Control and Maintenance of Food Safety in the Hospital Settings - Dissertation Example

?Control and Maintenance of Food Safety in the Hospital Settings The relevance of food safety has been an issue that is constantly being implemented in order to prevent consumers from getting illnesses or injury due to consumption. This is most important in the hospital settings, mainly due to the presence of immune-compromised patients that are easily-susceptible to getting even sicker or dying due to the lack of the capacity to combat diseases. In order to fully control the contamination of food, the implementation of HACCP in the hospital settings is an effective way in ensuring that the contamination of food in any way would be put to a minimum. Procedures such as frequent hand washing and the increase in focusing with sanitation maintenance is a brilliant way of implementing HACCP effectively. With the implementation of such procedures, food-borne diseases the hospital can be prevented, and the patients would have more time to recuperate from their illnesses. Control and Maintenance of Food Safety in the Hospital Settings Food has been the fuel that drives the evolution of many creatures, and its presence in the lives of humans for thousands of years attest to its utmost importance in the creation of cultures and societies (Knechtges 2). The impact of food in human lives can be seen in the evolution of agriculture, of the invention of strategies in food storage, the creation of different kinds of cuisines, as well as letting people know the health and spiritual benefits of food (Roday xii). Even until today, most of the economics in any country discusses, at some point how the availability of food in a country could dictate the health and wealth of that nation (Knechtges 2). It can be safely said that humanity has been, and would always have strong ties with anything related to food. Because food is a commodity that all people are more than willing to partake of, the importance of assuring the buyers of their full satisfaction with such product needs to be maintained at a constant pace. Food is something that is eaten, enters the body after being broken down, and supplies energy to living cells, and so there is a much more profound need to assure that eating any food would not cause any untoward problems in the consumer’s body (Roday xii). Problems such as the compromise of the freshness and the safety of food stuffs could not only prove detrimental to a person’s health, but also to the whole industry of food as well, and if such problems continue to persist, the economy of the region or place that was affected by it could also suffer as well (Kutz 15). Because of the constant possibility of the food carrying additional stuffs that could range from rather harmless to deadly, in recent years the concept of keeping food as free from dangerous substances and harmful organisms became one of the strongest aims of the food industry (Hester and Harrison 25). Food Contaminants: Their Point of Entry and Effects When the word “contaminant” is heard, it can range from harmless things such as an ant baked into a load of bread, to things that could cause illnesses or even death, like bacteria or dirt. However, in terms of food safety, there are three recognized major contaminants that could compromise the safety of food in general. These contaminants can be physical contaminants such as leaf stalks or stones, chemical contaminants such as pesticides or toxins, or microbiological contaminants such as bacteria or worms (Lelieveld 61). The entry of such contaminants in food is more often than not unintentional, but due to lack of knowledge in handling foods, the addition of unwanted material in the food gets overlooked by persons involved in the industry. Physical contaminants such as leaf stalks, debris, soil or stone particles, bones or cartilages, misplaced plastic packaging, and other inert substances do not greatly cause harm to those that may consume them, except perhaps if the object is rather sharp (Lelieveld 62). Chemical contaminants on the other hand can range from lubricants that spill from the machines in processing plants, to airborne particles such as insecticide sprays that enter the facilities, and even hazardous chemicals that were formed as by-products of the process itself (Lelieveld 64). Microbiological contaminants on the other hand can come from numerous sources: animals or vegetables harbouring microbes at the start and bring them passively straight out of the farm or slaughterhouse itself; sick or unhygienic persons handling the equipment or the raw food; or the left-over debris in the machinery, refrigerants, or trucks that let bacterial or fungal growth possible (Lelieveld 67). Among the three contaminants mentioned, the most dangerous is the microbiological contaminants, due to their capacity to increase logarithmically (Juneja and Sofos xi). While consuming the organism itself does not lead to sicknesses unless a person is immune-compromised, the ingestion of the toxins produced by these organisms is the real cause for alarm to healthy persons (Juneja and Sofos xi). Nematodes, microbial parasites and other worms can be avoided or prevented by thorough washing of the produce, disruption of their life cycles as early as