Progress 09/15/02 to 09/14/07
Outputs
Data collections instruments, reviewed by the advisory board, were developed for use in 39 assisted living (AL) facilities in Iowa to observe food handling practices and HACCP implementation by foodservice employees prior to training. Microbiological evaluations for aerobic plate count (APC) of five food contact surfaces and employees' knowledge and attitudes about food safety were assessed. Results showed a need for food safety and HACCP training. Findings from interviews with 186 residents indicated that over 50% stored potentially hazardous food items in their residences. A national sample of consultant dietitians in health care facilities and dietary managers who listed AL as employment location identified employee knowledge and experience and current food practices in facilities as food safety concerns. Training activities were developed as a result of findings. Iowa State University (ISU) Extension Food and Nutrition Field Specialists conducted ServSafe training
to employees from participating facilities. Researchers developed and conducted two levels of HACCP training workshops. Resource materials developed for the workshops included prerequisite program and standard operation procedures (SOP) checklists, 27 SOP and monitoring forms, and a series of eight lessons introducing the HACCP program. A follow-up visit occurred two years later. Findings showed that knowledge and food handling mean scores were higher than the initial visit. APC levels for surfaces were improved for swabs taken during follow-up visits. A food safety orientation brochure for new employees, a one-page handout for residents, and food safety educational puzzles for employees and residents were developed and distributed. A monthly newsletter was sent to each facility and posted at www.iowahaccp.iastate.edu. A food safety orientation DVD/videotape focusing on personal hygiene, time and temperature, and cleaning and sanitation was scripted, produced, and distributed. The
DVD/videotape is on the Extension food safety website (www.iowafoodsafety.org) as streaming video and in Podcast format. Glo Germ kits, refrigerator and bimetallic thermometers also were purchased for each facility. All educational materials were distributed to state directors and other professionals who oversee AL facilities. A 2007 food safety calendar was developed and distributed. The AL Standards of Excellence Orientation brochure has been updated to reflect Food Code 2005. Extension publications to assist in choosing an AL facility are available at www.extension.iastate.edu/store and can be used by AL facility employees and potential residents/families. Resources, such as monitoring forms and templates of SOPs, are available on the ISU website to support food safety and HACCP efforts in AL facilities. These materials reflect Food Code 2005 and can be accessed and adapted easily for use in any assisted-living or health-care facility at no cost. Six articles were published; and
three national, one regional, and six state presentations were given. The accessibility of educational materials and publications should enhance food safety and HACCP efforts in AL facilities.
Impacts
The project assessed food handling practices of foodservice employees and residents in 39 assisted living facilities and provided training to improve food safety. Team members' observations of food handling practices of employees in production kitchens and microbial analyses of food contact surfaces provided specific information about how foodservice employees demonstrated food safety knowledge. Residents of assisted living facilities also were interviewed about their understanding of food safety, particularly potentially hazardous food storage and hand washing techniques. ServSafe textbooks and training were provided to154 employees. Following a visit to each assisted living facility, researchers presented six-hour training sessions introducing HACCP to 63 dietary staff, administrators, directors of nursing, and universal care workers; an indication of the importance of involving all staff members in serving safe food to residents. During training, participants
reviewed the flow of food through their facilities, identified critical control points in recipes, and considered the significance of record-keeping information, such as temperatures and sanitizer concentrations. Food handling practices in all facilities improved during the 3-year study. Over 120 manuals and CD-ROMS containing food safety standard operating procedures (SOPs) with monitoring forms that can be tailored to each facility were given to participants, all state directors, and other professionals who oversee assisted living facilities. All materials are available through the Iowa State Website.
Publications
- Sneed, J., Strohbehn, C., and Gilmore, S.A. 2007. Impact of Mentoring on Food Safety Practices and HACCP Implementation in Iowa Assisted-Living Facilities. Topics in Clinical Nutrition, 22(2), 162-174.
