Infection Prevention and Control Team (IPCT) SECTION 13 PATIENT SELF CATERING POLICY

Infection Prevention and Control Team (IPCT) SECTION 13 PATIENT SELF CATERING POLICY WARNING This document is uncontrolled when printed. Check local intranet site for current version Page 1 of 24

Title of Policy: Patient self catering policy Policy Reference: Issue no 2, October 2010 Scope: Controlled document: Organisation Wide This document shall not be copied in part or whole without the express permission of the author or the author's representative. Expiry Date: October 2013 Author: Policy application / Target Audience Chris Paterson, Infection Control Nurse Throughout NHS Ayrshire and Arran RESPONISIBILITIES FOR IMPLEMENTATION Organisation: Directorate: Corporate: Departmental: Local: Policy Statement: Chief Operating Team Directors Senior Managers Heads of Wards or Departments All relevant staff All staff involved in supporting patients who undertake any from of self catering will ensure that the measures outlined in this document are fully implemented. Last reviewed: September 2010 Agreed by: Electronic approval by: Infection Prevention and Control Policy Review Group Professor Robert G Masterton Executive Medical Director Date: 08 September 2010 Page 2 of 24

TABLE OF CONTENTS 1.0 INTRODUCTION... 4 2.0 GENERAL PRINCIPLES OF FOOD HYGIENE... 5 3.0 RESPONSIBILITIES... 5 4.0 HAZARD ANALYSIS CRITICAL CONTROL POINT (HACCP)... 7 5.0 PATIENT ASSESSMENT... 7 6.0 PURCHASE OF FOOD... 7 7.0 PREPARATION OF SNACKS... 8 8.0 PREPARATION OF MEALS... 8 9.0 COOKING UTENSILS AND OTHER EQUIPMENT... 9 10.0 MICROWAVES... 9 11.0 DISHWASHING... 10 12.0 SELF CATERING KITCHEN ENVIRONMENT... 10 13.0 ENVIRONMENTAL CLEANING... 10 14.0 WASTE DISPOSAL... 11 15.0 INFECTION CONTROL MEASURES... 11 16.0 AUDITS OF THE LOCAL OPERATIONAL PROTOCOLS... 13 APPENDIX 1 - PROTOCOL FOR THE USE OF MICROWAVE OVENS IN WARD KITCHENS... 14 APPENDIX 2 - AGREEMENT TO REPORT INFECTION FORM... 16 APPENDIX 3 - COLOUR CODING... 17 APPENDIX 4 - HIGH RISK FOODS... 18 APPENDIX 5 - STORAGE OF FOOD FOR PATIENT SELF CATERING... 20 APPENDIX 6 - COMMON MICROBIOLOGICAL FOODBORNE DISEASES AND EXCLUSION FROM FOOD PREPARATION... 22 APPENDIX 7 PROTOCOL FOR THE USE OF BARBECUES... 23 Page 3 of 24

1.0 INTRODUCTION In many care environments patients e.g. mental health; learning disabilities; and occupational therapy; patients, clients & residents prepare food for themselves. The objective of this policy is to give these patients greater freedom and responsibility for their own nutritional intake whilst ensuring that the risk of foodborne illness is minimised. This will include the purchasing, storage and preparation of food without compromising food hygiene standards. The procedures outlined in this policy are best practice and should be used to educate patients in food safety and prepare them, where applicable, for discharge into the community. Meals and snacks for the majority of patients will continue to be provided by the Catering Department. Patient self catering is not permitted in ward kitchens where the requirements of this policy cannot be implemented. The policy and its appendices outline the criteria that must be met in all areas where food is prepared by patients or staff in ward or occupational therapy kitchens. Preparation of the following at ward level can be carried out without need to implement the main policy: a) beverages b) toast, including cheese and toast. c) those foodstuffs that are prepared in line with the Protocol For The Use of Microwave Ovens For Patients In Ward Kitchens (see Appendix 1) d) sandwiches with butter, jam or marmalade. Other sandwiches may involve the use of high risk foods and as such should only be carried out in line with the. Each area where patient self catering is practised must develop a local operational protocol that complies with this policy and the relevant food hygiene legislation. The level of food preparation permitted in each area will depend upon the facilities available and the abilities of the patient group. This must be clearly stated in each local operational protocol. Food preparation to a level not covered in the protocol is not permitted under any circumstances. The guidance given in the boards Code of Practice for Caterers and Food Handlers must also be adhered to at all times. There should be close liaison with the Dietetics Department when planning self catering to ensure that the types of snacks or meals chosen provide good nutrition. Page 4 of 24

