating illnesses.

 

Emergency & Other Outpatient Care Centers:

This industry includes establishments with medical staff primarily engaged in providing emergency, general, or specialized outpatient care not included in other industries.

Sleep Disorder Clinics:

This industry includes facilities that are devoted to the diagnosis and care of outpatients with disorders that affect, disrupt, or more generally involve sleep.

Dental Laboratories:

Dental laboratories manufacture or customize a variety of products to assist in the provision of oral health care by a licensed dentist.

Blood & Organ Banks:

Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. This industry includes companies that are primarily engaged in collecting, storing, and distributing blood, blood products, and body organs.

 

 

 

 

Hospital Departments:

Accident and emergency (A&E):

Also called Casualty Department, where you're likely to be taken if you have arrived in an ambulance or emergency situation.

Anesthetics: 

Doctors in this department give anesthetic for operations and procedures. An anesthetic is a drug or agent that produces a complete or partial loss of feeling. There are three kinds of anesthetic: general, regional and local.

Cardiology: 

Provides medical care to patients who have problems with their heart or circulation Chaplaincy - Chaplains promote the spiritual and pastoral wellbeing of patients, relatives and staff.

Critical Care:

Also called intensive care, this department is for seriously ill patients. Diagnostic Imaging - Also known as X-Ray Department and/or Radiology Department. Elderly services - Covers and assists with a wide range of issues associated with seniors. Gastroenterology - This department investigates and treats digestive and upper and lower gastrointestinal diseases. 

 

 

Health & Safety:

The role of the occupational health and safety department is to promote and maintain the highest possible degree of health and safety for all employees, physicians, volunteers, students and contractors, and actively participates in quality, safety and risk initiatives.

Infection Control:

Primarily responsible for conducting surveillance of hospital- acquired infections and investigating and controlling outbreaks or infection clusters among patients and health care personnel. The department calculates rates of hospital-acquired infections, collates antibiotic susceptibility data, performs analysis of aggregated infection data and provides comparative data to national benchmarks over time. Information Management - Meaningful information can be used in quality management, continuous quality improvement and peer review.

General Services:

Support Services include services provided by Departments such as Potering, Catering, Housekeeping, Security, Health & Safety, Switch, Laundry and the management of facilities such as parking, baby tagging, access control, CCTV etc.  General Surgery - Covers a wide range of types of surgery and procedures on patients. Gynecology - Investigates and treats problems relating to the female urinary tract and reproductive organs, such as endometritis, infertility and incontinence. Hematology - These hospital services work with the laboratory.

 

Maternity:

Maternity wards provide antenatal care, delivery of babies and care during childbirth, and postnatal support. Microbiology - The microbiology department provides an extensive clinical service, including mycology, parasitology, mycobacteriology, a high security pathology unit, and a healthcare associated infection investigation unit, as well as routine bacteriology and an expanding molecular diagnostic repertoire.

Neurology:

A medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.

Occupational Therapy:

Helps physically or mentally impaired people, including temporary disability, practices in the fields of both healthcare as well as social care. Oncology - A branch of medicine that deals with cancer and tumors. A medical professional who practices oncology is an oncologist. The Oncology department provides treatments, including radiotherapy and chemotherapy, for cancerous tumors and blood disorders. cancer and tumors radiotherapy chemotherapy.  

Ophthalmology - Ophthalmology is a branch of medicine which deals with the diseases and surgery of the visual pathways, including the eye, hairs, and areas surrounding the eye, such as the lagrimal system and eyelids Orthopaedics -Treats conditions related to the musculoskeletal system, including joints, ligaments, bones, muscles, tendons and nerves.

Pharmacy:

Responsible for drugs in a hospital, including purchasing, supply and distribution. Physiotherapy - Physiotherapists work through physical therapies such as exercise, massage, and manipulation of bones, joints and muscle tissues. physical therapies  Purchasing & Supplies - Purchasing & Supplies Department is responsible for the procurement function of the hospital.

Radiotherapy:

Also called radiation therapy, is the treatment of cancer and other diseases with ionizing radiation. Renal - Provides facilities for peritoneal dialysis and helps facilitate home hemodialysis. Rheumatology - Rheumatologists care for and treat patients for musculoskeletal disorders such as: bones, joints, ligaments, tendons, muscles and nerves.

Social Work:

Clinical social workers help patients and their families deal with the broad range of psychosocial issues and stresses related to coping with illness and maintaining health. Social workers, resource specialists and advocates form a network that addresses the challenges families face, increases accessibility to health care and other human services, and serves as a bridge between the hospital setting and a patient's family life, home and community.

 

Otolaryngology (Ear, Nose, and Throat):

The ENT Department provide comprehensive and specialized care covering both Medical and Surgical conditions related not just specifically to the Ear, Nose and Throat Pain Management - Helps treat patients with severe long-term pain. Alternative pain relief treatments such as acupuncture, nerve blocks and drug treatment, are also catered for severe long-term pain acupuncture Patient Accounts - The Patient Accounts Department answers all billing questions and concerns, requests for itemized bills, and account balance inquiries. The patient accounts department also assists patients in their insurance benefits for services rendered.

 

Department of clinical nutrition:

Purpose:

To establish the procedure by which patients are referred to the Clinical Nutrition Department for nutritional management.

Clinical Dietitians must be given at least 24 hours notice prior to the discharge of patients requiring take home supplies in order to arrange this supply.

Policy and procedure:

Defines the role of health care givers in assessment, follow up and monitoring of patients according to their nutritional needs.

Each patient has a complete order for food or other nutrients based on assessed nutritional status or need.

Include:

Each patient has a complete order for food or other nutrients based on assessed nutritional status or need. Ordering of food that is appropriate to the patient's clinical condition. 

Schedule for meals and timings of distribution of meals, Food storage, Food Preparation. Food is appropriate to the patient's clinical condition and needs. There is a schedule for meals and a process to ensure timely distribution of meals. 

Patients assessed as being at nutritional risk receive nutritional therapy as indicated. Food and nutrition products are stored order proper conditions of sanitation, temperature and ventilation. Policy and procedure governs the preparation, storage and administration of feeding tube nutritional therapy.

Job description:

Standard role of dietitian according to BAPEN:

Maintains itself as the  principal  source of evidence-based information on food and nutrition and is an important contributor on nutritional assessment and support, Supervises and supports dietitians and dietetic assistants, Provides nutritional advice and expertise in all units of the hospital, including Catering, Liaises closely with Nutrition Steering Committee and the Nutrition Support Team, Participates in education and training, Assesses diet and nutrition  in more detail than a basic screen.

Provides dietetic advice tailored to individual patient’s needs, Tailors food and supplements to special dietary/nutritional needs, Supervises, analyses and interprets dietary records and recalls. Prescribes or helps prescribe enteral feeds and supplements, liaising with doctors, nurses and the nutrition support team.

Is part of the ward understands wards and patient problems in order to help solve them, Liaises with clinical staff including ward nurses, SALT, doctors, occupational therapists and social workers etc. Advises about enteral feeding techniques, Advises about parenteral nutrition in liaison with Nutrition Support Team, Provides community liaison and care (extended roles –links with NNS, Provides out-patient nutritional care and follow up.

 

Food Safety in Hospitals:

Food hygiene is the conditions and measures that is necessary to ensure the safety of food from production to consumption. It is a fundamental requirement of any food process that the food produced should be safe for consumption. Food safety is a basic need but there is a danger that it may be overlooked in the development of effective and efficient processes. 

Food safety remains a critical issue with outbreaks of foodborne illness resulting in substantial costs to individuals, the food industry and the economy. Unsafe food has been a human health problem since history was first recorded, and many food safety problems encountered today are not new. 

Although governments all over the world are doing their best to improve the safety of the food supply, the occurrence of foodborne disease remains a significant health issue in both developed and developing countries. Food can become contaminated at any point during slaughtering or harvesting, processing, storage, distribution, transportation and preparation. 

Proper food preparation can prevent most food borne diseases (Five keys to safer food manual). More than 200 known diseases are transmitted through food. Recent years have seen a reversal in this trend but food poisoning remains a high priority for the public and government. 

Mishandling of food plays a significant role in the occurrence of foodborne illness. Improper food handling may be implicated in 97% of all foodborne illness associated with catering outlets. The chances of food contamination and cross contamination become higher especially in the lower socio-economic classes due to unsatisfactory environmental conditions, poor personal hygiene, poor quality and insufficient water supplies, unhygienic preparation storage and feeding of foods. 

 

General Food safety hazards:

Food safety hazards are contaminants that may cause a food product to be unsafe for production. Lack of adequate food hygiene can lead to food borne diseases and death of the consumer. Contaminated food presents one of the most common cause and major contributor to gastrointestinal illness 

(e.g. acute diarrhea, nausea, vomiting and abdominal pain), compromised nutritional status and less resistance to disease and loss of productivity in the world today. To a large extent gastrointestinal illness resulting from food contamination can be prevented if safe food-hygiene practices are followed at various stages of food purchase, storage, preparation and consumption. 

The World Health Organization (WHO) has long been aware of the need to educate food handlers about their responsibilities for food safety. In the early 1990s, WHO developed the Ten Golden Rules for Safe Food Preparation and introduced the Five Keys to Safer Food in 2001. 

Recognizing the importance of safe food in human health, WHO has selected the theme of Food Safety for the World Health Day 2015 with the objective of ensuring safety of food from farm to plate.

 

Food contamination during food processing 

The presence of unwanted materials such as dust and particles during the manufacturing and transportation time is called contamination. The term contaminants include any unwanted matter that is found in the product. 

These contaminants affect the quality of the product or the process. It has been demonstrated that food contamination, either from microbiological or chemical origin, is the highest concern for consumers. Sample treatment devices, such as micro extraction techniques able to remove the matrix interferences and to concentrate the analyses from the sample, have been developed and proposed as powerful tools for food analysis. But the task of identifying the contaminants, either those coming from the food production, the food processing or the packaging is still a challenge. 

The information about the likely contaminants coming from each step of the food processing is essential. In the following paragraphs the description of the main contaminants in each step, how to control them and how to prevent or diminish them from the food are discussed. This information is essential to identify the origin of the contaminants in the final food.

1. External raw food contamination:

Industrial growth, advances in the use of agrochemicals, or the urban activities can contribute to the presence of food contaminants. An important focus of food contaminants is the use of fertilizers and pesticides, since they can cause health problems if they are consumed by humans. 

Some studies detected pesticide residues in fruits and vegetables and also some derivatives with also adverse effects, such as metabolites from organochlorine pesticides have been found in fatty food. Heavy metals such as cadmium, lead, mercury, and arsenic, recognized as toxic, can be present in air, soil, and water and therefore they can be transferred to foodstuff. 

The analysis of heavy metals has been performed in several foodstuffs such as honey, spinach, potatoes, fish and tea. The major techniques employed for heavy metal analysis are flame atomic absorption spectrometry (FAAS), graphite furnace atomic absorption spectrometry (GFAAS), cold vapor atomic absorption spectrometry (CVAAS), inductively coupled plasma atomic emission spectrometry (ICP-AES), and inductively coupled plasma mass spectrometry (ICP-MS). 

Several methods have been developed for determining antibiotic residues in foodstuff such as meat, eggs or milk, such as using the microbial inhibition plate test, or by liquid chromatography methods. 

2. Contamination during food transport: 

Food contamination can also take place during transportation. It can be cause by from vehicle exhausts of petrol and diesel or because a cross contamination in the vehicle used for food transportation. This cross-contamination can create a serious risk for food safety. 

In 1999, a major illness in the European Economic Community was attributed to fungicide contaminated pallets used for transportation and storage of food packaging materials. Long distance transport ship has been also several times affected by cross contamination from chemicals used for disinfection or from other sources. The study carried out by is a good example of the contamination of food by permeation of naphthalene, methyl bromide, toluene, ethyl benzene and ortho par a xylenes through a theoretical high barrier material. 

3. Contamination caused by cleaning processes :

Cleaning and disinfecting during food processing eliminate the presence of possible microorganisms and therefore, they are crucial to reduce food contamination. 

Chemicals used as cleaners or disinfectants must be appropriate for food contact surfaces and need to be accepted by the legislation. Products such as glass cleaners or some metal cleaners can't be used because they might leave unsafe residues. 

The addition of sanitizers in quantities far above permitted levels could leave some residual concentration on treated materials or food even in minimum processed fruits and vegetables, and therefore, to quantify the residual chemicals present in the food is important in order to certify that they have been completely removed. 

Some common surfactants are quaternary ammonium compounds such as dodecyl-trimethyl-ammoniumchloride and nonionic surfactants such as stearyl alcohol ethoxylate. Factors affecting its elimination from different materials surfaces, such as rinsing time or water temperature. 

These compounds are commonly analyzed by liquid chromatography mass spectrometry. Problems related to residues coming from cleaning agents and disinfectants used in surfaces of food handling equipment and its transference to food that has been in contact with such surfaces have been discussed by several authors. 