possible, or making sure that the animals are free from such infections (Ortega 191). Fungi are more often associated with food production, and the only problems that they may cause are contaminations of mycotoxin-producing species such as Aspergillus, Penicillium and Fusarium (Juneja and Sofos 275). By making growth conditions unfavourable for fungal growth, mycotoxin accumulation can be easily prevented in food stuffs (Knechtges 189). However, bacteria could cause greater problems due to their fast rate of reproduction in all possible conditions, and are more pervasive compared to fungi (Juneja and Sofos 138). Species such as Salmonella, Escherichia, Shigella, Listeria, Campylobacter, Yersinia, among others are some of the most reported species of bacteria that are found as contaminants of foods during reports of an outbreak (Knechtges 18). To the immune-compromised, especially in hospitals, the entry of such organisms in their systems could be fatal due to having low counts of white blood cells to eradicate the infection, or causing destruction to organs (Lund and O'Brien 116). In any part of the supply chain, contaminants can enter in any procedure such as harvest, processing, transport or packaging of the food (Lelieveld 61). It is highly-expected that during harvest, the produce would have the highest levels of contamination, thus the need for the produce to be thoroughly washed. However, in the steps following harvest, debris in the processing machines, the delivery trucks, or even a food handler forgetting to wash hands could add to the already-present contaminants in the food. By thorough cleaning of all utensils or equipment involved in the processing, transport and handling of food, all forms of contamination can be minimized, if not prevented (Knechtges 36). The Effects of the Changes in the Supply Chain of Food Stuffs For the past half-century, there were so many observed changes in the availability and variety of so many food products, people now have more choices on what to buy and what to cook. However the very idea of assuring that these foods safe for eating has been much more of a challenge that is at times just set aside for convenience (McEarhern, Bungay and Ippolito 29). This kind of laissez faire attitude towards maintaining the level of contamination in food has caused the rise in outbreaks of different parasites and microorganisms in food, as well as the detection of high levels of toxins and poisons in them (Knechtges 6). Because of such hazards that can be acquired from improper food handling and storage, food safety became one of the biggest health issues given much attention to by numerous institutions, whether private or government-owned. For all consumers, it is very important that the food stuffs being handled are safe and free from any form of contaminants, which could cause dire health problems upon consumption. In the links of the supply chain, from the growing of the produce, to the harvest or collection, transportation, up to the level of consumers, utmost care must be made to prevent all forms of contamination (US Food and Drug Administration). The more steps are involved in these processes and the more complex it is, the more likely that there would be the accumulation of unwanted organisms or particles in the produce (Knechtges 35). It is a well-known fact that the farther the produce is being transferred, the more it collects dirt and other chemicals along the way, especially when improperly handled and stored. Due to the high probability of different food items harbouring unwanted elements such as pathogenic organisms, heavy metals, toxins, and other possible hazardous contaminants, the persons involved in each step of the handling and processing process are required to be as careful and as clean as possible in handling the food (US Food and Drug Administration). In doing so, the possible entry of unwanted foreign particles in any stage of the produce supply chain is prevented by all food handlers by procedures that aim to minimize and remove these contaminants, such as proper sanitation, disinfection, and transfer of these food products (Dillon and Griffith 39). Food Safety Awareness of the People Compared to the situations that previous generations had more than 50 years ago, at present there is an increased awareness in the importance of keeping food stuffs as clean and as safe as possible. Due to numerous outbreaks of different contaminants such as bacteria like Salmonella and Escherichia coli, toxins such as mycotoxins, and heavy metals like lead or cadmium in food, more and more people have now become more aware of the dangers of food contamination in production sites (Dillon and Griffith 48). However, many of these same people are not aware that even handlers of food could be possible sources of contamination as well. As reported by the Food Safety Authority of Ireland in 2001, in 100 reported food outbreaks, more than half of those are due to mishandling by inadequately-trained staff (Worsfold and Griffith 68). While it is usually expected that with regards to food, additional sanitary procedures must be undertaken, but in some cases other factors such as being able to provide knowledge to food handlers could prevent the dissemination of such information. It may be possible that