2.0 GENERAL PRINCIPLES OF FOOD HYGIENE The following general principles must be incorporated into all local operational procedures: i) Measures must be taken to ensure that cross contamination of food stuffs does not occur at any stage during the storage and preparation of food. ii) iii) Adequate temperature control must be maintained during all stages of food storage and preparation. All those involved in the preparation of food in self catering kitchens must maintain the highest standards of personal hygiene. Food must be consumed immediately after it is prepared. It must not be stored in self catering kitchens for consumption at a later date. Where food is prepared in a day hospital setting and is to be taken home by the patient for consumption later it must be transported in manner that protects it from contamination, i.e. properly wrapped. Perishable food must be consumed within 2 hours of preparation or transported and stored in a fridge within 2 hours of preparation. Food must not be reheated after preparation. 3.0 RESPONSIBILITIES 3.1 Service Manager The service or departmental manager is responsible for ensuring that all activity within self catering kitchens within their remit complies with this policy, the local operational protocol and the relevant food hygiene legislation. It is the responsibility of the Service Manager to ensure that all staff are trained to an approved level. A record of all staff training must be maintained. In order to show Due Diligence the Service Manager is required to ensure audits of the local operational protocols are undertaken every 6 months. This can be delegated to the Trained Person (See Section 3.2) in each area. Audit results must be reported to the service manager. It is responsibility of the service manager to ensure that areas are audited and results are reported. The Service Manager must take action to rectify any faults arising from a breakdown in practice or deficiencies in staff training. He or she will also ensure that all equipment undergoes regular maintenance and that arrangements are made for prompt repair of defects. The Service Manager should utilise the expertise of the Hotel Services or Catering Manager when advice is required. Page 5 of 24

3.2 Trained person The management teams, supported by training resources, have a responsibility for supplying adequately trained staff to meet the overall needs of the service and the board s obligations. Each service/department where food will be prepared by patients or staff will have at least one individual who is trained to Intermediate Food Hygiene Level (Trained Person). This will be a senior member of nursing or occupational therapy staff who has sufficient experience and authority to direct and change the practices of other staff. Refresher training should be undertaken every 3 years. One Trained Person may cover a number of different self catering kitchens within the same service. However they must be managerially accountable to the Service Manager for that area. For this reason both nursing and occupational therapy must have their own Trained Persons for their own self catering kitchens. Trained persons may operate a link system delegating the day to day responsibility for compliance with this policy and the local operational procedure with key staff. Link staff should be trained to Basic Food Hygiene standard. Where different staff groupings or disciplines share food preparation areas it is essential that one individual is identified as the Trained Person, who should ensure that the activities of the other staff groupings comply with this Policy and the Local Operational Protocol. The Trained Person is responsible for developing the local operational protocols in line with this policy and the relevant food hygiene legislation. He or she will identify risk procedures and ensure appropriate control measures are in place. It is the responsibility of the Trained Person to ensure that staff are trained in the implementation of the protocol, including the instruction of new members of staff in the local operational policy within one month of commencing in the unit. This role may be delegated to a link person if deemed appropriate. The Trained Person will carry out 6 monthly audits of all of the self catering kitchens in their remit and is responsible for advising the Ward or Departmental manager on what action is required to rectify any faults identified. 3.3 Nursing and Occupational Therapy staff All nursing and occupational therapy staff involved in food preparation in self catering kitchens will be instructed in the local operational protocol within one month of commencing in the unit. All staff must be trained to basic food hygiene level before involvement in food preparation can be undertaken. Previous food hygiene training can be taken into account. All staff will receive appropriate updating on the principles of food hygiene and safety every 3 years. All staff have a responsibility to fully comply with this policy, the relevant food hygiene legislation and the local operational procedure. Staff must sign an Agreement to Report Infection Form (see Appendix 2) and comply with the requirements to provide Page 6 of 24