4. Contamination due to heating steps 

The use of high cooking temperatures in combination with external factors, can lead to the formation of toxic compounds, which can have a deleterious effect on the food quality and safety. Certain toxics compounds (e.g., acrylamide, nitrosamines chloropropanols, furanes or PAHs) can be formed in foods during their processing, such as during heating, baking, roasting, grilling, canning, hydrolysis or fermentation. Frying is by far the cooking process that can act as a generator of a wide variety of toxic compounds into the food. 

Flavor substances are produced by reactions of oxidized frying oil with proteins and other sulfur and nitrogen substances in the food. Various compounds are released from the food into frying oil, enhancing discoloration or off-flavors. 

Pigments present in frying oil may also be adsorbed on the surface of fried food. A recent report from EFSA says that the mean exposure to 3-monochloro-1,2-propanediol (3-MCPD) was plasticizers, antioxidants, monomers, stabilizers, etc) can migrate from the package into the food. This results in a decrease of food quality and food safety. 

Microwaves can also increase the diffusion rates, cause degradation of migrants or polymer, or cause hot spots, which would increase the migration to higher levels than those expected from the bulk heating temperature.

5. Food packaging 

Food packaging provides many advantages such as physical protection, barrier protection and it also allows a better food preservation that will increase the shelf life of the product. The direct or indirect contact between the food and the packaging material can end up the transference of these substances from the packaging to food, in a phenomenon called migration. 

Migrants can pose a health risk for consumers if they have a toxic effect. To protect the consumers, there is a strict legislation in FDA, Europe, Mercosur, Australia and Euroasia as well as in many countries to avoid the contamination from the materials and articles to the food in contact with them. 

In Europe, food packaging materials must comply with the framework Regulation (EC) No 1935/2004 on materials and articles intended to come into contact with food (European-Commission, 2004) and with Regulation (EC) No 2023/2006 on good manufacturing practice (European-Commission, 2006). Migration from plastic food contact materials must fulfill the Regulation EU/10/2011 from the European Commission (European-Commission, 2011). 

Any compound with a molecular mass lower than 1000 amu can migrate and cross the polymeric or paper layers, arrive at the food and be dissolved in it. When metallic cans are used for food packaging, corrosion phenomena in the metallic surface of the can could produce a migration of metallic ions to food, such as iron or tin. 

Minor by-products from the manufacture of epoxy resins, such as bisphenol A, bisphenol A diglycidyl ether (BADGE) or cyclo-di- BADGE among others can migrate to food. 

Another common material used in marmalades, jams, vegetables, beans or sauces packaging is glass. In this case, migration comes from the metallic lids used for closing the glass jars. Epoxidized soybean oil (ESBO) is one of the additives used as plasticizer in PVC and its migration to food has been reported by several authors. 

Paper and board are commonly used for packaging dry food, such as flour or sugar, or products such as rice, cereals or frozen food. Migration from paperboard additives or from printing inks to foodstuff can take place. 

The most recycled packaging material and the use of recycled materials can produce food contamination of substances such as mineral oils or plasticizers coming either from printing inks or adhesives. 

Typical polymers used in food packaging materials are polyethylene (PE), high density polyethylene (HDPE), polyethylene terephthalate (PET), polyvinyl chloride (PVC), polystyrene (PS) and polycarbonate (PC). Migration from inks has been also widely studied, specially migration of photo initiators such as benzophenone (BP) or 2-isopropylthioxanthone (ITX) coming from UV curable inks. 

More recently migration from components coming from printing inks as a result of set-off transference has been reported. Plastic recycled materials have also special relevance, as they could contain chemical compounds coming from the previously packaged food, substances resulting from the misuse of the packaging by the consumer or intrinsic contaminants from the recycling process (chemical additives). 

The substances intentionally added to food packaging materials, non-intentionally added substance (NIAS) can also migrate to food and can have also adverse effects. Degradation processes of the polymer itself due to high temperatures or high irradiation energies that take place during polymer manufacturing, and also from degradation processes of polymer additives. NIAS can also come from impurities present in the raw materials. 

 

 

 

6. Contamination during food storage: 

Food storage conditions are key parameters in food quality and safety. Proper storage extends the shelf life of food, which depends on the food type, packaging and storage conditions, particularly temperature and humidity. 

Organoleptic changes should not occur during food storage and therefore packaging materials used for long term storage should exhibit very good barrier properties. 

Moisture can lead to the breakdown of some packaging materials (e.g., paper degradation and metal rusting). The optimal range of temperature is the cool to moderate range, between 4 and 210C. Direct sunlight can speed deterioration both on the food and on the packaging. Depending on the barrier properties the transference of compounds through the packaging material will be different as was demonstrated.  

Food Safety Hazards Agents:

Food safety hazards are contaminants that may cause a food product to be unsafe for production. Hazard is a biological, chemical or physical agent in, or condition of, food with the potential to cause an adverse health effect. 

Food safety hazards may be biological, such as pathogenic bacteria, chemical, such as a toxin produced during processing, or a physical object, like a stone or piece of metal. In other words, hazards are the factors that food safety practice seeks to protect against, contain and eliminate from foods. 

In order to be effective, food safety practice must be informed about the nature of these hazards, and food safety procedures must be science based. A thorough understanding of biological and chemical hazards is the first essential step in their control. This is less important for physical hazards, which also tend to have a much lower potential impact on public health. Physical hazards are not considered further here.

Hazards may enter a food product from its ingredients or may contaminate during processing or handling. It is important to understand the likely hazards that might be encountered in the chosen ingredient types, or that might be present in the processing environment. This allows the development team to identify the best ways to control these hazards, either by preventing their entry to the process, destroying them or reducing the contamination to a level. It is no longer process a food safety risk. 

This information on likely hazards and proposed control options should link with the prerequisite good manufacturing practice programs and HACCP systems to ensure everyday control is established in the manufacturing operation.

Biological Hazards:

It is generally biological hazards that pose the greatest immediate food safety threat to the consumer. For example, the ability of food-poisoning bacteria to cause large outbreaks of acute illness within a short time is a threat with which most food businesses are likely to have to contend. 

There are few foods that are not vulnerable to biological hazards at some point in their manufacture, storage and distribution. Technically, biological hazards may include larger organisms, such as insects and rodents. 

However, these rarely present a direct threat to health and are not considered further here. It is micro-organisms and certain foodborne parasites that are of most concern as food safety hazards. 

1-Bacteria: 

A significant number of bacterial species can be classified as food safety hazards. Some of these, such as Salmonella and Listeria monocytogenes, are very well known and familiar to consumers, whereas others are much less common and less well understood. 

Examples include Vibrio parahaemolyticus, a comparatively rare cause of food poisoning associated with seafood, and Yersinia enterocolitica, a cause of gastroenteritis that predominantly affects young children. 

Campylobacter is another example of a less well known cause of foodborne illness. Few consumers have heard of this organism, yet it is now the cause of more reported cases of food poisoning than any other agent, including Salmonella. Campylobacter is also less familiar to the food industry and there are still many unknowns surrounding its transmission to humans. 

This underlines the importance of continued research and scientific investigation for increasing our understanding of biological hazards. Bacterial food safety hazards fall into one of two categories according to the mechanism by which they cause illness:

A) Infection: 

Most foodborne bacterial pathogens cause illness by multiplying in the gut after ingestion of contaminated food. They may then provoke symptoms by invading the cells lining the intestine, or in some cases, invading other parts of the body and causing more serious illnesses. 

Salmonella, Campylobacter and E. coli O157 are all examples of bacteria that cause infective food poisoning. This type of food poisoning is usually characterized by a delay, or incubation time, of at least 8–12 h (sometimes much longer) before symptoms develop. 

This category also includes some bacteria that produce symptoms by multiplying in the gut and producing toxins, rather than by actively invading the tissues. An example of this type is Clostridium perfringens, a food-poisoning bacterium usually associated with cooked-meat products. 

B) Intoxication: 

There are a few foodborne pathogenic bacteria that produce illness not by infection, but by intoxication. These organisms are able to grow in certain foods under favorable conditions and produce toxins as a by-product of growth. The toxin is thus pre-formed in the food before ingestion and in some cases toxin may still be present even after all the bacterial cells have been destroyed by cooking. 

Bacillus cereus and Staphylococcus aureus are examples of bacteria able to cause intoxication, but the most important and potentially serious cause of intoxication is Clostridium botulinum. 

Intoxications usually have much shorter incubations times than infections, because the toxins are pre-formed in the food.

2-Viruses: 

Viral gastroenteritis is very common worldwide. There are a number of viruses that are capable of causing foodborne infections, although in most cases, other forms of transmission are more common. Perhaps the best known are noroviruses and hepatitis A, which has been responsible for a number of serious foodborne disease outbreaks, often as a result of poor personal hygiene by infected food handlers. 

New viruses may also pose a threat to food safety. For example, highly pathogenic avian influenza viruses primarily affect birds, but in some cases may be transmitted to humans and cause serious disease. So far, there is no direct evidence that this transmission can be foodborne, but these viruses are a source of great concern to the poultry industry and there is still much to learn about them.

3-Parasites: 

A wide range of intestinal parasites can be transmitted to humans via contaminated foods, although for most, fecal–oral, or waterborne transmission are more common. These organisms are much more prevalent in developing countries with poor sanitation, but the increasingly global nature of the food supply chain may increase their importance in the developed world. 

Currently, protozoan parasites are the most important, but other types also need to be considered as food safety hazard.

A) Protozoans: 

The protozoan parasites that can cause foodborne illness in humans include several well-known species, such as Entamoeba histolytica, the cause of amoebic dysentery, and Cryptosporidium parvum. However, in recent years, some unfamiliar species have emerged as threats to food safety, especially as contaminants in imported produce. 

An example is Cyclospora cayetanensis, the cause of several outbreaks of gastroenteritis in the USA associated with imported fruit.

B) Other Types of Parasite: 

Other types of foodborne parasite include nematode worms, such as Trichinella spiralis and the anisakid worms found in fish, and cestodes (tapeworms), such as Taenia solium. Although many of these are far less prevalent in developed countries than was once the case, thanks to improved sanitation, they are still significant causes of illness worldwide.

4-Prions: 

Prions are a relatively recent threat to food safety and are still not fully understood, but their probable involvement in potentially foodborne new variant Creutzfeldt–Jakob disease (vCJD), an invariably fatal brain disease, has lead to considerable concern.

 

 

 

Chemical Hazards:

The presence of chemical hazards in food is usually less immediately apparent than that of bacteria and other biological hazards. Acute toxicity caused by foodborne chemical contaminants is now very rare in developed countries. Of much more concern is the potentially insidious effect of exposure to low levels of toxic chemicals in the diet over long periods. In some cases this can lead to chronic illness and there is also the risk that some contaminants may be carcinogenic. 

There is potential for an enormous range of chemical contaminants to enter the food chain at any stage in production. For example, agricultural chemicals, such as herbicides and insecticides, may contaminate fresh produce during primary production, some commodities may contain natural biological toxins, and chemicals such as detergents and lubricants may enter food during processing. It is also possible for chemical contaminants to leach out of packaging into foods during storage.

 

Some of the main classes of chemical contaminant important in food safety are as follows: agricultural chemicals, pesticides,  veterinary drugs,  natural biological toxins, fungal toxins, plant toxins, fish toxins,  environmental contaminants (e.g. dioxins and heavy metals), contaminants produced during processing (e.g. acrylamide), contaminants from food-contact materials (e.g. plasticisers), cleaning and sanitizing chemicals, adulterants (e.g. illegal food dyes).

 

The total number of potentially harmful chemicals that may contaminate food is very large. For example, UK legislation contains maximum residue levels (MRLs) for over 28 000 pesticide/commodity combinations. It is therefore not practical to cover pesticides here in anything but the most general terms. 

Fortunately, the use of pesticides is very strictly controlled in many countries and residues in imported foods are regularly monitored. Links are provided in the ‘‘Sources of Further Information’’ section for readers needing specific information on pesticides. 

The list of potential adulterants is also an extensive one. Almost by definition, adulterants are often compounds that would not be expected to be present in foods and little may be known about their health significance if present in the diet. Recent examples include synthetic Sudan dyes found in imported spices and other commodities in the EU. These are illegal for food use, but the health effects of low levels in foods are uncertain, and there has been some discussion over their food safety significance. For these reasons, it is not practical to cover adulterants here. 

The chemical-hazards section focuses on contaminants that are known to be food safety hazards, and that have received some attention from food safety researchers and regulators to establish the level of risk they carry.

The Obligations of Food Business: 

In most countries, the safety of the food supply is regulated by national and by local authorities. Food businesses are required to meet the demands of food safety regulations, at the very least, in order to protect consumers from hazards in food. These are likely to include the setting up of an effective food safety management system, such as hazard-analysis critical control point (HACCP). In addition, many food businesses will need to meet the requirements of their customers, such as large retail chains, or will need to comply with the food safety provisions of third-party audit schemes. 