due to cross-cutting of budget, or simply being too expensive for some businesses, trainings with regard to proper food handling that should be normally given to food handlers become compromised, causing future problems to ensue in these institutions (Worsfold and Griffith 77). With such facts in mind, the future of completely having control over all aspects of food safety seems to be unclear. Food contamination is not a recent phenomenon, but is actually a part of human history for a long time. The classic example of the effects of contamination of food is the case of Mary Mallon, or “Typhoid Mary” in the early 1900’s. Because of the unsanitary habits and lack of proper sanitation procedures prevalent during those times, there was a large outbreak of typhoid fever in Long Island, New York (Knechtges 17). Due to the number of people that she got infected with, with at least 47 affected and at least three dead, she was forced to get herself isolated until her death in 1938 (Knechtges 18). With such outbreaks in mind, maintenance of high levels of food safety has become the aim of the food standards the world has today. Food Safety in the Hospital Settings Food safety maintenance is for the benefit of all consumers, and it is even more important in the hospitals. In the health care settings, food is regarded as a vital factor in speeding up the recovery process of patients, therefore the need to make sure that these only get food with the highest quality in terms of nutrients as well as of contamination levels (Lund and O'Brien 109). Because of the immediate need of all patients of getting to eat at regular intervals, most hospitals prepare their own food. They can also serve visitors as well, thus having a wider range of consumers (Lund and O'Brien 110). However, surveys conducted in the UK revealed that despite the Aside from the fact that there are numerous people going in and out in any time of the day, many diseases can also be passed within its confines, which could possibly enter the food. Even the mere scratching of food handlers could transfer substantial amounts of bacteria such as Staphyloccocus aureus in whatever food they may be delivering (Lelieveld 291). It would be even worse if immune-compromised patients were to eat these foods, because of the decreased capacity of their immune systems to combat pathogenic bacteria and the prevention of their entry to their systems (Lund and O'Brien 110). Getting infected through contaminated hospital food could add burdens to this people, and they could even die from such occurrences. Keeping such details in mind, it is highly relevant that food handlers be fully aware of their actions in order to keep the patients free from possible bacterial infection as much as they could. The Creation of the Principles of HACCP In the need to fully gain control over the safety of food, the US Food and Drug Administration convened in the mid-1990’s to come up with step-by-step procedures in maintaining the lowest contamination levels of food stuffs as much as possible. With the National Advisory Committee on Microbiological Criteria for Foods as the major force in the revision and implementation of new food safety principles, a more concise set of procedures was developed that would assure proper implementation and education of all people and institutions that are connected with food and its handling (US Food and Drug Administration). By aiming for total control of all steps of the supply chain of produce, the need of creating a stringent, reliable and rational means of keeping and assuring safety in all levels of food preparation and handling was realized. The result of these goals and procedures is the drafting of the Hazard Analysis Critical Control Point Principles, or HACCP Principles (US Food and Drug Administration). Utilizing the set principles ensures that in all participating food companies or farms could guarantee that whatever product or fresh produce they would be releasing to the market would be fully safe to eat and free from any harmful contaminants. Because the principles were created in order to be performed in a step-wise manner, it would be easy to detect if there were major deviations, procedure removals or substitutions in the plan set forth by an industry, or by safety auditors. By following the procedures covered in all steps of the plans using the HACCP Principle, there is an added assurance to the consumers that their food is guaranteed to be a hundred percent wholesome, from harvest to delivery to their dinner tables. In order to maintain the assurance of the reliability of the HACCP Principles, the committee made the system standardized with regards to the dissemination of information, training procedures and applications to all industries that needed it, be it privately-owned or government-owned (US Food and Drug Administration). The committee also added the possible dangers of other contaminants such as chemical and physical hazards, aside from biological hazards in considering the application of the HACCP Principles, which makes the process even more broad with regards to its applications (US Food and Drug Administration). As of date, there are different HACCP Principles made specifically for any one type of food and beverage industry, such as HACCP principles