relevant samples for microbiological investigation. The form will be kept in the staff members' personnel file. 4.0 HAZARD ANALYSIS CRITICAL CONTROL POINT (HACCP) HACCP is a widely accepted food safety management system, scientific based, designed to control hazards at points critical to food safety. The main aim of HACCP is to focus on Critical Control Points (CCPs) in the operation of the food business and to take measures to ensure that any risk is adequately controlled and deviations corrected. In areas where snacks are being prepared by patients and staff and where patients are preparing meals by themselves or in conjunction with staff then the principles outlined in this policy will minimise the risks and a full HACCP system is not required. 5.0 PATIENT ASSESSMENT All patients must be assessed by trained nursing or occupational therapy staff who have undertaken appropriate food hygiene training (Basic Food Hygiene Level) to determine what level of food preparation they can undertake. Close co-operation between nursing and occupational therapy staff is essential in ensuring the implementation of this policy and local operational protocols. The patient assessment must be formally documented and reviewed on a regular basis. It should include whether the patient is able to understand the risks presented by improperly prepared food; whether the patient understands all of the steps required to produce a safe product; and whether personal hygiene is satisfactory. The record of the assessment must note whether the patient is deemed competent to prepare food for others or only for his or herself. Any changes in the patients' abilities that will compromise food safety must be documented and the level of food preparation reassessed accordingly. 6.0 PURCHASE OF FOOD Food for patient self catering should be bought in small quantities. This will minimise storage problems in self catering kitchens and reduce the risk of food being kept longer than is safe. Perishable goods and those liable to deteriorate should be carefully purchased with due regard to storage dates. Page 7 of 24

7.0 PREPARATION OF SNACKS This will be the most common form of patient self catering. Snacks will include the heating of tinned food e.g. soup, beans, etc., and the preparation of sandwiches. 7.1 Preparation by patients An assessment of the patient's competency as outlined in 5.0 must be clearly documented. Preparation of snacks by patients must initially be carried out under the supervision of appropriately trained staff (Basic Food Hygiene Level). The level of supervision may be decreased as the patient s competency is established. However it must continue to be performed at periodic intervals as documented in the patient's action plan. 7.2 Preparation by staff All staff involved in the preparation of snacks in self catering kitchens must be trained to basic food hygiene level. The Trained Person (Intermediate Food Hygiene Level) must instruct such staff on the local operational protocol and be satisfied as to their competency before they can prepare snacks for patients. 8.0 PREPARATION OF MEALS This is a high risk activity and the Trained Person (Intermediate Food Hygiene Level) must be satisfied that all appropriate control measures are in place and staff have been suitably trained before this type of activity can commence. Preparation of meals in self catering kitchens can only be undertaken if the facilities in the kitchen are suitable. Meals will include the cooking of foods such as raw meat. Additional information on the storage and preparation of high risk foods is contained in Appendices 4 and 5. 8.1 Preparation by patients Preparation of meals by patients must initially be carried out under the supervision of appropriately trained staff (Basic Food Hygiene Level). An assessment of the patient's competency as outlined in 5.0 must be clearly documented. The level of supervision may be decreased as the patient s competency is established. However it must continue to be performed at periodic intervals as documented in the patient's action plan. 8.2 Joint preparation by patients and staff All staff involved in the joint preparation of meals must be trained to basic food hygiene level. The Trained Person (Intermediate Food Hygiene Level) must instruct such staff on the local operational protocol and be satisfied as to their competency before they can help patients prepare meals. Page 8 of 24

9.0 COOKING UTENSILS AND OTHER EQUIPMENT It is important that all equipment such as pots, knives, etc., used in the preparation of food is maintained in a good condition and is not chipped or broken. Damaged surfaces will harbour food particles and protect micro-organisms from the normal cleaning procedures. All equipment should be inspected regularly; any noted to be damaged or broken should be withdrawn from use and replaced. It is important that cross contamination of foodstuffs does not occur by using the same utensils with cooked and uncooked produce without thorough washing. Work tops, cooking utensils, chopping boards, etc., must be cleaned between each use with a suitable bactericidal liquid detergent. Raw and cooked foods must not be prepared or handled at the same time. A colour coding system may be implemented to prevent such cross contamination (see Appendix 3). The use of deep fat fryers is not recommended. 10.0 MICROWAVES Staff must comply with the Protocol for the Use of Microwave Ovens for Patients in Ward Kitchens (Appendix 1). Microwave heating is uneven and their routine use in self catering kitchens is not recommended. Only 1000 Watt microwaves must be used for heating food. The use of microwaves must be limited to heating tinned food such as soups and beans, as well as commercially prepared frozen meals in line with the manufacturers' instructions. Microwaves must not be used for cooking high risk foods (see Appendix 4) or defrosting frozen food prior to cooking, except in circumstances detailed below. The use of microwaves for cooking high risk foods is only permitted for patients who are being prepared for discharge to the community and where the use of an electric or gas cooker in the community may present a risk to the patient. A thorough documented risk assessment must be made by an occupational therapist to determine that microwave cooking is the only suitable method for this patient to prepare meals when discharged into the community. Training patients to use the microwave for cooking high risk foods is not permitted at ward level and must be carried out in an O.T. kitchen and be closely supervised. Microwave cooking is a high risk activity and it is essential that it is only used in clearly defined circumstances. All spillages must be thoroughly cleaned immediately after they occur. Responsibility for the weekly cleaning of the microwave must be clearly allocated in the local operational protocol e.g. patients, nursing staff, occupational therapists, housekeepers. The Ward or Departmental manager must ensure that appropriate arrangements have been made for regular maintenance of the machine. Page 9 of 24