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Progress 01/01/06 to 12/31/06
Outputs
A 2007 Food Safety Calendar focusing on hand washing, cross contamination and food defense was developed, printed and distributed to all assisted living facilities in the project. The "Guide to Food Safety" educational package - including a DVD/videotape, a brochure and other educational materials - were mailed to 97 additional facilities. The DVD/videotape was posted on the Iowa State University food safety Web site as streaming video and also in Podcast format. Approximately an additional 200 food safety orientation brochures and 100 resident handouts on keeping food safe were requested and distributed. Other food safety materials, including refrigerator thermometers, bimetallic stemmed thermometers, memo pads and pens imprinted with the Iowa HACCP Web site (www.iowahaccp.iastate.edu) were distributed. One presentation on food safety and HACCP implementation in assisted living facilities for the elderly was given at the 2006 USDA Food Safety Conference in Denver,
Colo. About 40 participants attended the session. An educational exhibit, viewed by approximately 300 attendees, displayed food safety education materials developed for this project for foodservice staff and residents in schools and assisted living facilities for the elderly.
Impacts
The researchers presented several food safety training sessions to many staff members from about 40 participating assisted living facilities. The project assessed food handling practices of foodservice employees and residents and provided training to improve food safety. Training sessions followed assessments of production kitchens during visits to each assisted living facility. Observations by team members and microbial analyses of food contact surfaces provided specific information about how foodservice employees demonstrated food safety knowledge. Residents of assisted living facilities also were interviewed about their understanding of food safety, particularly potentially hazardous food storage, and hand washing techniques. Training session participants also were introduced to HACCP (Hazard Analysis Critical Control Points). Dietary staff, administrators, directors of nursing and universal care workers attended those sessions, an indication of the importance of
involving all staff members in serving safe food to residents. During six-hour classes, participants reviewed the flow of food through their facilities, identified critical control points in recipes and considered the significance of record-keeping information, such as temperatures and sanitizer concentrations. An additional benefit to participants was a manual containing food safety Standard Operating Procedures (SOPs) that can be tailored to each facility. Participants also received the information on CD-ROM to ease customization to each facility.
Publications
- No publications reported this period
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Progress 01/01/05 to 12/31/05
Outputs
Follow-up site visits (two years after initial visit) were conducted at 38 assisted living facilities (ALF) remaining in the 3-year project. Data on employee food safety knowledge, food handling practices in production and service, and microbial samples were analyzed. Employee knowledge mean scores were higher (p=.000) for the posttest (15.9) than pre-test (14.6). The mean food handling practice score was higher (p=.000) at the follow-up (87.2) than the initial visit (82.9). More than half (n=22) of facilities in the follow-up visit had improved scores related to use of hair restraints, employee knowledge of proper end-point cooking temperatures, cleaning and sanitizing food contact surfaces, and documenting cooking temperatures, mechanical warewashing temperatures, chemical sanitizer concentrations, and temperatures of cold storage units. Microbiological swabs of food contact surfaces were taken and analyzed for aerobic plate count (APC) (standard: <1.3 log10 CFU),
Enterobacteriaceae (standard: <1.0 log10 CFU), and Staphylococcus aureus (standard: <1.0 log10 CFU). Swab results for food contact surfaces (work tables, mixing bowls, cutting boards) and refrigerator/freezer door handles were compared with the initial visit. Standards for all five samples were met by 17 facilities during the follow-up visit compared with two facilities in the initial visit. The APC for surfaces was improved for follow-up visits: only 5 of 38 cutting boards exceeded the standard compared to 29 of 40 in the initial visits, and 4 of 38 mixing bowls compared with 28 of 40 in initial visits. Work tables and cutting boards continued to be food contact surfaces most likely to exceed the standard for APC. A monthly newsletter highlighting food safety issues observed during onsite visits was mailed to facilities and posted at the www.iowahaccp.iastate.edu Website. Food safety education materials, such as crossword puzzles and word finds, were developed for employees and
residents. At the follow-up visits, packets of these and previously developed materials (food safety orientation brochure and resident handout on keeping food safe), and Glo germ kits (black light, lotion, and powder) were given to facilities, and ideas for using with employees and residents discussed. A DVD/Videotape, A Guide to Food Safety with an instructor's guide, was developed and mailed to each facility to use for orientation and training. The DVD/Videotape has three segments: personal hygiene, time and temperature, and cleaning and sanitizing. A packet of all educational materials, including the DVD/Videotape, was mailed to state directors who oversee ALFs, and other professionals involved in elderly care. Two presentations were given: cross-contamination issues at the Iowa Health Care Association and Iowa Center for Assisted Living Convention to about 100 attendees and food safety in ALFs to about 150 members of the Iowa Dietary Managers Association.
