Multiskilling: Dietary Practice for the Health Care Provider

M U L T I S K I L L I N G :

Dietary Assisting F O R

T H E

H E A L T H

C A R E

P R O V I D E R

DEDICATION To Larry, Angela, and Cristina To Mike, Charles, and John

ACKNOWLEDGMENTS Our thanks to Marianne Krismer for her encouragement and support during the writing of this book. Thanks also to Anita Woods for graciously allowing us to photograph her dietary department in operation.

M U L T I S K I L L I N G :

Dietary Assisting F O R

T H E

H E A L T H

C A R E

P R O V I D E R

Jo Ann R. Airaghi MEd, RD, LD Adjunct Professor, Cincinnati State Technical and Community College Health Technologies Division Cincinnati, OH

Rebecca S. Galvin MS, RD, LD Adjunct Professor, Cincinnati State Technical and Community College Health Technologies Division Cincinnati, OH

Beverly M. Kovanda PhD, MS, MT(ASCP), CLP(NCA) Series Editor

Cover Design: Scott Keidong’s Image Enterprises Delmar Staff Publisher: Susan Simpfenderfer Acquisition Editor: Dawn Gerrain Developmental Editor: Marjorie A Bruce Project Editor: Brooke Graves/Graves Editorial Service Team Assistant: Sandra Bruce

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All rights reserved. No part of this work covered by the copyright hereon may be reproduced or used in any form or by any means—graphic, electronic, or mechanical, including photocopying, recording, taping, or information storage and retrieval systems—without the written permission of the publisher. 1 2 3 4 5 6 7 8 9 10 XXX 03 02 01 00 99 98 Library of Congress Cataloging-in-Publication Data Airaghi, Jo Ann R. Multiskilling : dietary assisting for the health care provider / Jo Ann R. Airaghi, Rebecca S. Galvin. p. cm. -- (Delmar’s multiskilling series) Includes bibliographical references and index. ISBN 0-7668-0514-X 1. Dietetics. 2. Allied health personnel. 3. Nursing. I. Galvin, Rebecca S. II. Title. III. Title: Dietary assisting for the health care provider. IV. Series. [DNLM: 1. Dietary Services programmed instruction. 2. Health Facilities--organization & administration programmed instruction. 3. Dietetics--methods programmed instructon. 4. Allied Health Personnel programmed instruction. WX 18.2 A298m 1999] RM216.A43 1999 DNLM/DLC 98-51789 for Library of Congress CIP

MESSAGE FROM THE SERIES EDITOR The Multiskilling for Health Care Providers series consists of the Patient Care: Basic Skills for the Health Care Provider core text and many separate modular texts. The Multiskilling series offers a comprehensive vision of the diversity and many implications of multiskilling, whether in an acute care setting, home care, hospice, ambulatory setting, long-term care facility, or physician’s office. The core text and module subjects have been identified through research as key topics in multiskilling and patient care training across the nation. The framework for this series is found in the historic evolution of multiskilling, the National Health Care Skill Standards, and 13 years of personal experience in developing academic materials and successfully training thousands of multiskilled health care providers in a multitude of nursing and allied health skill areas. The concept referred to as multiskilling, cross-training, and (more recently) patient care skills began to gain national awareness in the mid-1980s, as pressures for cost containment in health care intensified. Institutions began to focus on more efficient use of personnel for economic survival. The implications of managed care are far-reaching. In 1994, the National Health Care Skill Standards were developed through a national collaborative effort of health care organizations, professional organizations, schools, and colleges of higher education. By implementing these standards, we can more effectively serve the needs of a diverse client population and maintain quality care, while increasing the efficiency of staff utilization. Health care costs can be contained; the new technology, which is changing how and where health care is delivered, can be prudently applied. We believe that the skill standards are important and so their intent has been incorporated into the entire series. The core text, Patient Care: Basic Skills for the Health Care Provider, meets the OBRA requirements for basic patient care skills. These skills are required of every health care provider who undertakes client care, regardless of the institutional setting or professional affiliation. We believe that the core-text-plus-modules concept is the only rational approach to meeting the vastly different academic and training needs in multiskilling, as we re-engineer careers in all health care settings. The modules are flexible, well written, and academically sound. The modular approach is costeffective. A health care worker’s skills can be developed based upon individual goals, institutional needs for retraining, or specific career development. Colleges, hospitals, other health care agencies, technical and career schools, and “tech prep” programs need only purchase the modules that address their unique, customized academic and training needs. Because multiskilling is market-driven, other modules continue to be developed as health care needs are identified and evolve. The modules are written by credentialed experts in each content area and multiskilling education. They have identified essential and appropriate nursing and allied health skills that can be accurately and safety performed by nonprofessionals to enhance the quality of patient care. The depth of theory and skills in each module goes beyond other texts, which are usually written from the perspective of one profession rather than by specialists in each identifiable allied health and nursing area. We believe that this principle provides a stronger basis for instruction and facilitates a higher level of quality patient care. The material in each module is organized in a clear, concise, straightforward manner to make learning easier, because health care institutions are demanding shorter—but intensified—training periods. The pedagogical features enhance retention and simplify learning.