11.0 DISHWASHING Where possible all cooking utensils, crockery and cutlery should be washed in a dishwasher. The dishwasher should reach thermal disinfection temperature i.e. 80 C for 1 minute. Where a dishwasher is not available cooking utensils, crockery and cutlery must be washed using clean hot water and an approved bactericidal detergent. Disposable cloths and towels should be used in most instances for washing and drying dishes. Where non-disposable cloths and towels are used for dishwashing in areas where patients are being prepared for discharge to the community then they should be washed daily at thermal disinfection temperature i.e. 80 C for 1 minute. During an outbreak of gastro-intestinal illness arrangements must be made for all cooking utensils, crockery and cutlery to be washed at thermal disinfection temperatures in a dishwasher. The service manager is responsible for ensuring that appropriate arrangements have been made for regular maintenance of the dishwasher. 12.0 SELF CATERING KITCHEN ENVIRONMENT This must be fully assessed prior to the development of the local operational protocol. There must be sufficient space to allow safe practice, taking into account the level of food preparation to be carried out; the number of people who will use the kitchen and proper segregation of foodstuffs. A limit to the number of people permitted in the kitchen will be included in the local operational protocol. All cupboards and work surfaces must be intact, impervious and clean. Equipment suitable to the level of self catering must be available and maintained in good working order. 13.0 ENVIRONMENTAL CLEANING All food preparation areas must be kept clean and free of food debris. Domestic staff will perform routine cleaning of ward and therapy kitchen areas. Staff involved in the provision of food in self catering kitchens must ensure that all equipment including cookers and grills are cleaned after every use. Further guidance on the cleaning of the kitchen is contained in Appendix 5. All spillages should be dealt with immediately. Page 10 of 24

Responsibility for the regular cleaning of all work surfaces in self catering kitchens must be clearly allocated in the local operational protocol e.g. patients, nursing staff, occupational therapists, housekeepers. A signed record of all cleaning activity must be maintained. 14.0 WASTE DISPOSAL Where possible, all food waste should be disposed of via a purpose built waste disposal unit. Where no waste disposal unit is available all food waste, including plate waste, should either be returned to the main kitchen immediately after each meal for disposal or placed immediately into a suitable rigid leak-proof bin lined with a plastic bag and fitted with a tight fitting lid. The bin must be cleaned regularly. This will discourage pests and vermin. Food handlers involved in the collection/compaction of meal waste must wash their hands immediately after handling refuse or refuse containers. 15.0 INFECTION CONTROL MEASURES 15.1 Hand hygiene Hands are a major source of contamination during the handling and preparation of food and must be thoroughly washed using liquid soap and warm water then dried using disposable paper towels. The types of situation where hands must be washed are: On arrival for duty; after coughing or sneezing; after blowing your nose; after breaks; after smoking a cigarette; after use of the toilet; before handling or preparing food; after handling raw food; after handling waste and before leaving the ward. All breaks in the skin must be covered with a waterproof dressing that can be easily identified. Anyone with an infected or discharging lesion on their hands or arms must not handle food. They must seek advice from the Occupational Health Department as to their fitness for duty. 15.2 Protective clothing Suitable protective clothing dependent on the type of activity being performed in the kitchen must be available at all times and detailed in the local operational protocol. It may be disposable e.g. plastic aprons, or re-usable, e.g. heat resistant oven gloves. Clean protective clothing must be worn and changed when soiled and at least daily. Page 11 of 24