for dairy, for juices, for retail and food services, and for seafoods (US Food and Drug Administration). The broad approach of HACCP is a good assurance that nearly all aspects of the food industry can provide high-quality food in all levels. The HACCP Principles The HACCP Principles consist of seven step-by-step principles that constitute a system that aims to standardize methods that promote food safety in all levels. The principles aim to have full control of all the processes involved in the food industry: raw material production; procurement and handling; manufacturing; distribution; and the consumption of the finished product (US Food and Drug Administration). It is therefore essential for those undertaking the implementation of HACCP to be fully aware of all the procedures that they perform, in order to change all guidelines into HACCP- guided ones. The following are the seven principles of HACCP in order of execution, as formulated and implemented by the US Food and Drug Administration: 1. Conduct a hazard analysis. 2. Determine the critical control points (CCP). 3. Establish the critical limits. 4. Establish monitoring procedures. 5. Establish corrective actions. 6. Establish verification procedures 7. Establish record-keeping and documentation procedures. Prior to the implementation of such principles in a given food setting, the implementing body is enjoined to be fully-committed in the application of all HACCP Principles in their food processing and handling procedures. There is also the introduction and implementation of prerequisite programs such as Good Agricultural Practices (GAP), or Good Manufacturing Practices (GAP) in order to further solidify the foundation and the application of the HACCP Principles in the companies that implement them, as well as their personnel (US Food and Drug Administration). A sample procedural layout that incorporates HACCP Principles is presented in figure 1. In the conduct of the hazard analysis, there should be a full-knowledge of all the steps involved in the procedural layout of the implementing body before changes in these procedures are made (US Food and Drug Administration). By doing so, hazards within the procedures can be easily pinpointed and traced. After identifying the hazards, the next step would be to evaluate which hazards should be addressed immediately. For example, in a catering service in a hospital, one hazard identified is the few numbers of hand washing stations. Another is the constant entry of insects in the food storage rooms. Because sanitation is compromised, the need to increase its levels was identified to be hazardous to end-users of the meat products. After identification of hazards is done, the implementing body is ready for step 2. Figure 1. Flowchart of a sample processing layout that incorporates HACCP Principles (Food Standards Agency. Food Assurance Safety System, (2005). Issue 1.1: 2.3) For step 2, or the determination of critical control points, the implementing body essentially creates methods by which the identified hazards can be eliminated, because they could cause considerable negative effects such as illness or injury (US Food and Drug Administration). In continuing the hospital catering service as an example, the identified hazards (not enough hand washing stations and easy entry of insects like flies and cockroaches) can be ameliorated by installation of more faucets and additional screening in the cooking station’s entry points. It is also possible to add more time in cleaning and disinfecting the whole storage and cooking facility, putting focus on its maintenance. With this done, the implementers can proceed to step 3. Step 3, or the establishment of critical limits would ensure that the procedures done in the facility would be readily duplicated and followed by all concerned personnel. By standardizing the procedures, there would be a greater control over food contamination. Going back to the hospital catering service, critical limits such as the establishment of specific number of entering personnel within the work stations at any given time, minimum number of insects that can be tolerated inside the plant, as well as setting the maximum volume of product output before thoroughly cleaning the facility can be done as critical and measurable procedural points. Creation of monitoring procedures is the fourth step, and it is fairly easy to understand. With regards to the hospital catering service, they could create logbooks that list the entry of all personnel in the cooking and storage area, as well as recording the volume of food taken out and sent in storage, and the times that general cleaning of all equipment and facilities are done. For the fifth step of correcting the established procedures, the implementers could check if their procedures are efficient or not (US Food and Drug Administration). By doing so, unnecessary steps or erratic methods can be removed or replaced with much more effective ones. In step 6, or verification of procedures, outsourcing can be used in order to check if the methods are able to greatly reduce the levels of contamination, or not (US Food and Drug Administration). In the example given, the hospital catering service could hire a third-party in checking the microbial levels of their