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MESSAGE FROM THE SERIES EDITOR

We believe that the Multiskilling series combines the knowledge, experience, successes, and expertise of all of the authors. It provides the tools and flexibility to custom-design a curriculum that truly meets worker/student professional goals, augments valuable skills, and strengthens employability, not only now but as we prepare for the 21st century. Beverly M. Kovanda, PhD, MS, MT(ASCP), CLP (NCA) Coordinator/Professor, Multicompetency Health Technology Columbus State Community College, Columbus, OH

DELMAR’S MULTISKILLING SERIES Patient Care: Multiskilling: Multiskilling: Multiskilling: Multiskilling: Multiskilling: Multiskilling: Multiskilling: Multiskilling: Multiskilling:

Basic Skills for the Health Care Provider Advanced Patient Care Skills for the Health Care Provider Phlebotomy Collection Procedures for the Health Care Provider Electrocardiography for the Health Care Provider Respiratory Care for the Health Care Provider Point of Care Testing—Capillary Puncture for the Health Care Provider Waived Laboratory Testing for the Health Care Provider Team Building for the Health Care Provider Health Unit Coordination for the Health Care Provider Dietary Assisting for the Health Care Provider

Modules Coming Soon Multiskilling: Rehabilitation Services for the Health Care Provider Multiskilling: Radiography for the Health Care Provider

Table of CONTENTS

MESSAGE FROM THE SERIES EDITOR PREFACE viii CHAPTER 1 PERSONAL HYGIENE AND SAFETY Overview 1 Professional Appearance 1 Jewelry and Cosmetics 1 Personal Hygiene 2 Handwashing 3 Procedure 1 Handwashing

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1

CHAPTER 5 SAFETY IMPORTANCE AND PRACTICES 36

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CHAPTER 2 SAFE FOOD HANDLING AND STORAGE 6 Overview 6 Receiving Food into the Kitchen 6 Storage of Food in the Kitchen 7 Proper Handling of Food During Preparation, Serving, and Holding 9 Proper Handling of Prepared Foods 13

CHAPTER 3 PLATING AND PORTIONING OF FOOD 17 Overview 17 The Menu and Spreadsheets 17 Importance of Sanitation 21 Setup of the Trayline 21 Procedure 2 Steps for Setting up a Trayline 22 Food Temperatures 22 Procedure 3 Taking Food Temperatures 25 Serving Utensils and Portion Sizes 26 Plating the Food Items 26 Breakdown and Sanitation 26 Procedure 4 Trayline Breakdown 27

CHAPTER 4 THE IMPORTANCE OF CLEANING AND SANITATION OF KITCHEN EQUIPMENT AND AREAS 28 Overview 28 Cleaning and Sanitizing Solutions

Three-Well Sink 29 Procedure 5 Setting up a Three-Well Sink 30 Dishwashng Machine 30 Procedure 6 Automatic Dishwashing Machine Use 31 Cleaning and Sanitizing Kitchen Equipment, Surfaces, and Areas 33 Procedure 7 Cleaning and Sanitizing Equipment and Surfaces 33 Procedure 8 Floor Care 34

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Overview 36 Personal Safety and Body Mechanics 36 Procedure 9 Safe Way to Lift Heavy Objects Kitchen Safety 38 Fire Safety 39 Material Safety Data Sheets 40 Handling Infectious Material and Universal Precautions 41 Disaster Planning 41

CHAPTER 6 PATIENT CONTACT

37

43

Overview 43 Initial Contact with Patients 43 Ways in Which the Dietary Aide May Interact with Patients 43 Bringing a Conversation to a Close 46 Confidentiality 46 APPENDIX Procedure Checklists 48

REFERENCES AND FURTHER READING INDEX

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PREFACE Dietary Assisting for the Health Care Provider introduces guidelines for working as a dietary aide in the dietary department of a health care facility. This module in the multiskilling series focuses less on direct patient care/contact, and emphasizes instead an important aspect in the medical treatment plan of all patients: the delivery of nourishment that supports the healing process. As health care evolves, it is important that all involved understand what other health care workers are doing and, in some cases, be able to perform some of each other’s duties. The dietary aide assists in the nutritional care of patients by practicing safe food handling, ensuring the food preparation and storage areas are kept clean and sanitary, and observing guidelines in personal conduct that promote a safe environment. This book is written to educate you as to how to perform the duties of a dietary aide. Besides reading this book, you must also practice the procedures described throughout the book and be able to explain the rationale for them. Your instructor will be an experienced practitioner who will provide further learning opportunities in the classroom, laboratory, and dietary department. Throughout the book you will be referred to the policies of the health care facility where you are employed, because your actual job duties will vary depending on where you work. The role of the dietary aide in providing safe, nutritious, and appetizing food is an important one. You will find your job challenging and rewarding as you help patients grow stronger and improve their health.

CHAPTER

1 OBJECTIVES

Personal Hygiene and Safety

After reading this chapter, you will be able to: Describe the components of professional appearance. Explain why jewelry is a safety hazard. List three reasons why cosmetics and makeup should be used sparingly. Explain why the use of perfumes and scented lotions is discouraged. Define personal hygiene. List five practices involved in personal hygiene. Describe the steps involved in proper handwashing.

OVERVIEW This chapter provides the basic information a dietary aide needs to achieve a safe and professional appearance. Uniforms, personal hygiene, jewelry, hair control, and handwashing are reviewed as they apply to your job as a dietary aide. Many of your personal grooming habits may have to be adjusted to fit the needs of a dietary position.

