HospitalInspections.org

Based on observation, interview and record review the facility failed to ensure that infection control measures were enforced as it pertained to their policy and procedures, to ensure patient ' s were free from harmful microorganisms as evidenced by facility failure to effectively and consistently monitor and document food temperatures at all critical control points to include following the rethermalization process and failure to rethermalize food to proper temperatures.

The findings included:

Review of the facility's Hot Food Temperature Monitoring Logs since the date of alleged compliance revealed results of hot food temperature monitoring following the rethermalization process. The logs reflected evidence of random monitoring of hot food temperatures testing various Burlodge carts during alternating meals for a total of 34 documented opportunities since 2/1/11. Further review of the logs revealed a total of 15 Burlodge carts had been tested. Review of the results revealed hot food temperatures were recorded below 165 degrees Fahrenheit (F) for 26 of the 34 temperature logs reviewed. The logs revealed documentation that the food would be heated manually in the microwave and/or the re-boost cycle would be activated. There was no documentation of final temperatures reached following the use of the microwave or re-boost cycles to ensure that temperature greater than (>) or equal (=) to 165 degrees had been reached.

Observation on 3/8/11 at 11:55am in the 7th Floor West pantry revealed the following test tray results. Following the rethermalization process two test trays were checked from the first Burlodge cart: first tray- soup 160 degrees F, chicken 142 degrees F, zucchini 136 degrees F, rice 138 degrees F, second tray- Soup 160 degrees F, Chicken 130 degrees F. After setting the cart for a 5 minute re-boost cycle the soup reached 180 degrees F, chicken 158.3 degrees F, rice 162 degrees F, and zucchini 138 degrees F. At 12:05pm a test tray was checked from a second Burlodge cart with the following results: Soup 130 degrees F, Rice 142 degrees F, Chicken 112 degrees F. After setting this cart for a 5 minute re-boost cycle the chicken reached 168 degrees F, zucchini 142 degrees F, and soup 190 degrees. These temperatures were taken using a digital thermometer calibrated in ice water to 32.7 degrees F.

Observation on 3/8/11 at 4:40pm revealed the following temperatures after the initial rethermalization process in cart #32: carrots 144.1 degrees F, mashed potatoes 151.1 degrees F, beef patty 153.6 degrees, and soup 189.5 degrees. At 5:05 following a 5 minute re-boost cycle the carrots reached 153.1 degrees F, mashed potatoes 162.8 degrees, and beef patty 169.9 degrees F. The post rethermalization temperature for cart #48 were carrots 114.5 degrees F, mashed potatoes 120.9 degrees F, and beef patty 116.8 degrees F. Following a 5 minute re-boost cycle the carrots reached 115 degrees F, mashed potatoes 128.8 degrees F, and beef patty 142.3 degrees F. Cart #48 was set for a second 5 minute re-boost cycle. Following the second re-boost cycle the carrots reached 119.1 degrees F, mashed potatoes 142.2 degrees F, beef patty 152.2 degrees F, and soup 196 degrees F. These temperatures were taken using a digital thermometer calibrated in ice water to 32.2 degrees F.

Interview on 3/8/11 at 5:22pm with the Assistant Nutrition Manager (ANM) revealed that the re-boost cycle can be conducted three times. The ANM stated that the carts are programmed to reach 266 degrees with 15 minutes of the 45 minute initial rethermalization process. The temperature of the unit hovers at 266 degrees F for the remainder of the cycle. If this temperature is not maintained, an alarm will sound and an error code will signal indicating a problem with the unit. During observation of the rethermalization process during the lunch and dinner meal on 3/8/11, there were no alarms or error codes.

Interview on 3/8/11 at 11:55am with the Nutrition Services Administrator revealed that the supervisors are assigned to monitor hot food temperatures randomly with different supervisors assigned to each wing. Interview on 3/8/11 at 2:30pm with the Executive Director of Nutrition Services and the General Manager confirmed that despite the results of random temperature testing revealing post rethermalization temperature results frequently below 165 degrees F, temperature testing continues to be done randomly. Currently temperatures are tested two days per week for different Burlodge carts on alternating units and meals. The General Manager reported that there were 22 service areas (pantries). The Executive Director reported that there were up to two Burlodge carts in use in each pantry and dependent on patient census there were 22-44 carts in use for each meal service. Record review reflected only 15 of 44 carts were tested since 2/1/11 and the results reflect temperature below 165 degrees F for 26 of 34 testing opportunities.

Interview on 3/8/11 at 3:10pm with the Executive Director confirmed that based on the results of the test trays observed during the lunch meal and review of the Hot Food Temperature logs, the volume of testing was not sufficient to ensure that safe food temperatures > or = to 165 degrees F were being reached following the initial rethermalization process. The Executive Director confirmed that a re-boost cycle was required for the majority of the testing opportunities and also confirmed that there was no documentation to indicate that temperatures where rechecked after the re-boost cycles to ensure that 165 degrees F had been reached. The ED reported that the re-boost cycle was only activated for those carts that were tested and temperatures results were found to be <165 degrees F.

Interview on 3/8/11 at 5:30pm with the Executive Director (ED) revealed that a plan would be put in place immediately to monitor and document post rethermalization temperatures for each Burlodge cart used daily at each meal. The ED also stated that if a re-boost cycle is indicated based on the temperature results, post re-boost cycle temperatures should be documented once adequate temperatures are reached to ensure temperature were > or = to 165 degrees F.

Review of the facility policy and procedure revised 1/26/11 titled "Burlodge System" revealed Purpose: To ensure all meal trays are rethermalized to the appropriate temperature before service. Procedure includes, but is not limited to: If the food has not reached the appropriate temperature, the 5 minute Boost cycle should be repeated until the temperature is satisfactory (> or = 165 degrees F).