Most of these will expect more extensive food safety measures than are required by relevant legislation. Most businesses will find it necessary to adopt a risk assessment and HACCP-based approach to addressing food safety, and there is considerable assistance and support available to help with this. 

Nevertheless, it is important that every food business develops at least a basic understanding of the specific food safety hazards that may be relevant to their products and processes. Only then can food safety management systems operate effectively. 

 

The Hazard Analysis Critical Control Point (HACCP):

HACCP (Hazard Analysis and Critical Control Point) is a systematic approach in identifying, evaluating and controlling food safety hazards. Food safety hazards are biological, chemical or physical agents that are reasonably likely to cause illness or injury in the absence of their control. A HACCP system is a preventive system of hazard control rather than a reactive one. 

HACCP systems are designed to prevent the occurrence of potential food safety problems. This is achieved by assessing the inherent hazards attributable to a product or a process, determining the necessary steps that will control the identified hazards, and implementing active managerial control practices to ensure that the hazards are eliminated or minimized.

Essentially, HACCP is a system that identifies and monitors specific foodborne hazards – biological, chemical, or physical properties – that can adversely affect the safety of the food product. This hazard analysis serves as the basis for establishing critical control points (CCPs). 

CCPs identify those points in the process that must be controlled to ensure the safety of the food. Further, critical limits are established that document the appropriate parameters that must be met at each CCP. Monitoring and verification steps are included in the system, again, to ensure that potential hazards are controlled. 

The hazard analysis, critical control points, critical limits, and monitoring and verification steps are documented in a HACCP plan. Seven principles have been developed which provide guidance on the development of an effective HACCP plan.

 

HISTORY OF HACCP 

HACCP has become synonymous with food safety. It is a worldwide-recognized systematic and preventive approach that addresses biological, chemical and physical hazards through anticipation and prevention, rather than through end-product inspection and testing. 

The HACCP system for managing food safety concerns grew from two major developments. The first breakthrough was associated with W.E. Deming, whose theories of quality management are widely regarded as a major factor in turning around the quality of Japanese products in the 1950s. Dr Deming and others developed total quality management (TQM) systems which emphasized a total systems approach to manufacturing that could improve quality while lowering costs. 

The second major breakthrough was the development of the HACCP concept itself. The HACCP concept was pioneered in the 1960s by the Pillsbury Company, the United States Army and the United States National Aeronautics and Space Administration (NASA) as a collaborative development for the production of safe foods for the United States space program. 

NASA wanted a "zero defects" program to guarantee the safety of the foods that astronauts would consume in space. Pillsbury therefore introduced and adopted HACCP as the system that could provide the greatest safety while reducing dependence on end-product inspection and testing. 

 

HACCP emphasized control of the process as far upstream in the processing system as possible by utilizing operator control and/or continuous monitoring techniques at critical control points. Pillsbury presented the HACCP concept publicly at a conference for food protection in 1971. 

The use of HACCP principles in the promulgation of regulations for low-acid canned food was completed in 1974 by the United States Food and Drug Administration (FDA). In the early 1980s, the HACCP approach was adopted by other major food companies. 

The United States National Academy of Science recommended in 1985 that the HACCP approach be adopted in food processing establishments to ensure food safety. More recently, numerous groups, including for example the International Commission on Microbiological Specifications for Foods (ICMSF) and the International Association of Milk, Food and Environmental Sanitarians (IAMFES), have recommended the broad application of HACCP to food safety.

 

Terms of HACCP System:

The following terms are used in discussion of HACCP that must be clearly understood to effectively develop and implement a plan: 

Acceptable Level: means that the presence of hazard which does not pose the likelihood of causing an unacceptable health risk.

Control point: means any point in a specific food system at which loss of control does not lead to an unacceptable health risk.

Critical control point: as defined in the food Code, means a point at which loss of control may result in an unacceptable health risk.

Critical Limit: as defined in the Food Code, means the maximum or minimum value to which a physical, biological, or chemical parameter must be controlled at a critical control point to minimize the risk that the identified food safety hazard may occur.

Deviation: means failure to meet a required critical limit for a critical control point.

HACCP plan: as defined in the Food Code, means a written document that delineates the formal procedures for following the HACCP principles developed by The National Advisory Committee on Microbiological Criteria in Foods. 

Hazard: as defined in the Food Code, means a biological, chemical, or physical property that may cause an unacceptable consumer health risk.

Monitoring: means a planned sequence of observations of measurement of critical limits designed to produce an accurate record and intended to ensure that the critical limit maintains product safety. Continuous monitoring means an uninterrupted record of data.

Preventive: measure means an action to exclude, destroy, eliminate, or reduce a hazard and prevent recontamination through effective means.

Risk: means an estimate of the likely occurrence of a hazard.

Sensitive Ingredient: means any ingredient historically associated with a known microbiological hazard that causes of contributes to production of a potentially hazardous food as defined in the Food Code.

Verification: means methods, procedures, and tests used to determine if the HACCP system in use in compliance with the HACCP plan.

 

 

Scope of HACCP

Aggressive competition required organization to reduce costs while maintaining quality. Increasing consumer awareness and legal liability to produce safe food. Changes in processed technology, increased automation, complex packaging solutions, new ingredients and improved formulations. Greater emphasis on sensory evaluations and complex distribution networks leading to reduce delivery times.

 

Seven principles of HACCP:

Principle 1: (Conduct a hazard analysis)

Identify the potential hazard(s) associated with food production at all stages, from primary production, processing, manufacture and distribution until the point of consumption. Assess the likelihood of occurrence of the hazard(s) and identify the measures for their control. 

 

Principle 2: (Determine the Critical Control Points (CCPs))

Determine the points, procedures or operational steps that can be controlled to eliminate the hazard(s) or minimize its (their) likelihood of occurrence. A "step" means any stage in food production and/or manufacture including the receipt and/or production of raw materials, harvesting, transport, formulation, processing, storage, etc. 

 

Principle 3: (Establish critical limit(s))

Optical limits must be specified and validated if possible for each Critical Control Point. In some cases more than one critical limit will be elaborated at a particular step. 

Criteria often used include measurements of temperature, time, moisture level, pH, Aw, available chlorine and sensory parameters such as visual appearance and texture.

 

Principle 4: (Establish monitoring procedures)

Monitoring is the scheduled measurement or observation of a CCP relative to its critical limits. Monitoring should ideally provide this information in time to make adjustments to ensure control of the process to prevent violating the critical limits. Where possible, process adjustments should be made when monitoring results indicate a trend towards loss of control at a CCP. 

The adjustments should be taken before a deviation occurs. Data derived from monitoring must be evaluated by a designated person with knowledge and authority to carryout corrective actions when indicated. 

If monitoring is not continuous, then the amount or frequency of monitoring must be sufficient to guarantee the CCP in control. 

 

 

Principle 5: (Establish corrective actions)

Specific corrective actions must be developed for each CCP in the HACCP system in order to deal with deviations when they occur. The actions must ensure that the CCP has been brought under control, Actions taken must also include proper disposition of the affected product. Deviation and product disposition procedures must be documented in the HACCP record keeping.

 

Principle 6: (Establish verification procedures)

Verification and auditing methods, procedures and tests, including random sampling and analysis, can be used to determine if the HACCP system is working correctly. The frequency of verification should be sufficient to confirm that the HACCP system is working effectively. Examples of verification activities include: 

Review of the HACCP system and its records, Review of deviations and product dispositions, Confirmation that CCPs are kept under control.

Where possible, validation activities should include actions to confirm the efficacy of all elements of the HACCP plan.

Principle 7: (Establish record-keeping and documentation procedures)

Efficient and accurate record keeping is essential to the application of an HACCP system. HACCP procedures should be documented. 

Documentation and record keeping should be appropriate to the nature and size of the operation. 

Documentation examples: Hazard analysis, CCP determination, Critical limit determination. 

Record  examples: CCP monitoring activities, Deviations and associated corrective reactions, Modifications to the HACCP system.

 

Development of the HACCP Plan:

Development of the HACCP plan goes through four distinct stages. The key tasks associated at each stage are applicable to any food processing operation.

The Team:

HACCP study begins with the selection of a team consisting of members drawn from various disciplines in the food processing operation. All the key functions of the organization should be represented in the team and may include a project leader, a production manager, a technical expert, an engineer, a secretary and others required. 

Once the team is formed, the members will require further training on HACCP principles and they should be provided with the necessary tools to perform the tasks.

 

Training:

HACCP training has now been accepted as the most cost-effective means of controlling hazards related to microbiological, physical and chemical contamination of foods. Implementation of the HACCP plan is a team exercise; thus training and education are essential if full benefits are to be achieved.

Product description and Intended use

The HACCP team needs to have a complete understanding of the product, its intended use, the ingredients used, the composition of the product, and the processing steps. It is necessary to have this information before analyzing for hazards because the food products have to be assessed in relation to the ability of different pathogens to grow. 

The product description should include (i) name of the product (ii) end product features (e.g., pH, preservatives, etc.) (iii) How the product is to be used (i.e., ready-to-eat products, further processing or heated prior to consumption) (iv) packaging details (e.g., packaging materials and conditions) (v) shelf life (vi) distribution outlets (vii) labeling instructions (viii) shipping conditions and (ix) target consumer group.

Flow Diagram:

Food processing operation is a continuous flow of food ingredients from “farm to fork”. A flow diagram breaks up the process into a series of sequential steps that assist further evaluation. 

It typically commences at the point where the food is received at the operation. Thus, the steps in the flow diagram include the entry of ingredients, processing steps, packaging, storage, distribution and handling by the consumer.  

 

Measures to Control Hazards:

1. Measure at the processing and packaging stages (Raw materials, packaging materials, processing steps, plant and machinery, storage and Distribution, premises and     personnel).

 






Method



Control parameters





Heat treatment



Time, Temperature and Humidity





Filtration



Pore, size and filter integrity





Irradiation



Dosage and Density of load





Chemical



Concentration, pH and Temperature





(Methods to Measure How to Control Hazards)

2. Measures at post processing and packaging stages (Retail and Food service)

3. The consumer (Food preparation and Food usage).

Critical controls for foodstuffs

Fresh juices

Fresh squeezed orange juice, Sparkling apple cider and All-vegetable cocktail. Americans quench their thirst with these and other fruit and vegetable juices, and the vast majority of those juices are not only healthy but safe. Very rarely, however, juice can turn dangerous.

 

NACMCF (National advisory committee on microbiological criteria for foods) conclusions for fresh juices

The Committee concludes that while the risks associated with specific juices vary, there are safety concerns associated with juices, especially unpasteurized juices.

The Committee concludes that the history of public health problems associated with fresh juices indicates a need for active safety interventions.

The Committee concludes that, for some fruit, intervention may be limited to surface treatment, but for others, additional interventions may be required.

The Committee recommends the use of safety performance criteria instead of mandating the use of a specific intervention technology. In the absence of specific pathogen-product associations, the committee recommends the use of Escherichia coli O157:H7 or Listeria monocytogenes as the target organisms, as appropriate.

The Committee believes that a tolerable 1evel of risk may be achieved by requiring an intervention(s) that has been validated to achieve a cumulative 5 log reduction in the target pathogen(s) or a reduction in yearly risk of illness to less than 10-5, assuming consumption of 100 ml of juice daily.

The Committee believes that Hazard Analysis Critical Control Points (HACCP) and safety performance criteria form the general conceptual framework needed to assure the safety of juices. Control measures should be based on a thorough hazard analysis. Validation of the process must be an integral part of this framework.

The Committee recommends mandatory HACCP for all juice products. Implicit in this recommendation is that plants have implemented and are strictly adhering to industry GMPs.

The Committee recommends industry education programs addressing basic food microbiology, the principles of cleaning and sanitizing equipment, GMPs and HACCP.

 

The Committee recommends further study in the following areas:

Research on the efficacy of new technologies and intervention strategies for safety. 

Research on the contamination, survival and growth of pathogens on produce with or without breaks in skin, areas of rot, and within the core. 

Research on how produce becomes contaminated with human pathogens including the relevant microbial ecology during production and processing of juice. In particular, there is an urgent need for these types of studies on E. coli O157:H7 in apple juice. 

Baseline studies on the incidence of human pathogens on fruits and vegetables, particularly those used in juice processing. 

Research on labeling information needed for consumer understanding and choice of safer juices and juice products.

 

Hazard Analysis:

Hazard Analysis, the first principle of the HACCP program, is necessary to identify those hazards that must be eliminated or reduced to an acceptable level to produce safe food. 

A hazard analysis serves three purposes: (i) to identify the hazards of significance to food safety, (ii) to select critical hazards on the basis of risk to the consumer, and (iii) to identify potential hazards that warrant specific preventive measures. 

When the same product is manufactured by different food processing organizations, the hazards will depend upon the following: (i) sources of ingredients, (ii) product formulations, (iii) processing machinery and equipment, (iv) processing and preparation procedures, (v) duration of processes, (vi) storage conditions, and (vii) experience, knowledge, and attitudes of the personnel. Hazard Analysis form, Hazard identification with inputs and Hazard analysis and CCP determination.

