standard operating procedure 1 (sop 1 ... - bcpft.nhs.uk

FS SOP 1: Dealing with a Suspected Outbreak of Food Poisoning of 17 Version 1.1 April 2019

Standard Operating Procedure 1 (SOP 1)

Dealing with a Suspected Outbreak of Food Poisoning

Why we have a procedure?

Food hygiene is more than just cleanliness; it includes all practices involved in:

Protecting food from risk of contamination, including harmful bacteria, poisons and foreign bodies

Preventing any bacteria present multiplying to an extent which would result in the illness of consumers or the early spoilage of food

Destroying any harmful bacteria in the food by thorough cooking or processing Most food poisoning outbreaks are caused by food hygiene negligence. People involved in the preparation, storage, distribution or processing of food may introduce contaminants that allow the multiplication of food poisoning bacteria. It is essential that suspected food poisoning is dealt with properly as any failure to do so places patients and staff at risk and exposes the Trust to prosecution and litigation. This procedure aims to ensure prompt action in the event of any suspected outbreak of food poisoning. The procedure will cover:

Prompt recognition of an outbreak of diarrhoea and vomiting

Identifying its defining aspects and characteristics

Preventing spread and reoccurrence

Communication with external agencies with responsibilities in relation to the outbreak .i.e. Environmental Health Department

What overarching policy the procedure links to?

Food Safety Policy

Which services of the trust does this apply to? Where is it in operation?

Group Inpatients Community Locations

Mental Health Services all

Learning Disabilities Services all

Children and Young People Services all

Who does the procedure apply to?

Food Handlers and Catering Staff

Ward staff involved in the ordering and serving of food for in-patients

Therapists undertaking food preparation and education of patients


It is the responsibility of Infection Prevention and Control Team, in conjunction with the Facilities Manager and relevant Managers to institute the procedure. The Infection Prevention and Control Team will ensure the day-to-day management of the outbreak in conjunction with PHE and the local authority

When should the procedure be applied?

Infection Prevention and Control Team have notification that more than one patient in a defined clinical area or member of staff reports that they are suffering from diarrhoea and/ or vomiting

Persons purchasing food from, or eating food prepared or bought on the premises complain that they have subsequently been ill

How to carry out this procedure

Immediate Action At any time any member of staff discovering a patient, or other member of staff with diarrhoea and/or vomiting, will report this to the nurse in charge of the ward, or their line manager immediately. If food or meals that have been prepared at Trust premises are implicated, this must be highlighted at this stage. The nurse in charge or line manager will promptly inform Infection Prevention and Control Team providing details. Infection Prevention and Control Team will provide advice on the isolation of those patients affected. Staff must be sent home in line with policy. Wherever possible a specimen should be collected first. To prevent cross-contamination, hand-washing techniques must be strictly adhered to. Infection Prevention and Control Team will contact the Trust Facilities Manager and Contract Hotel Services Manager and inform them of the location of the suspected outbreak of infection and information regarding the food or meals that have been implicated. If the suspected outbreak occurs during a weekend or Bank Holiday, the nurse in charge or unit manager must contact the Director on Call and in turn they must contact the on-call Public Health Doctor. It is also imperative that Facilities Manager and the Catering Lead are informed. Infection Prevention and Control Team will need to be informed of the incident as soon as normal working hours resume. The Trust Facilities /Catering Lead must ensure, that further meals or suspected food are not served from the premises concerned, until the Environmental Health Officer has carried out a full investigation. Infection Prevention and Control Team will contact the local Environmental Health Officer who will carry out an immediate investigation of the premises implicated. The Trust Facilities/ Catering Lead and Infection Prevention and Control Nurse must accompany the Environmental Health Officer during their inspection of the premises. The first priority of the Environmental Health Officer will be to establish whether or not the illness is food-borne and if so, prevent the spread.