15.3 Patients with gastro-intestinal Illness Any patient developing signs and symptoms of gastro-intestinal illness e.g. nausea, vomiting or diarrhoea must not be involved in the preparation of food for themselves or others. Specimens should be obtained for microbiological investigation. Where the patient is symptomatic but no diagnosis has been made then they must refrain from preparing food for at least 48 hours after the cessation of symptoms. Where a diagnosis has been made e.g. salmonella, then patients must not prepare food for the times specified in Appendix 6. Any symptoms must be clearly documented in the patients' notes. Authorisation from the nurse in charge allowing a patient to resume food preparation must also be clearly documented. The advice of the Infection Control Nurse, the Consultant Microbiologist or the Consultant in Public Health Medicine must be sought when there is uncertainty. During an outbreak of gastro-intestinal illness all food preparation must be discontinued until resumption is sanctioned by the Infection Control Team or the Outbreak Control Committee. In such circumstances arrangements must be made for the provision of all meals by the Catering Department. The Infection Control Nurse or on-call Consultant Microbiologist must be informed if staff suspect that an outbreak of gastro-intestinal illness is developing. 15.4 Staff with gastro-intestinal Illness All staff must sign an Agreement to Report Infection form (see Appendix 2). Any member of staff who develops signs and symptoms of gastro-intestinal illness e.g. nausea, vomiting or diarrhoea must not be involved in the preparation of food. The advice of the Occupational Health Department must be sought and specimens obtained for microbiological investigation. Where a member of staff is symptomatic but no diagnosis has been made then they should refrain from duty until at least 48 hours after the cessation of symptoms. Where a diagnosis has been made e.g. salmonella, then staff must seek approval of the Occupational Health Department prior to returning to duty. 15.5 Patients with other infections Patients with infections of the eyes, ears, mouth and skin present a risk to others and must not be involved in the preparation of food until symptoms resolve. 15.6 Staff with other infections Staff with infections of the eyes, ears, mouth and skin present a risk to others and must not be involved in the preparation of food. The advice of the Occupational Health Department must be sought as to their fitness for duty. Page 12 of 24

16.0 AUDITS OF THE LOCAL OPERATIONAL PROTOCOLS The service manager is responsible for ensuring that 6 monthly audits of each self catering kitchen are performed. The review and analysis of food hazard critical points and the control and monitoring should be carried out periodically or whenever the food operation changes. This may be delegated to the Trained Person for that area. A written record of each audit must be maintained and an action plan produced to rectify any deficiencies. The audit must examine all aspects of this policy including patient assessment; staff training; food storage and preparation; equipment cleanliness and maintenance; and environmental cleanliness and maintenance. The Environmental Health Officers have the legal right to inspect all kitchens. Page 13 of 24

APPENDIX 1 - PROTOCOL FOR THE USE OF MICROWAVE OVENS IN WARD KITCHENS INTRODUCTION This protocol details procedures for the safe use of microwave ovens when preparing food for patients in designated kitchens. Microwaves in ward kitchens are for the heating of patient food only. Staff food must not be prepared in patient areas. Food must not be prepared in a microwave whilst meals provided by the catering department are being served from the ward kitchen. The power of the oven must be 1,000 watts (1 kilowatt) or more. OPERATORS Microwave ovens may be used by: Staff who have undertaken Basic Food Hygiene training. Patients (in line with the procedures detailed in the ). Do not permit anyone (patient or staff) fitted with a heart pace-maker to operate a microwave oven. USE OF MICROWAVES Cleaning of the oven will be the responsibility of the user. This is vitally important from the point of view of both food safety and operational safety. Where patients or visitors have used a microwave staff must ensure that it has been cleaned after use. Prior to use, on every occasion the operator must: a) check the door fitments (hinges, safety catches, etc.) operate correctly and are not obstructed by food debris, cleaning materials, etc. b) check that the door seal is intact and clean. Note: Any obstruction to the door operation resulting in an inefficient seal may render this oven dangerous. PREPARATION 1. Cover all food to contain food moisture and prevent heat loss from the food surface. 2. Place food centrally or distribute evenly within the cabinet. OERATION 1. Select the appropriate time / power settings (refer to the manufacturers instructions for your oven). Page 14 of 24