Consumer protection:

The primary objective of an HACCP system is to protect the consumer from the harm caused by hazards associated with food products.

 

What Can Consumers Do in the Meantime? 

FDA urges high risk individuals, children, the elderly, and those with weakened immune systems to drink only pasteurized juices. And while manufacturers were asked before the date in the regulation to voluntarily place warning statements on the labels of juices that haven't been pasteurized, the agency advises people to be aware that a product without a warning label at this time might still be unpasteurized. 

A good rule of thumb for high-risk individuals, says FDA, is if you cannot determine whether a product has been pasteurized, the best choice is to not use the product. Another choice is to bring the juice to a boil to kill any possible harmful bacteria. 

The agency also advises consumers to be aware of the following symptoms commonly associated with food poisoning: diarrhea, abdominal pain, cramping, vomiting, fever, and headache. If you have any of these symptoms, you should contact your physician immediately. 

 

 

Management of The HACCP Program:

Review:

The HACCP program, just like the quality management system, is dynamic. Procedures such as management responsibility, management review and document approval and issue can be applied to the HACCP system. The function of the management representative then is to maintain the system through regular audits and reviews. 

Audit: 

An HACCP audit can be defined as a systematic and independent examination to determine whether (a) HACCP activities and related results comply with the planned arrangements, (b) these arrangements are implemented effectively, and (c) the arrangements are suitable to achieve the objectives. A schedule of audits must be prepared and carried out as planned. 

There is no international standard yet for the HACCP system equivalent to the ISO 9000 standard series. HACCP audits should be provided (a) an assessment of the adequacy of the existing system, (b) a bench mark against which improvements can be made and evaluated, (c) evidence that contractual and legal requirements have been met, and (d) feedback on safety issues.

 

The Product Recall system:

A reliable and well-tested method of recall should be in place to deal with a food item that has been established to be contaminated with a harmful ingredient or pathogenic organisms. 

The recall team should document the following information: (i) name of the product and pack size, (ii) reason for recall (iii) cause of the problem, (iv) chronological history of the recall events with actions taken, (v) effectiveness of the recall, (vi) total cost of the recall, and (vii) corrective actions taken.

BENEFITS:

Application of an effective HACCP system has clear benefits for consumers, industry as well as regulatory bodies.

 

Benefits of Implementing the HACCP System:       

Benefits for Consumers:

Lower risk of food borne illnesses, greater awareness of food safety, greater confidence in food supply, better quality of life through health and socioeconomic benefits

Benefits for Industry:

Greater consumer confidence on product, Minimizes legal and insurance costs, Increases market access, Lower wastage, fewer no recalls, minimum or no reprocessing, and corrective action, A consistent product, Enhanced staff commitment to food safety, Lower business risk.

Benefits for Regulatory Bodies:

Improved health among the community, More efficient food control, Lower public health costs, Trade promotion, Greater confidence of the community in the food supply.

 

Application Of HACCP: 

While the application of HACCP to all segments and sectors of the food chain is possible, it is assumed that all sectors should be operating according to good manufacturing practices (GMPs) and the Codex General Principles of Food Hygiene. The ability of an industry segment or sector to support or implement the HACCP system depends on the degree of its adherence to these practices. 

The successful application of HACCP requires the full commitment and involvement of management and the workforce. It requires a multidisciplinary approach which should include as appropriate, expertise in agronomy, veterinary health, microbiology, public health, food technology, environmental health, chemistry, engineering, etc. according to the particular situation. The application of the HACCP system is compatible with the implementation of TQM systems such as the ISO 9000 series. However, HACCP is the system of choice in the management of food safety within such systems.

Purchasing

What is a Hospital Purchasing Agent?

Any partner to the healthcare industry knows there are often many decision-makers in the buying process. Often one of the most pivotal roles in that of a hospital purchasing agent. This position is essential to ensuring a hospital has all the equipment, tools, parts, supplies, or services it needs to operate seamlessly and provide the best care.

What Does a Hospital Purchasing Agent Do?

The main goal of any hospital purchasing department is to deliver high-quality goods and solutions at the best price. They play a central role in negotiating, soliciting bids, and creating purchase orders. They also review requisitions for goods and services from various departments.A hospital purchasing agent will spend a significant amount of time analyzing price proposals, financial reports, and other data to determine fair market pricing.

Day-to-day activities and responsibilities include:

Negotiating or renegotiating contracts, Administering contracts with suppliers and vendors, Monitoring shipments of purchased goods, Executing sales or other financial transactions, Analyzing data to maintain budgetary restraints.

 

 

How Hospital Purchasing Works

In the world of hospital procurement, purchasing is often extended and tedious. It can take up to a year for a purchase to be approved. Much consideration, outside of pricing, drives a hospital purchasing department.The hospital procurement process has many stages, and healthcare suppliers should ensure they have strategies in place for all of them. The steps include:

Evaluation: consider how you can make this stage easy and simple?

Planning and needs assessment: how does your product or service fulfill that need?

Procurement: making the purchase

Installation or implementation: how will you continue to support the hospital post-sale?

Monitoring: continued outreach and relationship development

 

What Impacts Decisions in Hospital Buying?

For example, community hospitals have different needs versus a large healthcare system. The former’s volume will be smaller, and they may be more price sensitive. Whereas larger healthcare systems often have more negotiating power. 

But outside of price, there are more criteria for making a purchase, including:

Vendor relationships: many hospitals have preferred vendor agreements with rebates. Urgency of need for the product. Quality of goods and services (reliability, warranties, etc.)

Risk factors: will new goods or services disrupt certain workflows?

Compliance: hospitals deal with a variety of regulations, so any product or solution they choose must be compliant.

The Evolving Supplier-Provider Model

Many healthcare vendors are shifting away from a transactional model to something more effective. These alternatives include risk-based contracting for more advanced technologies and value-based purchasing. Healthcare is an ever-changing market, and the most successful suppliers understand that and have been able to pivot.

This has changed their approach in selling to hospital purchasing agents. Old transactional models didn’t consider many of the non-price motivations for hospital purchasing departments. One of those is the ability to provide convenience.

Hospital supply chains have changed dramatically in the last decade. Digital transformation has been a catalyst. With automation, purchasers can easily use platforms that allow for easy ordering and payment. With this transition, costs are reduced, as purchasing agents don’t have to spend so much time on procurement. 

Efficiency in buying is a strong driver for agents and could be the difference in why they choose certain providers.

Being the Best Hospital Vendor:

Being the best hospital vendor isn’t simply about having high-quality, innovative products and services. It’s also about how seamless you make the buying process for a hospital purchasing agent.

You can do that with these best practices:

Optimize the bid proposal process: ensure your bid is compliant and complete; always supply more information than requested and don’t attempt to compete based solely on price

Emphasize cost reduction and containment: agents typically have hard budget numbers and are often charged with minimizing cost inflation; articulate how your product or service will reduce costs

Make vendor management easy: purchasing agents spend much of their time managing vendors; be proactive in this relationship and responsive

Ensure consistent communication: throughout the process, you should be communicating with the agent regarding the contract, procurement, and delivery of the product or service.

Food Receiving:

Receiving, storage, and preparation are all important sections of a food safety flow chart, and receiving of products is the first step when developing a flow chart. 

The following are important elements to consider when receiving products in general:

The receiving dock and related areas should be well lit and kept very tidy. Incorporate this area into a daily cleaning schedule to ensure proper cleanliness.

Schedule your deliveries to allow adequate time for the proper inspection and receiving of all food products. Never assume that all the food you receive is good enough to eat.

Have all appropriate equipment and containers on hand. Scales, plastic gloves, containers, and thermometers are important pieces to have in easy reach.

Record the temperatures of the delivery trucks refrigerated and freezer storage. If the temperature is not within an acceptable range, do not accept the shipment (because you are unable to ascertain the length of time that the temperature has been unacceptable).

Each group of food, whether dry foods, dairy products, fresh produce, or meats, requires a slightly different procedure. No matter what the product type, the principal component in a receiving procedure is accuracy. 

Any carelessness or half-hearted attempts at checking the delivery will render the whole process useless.

Dry foods:

Dry foods or goods are usually shipped in cartons, bags, cases, or pails. Count the pieces and check that the number corresponds with what is listed on the invoice.

If a carton is damaged, check the contents carefully. Pay particular attention to signs of leakage in cartons that contain products in jars or bottles. It is extremely difficult to get credit at a later date for products stored in glass jars or bottles that have broken. In addition, visually check bags and pails for damage or leakage.

If sealed cartons show evidence of having been opened, check the contents. All unsealed or obviously repacked cartons should be checked to verify what they contain. Do not sign the invoice if there is any doubt about quantity, quality, or damage until you or your supervisor has cleared up the problem with the shipper.

Canned goods are delivered in cases or cartons. Do a count and a quality check of the cans.

The two most common types of damage to cans are swelling and large dents. If cans are swollen or bulging, it means the food has spoiled and must not be used. If the cans have large dents, seams may have split and the food may be contaminated. Again, the canned product is unsafe to use and should be sent back to the supplier. If a whole case of canned goods is unacceptable, the local health authority should be notified.

Dairy products:

Dairy products are perishable and do not store long. Check the best-before date on each container, which should be at least a week after the receiving date.

As with dry foods, compare the number of items received with the invoice and check all items for damage and leakage.

Produce:

Produce is delivered in bags, cases, or cartons. Count the number of pieces, weigh items, and check for quality. Open any closed cases and cartons to check the produce for ripeness, freshness, and other signs of quality.

When there are mistakes in delivery or an unacceptable quality of food has been received, you should insist that the supplier pick up the item and issue a credit.

Meats, poultry, and seafood:

Fresh meat is shipped in pieces and/or by weight. Count and weigh the fresh items. Check for leaking vacuum-packed (Cryovac) packages, and check the grade of the meat against the grade on the invoice. In addition, if specifications were given on the order form, confirm the cuts of meat do meet those specifications.

Fresh poultry and seafood should also be counted, weighed, and checked for quality.

Frozen products are often delivered in cases and cartons. Open the cases to count the items and to check for signs of freezer burn, torn wrappings, partial thawing, or other problems.

In summary, when receiving goods, remember:

The quantity of the goods received should match the quantity on the invoice and the quantity on the purchase order.

The quality of the goods received should be to the specifications given on the invoice or to specifications previously worked out with the supplier. This includes supplying the specific brand name when it is requested.

The prices of the goods should be listed on the invoice and should match the prices on the purchase order.

Storage: 

Storage Temperatures and Procedures:

A food service operation needs to have clearly defined storage areas and procedures for several reasons. 

First, by providing storage facilities it is possible to purchase supplies in quantities large enough quantities to get price breaks. 

Second, the ability to store supplies on the premises reduces the cost and time needed to order supplies and handle them upon delivery. 

Third, menu planning is easier when you are aware of the quality, quantity, and types of supplies that are on hand. If there is a run on a particular menu item, it is nice to know there are enough materials on hand to ensure that everyone who orders the item can be served.

In today’s market, many food service operations are reducing the amount of stock they keep on hand because storage is expensive. Not only does space need to be found but security needs to be tight. Many operators are willing to pay a bit extra to suppliers in order to avoid the headaches of keeping track of expensive items such as large quantities of high-quality meat, wines, and spirits.

Regardless, there still is a need for storing many types of supplies including dry foods, dairy products, frozen foods, produce, and fresh meats. Storage areas for such items often have design requirements that must be built into the space in order to efficiently handle the specific types of supplies.

Dry Foods:

The storeroom for dry foods should be located near the receiving area and close to the main kitchen. Unfortunately, the storeroom for dry foods is often an afterthought in food service facility designs, and the area designated for storage is sometimes in an inconvenient location.

No matter where the location, there are several essential points to be observed in the care and control of the dry storeroom:

The area should be dry and cool to prevent spoilage and the swelling of canned goods. The ideal temperature range is 10°C to 15°C (50°F to 59°F).

The storeroom should be easy to keep clean and free from rodents and vermin. This means all wall, ceiling, and floor openings should be sealed and protected to prevent access.

It should be designed so it is easy to arrange and rearrange supplies to facilitate stock rotation. The best arrangement is to have shelves situated in the middle of the room so they can be stocked from both sides. This allows you to rotate stock by simply pushing out old stock by sliding new stock in from the other side of the shelf. This guarantees that first items received will be the first items used, or the “first in, first out” (FIFO) concept in stock rotation.

The area should be well lit. Shelving must be at least 15 cm (6 in.) above the floor. Do not store items right on the floor.

Aisles should be wide enough to allow room for carts or dollies, which should be used to prevent possible injuries from lifting.

Food and supply storage areas should be kept under lock and key to prevent pilferage. Food storage control is an important step in the overall control of food costs. 

All storerooms should be considered to be like bank safes where the assets of the operation are being stored. This may mean that more valuable commodities such as liquor and wine should be stored and locked inside a larger storage area, such as the dry food storage area.