uncooked, pre-cooked and cooked food, as well as to check the contamination levels of their cooking area and storage facilities. They should do this before and after implementation of the HACCP plan in order to check whether their plans do work or not. After the results are out, if the results are favourable, the caterers could proceed to step 7, but if not, they should go back to step 3. The last step involves creating a documentation system of all procedures being done, as well as a summary of the steps and the rationale of all control procedures (US Food and Drug Administration). In the given catering service scenario, they could post all of the step-by-step procedures in their cooking area or food storage facilities, as well as keeping all record books to check for possible trends in problems that could arise. By doing so, they could re-invent their procedures to suit the changing times. The Supply Chain of Food Products and HACCP Integration With regards to food services in the hospital settings, the supply chain consists of the following: raw or stored materials phase; food preparation phase; processing phase; packing phase; distribution phase; consumption phase; storage or buffer phase. Contaminants could easily enter in any of the phases: raw food is easily contaminated due to being moist, and organisms are able to grow in moist environments; in the food preparation, processing, packaging and distribution phases, as well as the storage or buffer stage the handler shoulders the full responsibility of keeping the self thoroughly clean, as well as the workplace and the storage facilities because he or she is directly involved in these steps. Thus it is relevant that caterers are aware of all procedures being done in order to maintain cleanliness and safety in their food preparations (Hester and Harrison 28). That means that in the beginning, the caterers must be fully aware of the cleanliness levels of their food sources, so it would be logical to choose those with a HACCP certification to jumpstart the process of continuing the full control on food contamination. There should always be frequent hand washing, focus on personal hygiene, keeping the eating rooms, utensils, workstations and storage facilities thoroughly sanitized and frequently cleaned, as well as keeping a proper record and labelling of all the food that goes into the freezers and taken out. While the consumers are not exactly part of the whole process, they must also ensure that they could prevent the contamination of their food, even just by hand washing (Lund and O'Brien 116). Conclusions Food safety has been one of the most important topics that are relevant in today’s modern society. Its main concern is to prevent consumers from getting illnesses or injury due to eating contaminated food. The goal of attaining high levels of food safety is most important in the hospital settings. Due to the presence of immune-compromised patients with low tolerance to microbial invaders in their bodies, by getting lax in the mission to keep their food safe they get susceptible to getting even sicker or dying. The implementation of HACCP in the hospital settings is an effective way in minimizing the entry of contaminants to all food stuffs. It is suggested that frequent hand washing and the increase in focusing with sanitation maintenance are effective ways to control food contamination in hospital catering services. By implementing these procedures, food-borne diseases the hospital can be prevented, and the patients would have more time to recuperate from their illnesses. Works Cited Dillon, M. and C. Griffith. Auditing in the Food Industry: From Safety and Quality to Environmental and Other Audits. Boca Raton, FL: Woodhead Publishing Limited, 2001. Print. Hester, R. and R. Harrison. Food safety and food quality. Cambridge: Royal Society of Chemistry, 2001. Print. Juneja, Vijay K. and John Nikolaos Sofos. Pathogens and Toxins in Foods: Challenges and Interventions. Washinton, DC: ASM Press, 2010. Print. Knechtges, Paul L. Food Safety: Theory and Practice. Burlington, MA: Jones & Bartlett Publishers, 2011. Print. Kutz, Myer. Handbook of Farm, Dairy, and Food Machinery. Norwich, NY: William Andrew Publishing, 2007. Print. Lelieveld, H.L.M. Hygiene in Food Processing. Boca Raton, FL: Woodhead Publishing Limited, 2003. Print. Lund, Barbara M. and Sarah J. O'Brien. "Microbiological safety of food in hospitals and other healthcare settings." The Hospital Infection Society (2009): 73: 109-120. Print. McEarhern, V., et al. "Regulatory verification of safety and quality control systems in the food industry." Dillon, M. and C. Griffith. Auditing in the Food Industry: From Safety and Quality to Environmental and OtherAudits. Boca Raton, FL: Woodhead Publishing Limited, 2001. 29-47. Print. Ortega, Ynes R. Foodborne Parasites. New York, NY: Springer Science + Business Media, 2006. Print. Roday, S. Food hygiene and sanitation. New Delhi: Tata McGraw-Hill Education, 1999. Print. US Food and Drug Administration. Hazard Analysis & Critical Control Points (HACCP). 27 April 2011. Web. 9 October 2012. Worsfold, Denise and Christopher J. Griffith. "A survey of food hygiene and safety training in the retail and catering industry." Nutrition and Food Science (2003): 33 (2): 68-79. Print. Read More