In all cases of reported food poisoning the Environmental Health Officer has the responsibility to determine whether there has been a breach of hygiene regulations or the Food Safety Act. If the Environmental Health Officer believes that there has been a breach of legislation they will lead the investigation, with the assistance of Infection Prevention and Control Nurse. In some cases the officer may recommend that the premises be closed pending a thorough investigation. If the Environmental Health Officer is satisfied with the methods of food preparation and production, and believes there is no case for legal liability Infection Prevention and Control Team will continue with an internal investigation. This will be performed in collaboration with the Environmental Health Office. Please see Infection Prevention and Control Assurance - Standard Operating Procedure 4 (IPC SOP 4) Reporting Incidents of Infection to Public Health England and/or the Local Authority. Also see Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP 5) Management and Recognition of Outbreaks of Communicable Infection/Disease. Investigation The objectives of the investigation of an outbreak are:

To determine which organism, or chemical, was responsible

To trace all cases and carriers, especially those involved in food handling

To determine which stage of the food preparation allowed bacterial multiplication

To recommend how food should be prepared in the future to prevent recurrences and further spread

It is important that details of all persons reported to be suffering symptoms of suspected food poisoning are collected as soon as possible. Infection Prevention and Control Team will assist the ward /department manager in collecting this information. Infection Prevention and Control Team will advise which specimens need to be collected. The Environmental Health Officer may advise that everyone involved in the preparation of the suspect food will also be required to produce faecal specimens. If anyone involved in the preparation of the suspect food reports symptoms then their Manager must ensure that they are suspended from duty pending advice from Infection Prevention and Control Committee. End of Outbreak It is the responsibility of Infection Prevention and Control Committee to analyse the results of the investigation, initiate any remedial actions necessary action and to declare the outbreak over. A critical review of the cause, identification and management of any outbreak must be held soon after the event so as to identify positive aspects and those areas which require improvement. See IPC SOP 18: Undertaking a post infection review (PIR) in relation to serious infectious incidents. Findings must be reported to the Chief Executive, Executive Management Board and the Infection Prevention & Control Committee.


Hazard and Critical Control Point (HACCP) HACCP is a method of ensuring food safety by examining every step in a food operation, identifying those steps critical to food safety implementing effective control and monitoring procedures at these steps. HACCP is a preventative system that gives a high level of food safety assurance and is considered to be the best approach to producing safe food and thus preventing food-borne illness. Food Safety and Hygiene (England) Regulations 2013 require food businesses to ensure that food business operators implement a food safety management system based on the following HACCP principles:

Identifying hazards (Chemical, Physical, Microbiological and Allergenic)

Identifying the critical control points (CCP’s) at the steps at which control is essential to prevent or eliminate a hazard or to reduce it to an acceptable level

Establishing critical limits at CCP’s which separate acceptability from unacceptability

Implementing effective monitoring procedures at CCP’s

Establish corrective actions when a CCP is out of control

Establishing verification procedures

Establishing documents and records commensurate with the nature and size of the food business (Documents must be kept up to date and retained for a period of two years)

The system must be reviewed if the product, process or any step is modified These must be in place in order to support a HACCP system:

Approved suppliers

Premises and equipment well designed, constructed and maintained

Contingence plans in case of break down. Equipment calibrated

Water and ice in food production must be potable

Staff and managers must be trained commensurate with their work activities, i.e. they must be competent. They must have high standards of personnel hygiene. A health exclusion policy should exist to screen new employees and existing employees

Effective, planning The Trust encompasses all these within its Good Hygiene Practice guidance, documentation and records which are detailed in the Food Safety Manual. The principles of HACCP are:

Conduct a Hazard Analysis - a process flow diagram is needed, detailing the steps in the operation. Hazards must be identified at each stage, together with the significance of the risks presented and measures for control

Determine the Critical Control Points (CCPs) - establish the points where controls are critical to food safety

Establish Critical Limits - at the CCPs, a measurable critical limit describes the difference between what is safe and what is not


Establish a system to monitor control of the CCPs - monitoring actions, frequency and responsibility must be specified