 

 

Refrigerated Products:

The refrigerator, whether a walk-in or a standard upright, is an important component in planning the storage of food items. Most fresh foods must be stored in the refrigerator to delay their deterioration and decomposition. The most basic rule must be always followed: store raw products below, never above, your cooked or ready-to-eat products.

 






Critical Control Point





Keep foods 4°C (39°F) or colder, the safe temperature for refrigerated storage.





(Critical Control Point for Refrigerated Products)

Here are some considerations to ensure that the refrigerator does not break down and risk spoiling food:

Monitor the temperature of the refrigerator daily. All refrigerators should be provided with a thermometer so that daily readings can be taken.

Keep refrigerators in good working order. Maintain a regular servicing contract with a local refrigerator repair company.

Most breakdowns are beyond the ability of kitchen staff to repair, but if the refrigerator does stop running, first check that the power supply cord hasn’t simply been pulled out or the breaker has flipped off.

Clean refrigerators regularly. Shelves should be shallow and well vented to make such cleaning quick and easy. Develop and follow a schedule to ensure that refrigerators are cleaned on a consistent basis.

 

There are also several general rules that all personnel using the refrigerator should follow:

Store raw products below cooked or ready-to-eat products. Develop and follow a FIFO system for refrigerated food.

Designate areas in the refrigerator for certain items, and keep only those items in their designated place.

Never put hot foods in the refrigerator unless absolutely necessary. (Unfortunately, one person’s understanding of “necessary” may not be the same as another person’s, so consider developing guidelines.)

Never leave the refrigerator door open longer than needed.

Although lack of time and personnel shortages often make it difficult to observe these rules, it is imperative that they be followed.

Dairy Products:

Dairy products must be stored in the refrigerator at temperatures of 2°C to 4°C (36° to 39°F). Follow these guidelines:

The fat in dairy products has a tendency to absorb strong odors from the storage surroundings. To reduce the likelihood of this happening, store dairy products in their own area in protective coverings.

Do not store dairy products in a vegetable cooler; a separate refrigerator is much more acceptable. Keep the refrigerator clean at all times.

Rotate dairy products when fresh product arrives. Dairy products should not be ordered too far in advance of when they will be used. Ideally, such products should be delivered on a daily basis.

Produce:

Most produce is stored in the refrigerator at 2° to 4°C (36° to 39°F) to ensure freshness and to prevent rapid deterioration. There are, however, a number of exceptions, including potatoes and bananas, which should be stored at higher temperatures.

Keep these factors in mind when storing produce:

Soft fruits should not be stored too long. It is often best to buy soft fruit as you need it, keeping very little on hand.

Unripe fruit can be ripened at storeroom temperatures of 10°C to 15°C (50°F to 59°F). It will ripen much more slowly under refrigerator conditions.

Before storing and when rotating stock, it is important to remove rotting fruit from cases as one piece can affect others. The chain reaction can quickly destroy the quality of a whole case of fruit.

Be aware of special storage problems. For example, bananas stored in the refrigerator turn black quickly. Bananas should be stored under conditions where the temperature range is 10°C to 15°C (50°F to 59°F).

The length of time produce can be stored varies widely. For example, hardy vegetables such as carrots and cabbage will last for weeks, while delicate vegetables such as lettuce should be bought as fresh as possible as they do not keep for long.

Moisture on vegetables tends to soften them, causing rot. Even though in the early stages of rot there is nothing basically wrong with such vegetables, they can be unattractive to the eye.

Fresh Meats, Poultry, and Seafood:

These items are the most difficult to store and the most expensive food items sold by the restaurant. When storing meats, poultry, and seafood items, remember the critical control point.

 






Critical Control Point





Keep foods 4°C (39°F) or colder, the safe temperature for refrigerated storage.





(Critical Control Point for Refrigerated Fresh Meats, Poultry, and Seafood)

Keep these factors in mind when storing fresh meats, poultry, and produce:

All carcass meats should be unwrapped and hung so that air can circulate around them. They should be stored at 1°C to 3°C (34°C to 37°F) in a walk-in refrigerator. Place absorbent paper under the meats for quick cleanup of any unwanted drips.

Fresh meat must not be kept too long. Boned meat should be kept no longer than three days. Individual cuts should be used within two days, preferably on the day they are cut.

Individual meat cuts such as steaks, chops, stewing meat, and ground meat should be kept covered on plastic or stainless steel trays at 2°C to 4°C (36°F to 39°F).

Fresh poultry should be packed in ice and stored in the refrigerator.

Fresh seafood should be packed in ice, stored at −1°C to 2°C (30°C to 34°F) and used as soon as possible.

Store raw products on the lower shelves of the refrigerator, below cooked products.

Frozen Foods:

Frozen foods should be stored at –18°C (0°F) or lower. If the temperature rises above –18°C, food can become discolored and lose vitamin content. Lowering the temperature after it has risen does not correct the damage.

 






Critical Control Point





Frozen food must be kept at −18°C or lower to maintain its quality.





(Critical Control Point for Frozen Foods)

 

 

 

Keep these factors in mind when storing frozen foods:

Fruit and vegetables that are received frozen will keep for months if they are properly wrapped. Fish and meat properly wrapped also have a relatively long freezer shelf life.

Freezing fresh fruits and vegetables on the premises is time consuming and may be too expensive to consider. Fresh fruit must be properly prepared for freezing or it will not store well.

All freezer products not properly wrapped will develop freezer burn, which is a loss of moisture that affects both the texture and the flavor of the food. A common sign of freezer burn is a white or grey dry spot developing on the surface of the frozen product. Meat is particularly susceptible to freezer burn.

Rotating stock is extremely important with frozen foods. Such rotation is difficult in standard chest freezers as it often means that old stock must be removed before new stock is added. The temptation with frozen foods is to develop the unacceptable habit of using the last item bought first, instead of FIFO (first in, first out).

 

Inventory Control:

Also called stock control, inventory control consists of systems and procedures for managing inventory items in a company’s warehouse. 

It monitors the movement and storage of goods in a warehouse to help businesses maintain a sufficient supply in good condition. Establishing an inventory control system enables them to satisfy customer demands and maximize profits.

Inventory control is a key element of an inventory management system. Warehouse managers and production planners should adhere to the following activities and procedures in controlling their inventory:

Receiving, storing, and transferring goods. Placing items in strategic locations. 

Tracking inventory items and their locations in the warehouse. Documenting product details and histories. Monitoring the condition of items in stock. 

Fulfilling purchase orders with stock on hand. Integrating barcode scanners. Forming reorder reports.

 

Difference Between Inventory Control and Inventory Management:

Although these two concepts go hand in hand, there are slight differences between inventory control and inventory management. Inventory control handles existing stock in a warehouse, while inventory management involves the overall movement of goods across supply chains.

The table below compares the two processes against their scope, goal, areas of concern, and actions.






 



Inventory Control



Inventory Management





Scope



Existing inventory in the warehouse



Raw materials and finished goods during the entire production lifecycle





Goal



Ensuring stocks in the warehouse are enough and in good condition



Having the right inventory in the right place, at the right time, and with sufficient quantity





Areas of Concern





What items are in the inventory?

Where are these items located in the warehouse?

What is the condition and status of these items?






Which items should you order?

How many items do you need to order?

When should you order these items?






Actions





Receiving, storing, and transporting inventory

Checking stock items for their expiry dates, spoilage, quality issues, and so forth.






Predicting customer demands based on previous data

Reordering and managing inventory items in the supply chain.






Types of Inventory Control Systems:

There are two main types of inventory control systems: the periodic and the perpetual system. Choosing the right inventory control system will depend on the business type, size, and kind of inventory. This section discusses these two types in detail, covering their pros and cons, as well as what they’re best for.

A) Periodic Inventory Control System:

The periodic inventory control system pertains to a recurring count of goods at specific intervals. In this system, warehouse managers manually count their inventory on a monthly, quarterly, or annual basis. The exact period depends on an organization’s needs and business activities.

Pros: It’s relatively simple and easy to manage for smaller inventories. It doesn’t require any specialized technology and equipment, making it easier to train individuals in.

Cons: It becomes a lengthy process for companies with expansive inventories. The manual counting process is also highly prone to human error.

Best for: The periodic system is ideal for small companies with minimal inventory. It also works best for businesses selling niche products and counting larger-sized goods.

 

 

B) Perpetual Inventory Control System:

The perpetual inventory control system provides an accurate count of inventory levels in real-time. It utilizes technology, such as barcodes and Radio Frequency Identification (RFID) tags, for tracking products. The information is then logged in a centralized database that warehouse managers can easily access.

Pros: This method removes the need for manual counting. It gives warehouse managers a snapshot of their inventory counts over a specific period of time. Doing so drives data-driven decision-making for sales, ordering, and inventory management.

Cons: An inventory control software can be expensive to maintain. Moreover, it might not capture discrepancies due to product theft, loss, damage, and scanning errors.

Best for: The perpetual system works best for companies with multiple locations. It’s also great for businesses maintaining large inventories.

 

Inventory Control Techniques

Inventory control involves various techniques for monitoring how stocks move in a warehouse. Four popular inventory control methods include: ABC analysis, Last In, First Out (LIFO) and First In, First Out (FIFO), batch tracking, and safety stock. This section explains how each of these methods functions and how they can support your business.

 

ABC Analysis:

ABC analysis in inventory control classifies stocks based on their importance, price, and sales volume. These criteria determine the number of items a company will bring to the market.

Just as its name suggests, it consists of the following categories:

A class: expensive, high-class items with tight controls and small inventories. B class: average-priced, mid-priority items with medium sales volume and stocks. C class:  low-value, low-cost items with high sales and huge inventories.

Applying the ABC analysis of inventory control allows businesses to minimize the costs of carrying products while maximizing their stock returns.

Last In, First Out (LIFO) and First In, First Out (FIFO):

Both inventory control techniques organize how inventory items move in and out of the warehouse based on their arrival date. Priority will depend on the type of products available in the storage facility.

Using the LIFO method, the warehouse puts out the most recent batch of items to the customers first. Doing so prevents products from going bad when delivered to the market.

But with the FIFO technique, the warehouse prioritizes older stocks for processing and shipping. This way, they can keep the products fresh when the customer receives them.

Batch Tracking:

Batch tracking is also a great way of organizing stock items in a warehouse facility. In this method, goods of the same production date and materials are grouped together. 

Doing this helps warehouse managers keep track of the following information:

(a) Where the items come from. (b) Where the goods are heading. (c) When the items might expire.

Safety Stock:

Safety stock involves having an additional set of goods on hand as a preventive measure for the market’s volatility. The amount should be over the average demand or use of the product.

It acts as a safety net, should customer demand go above the projected amount. It also covers them for any uncertainty in supply performance, such as shipping delays.

 

General Safety Measures in Hospitals

What are the core elements of a safety and health management system? 

Most successful safety and health management systems have six “core elements,” all interrelated, each necessary to the success of the overall system: 

Management leadership: Managers at all levels of the organization demonstrate their commitment to improved safety and health, communicate their commitment, and document performance. Managers make safety and health a top priority, establish goals and objectives, provide adequate resources and support, and set a good example. 

Employee participation: Employees have unique knowledge of the workplace and must be involved in all aspects of the safety and health management system. For example, setting goals, identifying and reporting hazards, investigating incidents, and tracking progress. 

All employees understand their roles and responsibilities under the safety and health management system and what they need to do to carry them out effectively. Employees are encouraged to communicate openly with management and report safety and health concerns. Barriers to participation (e.g., language, lack of information, or disincentives) are removed. 

Hazard identification and assessment: Processes and procedures are put in place to continually identify workplace hazards and evaluate risks. An initial assessment of existing hazards and control measures is followed by periodic reassessments to identify new hazards and monitor the effectiveness of prevention and control measures. 

Hazard prevention and control: Processes, procedures, and programs are created and implemented to eliminate or control workplace hazards and achieve safety and health goals and objectives. Progress in implementing controls is tracked. 

Education and training: All employees are provided education or training to carry out their responsibilities under the safety and health management system. In addition, all employees are trained to recognize workplace hazards and trained in the corresponding control measures. 

System evaluation and improvement: Processes are established to monitor safety and health management system performance, verify implementation, identify deficiencies and opportunities for improvement, and take necessary actions to improve the safety and health management system and overall safety and health performance.

 

Safety and Health Management Systems in Hospitals: Best Practices and Examples: 

Safety and health management system success stories from VPP hospitals: 

Hospitals participating in Voluntary Protection Programs (VPP), which recognize workplaces that implement a comprehensive safety and health management system, report finding numerous synergies and efficiencies from aligning and integrating their patient safety and employee safety programs. 

Some of these include: 

Reduced employee and patient injuries. The University Medical Center at Brackenridge in Austin, Texas, has experienced declines in both the total number of recordable employee serious injuries and patient safety events. 

Reduced workers’ compensation costs. Saint Thomas Midtown Hospital (formerly Baptist Hospital) in Nashville, Tennessee, reported a $600,000 reduction in workers’ compensation costs in 2012. As a percentage of payroll, the annual workers’ compensation costs for Blake Medical Center in Bradenton, Florida, are 30 percent lower than other hospitals in Florida managed by the same parent company. 