PROFESSIONAL APPEARANCE If you have worked in or visited a health care facility, you may have observed that most staff members wear uniforms. Generally, wearing a uniform indicates to other staff, as well as to patients and visitors, that you are an employee of the facility. In addition, various departments are identified by the color or design of their uniform. Uniforms also serve to spare your own personal clothing from soiling and wear. If your facility requires a uniform, you may be asked to purchase the uniform, or it may be provided by the facility. In either case, a clean, fresh uniform is the beginning of a professional image. Proper laundering and care of your uniform will lengthen its useful life and maintain its cleanliness. Your work as a dietary aide will require many hours of walking and standing. An enclosed, supportive shoe with thick rubber soles provides safe and comfortable footwear. A specific style or color may be required by your employer as part of your uniform. For safety reasons, an enclosed shoe (no clogs, sandals, or sling-backs) is best; it protects the foot from falling objects and substances. Leather shoes provide more protection than canvas shoes and are usually preferred. Thick rubber soles provide foot support and cushioning comfort during the hours of walking and standing that are part of a dietary aide’s routine.

JEWELRY AND COSMETICS Jewelry is nice to wear. Earrings, rings, watches, necklaces, and brooches may be the finishing touch to an outfit. In the kitchen and on the nursing units,

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CHAPTER 1

safety hazard: a circumstance or situation that puts you or others at physical risk of either injury or infection

cosmetics (makeup): include preparations such as foundations, powders, rouge, mascara, eyeliner, lipstick, etc. that dietary aides may wear to enhance their appearance

allergies: physical reactions to a substance that a person may contact. Contact may be made with the substance externally, on the skin, or internally, through ingestion of food or breathing of air

however, jewelry should not be worn. It may become a safety hazard when you are working with equipment, or it may become part of the soufflé. Raw or cooked food may get caught in the jewelry and then your jewelry will need special cleaning. Most facilities have clocks everywhere, so a watch is often not necessary. If a watch must be worn, then a simple watch is appropriate. A simple wedding band may be worn. Plain post earrings are acceptable, but dangling earrings are unsafe for a worker in a food service operation. A necklace, if worn, should remain inside your blouse or shirt so that it does not become a safety hazard by getting caught in equipment or dangled or dropped in food. Brooches and pins should not be worn as part of your uniform, as they may drop into equipment or food, becoming a hazard to you and others. Name badges or service pins are appropriate to wear. In some facilities, a name badge is mandatory, and you could be subjected to a fine if you do not wear it. Check your badge each time it is applied to your blouse, shirt, or other piece of uniform to ensure that it is securely fastened. Cosmetics (makeup) should be used sparingly by the dietary aide for several reasons: 1. It can flake or fall from the skin into food, contaminating the food. 2. Makeup often causes the wearer to touch the areas of application frequently, thereby contaminating the hands. 3. It can rub off onto clothing and cause your uniform to become discolored and dirty. Check your facility’s policy regarding use of cosmetics. In addition, the use of strongly scented soaps, lotions, powders, or perfumes is discouraged because their aroma may be unpleasant to the patients whom you contact. Sometimes, medical conditions intensify or change the sense of smell, and what smells good to you may smell unpleasant to someone with an illness. In addition, some people have sensitivities or allergies to these preparations, which may cause a reaction.

PERSONAL HYGIENE As a dietary aide, you represent the dietary department, which is associated with cleanliness and sanitation. Your personal hygiene is important in maintaining the safety of the food you serve, as well as the health of the patients whom you contact. Personal hygiene is defined as personal cleanliness. Personal hygiene is a daily practice that includes bathing, hair care, mouth care, use of deodorants and antiperspirants, and the wearing of clean undergarments and clothes.

Bathing The first practice in personal hygiene is daily bathing and cleaning of your body. Bathing helps to maintain a clean body environment and prevent the spread of germs. Use soap and water at a temperature comfortable to you.

Hair Care Keeping your hair clean with frequent shampooing is the second practice in personal hygiene. Strongly scented shampoos should not be used. As stated earlier, the aroma may be unpleasant to the patients with whom you come into contact. Hair nets versus hair caps versus no hair restraint is always the question. The Federal Food Code states that food employees shall wear hair restraints (FDA Food Code, 1997, 2-402). Hair is very unpleasant to find in food that you are eating; more important, it is also a potential carrier of germs and disease-causing agents (pathogens). Each facility has developed its own policy and procedure regarding hair restraint and you should know and follow the policy where you work. You can also check your own state’s regulations concerning hair control. For example, the Ohio Department of Health’s Food Service Operation Law and Rules state: “Employees shall wear their hair clean, neat, and under control at all

Personal Hygiene and Safety

snood: a mesh or cloth covering placed over the mustache or beard that prevents hair from falling into food

3

times. Beards or mustaches shall be neatly trimmed or a snood is to be worn. Employees shall refrain from unnecessary handling of their hair and shall wash their hands after combing or brushing their hair.” (Ohio Food Service Operation Law and Rules § 3701-21-06 July 1996.) Hair must not be combed or brushed anywhere in the food service department, or in the nursing area. It should be combed or brushed only in the restroom or locker area.

Mouth Care Daily mouth care, consisting of brushing your teeth with a toothbrush and toothpaste, is another personal hygiene practice. By keeping your teeth clean, you are maintaining their health and preventing the growth of odor-causing bacteria which can cause bad breath.

Clean Undergarments, Antiperspirants, and Deodorants You should put on clean undergarments daily, after you have bathed, to help maintain a clean body that is free of odor. In addition, use of an antiperspirant or deodorant helps to maintain your feeling of cleanliness while preventing the development of offensive body odor during the course of your workday.