Establish corrective action for when a CCP is not under control - include actions to bring the process back under control and deal with products affected by the loss of control

Establish procedures for verification to confirm HACCP is working - develop and maintain procedures to keep HACCP system working

Establish documentation and records - records must be kept to demonstrate the HACCP system is working under control and corrective action is taken for any breached critical limits(See Appendix 1 & 2)

Ensuring Controls are Effectively Applied This is the system of checks and records to ensure controls are being effectively applied-essential at the CCP. Included are temperature records, cleaning schedule, inspection checklists, etc. Corrective action - action taken to remedy a breached Critical Limit, may involve refusal of a refrigerated delivery or disposal of out-of-date food. Verification - applying methods, procedures, tests, etc. in addition to monitoring – to determine compliance with the HACCP system in place. Examples are:

MYC4C

Microbiological and chemical testing of food items

Analysis of record data

Ongoing training

Keeping HACCP plan up to date Routine Environmental Health Inspections These inspections are undertaken periodically depending on the risk assessment of hygiene standards of the particular business. Within NHS establishments, this is usually every 18 months. Inspections, although routine, must be treated seriously. The most senior catering member of staff on duty must accompany the EHO around the premises, making all areas and any documentation available on request. The EHO will want to inspect:

The structure of the building,

Cleaning standards

Staff hygiene

Pest control measures

Lighting

Ventilation

Food temperatures e.g. freezers, refrigerators, hot holding equipment etc.

HACCP documentation

Training records


The EHO will also ask individual food handlers questions relating to the hygiene aspect of their role. Verbal feedback is received during the visit. However following the visit, formal notification will be received and the premises given a rating of one to five stars. Any matters for improvement and action, must be acted upon by the Trust immediately. Copies of the report must be sent to the Catering Lead so that the findings and recommendations may be actioned.

What do these terms mean?

Food Poisoning - May be defined as “an acute illness”, usually of sudden onset brought about by eating contaminated or poisonous food.” The symptoms normally include one or more of the following:

Abdominal pain, with or without diarrhoea

Vomiting and nausea The incubation period is normally short (between one and 48 hours). The number of bacteria required to cause illness in the healthy adult is usually large and multiplication of bacteria normally occurs within the food. Sufferers usually recover in a few days but where body defences are low, more serious consequences may arise. Food Safety Hazard - Anything that has the potential to cause harm to a consumer. They can occur before or after arrival of the food on Trust premises and are contamination of food by:

Biological-pathogenic micro-organisms or their toxins, allergens

Physical items (foreign bodies) –e.g. a piece of glass or a dead insect

Chemicals- e.g. cleaning chemicals, pesticide residues

Prevention, elimination or reduction of a food safety hazard to an acceptable level is essential

Hazard Identification - Identification of food hazards that may cause harm at each process step detailed in the process flow diagram. Process Flow Diagram - This details the Trust’s catering food chain as a series of steps. The Flow Diagram is generic and will not apply to all Units, but is designed to cover all eventualities in the food chain from purchase to consumption. (See further in this section) Controls - Measures designed to eliminate a hazard or reduce it to an acceptable level. Effective controls are designed to:

Prevent contamination of food

Prevent the growth of micro-organisms in food

Destroy harmful micro-organisms in food

Controls can be of specific, such as heating food to a minimum temperature; or more general, as in operating a system of programmed cleaning


Critical Control Point (CCP) - A process step where control is essential to prevent, eliminate or reduce a food safety hazard to an acceptable level and where a loss of control would result in unacceptable food safety risks. A CCP is where significant food safety hazard exists and a subsequent step in the process will not prevent, eliminate or reduce it. Critical Limits - A level which can be monitored and which, if exceeded, means a food safety hazard is out of control. Must be monitorable and therefore Critical Limits are specific, such as refrigerated food temperatures and cooling times. Corrective Action - Action taken to remedy an out of control hazard Contamination - The introduction or occurrence in food of any microbial pathogens, chemical, foreign material, spoilage agents, taints, unwanted or diseased matter, which may compromise

Where do I go for further advice or information?