2. As a sensible precaution do not look closely into the oven while it is operation. 3. Allow standing time to permit heat to evenly permeate the foods before temperature checking. PERMITTED FOODS Suitable foods will have a high water / moisture content. Permitted beverages include: Tea / coffee Beef tea Horlicks / Ovaltine Hot chocolate Cuppa soups Permitted foods include: Tinned soups Tinned pastas Tinned beans Tinned milk puddings Baked potatoes Packet Noodles Packet soups Any unused portion must be discarded; it must not be stored and heated in the microwave oven later. The microwave oven must not be used for cooking high risk food. Where a risk assessment indicates that a patient requires to be taught microwave cooking high risk foods prior to discharge this should be done under supervision in an O.T. Kitchen (see Section 10 of this document. Meals provided by the Catering Department must not be reheated in a microwave. Any drugs, or their packaging, must not be treated in any way in a microwave oven. Safety notes: 1. Do not allow anyone (patient or staff) fitted with a heart pace-maker to operate a microwave oven. 2. Use only non-metallic containers within the oven (be aware that some crockery may have metallic components in the application of its pattern). 3. Never operate the oven empty 4. As a sensible precaution never look into the oven closely for lengthy periods while it is in operation. 5. Know your oven and follow the manufacturers operating instructions closely - no two microwave ovens will be exactly alike. Page 15 of 24

APPENDIX 2 - AGREEMENT TO REPORT INFECTION FORM NHS AYRSHIRE AND ARRAN COMMUNITY HEALTH DIVISION I agree to report to my line manager or his/her deputy as soon as possible (by telephone if necessary): 1. If I suffer from an illness involving: a) Vomiting b) Diarrhoea c) Infected skin lesions (boils, infected cuts, etc., however small) d) Discharge from the ear, nose, throat or any other site 2. After any symptoms have passed, but before returning to duty, following an illness involving vomiting or diarrhoea or any of the above conditions. 3. After returning from a holiday during which an attack of vomiting or diarrhoea lasted for two days or more. 4. If any member of my household is currently suffering from diarrhoea and/or vomiting. Signed... (Employee) Date... Signed... (Manager) Date... Page 16 of 24

APPENDIX 3 - COLOUR CODING Staff responsible for the development of local operational protocols may wish to employ a colour coding system to minimise the risk of cross contamination. This would involve food preparation surfaces i.e. separate synthetic boards, knives, spoons/paddles, disposable cloths and rubber gloves, being provided in the colour appropriate to food activity. Permanent signs clearly defining the colour applicable in each area could be prominently displayed as a means of re-enforcing the code. If a colour coding system is implemented items should colour coded as follows: Colour Red Green Yellow Food Raw meat Fresh Vegetables General produce, including bread Page 17 of 24

APPENDIX 4 - HIGH RISK FOODS Some foods are considered high risk and require extra care during storage and preparation. High Risk foods include high protein foods that will not undergo any further cooking, regeneration or heat process prior to consumption. They also include raw meat. The classification of High Risk foods is as follows: Meat Poultry Seafood Dairy Products Other Foods Beef, pork, lamb, rabbit, ham, tongue, pressed meats, stock, stews, minces, curries, sausages, pies, pate and similar products Chicken, turkey, duck and game; eggs, pies, pate and similar products made with poultry meat and eggs Prawns, mussels, shrimps, cockles, crabs, oysters, smoked mackerel Milk, cream, soft cheese, mayonnaise, ice cream, custard Gelatine and glazes. Rice and root vegetables This is not an exhaustive list and it remains the responsibility of the Trained Person to ensure that all practices within the self catering kitchen are safe. MEAT AND POULTRY All uncooked meat and poultry must be considered to be potentially contaminated. Therefore it must be stored and handled in such a way as not to contaminate other foods. Thawing of meat and poultry Joints of meat and poultry must be thoroughly thawed before cooking. Since the liquid from thawed meat, especially poultry, may contain large numbers of food poisoning bacteria, care must be taken to prevent this liquid coming into contact with work surfaces or other food. Thawing procedure Remove meat from the freezer in plenty of time to ensure complete thawing. Thawing must be carried out in the refrigerator. Two small joints should be used rather than 1 large one as defrosting and cooking large joints is not recommended. Never refreeze raw food once it has thawed. All meat must be consumed within 24 hours of thawing. Guide to poultry thawing times Weight - LBS Refrigerator - Hours 2-3 28 approx. 3-4 36 approx. 4-5 48 approx. Page 18 of 24

