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CLINICAL I Fundamental care in practice, Series 4

Nutrition, Series 4.5:


food safety
Menna Lloyd Jones, Consultant Editor, BJHCA

Lucie Carlier

The provision of nutrition is essential to human life.

T
he provision of nutrition is is that the majority of foodborne disease You should be offered specific training on
essential to human life; however is preventable. As a healthcare assistant, food handling in accordance with your
it is recognised that food itself there is every likelihood that you will local policy, which you should be familiar
can lead to illness and, in extreme cases, be involved in the preparation, serving, with and comply with.
death. It is estimated that there are feeding and/or disposing of food. You Good food safety philosophy is
around one million cases of food-borne will therefore have a responsibility to important in all settings, but even more
illnesses a year in the UK (Department ensure the safety of the patients you care so in hospital, where food is produced
for Environment, Food and Rural Affairs for, by understanding and following the and served to the most vulnerable and
2015 MA Healthcare Ltd

(DEFRA), 2013). These range from principles of food safety throughout the immune-compromised in our society
minor nausea, diarrhoea and sore head food-handling process. i.e. the very young, pregnant women
to death. Of that one million, 20000 The aim of this section of series 4 is and the elderly and the infirm (NHS
people will be admitted to hospital and to give you practical guidance on the Scotland, 2014).
500 will die (DEFRA, 2013). The sad fact principles and relevance of food safety. Understanding the importance of safe

170 April 2015 Vol 09 No 04 British Journal of Healthcare Assistants


Lucie Carlier Fundamental care in practice, Series 4 I CLINICAL

Box 1. Common causes of food


poisoning
Food that is not cooked thoroughly
particularly food such as burgers, kebabs,
poultry, pork and sausages
Keeping cooked food unrefrigerated for
more than one hour
Not storing food that needs to be chilled
at below 5C
Consuming food that has been handled
by infected food handlers, for example,
someone who has diarrhoea and/or
vomiting
Contamination by poor personal hygiene
Food that has been subjected to cross-
contamination (Food Standards Agency
(FSA), 2015). See Glossary

(Adapted from NHS Choices, 2013)

The sad fact is that the majority of foodborne disease is preventable.

Box 2. Pathogens responsible for food poisoning


A pathogen is anything that can produce disease. Typically, the term is used to describe an infectious agent such as a virus, bacterium, prion, fungus,
or parasite that causes disease in its host.

Bacteria
Campylobacter
The most common bacteria cause of food poisoning
Found on raw meat, in particular, poultry, unpasteurised milk and untreated water
Estimated UK cases increased to 416 400 in 2011, 45% higher than the lowest level in 2004
Incubation period 2-5 days
Listeria monocytogenes
Found in a range of chilled, ready-to-eat foods, which include soft cheese, pate, butter, cooked sliced meats and smoked salmon
At 33% of cases, listeria accounts for the greatest proportion of deaths
Incubation period anything between 2 days and three months
Salmonella
Found in raw meat and poultry, eggs and unpasteurised milk
The UK incidence is reducing, although there was a small increase in the estimated cases of salmonella in 2011 to 23 300
Incubation period is 12 to 24 hours
Escherichia coli (E. coli)
Found in the digestive systems of many animals, including humans. Most strains are harmless, but some cause serious illness
Cases of E.coli O157 increased 44% in 2011 to an estimated 1300, largely as a result of one significant outbreak
Most cases occur after eating beef products, in particular mince, burgers and meatballs that have been undercooked
Incubation period 3 to 4 days, but it is possible for symptoms to take as long as two weeks to appear

Viruses
Norovirus
Highly contagious and easily spread and can be passed on if an infected person does not wash their hands before handling food
Found in shellfish. The FSA advises that the elderly, pregnant, very young children and those that are ill should avoid eating raw or lightly cooked shellfish
Incubation period between 12 to 24 hours

Parasites
Toxoplasmosis
Caused by a parasite found in the digestive systems of many animals, in particular cats
Cases occur following the consumption of undercooked contaminated meat, or food or water that has been contaminated by the faeces of contaminated
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cats, or cross-contamination of surfaces and equipment that has been in contact with undercooked or raw meat
Most serious in those people who are immuno-compromised

Adapted from NHS Choices, 2013 and Department for Environment Food and Rural Affairs (DEFRA), 2013.

British Journal of Healthcare Assistants April 2015 Vol 09 No 04 171


CLINICAL I Fundamental care in practice, Series 4

Box 4. Main principles of food safety


1. The Food Safety Regulation of 1995 recommended that all those handling food should maintain a high degree of personal cleanliness and wear suitable,
clean and, where appropriate, protective clothing, in order to maintain a high standard of personal hygiene at all times:
Wash hands as per local policy before handling and /or serving food
Keep fingernails short and clean. Nail varnish/acrylic nails etc. should not be worn
Any broken skin must be covered, as per local policy
Comply with local policy on wearing of jewelry and bare below elbow
Before handling food, always put on the appropriate coloured apron (usually blue) and replace it if non-food handling intervention is carried out
You should not eat or smoke while preparing or serving food and should avoid touching your nose and mouth etc.
Keep your hair short or tied back

