HospitalInspections.org

Based on observations, review of documents and policy, and staff interviews, the facility failed to ensure the sanitizing solution for the 3 compartment sink and sanitizer buckets reached the required concentration and that dietary staff handled food in a safe and sanitary manner. The administrative staff identified a census of 6 patients at the time of the survey and the Nutrition Services Manager reported an average of approximately 6 to 12 patient meals served daily.

Failure to effectively sanitize food contact surfaces and handle food in a sanitary manner could potentially result in foodborne illness and/or contamination of patient food.

Findings include:

A. During observation during the initial kitchen environment tour on 11/4/13, beginning at 10:00 a.m., the Nutrition Services Manager performed a pH test on the sanitizing solution (Oasis 146 - a disinfectant/sanitizer designed to kill germs) for the 3 compartment sink. The manager reported they currently did not have any of the required test strips. She relayed the wrong strips came in about 2 weeks ago and she had reordered the correct ones on 10/22/13, but had not yet received them. The Nutrition Services Manager reported the same solution is used for the sanitizer buckets and the 3 compartment sink, which is normally checked every 2 hours, while in use, and documented on a form titled "Ph Documentation Form", but dietary staff have been unable to perform the checks since around 10/25/13. The Nutrition Services Manager reported she would contact the supplier of the strips and request delivery of some today.
Review of forms titled "Ph Documentation Form", used to document the pH concentration of the 3 compartment sink and sanitation buckets, dated October 2013, revealed, beginning on 10/23/13, staff began to document there were no test strips. The forms identified were completed by the cooks, Staff A and Staff B, and revealed pH values recorded through the entire month of October. During an interview on 11/4/13, at 11:00 a.m., Staff B acknowledged she recorded values without testing the solution and indicated she did so because she didn't want to leave blank areas on her form. During an interview at the same time, Staff A reported she could not recall when the test strips ran out, but confirmed there were none currently available.
Review of an infection control policy titled "Nutritional Services Infection Control", approved on 2/7/13, revealed in part, "Purpose: To reduce and control the spread of communicable disease and infections through food handlers . . . 1. Food Preparation: A. . . The pH of each sanitation bucket is checked and documented every 2 hours . . . 2. Ware washing. B. v. . . solution of sanitizer and water that equals 200 parts per million (ppm) . . . Sanitizer sink solution pH is checked every 2 hours when in use . . ."
During an interview on 11/5/13 at 7:50 a.m., the Nutrition Services Manager reported the chemical supplier planned to deliver the correct pH test strips this morning and he arrived at 7:55 a.m., during this interview. The Nutrition Services Manager tested the pH of the sanitizing solution in the 3rd sink compartment which tested at 300 ppm and confirmed without the test strips, dietary staff were unable to ensure the solution reached the required concentration.
The Food Code, published by the Food and Drug Administration and considered a standard of practice for the food service industry, in both the 2005 and 2009 editions, requires a chemical sanitizer must be used for manual ware washing operations, used as indicated by the manufacturer's directions and the concentration of sanitizing solution must be accurately determined by using a test kit.
Review of the Oasis 146 product information revealed the solution is an effective sanitizer for hard non-porous surfaces at a required concentration of 150-400 ppm.

B. Observation during preparations for lunch meal service on 11/4/13, from 11:15 a.m. to 11:46 a.m., identified the following concern.

Staff B, cook, donned gloves twice without performing handwashing before and after changing gloves, touching several items in between changes, including, but not limited to, refrigerator handles, sink faucets, her apron, glove box, sliced meat package and a shredded cheese container and handled turkey and ham slices, a tomato and shredded cheese (ready-to-eat foods), and placed them on a salad for a patient, with the contaminated gloves.

During an interview on 11/6/13 at 11:00 a.m., the Nutrition Services Manager reported she provided education to her dietary staff on hand hygiene at an October inservice. She relayed the inservice covered her expectation for glove use with ready-to-eat foods (foods requiring no further heat treatment), which included, gathering all needed supplies, prior to donning gloves onto clean hands, and then performing one task only, without touching various pieces of equipment or surfaces.

Review of a nutrition services inservice attendance sheet, dated 10/24/13, revealed the topic of "Personal Hygiene and Handwashing" covered with all department employees including Staff B. Review of the material covered revealed, in part, handwashing must be done before putting on gloves for food handling.

Review of an infection control policy titled "Nutritional Services Infection Control", approved on 2/7/13, revealed in part, "Purpose: To reduce and control the spread of communicable disease and infections through food handlers . . . 9 B. Single use gloves shall be used for only one task, such as working with ready-to-eat-food . . . and discarded when . . . soiled or when an interruptions occur in the operation."

The Food Code, published by the Food and Drug Administration and considered a standard of practice for the food service industry, in both the 2005 and 2009 editions, requires that food employees wash their hands immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, before donning gloves for working with food and after engaging in other activities that contaminate the hands.