Infection Prevention and Control Assurance - Standard Operating Procedure 4 (IPC SOP 4) Reporting Incidents of Infection to Public Health England and/or the Local Authority

Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP 5) Management and Recognition of Outbreaks of Communicable Infection/Disease

Infection Prevention and Control Team

Facilities Manager

Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness.

Equality Impact Assessment Please refer to overarching policy

Data Protection Act and Freedom of Information Act Please refer to overarching policy

Dealing with a Suspected Outbreak of Food Poisoning of 17 Version 1.1 April 2019

Food Hygiene – Code of Practice for Food Handlers Agreement to Report Infection I agree to report to my Manager or their Deputy if I am suffering from an illness involving: a) Vomiting b) Diarrhoea c) Skin Rash d) Septic skin lesions (boils, infected cuts etc. however small) e) Discharge from ears, eyes and nose I agree to report to my Manager or their Deputy when returning, and before commencing work following an illness involving vomiting and/or diarrhoea, or any of the above conditions. I agree to report to my Manager or their Deputy after returning from a holiday during which an attack of vomiting and/or diarrhoea lasted for more than two days. I agree to report to my Manager or their deputy if another member of my household is suffering from diarrhoea and/or vomiting. I have read and understand the accompanying guidance on personal hygiene. Signed: ……………………………………………. Date:………………………………….. Full name: ……………………………………………………. Please return this form to you manager (To be kept in personnel File)

Appendix 1


CATERING HACCP, DETAILED

A of C = Absence of Contamination

P = Prerequisites, i.e. Hygiene training, Pest control contact, Cleaning and disinfection schedule, Planned Preventative Maintenance

CP = Control Point, CCP = Critical Control Point

Step Hazards Controls & Targets CP or CCP Critical Limits Monitoring Corrective Action

Purchase Contamination with harmful bacteria. Toxins, chemicals, allergens or foreign bodies.

Use only approved suppliers. Select least hazardous ingredients. e.g.-No nuts in the kitchen.

CP

Ensure suppler has effective HACCP system and good hygiene practices. Utilise customer references. Use suppliers under the NHS Supply chain Framework.

Audit supplier premises. Warn supplier. Change supplier.

Delivery & Unloading

Contamination with harmful bacteria, Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

Food covered or protected in suitable containers. Segregation of raw and high risk food. Segregation of allergens. De-boxing area. Use only approved suppliers. Check dates. Check temperatures - Chilled food below 8c, and frozen food below -18c. Move food to storage within 15 minutes of delivery.

CP

A of C + P Chilled food 8c or below. Frozen food not above -15c

Observation, supervision, and sensory checks. Condition of packaging/food. Condition of vehicle/driver. Supplier on approved list. Food is within date. Temperature of food using calibrated probe. Time from delivery to storage.

Change supplier. Refuse delivery. Return stock. Inform Supervisor/Manager. Review systems/training.

Appendix 2



Chilled Storage Contamination with harmful bacteria. Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

Food covered or protected in suitable containers. Segregation of raw and high risk food. Segregation of allergens. Food not stored in open cans. Load food correctly. Maintain temperature of 5c. Don't overload, and ensure stock rotation adhered to. Ensures items are within date.

CP CCP for ready

to serve items.

A of C + P Store 8c or below.

Observation and supervision. Condition of packaging/food. Food is within date. Air Temperature. Food Temperature. Time above 8c. Door seals.

Inform Supervisor/Manager. Discard unfit, contaminated, or out of date food. Review systems/Training. Adjust thermostat. Reorganise items to allow air circulation. Report faults to Estates. Discard any items >8c for 2 hours.

Frozen Storage Multiplication of food poisoning bacteria.

Food covered or protected in suitable containers. Maintain temperature of <-18c. Don't overload, and ensure stock rotation adhered to. Ensures items are within date.