Increased staff and patient satisfaction. VPP hospitals report positive correlations between their safety and health management system implementation, higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and improved employee satisfaction indicators, such as low turnover and improved morale.

 

Food Safety Guidelines Throughout A Foodservice Operation

A) Purchasing:

Safe food begins with safe raw materials. Food should be obtained from approved sources:

Meats should be inspected by the USDA or other agency with animal health jurisdiction. The parts or packaging should carry a federal or state inspection stamp.

Eggs should have a USDA grade; frozen and dried eggs should be pasteurized.

 

Shellfish should be purchased from suppliers that appear on public health service Food and Drug Administration lists of Certified Shellfish Shippers or on lists of state-approved sources. The control tags must be available if live shellfish are used.

B) Receiving:

All foods should be in excellent condition when they arrive. The quality and temperature of foods should be closely monitored at delivery. Delivery times should be planned for slow periods whenever possible to allow for inspection. 

Storage areas should be cleared prior to the receiving shipments, so food can be immediately stored, and the storage areas should be clean and well-lit to discourage pests. Sanitary carts and dollies should be readily available to store foods immediately.

Check frozen foods for signs of thawing and refreezing, such as blood on meat boxes, fluid leakage, frozen liquids at the bottom of the food carton or large ice crystals in or on the product. Refuse shipments that show signs of being thawed and refrozen.

Reject canned goods that are dented, bulging or rusty. Never taste the food in a damaged can.

Check packages to make sure they are dry and the seals are intact.

Refrigerate potentially hazardous foods immediately.

 

C) Storage:

Foods should be protected from time and temperature abuse by purchasing according to the storage space available. Keep food in rooms designated for storage not in restrooms or hallways. 

Do not store frozen, refrigerated or dry food directly on the floor or under overhead pipes. Place food on shelves or on mobile equipment at least six inches off the floor. 

Space foods so air can freely flow around them. Monitor expiration dates and rotate stock. Use the “FIFO” principle – first in, first out.

1) Freezer Storage:

Maintain freezers at 0 F or lower. Monitor and record temperatures regularly.

Defrost units regularly. During defrosting, store frozen foods in another freezer. Do not refreeze thawed foods unless they have been thoroughly cooked.

2) Refrigerator Storage:

Maintain refrigerators at 41 F or lower. Place thermometers in the warmest and coldest areas of refrigerators; Measure and Record air temperature regularly. Do not store raw uncooked meats above prepared foods.

3) Dry Storage:

Keep canned and dry goods dry. Label and date all dry goods. Measure and record temperature regularly.

Keep all goods in clean wrappers and containers. In most cases, wrap products in moisture proof and air-tight materials.

Do not store foods taken from their original containers in galvanized (zinc-coated) containers such as garbage cans. In addition, food should not be stored in enamelware, which may chip. 

Tomatoes, fruit punches or sauerkraut should not be stored in metal containers (unless made of stainless steel), due to potential leaching out of metals and other potential toxicants. Foods may be stored in food-grade plastic or glass containers.

 

Food Safety in Production and Service:

After monitoring receiving and storage for safety, it is essential to avoid cross-contamination and temperature/time abuse during preparation, cooking, serving and cooling. Calibrated thermometers should be used to monitor temperatures. 

The following guidelines illustrate safe food handling at each stage:

Preparation:

Wash hands before beginning a task and after every interruption that could contaminate hands. The hand-washing sink not the prep sink should be used.

Avoid cross-contamination. Cross contamination occurs when harmful bacteria are transferred from one food to another by means of a nonfood surface, such as utensils, equipment or human hands. 

Cross contamination can also occur food to food, such as when thawing meat drips on ready-to-eat vegetables. 

Prevent cross contamination by observing these recommendations:

Use proper hand-washing procedures. If plastic gloves are worn, hands should be washed before putting them on. Plastic gloves should be changed whenever changing tasks that could cause contamination. Improperly-used plastic gloves can contaminate foods as easily as bare hands can.

Use clean and sanitized utensils and cutting boards when preparing food. Clean cutting boards thoroughly with hot soapy water, followed by a hot water rinse and a final sanitizing step (1 tablespoon bleach per gallon of water) after using. Store cooked food and raw food separately. 

Wash all fresh fruits and vegetables with clear running water in a designated produce sink or in a ware-washing sink that has been properly cleaned and sanitized. Use a brush as necessary. Detergents are not suggested because they may leave residues.

Disassemble, clean and sanitize meat slicers (and other equipment) on a timely basis.

Wash, rinse and sanitize can openers. Wash and rinse tops of cans before opening. Prepare batches of food no further in advance than necessary.

 

Thawing:

Thaw foods in refrigerator units, under cool running water at a temperature of 70 F or lower, or in a microwave oven (depending on the amount of food). If thawing foods in running water, do not allow thawed portions of raw animal foods to be above 41 F for more than four hours.

Thaw ready-to-eat foods above raw food, so the thaw water does not contaminate the ready-to-eat food. Cook microwave-thawed foods immediately.

Frozen food, such as vegetables and seafood, may be cooked directly to the recommended internal temperature. Allow additional time for cooking. Large food items, such as whole turkeys, should not be cooked from the frozen state.

 

Cooking:

Cook foods to safe time-temperature exposures. Use a clean sanitized thermometer to measure the temperature by placing the thermometer in the thickest part of the food. In sauces and stews, insert the thermometer at least two inches into the food.

Calibrate thermometers regularly by inserting into a mixture of ice and water and adjusting the reading to 32 F/ 0 C. Thermometers that have been dropped or exposed to extremes in temperature should be calibrated.

 

Cook foods to the following minimum internal temperatures for safety:

Stuffed meat and pasta, microwave-cooked foods 165 F for 15 seconds.

Microwave-cooked foods should be stirred and rotated during cooking. After cooking, the food should be allowed to stand for two minutes for even distribution of heat.

Poultry:165 F for 15 seconds

Ground beef:

155 F for 15 seconds

Pork, beef, lamb roasts and steaks:

145 F for 15 seconds. Allow three-minute stand time.

Eggs:

145 F for 15 seconds (immediate service), 155 F for 15 seconds (eggs thatwill be held).

Cooked vegetables, commercially processed, ready-to-eat foods (cheese sticks, deep-fried vegetables, chicken wings):

135 F for 15 seconds

Do not interrupt cooking times by partially cooking foods. Use tasting spoons not the stirring spoon to test foods. A clean tasting spoon should be used every time the food is tested.

 

Holding/Displaying Foods between Preparation and Serving:

Keep hot foods hot and cold foods cold. Maintain hot foods at 135 F or higher and cold foods at 41 F or lower. Measure temperatures periodically near the top surface before stirring; stir with a clean, sanitized utensil, measure and record temperature.

Do not use holding units, such as steam tables or chafing dishes, to cook or reheat foods.

Hold cold foods in serving containers on ice; the food should not be in contact with the ice.

Do not put previously held food on top of freshly prepared food. Use up the previously held food first.

Do not handle ready-to-eat foods such as lettuce, ham and cheese with bare hands. Use spatulas, tongs, clean plastic gloves or deli tissue to handle food.

In self-service/buffet situations, provide spoons or tongs so human hands do not touch food. Provide clean plates for every trip through a buffet line.

Linens and napkins used as liners that contact food must be replaced whenever the container is refilled.

Handle plates by their edges, glasses by the bases and cups by their handles. Handle utensils by their handles. Use metal or plastic scoops – not glasses, bowls, cups or plates – to scoop ice.

Discard potentially hazardous foods that have been removed from temperature control for more than four hours.

 

Safe Use of Disposables:

Single-service items are used in many foodservice settings. They are manufactured to be safe and sanitary and should be handled carefully in foodservice establishments to maintain their cleanliness.

Disposables should be stored in their original storage containers at least six inches above the floor, away from pesticides, detergents and cleaning compounds. Only the amount needed should be removed from the container. 

To help keep disposables sanitary, Follow these tips:

Handle containers as little as possible. In waited surface, servers should keep fingers away from any food-contact surfaces of cups, plates or other containers. In self-service situations, stack disposable plates, bowls and cups bottom side up, so customers do not touch the eating surface of another customer’s plate.

Handle unwrapped forks, knives and spoons by the handles. Load utensil dispensers with the handles pointing out.

Do not touch the drinking surface of cups when removing them from their plastic sleeves. Avoid overloading cup dispensers. Never re-use single service articles even if they appear clean.

Cooling:

Label and date food before cold storage. Cool foods from 135 F to 70 F within 2 hours and from 70 F to 41 F within 4 hours. Do not cool food at room temperature before putting in the cooler.

Do not mix fresh food with leftover food. Divide food into smaller batches and put in shallow 4-inch deep metal pans. Liquid foods should be no more than three inches deep, and thicker foods should be no more than two inches deep. Set the open pans on the top shelf of the cooler and cover the food after it has cooled.

Use an ice bath to speed cooling. Place container of food in a larger container filled with ice water to reduce cooling time. 

Stir frequently during chilling to promote cooling and measure temperature periodically.

 

Reheating:

Reheat previously prepared foods to at least 165 F for 15 seconds within two hours. Microwave-cooked foods should be rotated or stirred midway through the heating process and should be allowed to stand two minutes to allow for dispersal of heat.

Do not reheat foods in hot holding equipment such as steam tables.

 

 

Personal Hygiene Guidelines for Employees:

Foodservice workers must pay close attention to personal hygiene. Policies on personal hygiene should be reviewed with employees and posted as reminders. For instance, workers who have a cold, the flu or another communicable illness, should inform their supervisor and not handle food. 

The following guidelines should be stressed to any worker dealing with food:

Keep clean by bathing daily, using deodorant, and washing hair regularly. Keep hair under control by wearing a hair restraint.

Wear clean clothing/uniform and/or apron. Avoid wearing jewelry, which can harbor bacteria and cause a physical hazard if parts fall into the food. Jewelry also can pose a personal safety hazard if it gets caught in the equipment.

Keep  fingernails clean, unpolished and trimmed short. Wear a bandage and plastic gloves if you have open cuts or sores. In some cases, employees should perform other non-food-related tasks until the wound heals.

Do not chew gum while on duty. Do not smoke cigarettes while performing any aspect of food preparation.

Avoid unguarded coughing or sneezing. Wash hands after coughing or sneezing.

 

 

Wash Hands Thoroughly

Before starting work. During food preparation as often as necessary to prevent cross contamination when changing tasks and when changing from handling raw foods to cooked foods.

After:

Coughing, sneezing, using a handkerchief or tissue. Touching bare humanbody parts.

Eating, drinking or smoking. Handling raw meats, poultry and fish. Handling garbage, sweeping or picking up items from the floor.

Using cleaners and other chemicals. Using the toilet.

Handling soiled equipment and utensils. Switching between raw foods and ready-to-eat foods.

 

Hand Washing Guidelines

Use water as hot as can be comfortably tolerated. Moisten hands and add soap. Lather to the elbow if possible.

Scrub thoroughly. Wash all surfaces, including backs of hands, wrists, between fingers and under fingernails.

Rub hands together for at least 20 seconds. Rinse thoroughly under running water. Dry hands thoroughly with a paper towel or hot air dryer.

Don’t touch anything that will re-contaminate your hands. Use a paper towel to turn off the water faucet and open the restroom door if necessary.

 

Wash, Rinse And Sanitize:

Surfaces and equipment may look sparkling clean, yet bacteria may be present in large numbers. Cleaning is the physical removal of food and/or soil from surfaces. Clean does not necessarily mean sanitary. All food contact surfaces must be sanitized.

Sanitizing takes cleaning a step further by reducing the number of bacteria present. Sanitizing does not make a surface sterile or germ-free. Sterility would be impractical and too expensive for foodservice operations.

Sanitizing agents differ in the amount of contact time required, their concentration and temperature requirements. When using combination products, such as detergent-sanitizers, cleaning and sanitizing must done in two separate steps. 

First use the detergent-sanitizer to clean, then prepare another solution of the same agent to sanitize. Cleaning cloths can contaminate surfaces. They should be stored in sanitizing solution when not in use.

Sanitizing may be accomplished manually or with equipment such as dish-machines using heat (as steam or hot water) or chemicals. When heat sanitizing, using a higher temperature generally shortens the time required to kill bacteria.

Since equipment varies, procedures should be written that specify cleaning and sanitizing chemicals and methods for all areas of foodservice. A schedule should be in place for cleaning, with records kept of when it was done.

The Correct Order Of Steps Involved In Manual Cleaning Are:

1.     Scrape or remove large particles of food.

2.     Wash with an appropriate detergent/ water solution at 110 F.

3.     Rinse in clean hot water.

4.     Sanitize in hot water (171 F for at least 30 seconds) or use an appropriate chemical sanitizing solution such as chlorine (25 ppm: 120 F; 50 ppm: 100 F; 100 ppm: 55 F); iodine (12.5 to 25 ppm at minimum temperature of 75 F ) or quaternary ammonium (100 to 200 ppm at a minimum temperature of 75 F) according to manufacturer’s directions. Also refer to the requirements of your local regulatory agency.