Impacts
Food handling practices in the 38 facilities that continued in the three-year study improved. Resources, such as monitoring forms and templates of standard operating procedures, are available on the Iowa State University Website to support food safety and HACCP efforts in assisted-living facilities. These materials can be accessed and adapted easily for use in any assisted-living or health-care facility at no cost.
Publications
- Gilmore, S.A., Sneed. J., Mahoney, M., and Strohbehn, C. 2005. Food handling practices of residents in assisted-living facilities. Is there a concern? The Consultant Dietitian 29(3):18-21.
- Gilmore, S.A., Sneed. J., Strohbehn, C., and Mahoney, M. 2005. A look at food handling practices of residents in assisted living facilities. Dietary Manager 14(1):28-30.
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Progress 01/01/04 to 12/31/04
Outputs
Training materials were developed for the HACCP Training II Workshop, which centered on the final steps of HACCP implementation. The workshop was conducted by project researchers. It was held in five locations and attended by 53 foodservice directors from 33 Iowa assisted-living facilities that are part of the study. Two workshops on cleaning and sanitation were given to 36 foodservice employees in two locations. A presentation on Building Strong Food Safety Programs in Assisted-Living Facilities was given at the Iowa Assisted Living Association and attended by 40 people. ServSafe training continued and was attended by 34 employees during 2004. These training sessions were conducted by Iowa State University Extension Food and Nutrition Field Specialists. Researchers developed several educational materials for use in the assisted living facilities. A food safety orientation brochure was developed for use with new employees. A one-page handout, Suggestions for Keeping
Food Safe in Apartments, was developed for use with residents, employees, and family members who are involved with the care of residents. A monthly newsletter focused on timely issues and concerns identified by foodservice employees in assisted-living facilities was developed. The newsletter is distributed to facility administrators and project advisory board members. The script for an employee food safety orientation videotape/DVD was written and production began. The script focuses on three areas: personal hygiene, time and temperature, and cleaning and sanitizing. An advisory board meeting was held to provide mid-project feedback.
Impacts
It is expected that the HACCP II training for 53 foodservice directors from 33 assisted-living facilities and ServSafe training and other presentations to 110 employees will improve food handling practices. Materials and newsletters distributed to administrators, employees, residents, and family members should lead to increased awareness of the importance of food safety when serving the elderly. It is anticipated that operations have begun implementing prerequisite programs necessary for HACCP.
Publications
- Strohbehn, C.H.,Gilmore, S.A., and Sneed, J. 2004. Food safety practices and HACCP implementation: Perceptions of registered dietitians and dietary managers. Journal of The American Dietetic Association, 104, 1692-1699.
- Sneed, J., Strohbehn, C.H., Gilmore, S.A. and Mendonca, A. 2004. Microbiological evaluations of foodservice contact surfaces in Iowa assisted-living facilities. Journal of The American Dietetic Association, 104, 1722-1724.
- Sneed, J., Strohbehn, C.H., Gilmore, S.A. 2004. Food safety practices and readiness to implement HACCP programs in assisted-living facilities in Iowa. Journal of The American Dietetic Association, 104, 1678-1683.
