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

NC Safe Plates Module 6

Military hospital Emergency Department received 13 people with gastrointestinal illness Symptoms:

Nausea, vomiting, abdominal cramps or pain, diarrhea, headache

Symptoms appeared 2-3 hours after a lunch party

Everyone ate Perlo (a chicken, sausage, and rice dish)

What Happened?

Morbidity and Mortality Weekly, December 20, 2013, Vol.62, No.50

The Recipe• Frozen chicken thighs and sausage

defrosted in the microwave

• Defrosted chicken thighs cooked in stock pot of boiling water

• Thighs cooled, meat removed & placed back in stock pot

• Sausage cooked and added to the stock pot

The Recipe (continued)• Onions and other seasonings sautéed in

sausage oil & added to stock pot• Rice added to stock pot & cooked until all

water absorbed• COOKED PERLO PLACED IN UNHEATED OVEN

FOR APPROXIATELY 8 HOURS (OVERNIGHT)• PERLO TRANSFERRED TO SLOW COOKER &

REHEATED FOR 1 HOUR ON HIGH SETTING BEFORE TRANSPORT AND CONSUMPTION

Likely CauseFood contained Staphylococcus aureus Could have been handling cooked chicken or taste testing•Overnight storage of Perlo in oven (not refrigerated) allowed growth & toxin production•Rewarming in slow cooker would not destroy toxin (food in TDZ)

– May have increased toxin production

Learning Objectives• Describe best practices to reduce or eliminate

the risk of Staphylococcus toxin forming• Identify the symptoms and foods for Staph. • Explain the difference between a restricted

and excluded employee• List reasons for exclusion/restriction of

employee

Key Terms• Toxin – poison produced by microorganism• Heat stable toxin – not destroyed by cooking

(165oF)• Temperature Danger Zone (TDZ)- Above 41oF

and below 135oF • Excluded employee- can’t work in operation• Restricted employee- can’t work with or

around food• Reinstated employee- approved to work

Staphylococcus aureus – a bacteria• Termed “staph”• Common in the environment• Lives in humans and animals

– Present in nasal passages & throats– Hand or arm sores (especially pus)– Cough or sneeze

• Can be destroyed by proper cooking• Can produce toxin that is not destroyed by

cooking

Toxin• Can cause nausea, stomach cramps, vomiting, and

diarrhea• Symptoms usually last for a few hours to a day• Fast acting

– Causes symptoms within 1-7 hours after eating contaminated foods

– Controlled by good personal hygiene and avoid temperatures in temperature danger zone

Foods linked to Staph• Meat and meat products• Poultry and egg products• Salads (egg, tuna, chicken, potato, macaroni)• Bakery products (cream-filled pastries, cream

pies, chocolate éclairs)• Milk and dairy products• Any food product handled after cooking

From Our Case Study

Corrective Action/ Prevention• Main contributing factors:

– Poor food handling practices (human contamination)

– Inadequate refrigeration of foods

• Using clean food preparation, storage, & equipment surfaces

• Immediately cooling using proper techniques

Remember from before?• Temperature Danger Zone

– Store TCS food at or below 41oF – Hot hold at 135oF or above if stored for more than 2

hours

• Check temperature– Do you document it?

• Store food in small portions in shallow containers

Corrective Action / PreventionPersonal Hygiene

Staph is naturally present on our skin, around the mouth and nose.

Open sores and cuts are problematic• Proper hand washing for 20 seconds, no bare hand contact• Exclude employees with wounds on hands or arms (unless

covered)• Cover open wounds with appropriate bandages and gloves

FDA Food Code

Reinstate restricted employee if skin, infected cut, or boil is covered with :•Impermeable cover (finger cot or stall) and single use glove if it is on hand, finger, or wrist•An impermeable cover on the arm if infected wound or boil on arm•Dry, durable, tight fitting bandage on body

Corrective Action / PreventionPersonal Hygiene

Hand washing, glove useLimit bare hand contact (utensils)BathingClean uniforms and clothsJewelry- maybe plain wedding band Hair restraintProper taste testing practicesCough and sneeze

When Gloves are Required

• Handling ready to eat foods (except washing produce)

• Slash resistant gloves for carving/cutting• Change gloves between raw and RTE• Open cut or sore- remember regular hand

washing

Case Study

Case Study

Activity

Write down a list of best practices to minimize the risk of staphylococcus aureusRemember:•Personal hygiene•Cross contamination •Temperature Danger Zone

QuizYou see that the food handler you assigned to prepare the salad has a small cut on their hand. You should:

a)Have them start preparing the salad anyway

b)Move them to the meat slicing area

c)Send them to see the doctor, then home for the day

d)Have them put on a watertight bandage over the cut and wear gloves

Quiz

When an individual is made sick by a toxin present in the food, it is called

a)Toxin mediated infection

b)Foodborne infection

c)Foodborne intoxication

d)None of these

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