5.     Air-dry.

 

Emergency Policies: Incident, Injury and Hazard Reporting

1) Procedure Statement:

The Hospital is committed to the provision of a safe and healthy work environment for all employees, contractors and visitors.

The hospital will maintain records of all hazards, near misses, incidents and injuries for the purposes of minimizing risk of injury and ill-health or the recurrence of an incident. Accordingly, all staff are expected to report hazards, near misses and incidents and managers are expected to address these in consultation with staff. 

In doing so, this will ensure that the hospital complies with the requirements of the Occupational Health & Safety Regulations 2017, the Occupational Health and Safety Act 2004 and the Workplace Injury Rehabilitation and Compensation Act 2013 (WIRC Act).. 

2) Persons affected:

All staff and visitors.

3) Definition of terms:

Hazard:  something that has the potential to injure or harm people, property and equipment

Incident: an event that has the potential to or does lead to an injury or damage to property and equipment as result of losing control of a hazard

Near miss: any unplanned incidents that occurred at the workplace which, although not resulting in any injury or disease, had the potential to do so

Notifiable Incident: an incident for which you are legally required to notify Worksafe Victoria. 

 

 

Incidents that must be reported include those that result in: 

Death, A person needing medical treatment within 48 hours of being exposed to a substance, A person needing immediate treatment as an in-patient at a hospital.

A person needing immediate medical treatment for one of the following injuries: amputation, serious head injury or serious eye injury, removal of skin (example: de-gloving/ scalping) electric shock, spinal injury, loss of a bodily function, serious lacerations (example: requiring stitching or other medical treatment). 

4) Responsibility:

Employee:

Report any hazard, near miss, incident or injury to their manager.

 

Health and Safety Representative:

To assist the manager and consult with employees within the designated work group with regard to incident investigation and risk control.

 

Head of Department/Unit Manager:

Respond to hazard reports. Investigate near misses and incidents. Close all hazard, near miss and incidents reported with 30 days.

Consult with the Health and Safety Representative with regard to incident investigation and risk control.

Assist the injured/ill employee and seek first aid medical attention if appropriate. Record hazards identified, near misses and incidents.

In the event of a serious incident, refer to the Incident Notification Fact sheet which provides a step by step guide on how to report the incident to WorkSafe. Ensure compliance with return to work plan.

 

Workplace Health and Safety Team:

Provide support to department managers with risk control and injury management. Retain records of notifiable incidents.

Injury Management Coordinator:

Activate early intervention strategies. Support injured staff in achieving timely return to appropriate work.

Support managers in achieving timely return of injured staff to appropriate work. Records maintenance.

Preparation of incident data summaries. Conduct a periodic claim review.

 

 

 

 

5) Procedure:

Hazard Reporting:

Hazards identified during day to day activity must be reported to the appropriate manager. If the hazard can be remedied immediately, the manager should take appropriate action in consultation with the Health and Safety Representative.

If a hazard requires greater investigation and the sourcing of risk controls, this should be recorded by the manager or the reporting staff member within VHIMS and the proposed risk controls identified in consultation with the Health and Safety Representative.

Hazards identified during formal inspections should be recorded with an action plan on the inspections checklist.

 

Near Miss and Incident Reporting:

All near miss / incidents should be recorded by the manager or the reporting staff member.

If a person has been injured, the need for first aid should be assessed and action taken as appropriate. Managers should follow the Early Intervention Guide, and contact their relevant Injury Management Coordinator if the staff member requires time off work or medical treatment as a result of an incident. 

If the near miss / incident is considered to be serious, the manager should contact the hospital team for advice. The hospital team will advise regarding the notification of the incident to WorkSafe.

The incident is deemed to be a "Notifiable Incident" and must be reported to WorkSafe if it resulted in:

The death of a person, or A person requiring medical treatment within 48 hours of exposure to a substance. A person requiring immediate treatment as an in-patient.

A person requiring immediate treatment for:

The amputation of any body part or A serious head injury or A serious eye injury or De-gloving or scalping or Electric shock ormA spinal injury.

The loss of a bodily function or Serious lacerations.

 

Notifiable incidents also include those involving:

Registered or licensed plant collapsing, overturning, falling or malfunctioning.

Collapse or failure of an excavation, or shoring supporting an excavation. Collapse of a building structure (or partial collapse).

Implosion, explosion, or fire. Escape, spillage or leakage of any substance. Plant or objects falling from high places.

If the incident is notifiable, the site of the incident is to remain undisturbed until a WorkSafe Inspector arrives on site or gives permission for disturbance.

The manager should undertake an incident investigation in consultation with the Health and Safety Representative and record the findings and recommendation within the VHIMS report of the incident.

Complex investigations or investigations where there is uncertainty will be supported by the hospital team upon request of the manager or Health and safety Representative.

 

Injury Reporting:

Any injury to staff or visitors should be recorded within VHIMS by the manager or the reporting staff member.

If a person has been injured the need for first aid should be assessed and action taken as appropriate.

If an injured staff member loses time from work or requires medical treatment for their injury, the manager should follow the process as outlined in the Early Intervention and Rehabilitation – Work Related Injury procedure.  

 

 

 

TIME / TEMPERATURE CONTROL 

What are potentially hazardous foods?

Under the Food Standards Code, potentially hazardous food is defined as food that has to be kept at certain temperatures to:

Minimize the growth of any pathogenic micro-organisms that may be present in the food. Prevent the formation of toxins in food.

Examples of potentially hazardous foods include:

Food containing raw and cooked meats including casseroles, pies and sandwiches.

Dairy products and processed foods containing eggs, beans and nuts. Seafood.

Processed fruits and salads such as pre-prepared salads and ready to eat fruit packs. Cooked rice and pasta.

 

What is a safe temperature?

Safe temperatures are 5 °C or colder, or 60 °C or hotter.                          Potentially hazardous foods need to be kept at these temperatures to prevent any food-poisoning bacteria, which may be present in the food, from multiplying to dangerous levels.

You can also use time, rather than temperature to keep food safe. This is known as the 2 hour/4 hour guide. You must keep records if using this method.

A) The 2 hour/4 hour guide:

Potentially hazardous foods should be kept at 5 °C or colder or above 60 °C wherever possible, however ready-to-eat foods can safely remain between 5 °C and 60 °C for up to 4 hours.

This is because it takes more than 4 hours for food poisoning bacteria to grow to dangerous levels.

The 2 hour/4 hour guide only applies to ready-to-eat and potentially hazardous foods. The time refers to the life of the food, including preparation and cooling, not just to display times. When using the guide, please remember to use the total time.

 




 









Total time limit between 5 °C and 60 °C:



What you should do:





Less than 2 hours 



Refrigerate or use immediately





Between 2 hours and 4 hours 



Use immediately





More than 4 hours        



Throw out





(The 2 hour/4 hour Guide)

 

B) Thermometers:

Every food premises that prepares, handles or sells any potentially hazardous food must have a thermometer to ensure food is kept at safe temperatures. The thermometer must be accurate to ±1 °C.

Remember the temperature at the center of the food may be different to the surface temperature, therefore when checking the temperature make sure you check the center of the food.

How to use the thermometer to measure the temperature of food?

Before use, ensure the thermometer is clean and dry. If using a probe thermometer, ensure the probe has been sanitized.

Place the probe into the food and wait until the temperature reading has stabilized before reading.

Measure different parts of a food as the temperature may not be the same in all parts. For example, if food is being cooled in a refrigerator, the top of the food may be cooler than the middle of the food.

Clean and sanitize the thermometer after measuring the temperature of one food and before you measure the temperature of another food.

If using the thermometer to measure hot and cold food, Wait for the thermometer to return to room temperature between measurements.

Measure the temperature of different foods in a refrigerator or display unit as there will be colder and hotter spots within the refrigerator or unit.

Measure the temperature of packaged chilled food by placing the length of the thermometer between two packages, the temperature will be approximate but the package remains intact.

 

How to clean and sanitize a thermometer?

As the thermometer probe will be inserted into food, it must be cleaned and sanitized before it is inserted into different food.

If the probe is not cleaned and sanitized, food poisoning bacteria may be transferred from one food to another. For example if the thermometer is used to measure the temperature of raw food and then cooked food, such as a raw hamburger patty and then a cooked hamburger patty.The probe of a thermometer can be cleaned and sanitized using these steps:

Wash the probe with warm water and detergent. Sanitize the probe appropriately (alcohol swabs can be used).

Rinse the sanitizer away if necessary (refer to the instructions on the sanitizer). Allow the probe to air dry or thoroughly dry it with a disposable towel.

Maintaining a thermometer:

You need to maintain the thermometer in good working order. This means replacing the batteries if they are flat or repairing the thermometer if it breaks.

You will also need to maintain the accuracy of the thermometer. This means that you should make sure it is calibrated correctly on a regular basis.

 

Al Nas Hospital:

Al Nas is a new charitable hospital for children located in the very densely populated Shubra El Kheima area, north of Cairo, in Qalyubia governorate, one of the largest area and population governorates of the Greater Republic.

This hospital considers one of the largest distinguished medical centers in the Arab region and Africa with capacity reaches about 600 beds, it should be noted that the hospital’s five buildings have been completely completed in terms of construction, finishing and equipping on an area of 30,000 M containing, in addition to the new services building, the following:

557 hospital beds, 10 operations room, 140 intensive care units, 4 cardiac catheterization units, and 48 outpatient clinics.

This hospital is proud to serve all patients for free as of September 2019, as it started its activities and services in the children's heart diseases building first, as these diseases cause the death of nearly half of all deaths from all diseases in Egypt,  In addition, there are long waiting lists for these surgeries.

 

These services are free 100% according to the best and latest standards and technologies. After they succeeded in attracting the best professional cadres of doctors, specialists, nursing teams, and technicians necessary to work in this hospital equipped with the latest medical equipment.

 

The Vision:

Providing free medical services with a global level to the Egyptian citizen to achieve a decent life for every citizen while preserving his human dignity through the completion of the construction of an integrated medical edifice contains about 600 room in 5 buildings which represents a medical city at the highest level to serve the Egyptian citizen everywhere.

 

The Goal:

The hospital started its activity in 2019 at the first building which contains 110 rooms to treat babies with congenital heart defects at birth, through heart operations, also we aim to open the second building in early 2021, this treatment is 100% free in order to eliminate waiting lists for this dangerous disease.

 

 

 

 

Al-Nas Hospital Departments:

1) Outpatient Department (OPD):

The outpatient department provides treatment services to patients through 48 outpatient clinics and aims to provide high-quality medical care services using the latest diagnostic methods (Cardiac ultrasound, Holter, CT scan and MRI) and therapeutic techniques, while at the same time keen to make the patient experience as easy and smooth as possible. 

 

2) Cardiac Surgery Department:

The Department of Cardiothoracic Operations contains 10 equipped operating rooms, through which open heart surgeries are performed for the treatment of complex congenital defects of the heart, repair and change of heart valves, and surgeries for making junctions for patients with insufficiency and narrowing of the coronary arteries.

 

3) Intensive Care Unit (ICU):

The hospital contains 140 intensive care units that receive critical cases and take care of and observe patients after undergoing various heart surgeries through an integrated medical staff and under the supervision of specialized doctors in addition to highly experienced nursing staff who have been carefully selected and trained to provide an integrated medical service to patients. The unit is also equipped with the latest equipment for care, artificial respiration and central oxygen, and the department is linked with a monitoring system for all patients. 

 

4) Cardiac Care Unit (CCU):

Provides high-quality care to patients with conditions such as acute coronary syndrome, myocardial insufficiency, care and observation of patients after cardiac catheterization. 

 

5) Cardiac Catheterization (Cath.LAB):

The Vision in Al Nas Hospital is to provide the full spectrum of treatment for pediatric cardiac interventions providing top notch quality service.

They’ve mastered new approaches to treat common heart conditions, like defects in the heart and narrowed valves. These problems can often be treated by catheterization, rather than open-heart surgery.

They also specialize in treating rare, life-threatening problems that require extremely nuanced technical skills. Examples include neonatal cardiac interventions, stenting of PDA in duct dependent circulation, perforation of pulmonary atresia, stenting of pulmonary veins, stenting of complex coarctation of the aorta.

The catheterization team is at the forefront of this innovation, continually developing new, non-surgical ways to treat heart conditions.

The team understands the importance of collaboration, and routinely cooperates with cardiac surgeons and other clinicians to develop new approaches of care. When appropriate, They also use a hybrid approach, which combines surgical and catheter treatments. 

Recent advanced cardiac imaging tools which are available in Al Nas Hospital, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging allow more types of congenital heart diseases to be treated in the cardiac catheter laboratory. 

The hybrid approach has enabled overcoming limitations inherent to percutaneous access.

Teaching is an important part of our mission.

Collaboration with international teams to share experience and exchange knowledge.

