The Safe Foodhandler
The Food Code increased the emphasis placed on the responsibility of the person in charge to restrict or exclude ill workers from food handling, highlighting those pathogens that represent a significant threat to public health due to their easy transmission by ill food workers. These pathogens are:
- Norovirus
- Salmonella typhi
- non typhoidal Salmonella
- Enterohemorrhagic E. coli (STEC)
- Hepatitis A
- Shigella
The Food Code recommends that businesses implement a multi-tiered, risk-based system that insures the public safety without unduly restricting operations. It is designed to remove a food employee who is most likely to transmit a disease, and gives guidance on when that employee may safely return to work. It also emphasizes that an employee may not be hired unless he or she complies with the employee health provisions of the Code.
The Three Risk Levels
LEVEL ONE
This level represents the greatest risk in food safety and involves employees who have specific symptoms (such as vomiting, diarrhea, jaundice, sore throat with fever, or an open lesion or wound that is not covered by an impermeable cover if on the hands or arms) while in the workplace. This level also includes employees diagnosed with typhoid fever or an infection with Hepatitis A (within 14 days of symptoms). Employees at this level are likely to be excreting high levels of an infectious agent, increasing the likelihood of a foodborne disease. The most significant level of restriction and exclusion is applied at this level. Employees demonstrating these symptoms are excluded from food handling and may return to work only after one or more of the following conditions are met:
- the person in charge obtains approval from the regulatory agency
- the food employee provides a written medical document from a health practitioner that states the food employee is free from the disease
- a food employee did not develop symptoms and a prescribed number of hours or days have passed since the food employee was diagnosed
- a prescribed number of hours or days have passed since an employee who exhibited symptoms became asymptomatic
LEVEL TWO
This level relates to employees who have been diagnosed with a specific agent or concern, but who are not currently exhibiting symptoms of disease. These persons may be carriers of the pathogen, but are less likely to spread the disease to the food. However, these employees still pose a risk and the Food Code lists a series of exclusions (if the employee works with a highly susceptible population) and restrictions (if working with a non susceptible population group).
LEVEL THREE
This level relates to those persons who are clinically well but have been exposed to a listed pathogen and are within the incubation period of the disease. The Food Code restricts food employees who have had a potential exposure based on the incubation times of the various pathogens.
Personal Hygiene Issues
Hair
Cosmetologists report that approximately 100 hairs fall out each day. While not life threatening, hair does carry bacteria and is extremely unpleasant for consumers. Two problems are often encountered in this regard. First, effective hair restraints such as hair nets are often rejected by employees. Substitutes, such as visors, frequently do a poor job of hair containment. Secondly, the person most likely to omit the hair restraint is, surprisingly, the manager, thus setting an extremely poor example in an important area. Hair restraints also discourage food workers from touching their hair.
Note: the Food Code also mentions beard restraints. How long does the beard have to be? But what about a mustache? While we’re at it, what about eyebrows? None of these specifics is addressed in the Food Code.
Fingernails
Nails should be short, clean and without polish — polish chips off and enters the food. (Those employers who allow clear or light-colored polish miss the point.) Short nails are less likely to break off.
EXAMPLE: Once I was making chocolate chip cookies at home. I opened the bag of chocolate chips, poured some in my hand and popped them into my mouth (yes, dietitians do these things, too). I knew right away that something wasn’t right — I had eaten a piece of a fingernail. Now, if I had bought that cookie in a shop, who would have been responsible for the nail? The shop, of course.
Another issue concerns acrylic nails, the true nightmare of food preparation. Usually brightly painted, these nails become detached and find their way into food. (The reaction of the recipient need not be described.) The Food Code has been revised to require those persons with false fingernails or fingernail polish to wear gloves. Those employees who are allowed to wear acrylic nails should be required to wear gloves at all times.
Uniforms
Each person working with food needs to have a clean uniform each day. Uniforms, or any cloth materials, are a tremendous vehicle for cross contamination, which we will address later.
Gum Chewing and Eating
Neither of these activities is appropriate while working with food. Both gum and food particles fall out of the mouth while chewing; a wad of already-been-chewed gum in their food is not a pleasant sight to anyone.
Food workers should consume food in a separate area. The habit of treating food as a product of production rather than as a snack, as we do in our own kitchens, is fundamental in this industry. Beverages may be consumed in the work area from a closed container that does not allow contamination of hands, food or work surfaces.
Jewelry
The Food Code states that employees may not wear jewelry on their arms and hands. Exceptions are sometimes made for a plain wedding band (I’ve had people say that they will quit their job before taking off their wedding band), but strictly speaking, these too harbor bacteria.