HANDWASHING The first thing to do when you enter the dietary department is to head for the handwashing sink and wash your hands thoroughly. A handwashing sink will be identified and separate from all the other sinks in the kitchen area. The U.S. Public Health Service Food Code (2-301.11, 1997) states that food employees shall keep their hands clean. The single most important way to prevent the spread of bacteria is by frequent handwashing. Effective handwashing involves three factors: soap, running water, and friction.

PROCEDURE

1

HANDWASHING

Equipment Required paper towels in dispenser liquid soap in dispenser approved wastebasket lined with disposable plastic bag Procedure 1. Check the paper towel dispenser to be sure clean paper towels are available to dry your hands when you are finished washing and rinsing them. 2. Turn the water on to a comfortable temperature and force. The force of the water should not be so strong that it splashes the surrounding areas. 3. Wet your hands thoroughly, as shown in Figure 1–1, and lather well with soap. Make sure you have carefully washed all areas on your hands and fingers, including under your

Figure 1–1 Wet hands thoroughly while keeping fingers pointed down at all times.

continues

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CHAPTER 1

1

PROCEDURE

continued

fingernails. The friction of rubbing your hands together and over each other is an important part of this cleansing action. This process should last for at least 20 seconds. Hands should be kept pointed down at all times. This prevents the water from running up the arms and recontaminating the hands. 4. Rinse well. Do not turn water off. 5. Dry your hands, using clean paper towels. 6. Turn the water off using a clean paper towel, so you do not contaminate your hands from the dirty faucet (Figure 1–2). ■■ Note: Frequent handwashing can dry out your skin. Hand lotion or creams may be used after handwashing only if the next activity does not involve direct food contact, because the lotion or cream could contaminate the food. Also, do not use oil-based lotions before putting on gloves. ■■

Figure 1–2 Use clean paper towels to turn off the faucets.

When should you wash your hands? Whenever you enter the dietary department. Also, wash your hands after: 1. Using the restroom 2. Eating, smoking or drinking 3. Touching dirty surfaces or equipment 4. Touching your face or hair You should always wash your hands when moving from one kind of food handling to another. It is necessary to wash your hands frequently throughout the course of your workday, to prevent the spread of germs. Wash Early, Wash Often!

REVIEW QUESTIONS Multiple Choice Questions 1. Which of the following shoe types are most appropriate for a dietary aide to wear? a. Clogs with thick rubber soles b. Canvas tennis shoes c. Enclosed leather shoes with thick rubber soles d. Enclosed leather shoes 2. The three most important components of handwashing are: a. soap, water, and clean paper towels. b. soap, water, and friction.

c. water, friction, and clean paper towels. d. soap, friction, and a clean paper towel.

True/False Questions 3. _____ You may use hand lotion and creams at any time when you are working in the dietary department. 4. _____ A wedding band and plain post earrings are acceptable jewelry to wear and pose no safety hazards in the dietary department.

Personal Hygiene and Safety

Fill in the Blank Question 5. Personal hygiene is defined as ____________________________ ____________________________ .

Short Answer Questions 6. List five different times or situations when dietary aides should wash their hands while working in the dietary department. 7. List three reasons why cosmetics should be worn sparingly by dietary aides.

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Critical Thinking Scenarios 8. You are working in the storeroom, putting away canned goods, when your supervisor asks you to come to the kitchen area and assist with the preparation of the salads for dinner. Discuss the steps you would take before starting this next work assignment. 9. You are asked to report to work on your day off because another employee is sick and cannot come in. As you look around your apartment, you begin to think about what you will need to get ready for work and the uniform your facility requires. List what you would do to get ready for work and what the appropriate uniform is for work.

CHAPTER

2 OBJECTIVES

Safe Food Handling and Storage

After reading this chapter, you will be able to: Describe at least three ways in which food can become contaminated with bacteria. List at least three organisms that can cause foodborne illness. Define potentially hazardous food. Describe at least five ways in which cross-contamination can occur. List five actions to prevent food spoilage in dry storage areas. Define the acronym FIFO. Explain the temperature danger zone. Describe how to properly label and date a food item for storage.

OVERVIEW Safe food handling is important in preventing an outbreak of foodborne illness. The moment food arrives in the food service department, it must be handled carefully to prevent exposure to microorganisms. This chapter provides guidelines for safe and sanitary storage of food, safe practices in the preparation of food, and safe transport of food from one area to another, with emphasis on maintaining proper temperatures.

RECEIVING FOOD INTO THE KITCHEN It is the responsibility of the food service director to purchase safe food items of good quality from reputable vendors. Food is delivered to facilities by vendors in refrigerated trucks to maintain the quality of the food. Each vendor is scheduled to deliver food at designated times so that a facility dietary employee can check the items delivered against the invoice listing. The intent is to move food items from the delivery truck to food storage areas (i.e., the refrigerator, freezer, or storeroom) as quickly as possible, to maintain safe food temperatures. Fresh produce should be free of insects and spoilage. Frozen foods should still be frozen. This can be checked by placing a metal-stemmed thermometer between two frozen packages to register a temperature of 10˚F or below. Refrigerated foods, such as milk, should be free of leaks and should be at a temperature between 32˚F and 38˚F. Canned goods should be free of dents and punctures. Dry goods packages should be free of punctures and tears. Any food product that does not meet these guidelines should be returned to the delivery person. If this is not possible, the items are put aside and returned with the next delivery. Figure 2–1 shows a designated area of the storeroom for items to be returned to the vendor.

