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he moment I arrived at the facility, I was called into the administrator’s office. A situation had been brewing for several days, and the facility’s management team was anxiously awaiting my arrival to discuss it. It seems that Mrs. Holmes was complaining to anyone who would listen that her roommate, Mrs. Julius, was “smelling up the room with the awful food stuffed in her night table drawer.” I had to chuckle to myself as the director of nursing (DON), the administrator, and the foodservice director debated whether or not the smell emanating from Mrs. Julius’ nightstand was mildly or highly offensive. I wondered aloud about the type of food Mrs. Julius was keeping. Was it only crackers and cookies or did she have an entire dinner in that nightstand? Why was she keeping food in the nightstand in the first place? Hoarding food can be a symptom of a psychological problem. Or maybe she was simply keeping a supply of her favorite foods, which had been brought in by her family. Many questions needed to be answered, but my first question was, “What is your facility’s policy about residents keeping food in their rooms?” Unfortunately, this facility never gave much consideration to this aspect of food safety until they had a problem.

Can I Bring You Something To Eat?
       In our quest to minimize involuntary weight loss (IWL) in our long-term care residents, we take any steps we can to increase caloric intake. But we have to be careful, because some of those steps may lead to unforeseen problems. Consider this situation: Your resident is not eating well. She complains meal after meal that she just doesn’t care for the food. Her daughter visits most days and offers to bring in some of her homemade chicken and dumplings for mom. The next day, the daughter makes the meal and packs it in a plastic container, which she puts on the front seat of her car. On her way to visit mom, she remembers that she promised mom some sucking candies, so she stops at the drugstore along the way. Then she glances at the gas gauge and decides to stop to fill up the gas tank so she doesn’t have to do it during rush hour on the way home. Finally, the daughter arrives to visit mom and the chicken dish is reheated in a microwave and served to mom. Is that dish of chicken and dumplings safe to eat?
       There are so many variables that it is impossible to say whether or not this scenario will lead to problems. But there are certainly many points during this chain of events that may lead to danger. These include the age and condition of the poultry the daughter purchased, how long she had it at home, the conditions under which she prepared it, the length of time and temperature in the car, and to what temperature she reheated it. In order to minimize the risk of such a commonplace event as a loved one bringing in comfort foods to a facility, there have to be appropriate policies and procedures along with a good working knowledge of food safety for the entire facility staff. While we don’t want to penalize our residents by forbidding all outside foods, it is our responsibility to keep them safe. Policies that deal with this issue should include how outside foods are reheated, the types of foods permitted, how the food is labeled and stored, how long it is kept before being discarded, and how adherence to therapeutic diet orders are assured.

The Two-Hour Rule
       The goal of any food safety program is to minimize food spoilage and avoid any organisms that can cause food poisoning. An outbreak of food poisoning among infirm or elderly people can have devastating consequences. Keeping foods at proper temperatures may be the most proactive step you can take to minimize the risks of foodborne illnesses. The food temperature danger zone is between 40 and 140 degrees F. It is in this temperature range that bacteria thrive and multiply. Most food poisoning bacteria particularly like room temperatures around 60 to 90 degrees F. To fight back, there should be a “two-hour rule.” Simply put, discard any perishable foods left at room temperature longer than two hours. Some residents take a considerable length of time eating their meals, and it is possible for a resident to sit with her tray for two hours. Once the two-hour mark hits, the tray should be removed and discarded. When temperatures are above 90 degrees, food should be discarded after one hour.

Cook and Serve at Proper Temperatures
       If you work in healthcare, you have likely heard the complaint that “the food is cold” in reference to the hot food. In other words, the food that is supposed to be served hot is cold, and the food that is supposed to be served cold is hot. This is not only an aesthetic problem because food simply tastes better at the expected temperature but it is also a food safety problem. Often, this problem begins in the kitchen, but just as often, the food departs the kitchen at the proper temperature only to sit in a cart in the hallway or at the front of the dining room for an extended period of time. Each minute the meals are sitting there, they are approaching room temperature. Every effort should be made to serve the meals as soon as they are ready. To determine if there is a problem, order a test tray from the kitchen and make it the last tray to be served. Use a food thermometer to test each item on the tray. You might be very surprised at the results. If meal temperatures are an ongoing problem, form a task force to look at ways to correct the problem using a systemic approach.

Wash Your Hands
       Proper handwashing is an essential component of any good food safety program, because it is the best way to get rid of bacterial contamination. Many people rush through this process without actually accomplishing anything. The proper steps to wash your hands are:
• Wet your hands with warm running water
• Add soap and then rub your hands together, making a soapy lather for at least 15 seconds
• Don’t forget about the back of your hands, knuckles, as well as between your fingers and under your nails
• Rinse hands well under warm running water—leave water on
• Dry hands with paper towel
• Turn off tap with paper towel and not with your bare hands.
       It is important to wash your hands after handling food, after using the bathroom, after smoking, after touching your nose, mouth, or hair, and after handling pets, such as in pet therapy. Universal precautions should be adhered to when treating residents.
       An inservice about handwashing is in order annually at every facility. This year, make it memorable by using a product called Glo Germ™ (Glo Germ™ Company, Moab, Utah). Glo Germ teaches handwashing, isolation techniques, aseptic techniques, and general infection control and has been used by healthcare and educational professionals for many years. Glo Germ contains safe, inert ingredients in a lotion or powder form that cast a revealing glow when exposed to standard UV light. This gives a visual demonstration to show when improper cleaning or handwashing has taken place. A Glo Germ kit is very inexpensive and contains all you will need to conduct a very revealing inservice. Ask a volunteer to rub some Glo Germ lotion on her hands. The volunteer then washes her hands as usual. The fluorescent lamp (included in the kit) then reveals all the bacteria that were not removed by the usual handwashing techniques. It is a very visual demonstration that your staff will remember and be talking about for months!

But I Don’t Work in The Kitchen
       Food safety is everyone’s responsibility, not only the dietary department. There are opportunities for trouble unless the entire staff is on the lookout for food safety violations. Food safety not only concerns the meals the residents consume but also the staff. The staff lunchroom and staff refrigerator should be inspected and cleaned as necessary. You may find some unrecognizable foods lurking in the back of your staff refrigerator. Remember the old adage, “When in doubt, throw it out.” Just think back to the last time you were doubled over with cramps, running to the bathroom muttering, “It must have been something I ate!”

Helpful Websites
• http://www.glogerm.com—Glo Germ™ Company
• http://www.homefoodsafety.org—American Dietetic Association Home Food Safety
• http://www.fsis.usda.gov—United States Department of Agriculture Food Safety and Inspection Service
• http://www.fightbac.org—Partnership for Food Safety Education