CP

<-15c Condition of packaging/food. Food is within date. Air Temperature. Food Temperature.

Inform Supervisor/Manager. Discard unfit, contaminated, or out of date food. Review systems/Training. Adjust thermostat. Reorganise items to allow air circulation. Report faults to Estates. Discard any items >-15c



Ambient Storage Contamination with harmful bacteria, Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

Food covered or protected within suitable containers. Care with handling. Segregation of allergens. Maintain in a cool, dry condition. Ensure food is within date. Ensure stock rotation.

CP

A of C + P Observation. Condition of packaging. Condition of food. Condition of canned goods.

Inform Supervisor/Manager. Discard unfit, contaminated, or out of date food. Review systems/Training. Store out of direct sunlight. Discard damp or spoilt food. Report any damp issues to Estates.



Preparation (including sandwich & salad packing)

Contamination with harmful bacteria, Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

Separation of raw and high risk food. Use separate equipment. Colour coding. Organisation and workflow. Disposable cloths. Minimise handling of ready to eat foods where practical. Wash ready to eat food items, i.e. salads/garnishes. Don't top up sauces. Segregate allergens. Exclude staff with food poisoning symptoms. Maximum time for food items at room temperature 30 minutes. Return packaged items to chilled storage. Pre-cool salad & sandwich ingredients.

CP CCP for ready

to serve items.

A of C + P 2 hours.

Observation & supervision. Staff sickness records and exclusions. Temperature of food. Time food at room temperature.

Inform Supervisor/Manager. Discard contaminated food. Review systems/training. Discard high risk food left at room temperature for > 2 hours. Reduced quantities/portion control.



Thawing Contamination with harmful bacteria. Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

High risk food should be thawed in a refrigerator. Use thawed food within 24 hours. High risk and raw food should not be thawed in the same area. Raw food should not be thawed in the same area used for cooling cooked foods. Segregate allergens. Raw frozen food must be completely thawed before further processing.

CP CCP for ready

to serve items.

2 hours once thawed. A of C + P Absence of ice.

Temperature of food. Placement of food. Observation and supervision. Temperature/visual and physical checks.

Inform Supervisor/Manager. Discard food that has thawed and been left at room temperature for > 2hours. Discard contaminated food. Review systems/training. Continue thawing. Allow a longer thawing time in future.

Cooking Contamination with harmful bacteria, Toxins, chemicals, allergens or foreign bodies. Survival of harmful bacteria/spores/toxins.

Cook to a core temperature of 75c for 30 seconds. Boil liquids. Do not reheat more than once. Cook/reheat as close to serving as possible. Follow microwave procedures. Follow packaging instructions. Stir liquids to maintain an even temperature. Ensure frozen meat is completely thawed before cooking. Protect from contamination. Segregate allergens.

CP CCP for ready

to serve items.

75c A of C + P

Core temperature of food. Observation and supervision.

Inform Supervisor/Manager. Extend cooking time until core temperature is reached. Allow longer cooking times in future. Carry out cooking trials. Discard high risk simmering items that have not been stirred for 2 hours. If less than 2 hours, stir and bring to the boil. Review systems/training. Report faulty equipment to Estates. Discard contaminated food.



Cooling (including packing meals for regen service)

Contamination with harmful bacteria, Toxins, allergens or foreign bodies. Multiplication of food poisoning bacteria, formation of toxins, and/or germination of spores.

Separation of raw and high risk food. Segregation of allergens. Protect from contamination. Rapid cooling in blast chiller. Minimise weight and thickness of joints (2.5kgs). Cool liquids in clean shallow trays. Blast chiller (90mins). < 5c in <90 minutes. 3c to -18c in <4hours. Store regen meals to frozen storage.

CP

A of C + P <5c 2hours. 3c to -18c 4hours.

Observation and supervision. Time to cool. Temperature of food.

Inform supervisor/Manager. Discard contaminated food. Review systems/training. Discard food if not cooled and refrigerated within critical limits. Report faulty equipment to Estates.