Safe Food Handling and Storage

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Figure 2–1 Food items to be returned to vendors are placed in a designated storage/holding area.

STORAGE OF FOOD IN THE KITCHEN Food is stored in one of three ways: dry storage, refrigerator storage, or freezer storage. Each method of storage has specific requirements to meet regulatory standards and to assure safety.

Dry Storage

first in, first out (FIFO): system for the rotation of stock so that older food items are used before recently delivered food items; this approach applies to all types of food items

The dry storage area (storeroom) should be maintained at a temperature of 60˚F to 70˚F, with a relative humidity of 50% to 60%. The room should contain shelving units that meet food storage guidelines. These may be metal wire racks on rollers or finished wood-framed shelves that are stationary. Nothing should be stored on the floor. Food packages and containers must be at least 6 inches off the floor and not come closer than 18 inches to the ceiling. Food storage areas should be used for food storage only. Cleaning chemicals and supplies, as well as trash or garbage cans, should be stored in specially designated areas away from food storage and preparation. As food items are placed on shelving units, they should be dated and placed behind similar existing containers on the shelves. For example, if you are placing canned peach halves on the shelf, look to see if there are any other canned peach halves already on the shelf. Always store similar items together, with the most recently delivered ones behind the older items, so that the older items will be used first (Figure 2–2). This process of storing food items is called stock rotation or “First In, First Out” (FIFO). By using this method of food storage rotation, you prevent loss of food from spoilage or becoming outdated. Some food items have expiration dates or “best used by” dates. These dates must be monitored to avoid using outdated products. Each can or box of food that is removed from a packing case is marked with the date it was received and placed on the shelf. Some food items that come packaged in smaller containers or bags can be left in their packing case; in this instance, the outside of the packing case is marked with the date it was received and placed on the shelf. However, if the smaller items are removed from their marked case and placed on the shelf with new items, the previous date should be transferred onto those older food items, so they will be used first.

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Figure 2–2 As new food is added to the storage area, new stock is placed behind existing stock with earlier dates. Older stock is always issued first, following the “first in, first out” (FIFO) principle.

Some food items that are delivered in bulk quantities, such as flour, sugar, pasta, and rice, should be repackaged after they are opened. Containers used for repackaging should be free of cracks or holes and have an airtight closure or lid. They should be made of material approved for food storage. When food is repackaged, it should be labeled with the name of the food and the date it was originally received.

Refrigerated Storage

cross-contamination: the transfer of harmful microorganisms from one food item to another food item that will not be cooked further before being served; one of the most frequent cross-contamination problems occurs when raw meat is stored over prepared foods or fresh produce

The refrigerated storage area should be maintained at a temperature of 38˚F or below to keep food at or below a temperature of 40˚F. Remember that the temperature of the refrigerated storage area is influenced by the number of times the door is opened and closed, and how long the door is left open during delivery or retrieval of food. Plan ahead to avoid frequent opening of the door and the resulting increases in temperature. Shelves in the refrigerated storage area should consist of open metal wire racks that allow circulation of cool air around the food products. The shelving units may also be portable, which makes cleaning the refrigerated storage area easier. A reminder: All food is stored at least 6 inches off the floor and 18 inches or more from the ceiling. The way food is stored in the refrigerated storage area helps to prevent crosscontamination. Cross-contamination occurs when harmful microorganisms are transferred from one food item to another food item that is not going to be cooked any further before it is served. It can occur when raw meat, raw poultry, or raw fish is stored or thawed on a shelf above prepared food or fresh produce that will be served “as is.” The raw juices from the meat, poultry, or fish can drip on the food below and contaminate it with harmful microorganisms. Therefore, raw meats, poultry, and fish should be stored on the bottom shelves in the refrigerated storage area to prevent cross-contamination. As food items are placed in the refrigerated storage area, they should be dated and placed behind similar existing containers on the shelves. Remember to use the FIFO method. Leftover canned beverages and food items should be repackaged in clean, crack-free containers with tight-fitting lids. Containers should be made of ma-

Safe Food Handling and Storage

9

terial approved for food storage. These containers should be labeled with the name of the food or beverage and dated with the current day’s date. Dairy products such as milk, cottage cheese, yogurt, and sour cream come in containers that are suitable for continued storage, even after they are opened and part of the product is used. The container should be re-dated with the first date of opening, and the container lid should be re-closed tightly after each use. Some dietary departments have separate storage facilities for milk, called milk coolers. The temperature within the cooler should be maintained at 38˚F or below to keep the temperature of the milk below 40˚F. Check the expiration date or “use-by” date on each milk carton, and keep older milk in the more accessible part of the cooler so that it will be used first (the FIFO method of stock rotation).

Freezer Storage The freezer storage area should be maintained at a temperature of 0˚F or below to keep food frozen. Again, the number of times the freezer door is opened and closed will influence the temperature of the freezer storage area. Once frozen food products are received and inspected, they should immediately be stored in the freezer storage area to maintain quality. Shelves in the freezer storage area should consist of open metal wire racks that allow circulation of cool air around the food products. The shelving units may also be portable, which makes cleaning the freezer storage area easier. In addition, the packages of food should be placed so they are not touching each other, to allow for effective circulation of cool air. As previously stated, all food is stored at least 6 inches off the floor, and 18 inches or more from the ceiling. Use the FIFO method and date frozen food items as you place them in the freezer storage area.