Refrigerator storage All uncooked meat and poultry must be stored in the refrigerator on the bottom shelf or in a dedicated compartment. Drip trays should be used to prevent the refrigerator from becoming contaminated. The manufacturers use by dates must be followed rigidly. Handling and preparation of meat and poultry Instruments e.g. knives, chopping boards, used for raw meat and poultry must not subsequently be used on other food stuffs without being thoroughly washed and dried. Hands must be thoroughly washed and dried after handling raw meat and poultry. Meat, fish, stock and gravy must be thoroughly cooked so that the core temperature reaches 72 C. Meat joints, burgers and poultry must be cooked until the juices run clear, the temperature should be at least 82 C. A probe thermometer may be used to check the temperature of the joint at the thickest part. All meals prepared in self catering kitchens must be consumed immediately after preparation. Cooked food must not be stored in self catering kitchens and later reheated. SHELL EGGS All shell eggs must be considered to be potentially contaminated. On no account is it permissible for raw eggs to be consumed. Shell eggs must not be used in the preparation of lightly cooked or uncooked foods e.g. mousse, custard, mayonnaise. The preparation of shell eggs for consumption by patients who are physically ill or frail is not permitted. Powdered or pasteurised eggs may be used as an appropriate substitute for beaten whole eggs. Where possible eggs that are individually date stamped should be purchased. If they are not then they must be kept in the original packaging until required. Eggs should be stored in a cool dry place. If they are stored in a refrigerator they must be stored at room temperature for one hour prior to cooking. PATE Pate should ideally be stored below 3 C as some bacteria can grow above these temperatures. It must be consumed before the expiry date. DAIRY PRODUCTS Milk and Fresh Cream Only pasteurised milk and fresh cream may be used. Soft Cheeses, e.g., Cream Cheeses These should ideally be stored below 3 C as some bacteria can grow above these temperatures. They must be consumed before the expiry date. COOKED RICE Cooked rice must be consumed immediately. It must not be stored in self catering kitchens for consumption later. Bacteria found in rice can release toxins that are not destroyed by the reheating process. Page 19 of 24

APPENDIX 5 - STORAGE OF FOOD FOR PATIENT SELF CATERING Food must be stored in line with the manufacturer s recommendations and must be consumed by the use by date or discarded. Cupboard storage Cupboards must have impervious surfaces and be maintained in good condition. Any defects must be reported to the Estates Department. Food must be kept in the original packaging or decanted to sealable airtight containers. These must be clearly marked with the contents and a use by date. If food is decanted the containers must not be topped up. They should be allowed to empty then washed thoroughly in the dishwasher, if suitable, or with hot water and a bactericidal detergent. All spillages must be thoroughly cleaned immediately after they occur. Responsibility for the weekly emptying and cleaning of cupboards must be clearly allocated in the local operational protocol e.g. patients, nursing staff, occupational therapists, housekeepers. Self catering refrigerators Food for patient self catering must be kept in a separate refrigerator from supplies provided by the Catering Department. Food must not be stored in the refrigerator ice compartment. The refrigerator should be fitted with a thermometer and be maintained between 0-5 C. The temperature must be monitored daily and a signed record kept. This is completed by the domestic who is allocated to the ward. The domestic supervisor will then collect the completed daily fridge temperature sheets at the end of each week and replace it with a new sheet. The records are then filed in the domestic office and are kept for a period of 6 months. Any defects with maintaining fridge temperatures must be reported to the Estates Department. All spillages must be thoroughly cleaned immediately after they occur. Responsibility for the weekly defrosting and cleaning of the refrigerator must be clearly allocated in the local operational protocol e.g. patients, nursing staff, occupational therapists, housekeepers. The Service Manager is responsible for ensuring that appropriate arrangements have been made for regular maintenance of the refrigerator. Storage arrangements within the refrigerator must ensure that there is no cross contamination of foodstuffs. Shelves must be labelled to ensure cooked and raw separation. Food should be placed in the refrigerator to ensure good air circulation. It must not be overloaded. All items must be covered. Items such as raw meat must be kept on the bottom shelf or in a dedicated compartment. All foodstuffs must be clearly marked with a use by date. Page 20 of 24

