HospitalInspections.org

Based on policy and document review, observations and staff interviews, the hospital dietary staff failed to use sanitary practices during food preparation and patient meal service and maintain equipment in a sanitary manner. The administrative staff identified a census of 117 patients, an average census of 141 patients and the Nutrition Services Department identified an average service of 423 patient meals daily.

Failure to maintain equipment and use sanitary practices could potentially result in contamination of the patient's food leading to foodborne illness.

Findings include:

1. Review of a hospital policy titled "Food Preparation in Nutrition Services", with an effective date of 4/3/13, revealed in part ". . . All foods are prepared in accordance to food safety guidelines and practices outlined in the Food Code. . ."

Review of a hospital policy titled "Nutrition Services - Employee Infection Control Measures", with an effective date of 4/3/13, revealed in part ". . . Nutrition Services personnel will comply with the current food code. . ."

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 2013 editions requires the following:
Surfaces such as cutting blocks and boards, that are subject to scratching and scoring, shall be resurfaced if they can no longer be effectively cleaned and sanitized, or discarded if they are not capable of being resurfaced.
Food-contact surfaces of cooking equipment and pans must be clean to sight and touch and kept free of encrusted grease deposits and other soil accumulations.

Single-use gloves can be used for only one task, such as working with ready-to-eat food and for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation. In addition, food employees shall clean their hands immediately after handling soiled equipment or utensils, and before donning gloves for working with food.

Cloths used for wiping counters and other equipment surfaces shall be held between uses in a chemical sanitizer solution.

2. During the kitchen environment tour on 6/16/14, beginning at 10:15 AM, identified equipment with compromised, unsanitizable surfaces, including:

a. 2 small white, 2 medium red, 1 medium green, 1 medium blue, 1 large yellow, 1 large blue, 1 large red and the white cold table cutting boards with heavily marred surfaces and imbedded stains

b. 3 small and 1 medium skillet with a heavy carbon buildup on the majority of the food contact surfaces.

During the environment tour, the Director of Nutrition Services acknowledged the poor condition of the cutting boards and skillets and reported they would be discarded. During a follow-up interview on 6/18/14 at 11:30 AM, he confirmed the equipment in question had been discarded, except for the cold table cutting board, which they planned to attempt to resurface.

3. Observations during food preparation and patient meal service on 6/16/14, from 11:00 AM to 12:10 PM, revealed the following concerns:

a. Observed Staff A and Staff B, trayline aides, participating in placing food items on patient meal trays with gloves. They touched multiple items including, but not limited to, their clothing, paper menus completed by patients and handled by staff, condiments, soda cans, milk cartons, plastic wrapper with dinner rolls and placed dinner rolls on patient plates with the contaminated gloves.

b. Observed Staff C, cold food aide, assemble egg salad sandwiches for patient meal service, with gloved hands. She touched multiple items including, but not limited to, bag of carryout containers, refrigerator and freezer handles, bread wrappers, egg salad serving scoop and handled bread slices, to assemble the sandwiches, with contaminated gloves. At one point, Staff C used a wet cloth (which had been lying on the counter) to wipe off the surface used to assemble the egg salad sandwiches, and left the cloth lying on the counter, then returned to making sandwiches with the same gloved hands.

c. At 11:50 AM, observed Staff D, cold food aide, wipe food contact surfaces in the cold food prep area with the same cloth, that remained on the counter.

4. Observations during food preparation and patient meal service on 6/17/14, from 10:25 AM to 12:15 PM, revealed the following concerns:

a. Staff A donned gloves after cleaning her hands. She handled dinner roll wrappers and a refrigerator handle and then handled the dinner rolls to place them in a container, in preparation for service to patients.

b. Observed Staff C don gloves multiple times, during the entire observation period, without performing handwashing before and after changing gloves. Staff C touched multiple items in between changes, including, but not limited to, refrigerator handles, bread wrappers, plates, food containers, serving scoops, counter surfaces, clothing, utility cart, saran wrap box, bag of carryout containers and a pen. Staff C handled patient food items with contaminated gloves, including bread, lettuce, sliced tomatoes, onions, sliced roast beef and ham, cherry tomatoes, shredded cheese, boiled eggs and pear halves.

c. Staff E, cook, donned gloves after cleaning hands and handled a paper menu completed by a patient and handled by staff, condiments, oven handle, refrigerator handle, cold table cutting board and a soda bottle. Staff E handled patient food items with contaminated gloves, including lettuce, sliced tomato and onion, pickles and a prepared chimichanga.

d. Staff F, trayline aide, donned gloves after cleaning hands, in preparation to begin patient meal service. Staff F touched multiple items, during the remainder of the observation period, including, but not limited to, hamburger bun wrappers, paper menus completed by patients and handled by staff and a hot holding cabinet handle. Staff F handled patient hamburger buns with contaminated gloves.

5. Review of dietary staff training documentation revealed a training conducted on 3/24 and 3/25/14, with a guest speaker from the Cerro Gordo Department of Public Health. The speaker presented information on food safety including glove use and hand hygiene. The handouts from the training directed staff to change gloves between tasks and to wash hands before putting on gloves.

Review of annual mandatory staff training revealed a module titled "How do we prevent healthcare associated infections?" The module identified hand hygiene as the cornerstone of an infection prevention program and the most common mode of transmission of pathogens is via the hands. The module identified hand hygiene must be used before donning and after removing gloves.

6. During an interview on 6/16/14 at 3:50 PM, Staff C reported gloves needed to be changed if she left an area to do something else but lacked the knowledge of the need to wash her hands prior to donning clean gloves each time.

During an interview on 6/16/14 at 4:05 PM, Staff B reported gloves needed to be changed when they got dirty but lacked the knowledge of the need to wash her hands prior to donning clean gloves each time.

During interviews on 6/17/14 at 8:55, 9:05, 9:15 AM, Staff H, cook, Staff I, cold food aide, and Staff J, cook reported gloves need to be changed when changing tasks but lacked the knowledge of the need to wash her hands prior to donning clean gloves each time.

During an interview on 6/18/14 at 10:20 AM, Staff G, Infection Prevention Nurse, reported she expected dietary staff to wear gloves with direct food contact, remove the gloves when they left the task and wash hands prior to donning clean gloves.

During an interview on 6/18/14 at 11:30 AM, the Director of Nutrition Services reported he expected dietary staff to wear gloves with direct food contact and staff should change the gloves when changing tasks. He acknowledged dietary staff are wearing gloves when handling non-food items, lending itself to cross contamination when food items are touched without a glove change.