Temperature Monitoring Temperatures in the refrigerated and freezer storage areas should be monitored daily and recorded on a temperature log. Such temperature monitoring ensures that foods are being held at safe temperatures. Figure 2–3 is a sample of a refrigerator/freezer temperature log. Ideally, temperatures should be recorded upon opening the dietary department in the morning and in the evening shortly before closing the dietary department. If you observe a temperature above the accepted temperature range of either the refrigerated or the freezer storage area, report it to your supervisor immediately so that corrective action or repairs can be initiated. The purpose is to prevent loss of food due to spoilage. Figure 2–4 shows a thermometer mounted on the doorjamb. This type of thermometer allows you to monitor the temperature of the freezer or refrigerated storage area without entering the area and allowing cold air to escape.

PROPER HANDLING OF FOOD DURING PREPARATION, SERVING, AND HOLDING foodborne illness: disease or sickness caused by eating a food item that has been contaminated with microorganisms

The purpose of proper, or safe, handling of food during preparation, serving, and holding is to prevent foodborne illness. Transferring microorganisms and/or their toxins from food to humans causes foodborne illness. There are several things that must happen for foodborne illness to occur: 1. Poor handling of food allows microorganisms to get into the food. 2. The microorganisms are allowed to grow in the food. 3. Someone must eat the food contaminated with the microorganisms. As previously mentioned, frequent handwashing during your workday is just one way of preventing food from becoming contaminated with microorganisms. Other ways microorganisms can get into foods (cross-contamination) include unprotected sneezing or coughing, use of dirty utensils in food preparation, or preparation of food on dirty work surfaces such as cutting boards. Table 2–1 summarizes three of the most common foodborne illnesses, their sources, and their symptoms.

CHAPTER 2

Temperature Log Month Please record initials when recording the temperature. Ideal temperature: Refrigerator 35˚ F to 38˚ F; Freezer –10˚ F to 0˚ F

Date

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Refrigerator AM PM

Milk Cooler AM PM

Freezer AM PM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Figure 2–3 A refrigerator/freezer temperature log allows staff to monitor the temperature of equipment, to ensure that foods are held at safe temperatures.

Figure 2–4 This thermometer is mounted on the outside of the refrigerator/freezer, but its probe registers the temperature inside the unit.

Safe Food Handling and Storage

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Table 2–1 The Three Most Common Foodborne Illnesses Foodborne Illness

Cause/Source

Symptoms

Salmonella

Food: meat, poultry, eggs, shellfish. Non-food: dirty work surfaces; dirty utensils; unwashed, uncleaned hands.

Nausea, diarrhea, fever. May appear 6–48 hours after eating contaminated food. Can last 2–3 days.

Staphylococcus

Food: ham, stews, gravies, improperly reheated foods, custards, cream-filled pastries. Non-food: human nasal passage, bites, sores, cuts.

Nausea, vomiting, diarrhea. May appear 1–6 hours after eating contaminated food. Can last 1–2 days.

Clostridium

Food: raw foods that come in contact with soil, such as potatoes, carrots.

Diarrhea, nausea, vomiting. May appear 8–24 hours after eating contaminated food. Can last 24 hours.

potentially hazardous food: a food that requires temperature control because it is in a form capable of supporting the growth of infectious microorganisms temperature danger zone: the temperature range between 40˚F to 140˚F that promotes bacterial growth

If microorganisms have been introduced into food, three things are required for their continued growth: 1. Any food, but especially potentially hazardous food. 2. Temperature (40˚F–140˚F). This temperature range is referred to as the temperature danger zone. 3. The time (2 to 4 hours) that food sits in the temperature danger zone. The Food Code of 1997 defines potentially hazardous food as “a food that is natural or synthetic and that requires temperature control because it is in a form capable of supporting the rapid and progressive growth of infectious or toxigenic microorganisms” (FDA Food Code, 1997, 1-2[59]). In plain words, potentially hazardous food items include high-protein foods, such as whole milk or milk products, shell eggs, meats, poultry, fish, shellfish, and edible crustaceans. Other examples include baked or boiled potatoes, rice, tofu, and other soy protein foods, gravies, bread stuffing, cooked or heated vegetables, beans, winter squash, and cut melons. Let’s apply this to a menu you might see in your health care facility: see Figure 2–5A for Thursday’s Lunch Menu and list the potentially hazardous foods in the menu. If your answers included the food items highlighted in Figure 2–5B, then you are ready to continue with the chapter. If your answer was incomplete, then reread the definition of potentially hazardous foods in this paragraph. Keeping food out of the temperature danger zone helps to prevent the growth of bacteria. Figure 2–6 illustrates a range of temperatures and the effect of temperature on bacterial growth, survival, or destruction. Food that is between 45˚F and 60˚F or between 120˚F and 140˚F will support at least survival and even growth of some food-poisoning bacteria. Food that is between 60˚F and 120˚F supports rapid growth of food-poisoning bacteria and production of toxins by some bacteria. It is important to note that refrigeration of food does not kill bacteria—it only slows their growth. Even freezing food will not kill bacteria, although it will stop their growth. Similarly, holding food at temperatures above 140˚F will not kill bacteria, but it will prevent their growth. As cooking temperatures increase above 165˚F, destruction of most bacteria takes place. However, if an “infected” food has been allowed to sit in the temperature danger zone for just two to four hours, the harmful toxins produced by the multiplying bacteria can still cause foodborne illness, even if the food is cooked and the bacteria themselves are destroyed. Therefore, it is important to minimize the time food is