Self catering freezers Freezers must have a thermometer, preferably liquid crystal display and the temperature must be maintained at -18 C to -20 C. The temperature must be monitored daily and a signed record kept. The domestic supervisor will then collect the completed daily fridge temperature sheets at the end of each week and replace it with a new sheet. The records are then filed in the domestic office and are kept for a period of 6 months. Any defects with maintaining freezer temperatures must be reported to the Estates Department. All spillages of food must be cleaned immediately after they occur. Responsibility for regular defrosting and cleaning must be clearly allocated in the local operational protocol e.g. patients, nursing staff, occupational therapists, housekeepers. The Service Manager is responsible for ensuring that appropriate arrangements have been made for the regular maintenance of the freezer. Only commercially prepared frozen foods may be kept in self catering kitchens. These must be stored in line with the manufacturers' instructions and used by the expiry date or discarded. On no account must fresh produce or food cooked in self catering kitchens be frozen. All frozen food must be wrapped to prevent freezer burn. Food must be stored so that no cross contamination can take place. Ice cream must be stored in a separate compartment. Page 21 of 24

APPENDIX 6 - COMMON MICROBIOLOGICAL FOODBORNE DISEASES AND EXCLUSION FROM FOOD PREPARATION Causative Agent/Illness Campylobacter Salmonella (Except Typhoid and Paratyphoid) Verocytotoxin producing E. coli O157 Hepatitis A Virus Shigella spp Norovirus Typhoid and Paratyphoid Additional Exclusion From Food Preparation After Clinical Recovery and 48 hours Symptom Free Nil Nil if personal hygiene good 2 consecutive negative stools at a minimum of 24 hours apart. The Consultant in Public Health Medicine may vary these criteria 7 days from onset of jaundice On advice of Consultant in Public Health Medicine Nil 6 consecutive negatives at 2 weekly intervals starting 2 weeks after antibiotic treatment completed. Adapted from: Guidance on The Investigation and Control of Outbreaks of Foodborne Disease in Scotland Food Standards Agency/Scottish Executive Health Department 2002 Amendment No. 08-2006 This is not an exhaustive list and advice should always be sought from the Infection Control Nurse, the Consultant Microbiologist or the Consultant in Public Health Medicine (CPHM). Page 22 of 24

APPENDIX 7 PROTOCOL FOR THE USE OF BARBECUES INTRODUCTION Many areas organise barbecues for patients and clients. This protocol details the procedures that must be followed to ensure that safe food is prepared and served to all users. Gas barbecues must be used on board premises. This ensures that cooking temperatures can be adequately controlled. The use of charcoal barbecues or pre-packaged small foil trays filled with charcoal is not permitted. OPERATION OF GAS BARBECUES BY STAFF AND PATIENTS Operation of gas barbecues must be carried out in line with the procedures detailed in the. Staff operating the gas barbecue must have been trained in Basic Food Hygiene. They must also comply with all health and safety regulations and guidelines relating to the storage and use of gas. Patients who have been previously assessed as being capable of preparing food for others (See Section 5 of the ) may use the barbecue equipment under the supervision of appropriate staff. Any person, staff or patient, suffering from a diarrhoeal illness is not permitted to prepare food. USE OF GAS BARBECUES Cleaning of the barbecues will be the responsibility of the user on each occasion of use. This is vitally important from the point of view of food and operational safety. Prior to use, on every occasion, operators a) must check that there is sufficient gas for the operation of the barbecue and follow the manufacturers instructions at all times b) check that all fitments/attachments and utensils are clean Temperature Control 1. Using appropriate disposable wipes ensure that the temperature probe is clean and free from any food debris, fat or oil between food items. Wash thoroughly after use. 2. Ensure food has reached a core temperature of 72 C for 2 minutes at the thickest part before serving for consumption. The Catering Department should be contacted for advice on suitable wipes and temperature probes. Page 23 of 24

FOOD THAT CAN BE BARBECUED Permitted foods include: Pork Sizzlers Ready bought chicken, beef, lamb burgers Beef and pork links Boneless King Ribs Baked potatoes Boneless Chops All above foods should be kept in refrigerated storage prior to cooking. The use of a cool box with eutectic plate for storage of raw meats should be employed during barbecuing. Food with bones such as chop, chicken legs, etc. should not be barbecued as thorough cooking cannot always be guaranteed. Note: Under no circumstances should any cooked food be kept and reheated. Page 24 of 24