Jewelry should not be worn while preparing or serving food. There are three reasons for this. First is pathogenic contamination; these ornaments are hard to clean thoroughly. Second, parts of jewelry may fall into the food and cause a physical contamination, and third, jewelry poses a safety risk for the employee. Necklaces and bracelets can become entangled in equipment, resulting in burns or cuts.
EXAMPLE: One manager I was working with snagged her bracelet while carrying a large pot of boiling water with cooked pasta in it. The pot emptied on her and burned her foot so badly that the plastic in her shoes stuck to the bones of her feet. Employees have kitchens at home and feel safe wearing jewelry there. They seldom consider the dangers of an industrial kitchen.
Illness
Our lengthy description of pathogens, particularly those associated with illness, should emphasize the importance of not touching food while ill. Many times, an individual has no idea where they acquired their recent “cold,” yet it may very well have come from the person involved in preparing the food they ate. Sneezing, coughing, runny noses and particularly diarrhea are symptoms of importance. Persons with these symptoms should not be working with food.
Cuts and Abrasions
Any skin opening needs to be covered with an antiseptic bandage and then with a waterproof covering. While the food needs to be protected from the possibility of pathogens, the food worker also needs protection from contamination entering through the cut. Please refer to the Safety in the Food Service Department PDF located within the Additional Materials portion of this course for further discussion on safety issues. Please note that material in this document may be included on a national examination.
Money, money, money…
One of the most common complaints voiced by the public when calling to report unsafe practices to the health department is the practice of food handlers handling money without washing their hands. How dirty is money? Does it result in foodborne illness? A study done by the University of California at San Francisco on money obtained from various urban sources (an ATM, coffee house, newsstand, post office, deli, etc.) examined the bacteria on 73 bills and 40coins. Pathogens, primarily Staph, were found on 18% of the coins and 7% of the bills (Chase). Although it would be difficult to find a study linking money to disease outbreaks, it does illustrate how pathogens travel from hand to hand.
Accidents and Injury
Most, if not all, employees have kitchens at home. Consequently, many take a very casual approach to the dangerous quality of their working environment. The truth is, food service is the fifth most dangerous industry in the United States according to actuarial tables. Most accidents, like food contamination in general, are preventable. In this section we will cover the most common problems: cuts, burns and falls.
Before we begin, a word about training. Most accidents occur because workers are not trained properly in the use of equipment or the potential for harm. Training is fundamental to any safety program. May I also mention again the importance of maintaining records of training sessions and the names of persons who attended?
CUTS
Most cuts occur because of misuse of equipment. Cuts may be caused from a simple action such as catching a falling knife, or something as severe as not using the proper guard on a slicing machine. The following specific suggestions can be made:
- Sharpen knives regularly (dull knives cause more injuries than sharp ones).
- Always cut away from hands and body.
- Tear plastic wrap and aluminum foil carefully.
- Follow safe procedures when cleaning equipment.
- Use metal gloves when operating slicing equipment.
- Wash knives separately; never place in dirty dishwater.
- Use the proper piece of equipment for the job.
BURNS
Again, burns can be first degree (red and painful) or as severe as third degree burns which involves skin layers and perhaps muscle tissue. Commercial cooking equipment is very different from the typical home kitchen. We are not commonly used to dealing with steamers, ovens set at 600°, deep fryers or grills. The following tips may help prevent burns:
- Use proper protective gear; oven mitts should protect the whole forearm if necessary.
- Maintain proper traffic patterns in work areas so that personnel don’t run into each other.
- Keep pot handles turned toward the back of the stove.
- Use proper precautions when opening hot equipment or taking covers off of pots.
- Use long handled utensils when stirring food.
- Chemical burns: label all chemicals correctly, follow directions carefully and wear protective goggles and other gear.
Any skin opening needs to be covered with an antiseptic bandage and then with a waterproof covering. While the food needs to be protected from the possibility of pathogens, the food worker also needs protection from contamination entering through the cut.
FALLS
Falls are frightfully common in food service and result not only in pain but lost days of work and expenses. For the most part, falls are preventable. Consider the following suggestions:
- Use only non-skid flooring and shoes. Use mats in highly dangerous places such as the areas in front of the stove and in the dish cleaning area.
- Clean up spills immediately.
- Use signage when floors have been freshly mopped.
- Traffic patterns, again, are important.
- Avoid trip hazards – move obstacles out of traffic areas.
- Do not step on shelves or chairs to reach items.
A first-aid kit should be kept in the food establishment, away from food, for treating minor problems. Referral to the proper medical personnel is essential when indicated.