Transport & Delivery

Contamination with harmful bacteria, toxins, chemicals, allergens or foreign bodies Breach of critical limits.

Pack products into pre-chilled transport boxes. Return boxes to freezer/refrigerator until collection. Transport to destination within 30 minutes. Unpack immediately on arrival and transfer to storage.

CP

A of C + P 1 hours <-15c Frozen <8c chilled

Observation and supervision. Time and temperature. Recorded temperature trials.

Inform Supervisor/Manager. Discard if critical limit is not met. Discard if contaminated.



Frozen Storage Multiplication of food poisoning bacteria.

Food covered or protected in suitable containers. Maintain temperature of <-18c. Don't overload, and ensure stock rotation adhered to. Ensures items are within date.

CP

<-15c Condition of packaging/food. Food is within date. Air Temperature. Food Temperature.

Inform Supervisor/Manager. Discard unfit, contaminated, or out of date food. Review systems/Training. Adjust thermostat. Reorganise items to allow air circulation. Report faults to Estates. Discard any items >-15c

Chilled Storage Contamination with harmful bacteria. Toxins, allergens or foreign bodies

Food covered or protected in suitable containers. Segregation of raw and high risk food. Segregation of allergens. Food not stored in open cans. Load food correctly. Maintain temperature of 5c. Don't overload, and ensure stock rotation adhered to. Ensures items are within date.

CCP

A of C + P 8c for 2 hours.

Observation and supervision. Condition of packaging/food. Food is within date. Air Temperature. Food Temperature. Time above 8c. Door seals.

Inform Supervisor/Manager. Discard unfit, contaminated, or out of date food. Review systems/Training. Adjust thermostat. Reorganise items to allow air circulation. Report faults to Estates. Discard any items >8c for 2 hours.



Regeneration Contamination with harmful bacteria. Toxins, allergens or foreign bodies. Survival of harmful bacteria/spores/toxins.

Reheat to a core temperature of 75c. Do not reheat more than once. Reheat as close to serving as possible. Follow microwave procedures. Follow packaging instructions. Protect from contamination. Segregate allergens (lid on).

CCP

75c A of C + P

Core temperature of food, probed and recorded. Observation and supervision.

Inform Supervisor/Manager. Extend reheating time until core temperature is reached. Allow longer reheating times in future. Carry out reheating trials. Review systems/training. Report faulty equipment to Estates. Discard contaminated food.

Service/Hot holding

Contamination with harmful bacteria. Toxins, chemicals, allergens or foreign bodies. Multiplication of food poisoning bacteria.

Protect from contamination. Minimise handling. Ensure temperatures are maintained throughout service (>63c & <5c)

CCP

A of C + P 63c and 8c (2 hours)

Observation and supervision. Time and temperature of food.

Discard any hot food that has been held for 2 hours. Discard any cold food that shows above 8c.

A of C = Absence of Contamination

P = Prerequisites, i.e. Hygiene training, Pest control contact, Cleaning and disinfection schedule, Planned Preventative Maintenance

CP = Control Point, CCP = Critical Control Point


Standard Operating Procedure Details

Review and Amendment History

Version Date Description of Change

1.1 April 2019

Reviewed HACCP.

Reviewed and updated (minimal changes required)

Food Hygiene code of practice for food handlers moved to Appendix 1

Critical control point hazard analysis moved to Appendix 2

1.0 June 2016

New SOP for BCPFT to support Food Safety Policy

Unique Identifier for this SOP is BCPFT-EST-SOP-02-1

State if SOP is New or Revised Revised

Policy Category Estates

Executive Director whose portfolio this SOP comes under

Director of Estates

Policy Lead/Author Job titles only

Catering Manager

Committee/Group Responsible for Approval of this SOP

Infection Prevention and Control Committee

Month/year consultation process completed

n/a

Month/year SOP was approved September 2019

Next review due September 2022

Disclosure Status ‘B’ can be disclosed to patients and the public