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Progress 01/01/03 to 12/31/03
Outputs
Site visits to the 40 assisted-living (AL) facilities in the project were completed. Data were analyzed providing results about resident food handling and handwashing behaviors, employee knowledge related to food handling, and microbiological quality of food contact surfaces. Findings from 186 residents interviewed showed that over 50% of residents stored potentially hazardous food (PHF) items, and 67% prepared food in their apartments, with 31% preparing breakfast and 45% snacks. Of PHF items, sandwiches and eggs were prepared most often. Less than 30% reported using sanitary procedures during food preparation. Almost all (90%) washed their hands with soap and warm water, however, only 63% washed for at least 20 seconds. Foodservice employees had a significant amount of food safety knowledge (14.6 + 3.0 out of 20 possible points), and employees with food safety certification scored higher than those with no certification (15.6+2.6 and 13.9+3.1, respectively). Proper
food handling practices were followed in many facilities, but areas needing improvement were identified. Some prerequisite programs for HACCP were inadequate, such as lack of written standard operating procedures, documentation, and training. Temperatures and chemical concentrations needed to be checked routinely. Microbiological analyses (aerobic plate count, Enterobacteriaceae, and Staphylococcus aureus) were conducted for four food contact surfaces (work tables/counters, cooking equipment such as mixing bowls, and cutting boards) and a surface that could cross contaminate food (refrigerator or freezer handle). Based on the literature and performance in practice, the following standards were set for the three tests: Aerobic plate count (APC), <1.3 log10CFU; Enterobacteriaceae, <1.0 log10CFU; and Staphylococcus aureus, <1.0 log10CFU. Two facilities met standards for all five surfaces for each of the three tests. Fewer facilities met the standard for APC, and nearly three-fourths of
facilities failed to meet the APC for cutting boards. A national sample of consultant dietitians in health care facilities and dietary managers who listed AL as employment location identified employee knowledge and experience and current food practices in facilities as food safety concerns. Over 80% of respondents agreed that most of listed HACCP prerequisites were necessary. Greatest barriers to implementation of HACCP were those related to time. ServSafe training was conducted by Extension Nutrition and Health Field specialists, and the research team held six HACCP training workshops. HACCP resource materials, which were developed and distributed to each facility at a training session, included a prerequisite program checklist, standard operating procedures checklist, and 37 standard operating procedures with monitoring forms. A series of eight lesson plans designed to introduce the HACCP program to foodservice employees was included.
Impacts
It is expected that the ServSafe training for 120 employees from 33 facilities and the HACCP training to 63 managers from 35 facilities will lead to improved food handling practices and support for HACCP implementation. Foodservice directors who are part of a corporation are expected to share HACCP principles and practices with facilities within the company.
Publications
- Gilmore, S.A., Sneed, J., and Strohbehn, C.H. (2003) Food Handling Practices of Residents in Assisted Living Facilities. Food and Nutrition Conference and Conference and Exhibition Abstracts, 103(9) A102.
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Progress 01/01/02 to 12/31/02
Outputs
Data collection instruments were developed for review by the advisory board at its first meeting. The advisory board includes a representative from the Dietary Managers Association, Consultant Dietitians in Healthcare Facilities, Extension nutrition/health field specialists, Iowa Department of Elder Affairs, Iowa Assisted Living Association, National Center for Assisted Living, and the Food & Consumer Safety Bureau of the Iowa Department of Inspections & Appeals as well as assisted living facilities directors/foodservice directors. The data collection protocol was pilot tested at an assisted living facility. Two rounds of a modified Delphi technique were conducted with a national sample of consultant dietitians in health care facilities (CD-HCF) to determine content for a questionnaire designed to assess consultant dietitians' perceptions of current food handling practices, prerequisite programs needed for HACCP implementation, and barriers to HACCP implementation in
assisted living facilities. Forty assisted living facilities in Iowa were recruited for the project. Thirty-nine facilities were visited to conduct an initial assessment that included observation of food handling practices of and HACCP implementation by foodservice employees, microbiological evaluations of food contact surfaces, employee knowledge and attitudes about food safety, and demographic information about the facility. Five residents in each facility were interviewed about their food preparation techniques in their apartments and personal hygiene (i.e., washing hands). Databases were developed and an individualized report for each facility was written. Coordination with Extension Nutrition and Health Field specialists who will provide ServSafer training has been done.
Impacts
It is expected that the 40 assisted living facilities in Iowa will improve practices and implement more HACCP components than they currently practice. Foodservice directors who are part of a larger company are expected to share HACCP principles and practices with other assisted living facilities within the company. Education materials for residents developed as a result of this study may improve their food handling practices within their apartments.
Publications
- No publications reported this period
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