12

CHAPTER 2

Thursday’s Lunch Menu Roast Pork Rice Pilaf Seasoned Spinach Dinner Roll/Margarine Pumpkin Pie Milk Beverage

A

Thursday’s Lunch Menu Roast Pork Rice Pilaf Seasoned Spinach Dinner Roll/Margarine Pumpkin Pie Milk Beverage

B

Figure 2–5 A. A typical menu. Name the potentially hazardous foods on this menu. B. The menu with potentially hazardous foods highlighted.

allowed to sit in the temperature danger zone. One bacterium can reproduce itself in just twenty minutes. At this rate of growth, 1 bacterium can become 500 bacteria after just 3 hours! To help you understand how to use this information to prevent foodborne illness, let’s look at the handling of a menu item from preparation to holding to service. The menu item will be beef stew from a recipe that includes beef, fresh potatoes, onions, carrots, celery, beef stock, flour, and seasonings. See Figure 2–7 for the steps involved in preparing and holding the beef stew. Maintaining cooked food (such as the beef stew) at a temperature of 140˚F or greater during service, as well as limiting the serving time to four hours or less, helps to prevent the growth of microorganisms. This would include taking the temperature when the food item is placed on the steamtable at various times during the serving period, such as midway through serving and at the end of

165˚F 140˚F

Cook hot food to destroy most bacteria. Hold hot food above 140˚F. Food temperature supports survival and even growth of some food-poisoning bacteria.

120˚F Temperature Danger Zone

Supports rapid growth of food-poisoning bacteria and production of toxins by some bacteria. 60˚F Food temperature supports survival and even growth of some food-poisoning bacteria.

45˚F 40˚F –10˚F

Store/hold hot food below 40˚F. Freezing will not kill bacteria, but prevents growth.

Figure 2–6 Temperature danger zone. Proper handling of food, from receiving through serving, affects the growth of bacteria. Microorganisms grow rapidly between 40˚F and 140˚F. It is important to minimize the time food is allowed to sit in the danger zone.

Safe Food Handling and Storage

13

1. The cook properly washes his or her hands before handling the recipe ingredients. 2. The cook uses cooking utensils and food preparation surfaces that are cleaned and sanitized. 3. The cook removes the thawed beef from the lowest shelf in the refrigerated storage area and cuts it into bite-sized cubes using a cleaned and sanitized knife and cutting board. 4. The cook places the cubed beef into the cooking vessel, where the meat is browned on all sides. 5. The cook again properly washes his or her hands to prevent cross-contamination from the raw meat he or she was handling to the vegetables he or she will be handling. 6. The cook thoroughly washes the vegetables to keep soil on them from contaminating the other ingredients. 7. The cook adds the vegetables to the cubed beef, pours in the proper amount of beef stock, liquid, and seasonings, and cooks the stew for the designated amount of time. 8. When the stew is thoroughly cooked, the cook checks the temperature to ensure it has reached a high enough temperature, and remained there long enough, to destroy any bacteria that may have been on the ingredients.

Figure 2–7

batch method: the use of smaller quantities of food to maintain temperature control; can be used with hot or cold foods

Some steps for preparing beef stew using good food preparation techniques.

the serving period. The temperatures are recorded on a Food Temperature Log (Figure 2–8). If the food temperature is found to be below 140˚F, reheat the food item to an internal temperature of 165˚F. Reheating can be on top of the stove, in the steamer, in the oven, or in a microwave. Check with your supervisor for the procedure used in your facility. Another method of maintaining the hot temperature of cooked food is the batch method. Smaller quantities of cooked menu items are placed on the steamtable for trayline service. As needed, additional small quantities are taken from the oven and placed on the steamtable. Equally important is maintaining the temperature of cold food items so that the internal temperature does not exceed 40˚F. Several methods may be used to maintain the temperature of cold food items on the trayline. Cold food items may be placed on a thermostatically controlled refrigerated table. Another method uses an ice-filled container, often called an ice bath, into which cold food items are placed. The temperature of individual cartons of milk may be maintained by placing the cartons in the freezer for 15 to 45 minutes before they are served on the trayline. The batch method of trayline service for cold foods involves taking a smaller number of servings of menu items from the refrigerator and placing them on the trayline. As needed, more chilled food items are placed on the trayline. This allows the food to remain under controlled temperatures.

PROPER HANDLING OF PREPARED FOODS Some of the foods prepared in the dietary department may have to be prepared in advance of their serving date. Occasionally some menu items are prepared in larger amounts, with portions left over (leftovers). These prepared foods must be cooled rapidly (less than 4 hours) to an internal temperature of 40˚F or less

Initials

Beginning Res. Trayline Temperature

Day

Initials

Ending Trayline Temperature

Date

Initials

Test Tray Temperature

Breakfast Hot Cereal Pureed Hot Cereal Entree Pureed Entree Hot Beverage Milk Juice Lunch Soup Pureed Soup Meat Pureed Meat Potato/Starch Pureed Starch Vegetable Pureed Vegetable Hot Beverage Cold Plate/Sandwich Pureed Cold Plate/Sandwich Fruit Salad Dessert Pureed Dessert Milk Supper Soup Pureed Soup Meat Pureed Meat Potato/Starch Pureed Starch Vegetable Pureed Vegetable Hot Beverage Cold Plate/Sandwich Pureed Cold Plate/Sandwich Fruit Salad Dessert Pureed Dessert Milk Figure 2–8

Daily food temperature log for various times during the serving period. (Courtesy of Airaghi Group, Inc.)