Projects which are different in Al-Nas Hospital:

Full range of neonatal cardiac catheter-based interventions including preterm.

Transthoracic guided ASD device closure.

Transthoracic guided VSD device closure.

RVOT procedures in neonatal Fallot patients.

Percutaneous pulmonary valve implantation.

Structural interventions including Paravalvular leak closure.

VSD device closure in low weight patients.

 

6) Inpatient Department:

The hospital includes 557 beds equipped to the highest level to receive all cases and provide all medical services and amenities for the patient.

 

7)  Radiology Department:

The radiology department contains the latest cardiac tomography and magnetic resonance imaging devices in the Middle East, and the whole department uses digital devices equipped with the PACS system (for preservation and communication via the Internet) in order to ensure the best health service for patients. 

 

8) Laboratories and Blood Bank:

Laboratories provide all analyzes that patients need. The laboratories apply the quality system in all analysis results using certified standard materials, as well as barcodes with programs linking all devices with a single patient number and results to prevent human errors. It also features a selection of the best doctors and consultants in various medical specialties, in addition to the latest medical devices.

 

 

Services provided:

Emergency tests for inpatients within an hour, Normal test run results released within 3 hours.

Lab investigations:

All Chemistry lab tests, Electrolytes, All Hormonal assays, Drug assay, Virological tests, Microbiology tests, Haematology tests, Serological tests, Tumor markers, Coagulation tests, and all Blood Bank services.

Available devices:

- Beckman Coulter for Haematology.

- Beckman 480 IU for all Chemistry and electrolytes.

- Beckman ACCESS 2.

- Immunochemiluminesence.

- Bactec BD for quick blood cultures.

 

9) Pharmacy:

At Al-Nas Hospital Pharmacy in addition to pharmaceutical services, they provide a unique service to the patients through the "Clinical Pharmacy" department.

Clinical pharmacy provides comprehensive therapeutic care by directing it towards the chemistry, synthesis, and preparation of drugs to use the most effective treatment for each patient. The hospital also provide regular monitoring of patient compliance and response to treatment.

 

10) Anesthesia Department:

Vision:

The Department of Anesthesiology is to become a leading example in delivering international level of perioperative medical care in terms of safety, efficiency and sustainability. They believe that the model will foster the growth of like-minded anesthesia practices all over the world.

Mission: 

The Department of Anesthesiology is to provide the highest quality, cost effective and efficient medical practice to the patients.  The department is to advance medicine and health via retaining the best and brightest anesthesiologists, engaging in innovative scientific discovery, and disseminating new knowledge into practice.

Core values: 

These standard core values steer the practice to accomplish the hospital goals: Integrity Commitment to innovation and excellence Professionalism Life-long learning Team work Collaboration among disciplines, professions, and in their community Accountability and Responsiveness to those whom they serve. 

 

Goals & Objectives

Delivering quality patient care is the primary goal. Patient satisfaction.

Collaborating with other physicians to ensure quality service. Maintaining an efficient Operating Room.

Attraction and retention of team members who share the same values.             Full alignment with the hospital goals and policies.

 

The Team:

Dr Ahmad Mahmoud Hasseb: Head of the Department

Dr Ahmed Abelkader Elesawy: Anesthesia Consultant

Dr Hazem Abdelmoneim Alteregie: Anesthesia Specialist

Dr Khaled Abdelfattah Elsawa: Anesthesia Associate Specialist

Dr  Mohamed Khaled: Anesthesia Associate Specialist

Dr Khaled Abdelfattah: Anesthesia Associate Specialist

Dr Ahmed Elkhateeb: Anesthesia Associate Specialist

Dr Anas Elshemy: Anesthesia Associate Specialist

Dr Khaled Ashraf: Anesthesia Associate Specialist

 

 

Aesthesia Department services: 

The anesthesia department is responsible for preparation of patients scheduled for any procedure done in Al Nas hospital. This includes pre-procedural assessment of patients, making sure they are optimized and well prepared to go through the scheduled procedure safely and in accordance with the latest evidence-based standards of care.

Provision of anesthesia and sedation for any intervention is the responsibility of the Anesthesia department at any site within the hospital (OR, Cath lab, Radiology department and OPD). It is their responsibility to make sure the service delivered is safe, effective and meets the patient satisfaction.

The Anesthesia department members are responsible for covering any consultation from other departments as airway and vascular access experts. This includes serving patients in need, as well as training their colleagues from other departments.

The Perioperative transesophegeal echocardiography is provided by our team members. This includes adult and pediatric patients.

The Department is periodically auditing the clinical practice to ensure every procedure is done according to the hospital policies and procedures manual. Also, the department is involved in updating the hospital polices as needed.

Research projects are being conducted in collaboration with other departments. The Anesthesia department is constructing a perioperative transesophageal echocardiography course and sedation course for non-anesthetists.

The Equipment:

Anesthesia machines: Draeger Primus.  Anesthesia monitors: Draeger omega. Transesophageal echocardiography machine Siemens Acuson. Portable Fiberoptic bronchoscope: Carl Storz.

 

Stages of food safety in Al-Nas Hospital:

First: Receiving and Storing Processes:

You must know the conditions and Ingredients for receiving, as 5 materials are received and they are: chemical, dry materials, refrigerated materials, frozen materials and fresh materials.

They must be divided because each receipt of an item from them has its own conditions that we must know in order to avoid causing the receipt of damaged or problematic products, and the beginning of the problem to be from the receiving stage.

Conditions for each section of receiving materials:

A) The chemical:

Receiving:

Receive product identification data in both languages: including product definition, product risks and disadvantages of use, solutions and treatment for the risks, installation risks: such as mixing of chemicals during the use process. 

Fires: You must know the most dangerous element, such as the most flammable.

Storage of chemicals:

It must have a special method for storage, such as closing it tightly, whether it interacts with light, heat or moisture or not, so as not to cause problems.

Read the instructions for the product from start to the end to maintain safety. Then store the chemicals in a separate storing section away from cooking utensils or food.

 

The dry materials:

Such as jam, honey, rice, pasta, sugar, legumes. It is necessary to know the date of production and the date of expiration with the receipt of the product in the first third of the date of production because it is in the safety period (in case of storage) even though the system works with the monthly order.

It's important to have the products batch number.

Examine the product to check if it has any impurities, mixing it with another product, whether it has fractures or contains any kind of insects. For the examination, the following must be done: Bring flat white parchment paper and dump a random product on it so that they can see the sample and examine it well (always use known products No. 1 In Egypt, and on the white list), which has obtained the Food Safety Authority seal of approval, which is the safety accreditation.

Then start registering the products as safe (choosing 3 types of the same product imported and 3 from the local one to avoid any risks of unavailability of the product for any reason).

 

The chilled or frozen products:

If the product is frozen, it must be received in a freezer tank, and if the product is chilled, it must be received in a refrigerator tank.

While receiving from the refrigerator or freezer: Open the door before turning off the refrigerator, read the digital of the refrigerator, then test the product by the thermometer, and record the temperature, whether it is refrigerator or freezer.

If the products are frozen, customs release must be received, to see if a period of more than 3 months has passed on the product or not. Confirming that the meat has no leakage, ventilation, so they know that the product has been dismantled and then frozen again.

 

 

 

Fresh products: vegetables and fruits:

Providing a validity period of 3 to 7 days, depending on the method of receiving it, as there are two methods:

First, give a validity of 3 days: If they check the product and then receive it, then wash it, purify it, then put it in the refrigerator (as the product has moisture and if it spends a period in the refrigerator, it will spoil).

Secondly, giving a validity period up to 7 days: If a place is provided for receiving dirty vegetables, It will be received and stored on the following steps: check the products, receive it, then sort it and place it in a separate refrigerator without washing.

The staff records the temperatures manually beside their training on the alarm system automatically.

 

Second: Preparation Process:

To prepare the chicken and meat: put the chicken on a perforated sideboard, and another closed underneath. They put the chicken in the cultured lengthwise, opening the bag that contains the chicken from the bottom until the separating liquid comes out of it, then cutting it for the stage of preparation for cooking. 

If it is meat: They open small holes in the bag of meat as well. If the chicken is whole, boneless breasts: the same method apply, but seal it in a bag with the product data.

 

Third: Cooking Process:

The chef, while cooking, measured the product twice with a thermometer, to ensure that the product exceeded the temperature limit in which bacteria live, and the second time to confirm the doneness of the food in the cooking process.

Bain Marie stage, which is the completion of cooking: When the product is placed after cooking to prepare for distribution, the surface of the bain-marie must be preheated.

Preservation period on the bain-marie: For the international standard, its duration is from 2 to 4 hours. For the hospital, a less dangerous precaution is taken and it is for two hours.

Monitor the temperature of the product again before placing it in the distribution trolley and placing it in the food hot box at a temperature of 80 degrees, as when the food reaches the patient, the temperature of the food must be between 70 and 80 degrees and has not reached the dangerous zone yet. 

The distribution time for one floor is 7 minutes, there are two people from the distribution staff distributing in opposite directions to the same floor to ensure the speedy arrival of food to the patient without the food temperature dropping to the dangerous zone.

Patient dishes are sealed and can withstand temperatures up to 110 degrees, and are for just one use. An hour after the patient finishes the meal, the staff are passed to throw the meal or what is left as there is no reheating system, to prevent any infection.

For employee food distribution: stainless steel utensils are used.

 

Fourth: Washing Process:

The food hot box and serving trays are washed, to avoid collision and contamination. There are two elevators: one is used during the distribution of food and the other is to back the tools to be washed and they are in a direction different from the direction of the exit of the food for distribution.

Then all utensils used during the meal or for the distribution are soaked in the soaking tub to ensure a higher degree of disinfection, then rinsed and stacked their in place.

 

 

 

 

 

 

 

 

References:

1) Rev. ( January 2022): NYS DOCCS Food Service Operations Manual.

2) V. A. do Rosario, and K. Walton. (2022): School of Medicine, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, NSW, Australia. Springer Nature Switzerland AG 2020 H. L. Meiselman (ed.), Handbook of Eating and Drinking, https://doi.org/10.1007/978-3-030-14504-0_74.

3) Bednarczuk, Barbara, and Czekajło-Kozłowska, Anna. (2019): Role of nutritional support provided by qualified dietitians in the prevention and treatment of non-communicable diseases. Roczniki Państwowego Zakładu Higieny. 70. 235-241. 10.32394/rpzh.2019.0080.

4) Bhattarai, Jyoti. (2018):  Medical Nutrition Therapy.  Journal of Diabetes and Endocrine Association of Nepal. 2. 36. 10.3126/jdean.v2i1.21198.

5) Krishnakumar, T. (2021): Reference HACCP: HACCP AND FOOD SAFETY. 10.13140/RG.2.2.12488.03848.

6) https://www.carevoyance.com/blog/hospital-purchasing-agent#:~:text=The%20main%20goal%20of%20any,and%20services%20from%20various%20departments.

7) BC Centre for Disease Control. (n.d.). (May 5, 2015): http://www.bccdc.ca.

8) FOODSAFE. (n.d.). (April 21, 2015): http://www.foodsafe.ca.

9) Food Safety Definitions for Food Vendors at Special Events. (n.d.). (April 22, 2015): http://www.halton.ca/cms/one.aspx?portalId=8310&pageId=37644

10) Hazard Analysis Critical Control Point (HACCP). ( April 22, 2015): http://www.inspection.gc.ca/about-the-cfia/newsroom/food-safety-system/haccp/eng/1346306502207/1346306685922

11) Public Health Act. (n.d.). (April 21, 2015): http://www.bclaws.ca/civix/document/id/complete/statreg/08028_01.

12) https://safetyculture.com/topics/inventory-management-system/inventory-control/#:~:text=Four%20popular%20inventory%20control%20methods,batch%20tracking%3B%20and%20safety%20stock.

13) Centers for Disease Control and Prevention. (2015): Foodborne diseases active surveillance network (FoodNet). www.cdc.gov/foodnet.

14) Hoffmann, S., Batz, M, and Morris, J.G. Jr. (2012): Annual cost of illness and quality adjusted life year losses in the United States due to 14 foodborne pathogens, Journal of Food Protection, 75(7), 1291-1302.

15) National Restaurant Association. “n.d.” Food safety. (2022): www.restaurant.org/Manage-My-Restaurant/Food-Nutrition/Food-Safety.

16) Scharff, R. (2012): Economic burden from health losses due to foodborne illness in the United States, Journal of Food Protection, 75(1), 123-31.

17) Scharff, R. (2010): Health-related costs from foodborne illness in the United States. Produce Safety Project, Georgetown University.  www.publichealth.lacounty.gov/eh/docs/ReportPublication/HlthRelatedCost….

18) U.S. Food and Drug Administration. (2013): Food Code 2013. Retrieved from www.fda.gov.

19) https://www.osha.gov/sites/default/files/2.4_SHMS_roadmap_508.pdf.

20) https://ww2.health.wa.gov.au/Articles/F_I/Food-temperature-control.

21) https://alnas-hospital.com/en.