2. It is really important to prevent contamination of food and therefore you should report to your immediate supervisor (as per local policy) if you suspect
that you might be suffering from, or likely to be a carrier of, an illness or disease that is likely to be transmitted through food or while afflicted; for
example, if you have infected wounds, skin infections such as boils, or have diarrhoea and/or vomiting

3. Hot food should be maintained at a temperature of above 63 and cold food below 5. In order to maintain these temperatures, always ensure that:
The food trolley is plugged in as soon as it arrives on the ward
Serve the food as soon as possible
Any item that requires to be refrigerated is stored in the refrigerator as soon as it is received (any food should be stored and dated as per local policy)
Report immediately to your supervisor if you find that the temperature of the ward fridge rises above 5
If a patients meal has gone cold, you should contact catering for a fresh meal. You should never, ever re-heat food at ward level
Following meal service, always collect and dispose of any waste food, as per local policy

4. All food kept in the ward kitchen should be stored as per local policy, for example:
Bread should be stored in its original packaging and should not be used after its use by date
Spreads such as butter and margarine should be kept in the ward fridge. These products should not be consumed after their use by date; ensure that the
most recent stock is placed at the back. Tubs of butter or margarine should always be decanted into single-use containers before they are taken into the
ward and any left over should be discarded
Sachets of tomato sauce can be stored at room temperature, but once opened, any sauce left in the sachet should be discarded. In the same way as
spreads, the sauce in any bottle should be decanted into single-use containers before taking into the ward area and then any left over discarded
Check and store any dry foods, as per local policy.
Check local policy with regards to eggs, which are a source of salmonella. The cooking of eggs at ward level may be prohibited unless the eggs are supplied
by the hospital catering service

5. Some foods brought into hospital can constitute a serious health risk to the patient
Always check that any food brought in for a patient is suitable for them, for example, food such as cooked meats, sandwiches, cooked, eggs etc. can be
dangerous, especially for the immunocompromised patient (see local policy and check patients notes with regards to special diets). If in doubt, always
check with your supervisor
Ensure that any patients food is stored according to local policy and if it has passed its use by date, always inform the patient before you discard any
unsuitable food etc.

Adapted from Ministry of Agriculture, Fisheries and Food (1995) and Newcastle upon Tyne Hospitals NHS Foundation Trust Ward Food Hygiene Policy (2013).
Lucie Carlier

Box 5. World Health Organisations


Golden Rules for Safe Food
Preparation
1. Choose foods processed for safety
2. Cook food thoroughly
3. Eat cooked foods immediately
4. Store cooked foods carefully
5. Reheat cooked foods thoroughly
6. Avoid contact between raw foods and
cooked foods
7. Wash hands repeatedly
8. Keep all kitchen surfaces meticulously clean
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9. Protect foods from insects, rodents and


other animals
10. Use safe water

Source: World Health Organisation (WHO), 2014


As an HCA, you will often be involved in the preparation, serving, feeding and/or disposing of food.

172 April 2015 Vol 09 No 04 British Journal of Healthcare Assistants


Fundamental care in practice, Series 4 I CLINICAL

Lucie Carlier
food preparation and following your local
policy will help to protect the patients in
your care form the unnecessary suffering
of a foodborne illness. BJHCA

The reference list below will give you


more in-depth information with regards
to food safety.

References
Department for Environment, Food and Rural
Affairs (DEFRA) (2013) Food Statistics Pocketbook
2013. http://tinyurl.com/nzbb54e (accessed 10
March 2015)
Food Standards Agency in Northern Ireland (FSA)
(2015) Cross-contamination. http://tinyurl.com/ Good food safety philosophy is important in all settings.
oeez7sd (accessed 10 March 2015)
Ministry of Agriculture, Fisheries and Food (1995) Glossary of terms
Food Safety (General Food Hygiene) Regulations
1995. http://tinyurl.com/829up9n (accessed 10 Cross-contamination Occurs when harmful bacteria such as E. coli are spread between
March 2015) food surfaces and equipment. For example, if you prepare poultry on
Newcastle upon Tyne Hospitals NHS Foundation a chopping board and then use the same board without washing it
Trust (2013) Ward Food Hygiene Policy. http:// to prepare fruit and vegetables that will not be cooked, for example
tinyurl.com/p843fal (accessed 10 March 2015)
a salad, that is cross-contamination. In the same way, raw meat
NHS Choices (2015) Food poisoning Causes. http://
should always be stored on the bottom shelf of a fridge, in order to
tinyurl.com/yh8vgcj (accessed 10 March 2015)
NHS Scotland (2014) NHS Scotland National Food prevent any juices from the meat dripping onto any ready-to-eat
Safety Assurance Manual. http://tinyurl.com/ foods below, which again causes cross-contamination
pok8qjs (accessed 10 March 2015)
World Health Organisation (WHO) (2014) The Incubation Period The time between eating contaminated food and the onset
WHO Golden Rules for Safe Food Preparation. of symptoms
http://tinyurl.com/nrn897l (accessed 10 March
2015) (Adapted from NHS Choices, 2013.)

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