Initials

Comments

CHAPTER 2

Meal

Steamtable Temperature

Week

14

Daily Food Temperature Log Cycle

Safe Food Handling and Storage

15

to prevent the growth of microorganisms. The procedure for food items prepared in large pots, such as soups or stews, is: 1. Divide into small, shallow pans. 2. Store on top shelves of refrigerator (do not stack). 3. Monitor temperature and time. 4. Stir frequently. The procedure for large food items, such as a roast or a turkey, is: 1. Slice into serving sizes and place in shallow pan or divide by cutting into smaller portions. 2. Store on top shelves of refrigerator (do not stack). 3. Monitor temperature and time. An ice bath can also be used to cool food quickly. To cool a food item in an ice bath, place the container of food in a larger container of ice water. Stir the food frequently to accelerate the cooling process. After a food item has been cooled to 45˚F or less, it should be covered, labeled, dated with the preparation date, and placed in the refrigerator. To label means to identify the food or menu item in a container; for example, labeling containers of flour and cornstarch so they are readily identifiable and not mistaken for each other. Dating a food item means marking on the label the date the food was handled in the dietary department—received date, thaw date, preparation date, or serve date. A food item may be dated several times during its journey through the dietary department. Cases of food or packages of food are initially marked with a received date. Frozen food items that are removed from the freezer and placed in the refrigerator to thaw are marked with a thaw date. Prepared foods that are stored for later service are marked with a preparation date. Leftover foods that are cooled for later service are marked with a serve date. Your dietary department will have a designated position/person responsible for checking the dates of food items, because unused food must be discarded after a certain length of time. Careful food handling, including proper preparation, holding, serving, and storage of foods, helps to prevent foodborne illness.

REVIEW QUESTIONS Multiple Choice Questions 1. Potentially hazardous foods include all except the following: a. peach jello. b. cream of potato soup. c. chicken salad. d. poultry dressing. 2. The temperature danger zone is: a. 60˚F to 120˚F. b. 40˚F to 145˚F. c. 50˚F to 140˚F. d. 40˚F to 140˚F.

True/False Questions 3. _____ The term FIFO refers to the process of rotating stock. 4. _____ Cross-contamination occurs when one employee puts a food item in the oven and another employee takes it out of the oven.

Fill in the Blank Questions 5. FIFO means: F___ ___ ___ ___ I ___, F ___ ___ ___ ___ O___ ___ . 6. The purpose of proper handling of food during preparation, serving, and holding is to ________________________________________________.

Short Answer Questions 7. Describe three ways in which a food item can become contaminated with microorganisms. 8. Describe three practices that prevent spoilage of food in dry storage areas. 9. Name a foodborne illness and list its cause/source and symptoms. 10. Describe the different kinds of dates that may appear on a package of frozen ground beef that is delivered three days prior to being included in a spaghetti sauce recipe.

16

CHAPTER 2

Critical Thinking Scenarios 11. Today you are the storeroom clerk. You are responsible for checking in and putting away today’s delivery from Smith & Co., which includes canned goods, frozen food items, and paper products. List the steps you will take from checking in to putting away the delivered items. Also review how the storage areas are organized.

12. Tonight you are taking down the salad bar and putting the food items away. Food items include lettuce, celery, radishes, tomatoes, diced eggs, diced ham and turkey, shredded cheese, salad dressings, sliced mushrooms, and shredded carrots. Review the steps you will take in putting the food items away and cleaning the salad bar.

CHAPTER

3 OBJECTIVES

Plating and Portioning of Food

After reading this chapter, you will be able to: Define the term menu. Describe how a spreadsheet is used. Define the term special or therapeutic diet. Explain why sanitation is important on the trayline. List the five components of trayline setup, operation, and breakdown. Describe how to properly determine the temperature of a food or beverage item.

OVERVIEW This chapter describes the menu and spreadsheets used to guide the dietary department’s operations. The importance of sanitation as it applies to those operations is emphasized. Additionally, the portioning and plating of food are discussed.

THE MENU AND SPREADSHEETS cycle menu: lists meal selections for the future, from 10 days to 6 weeks, and includes seasonal foods. Allows patients and residents to expect certain foods and guides dietary department operations such as food buying and preparation special or therapeutic diets: diets prescribed by the physician as part of a patient’s medical treatment. Nutritional components, such as protein, carbohydrate, fat, sodium, potassium, etc. may be modified to meet the nutritional requirements for the patient’s medical condition. Modification of the consistency of the food itself may also be required, such as mechanical soft food or pureed food

The menu is a tool that is used in a variety of ways. It informs the patient what to expect in upcoming meals. It guides the dietary department’s operations by identifying foods that must be purchased and prepared for meals. In a healthcare facility, a dietitian edits the menu to ensure that nutritional standards are met. Cycle menus are written for periods of time that can range anywhere from 10 days to 6 weeks. They also are written for different seasons of the year, such as spring/summer or fall/winter, to make the best use of seasonal food items. Figure 3–1 is a sample of a cycle menu. In some facilities, the dietary department distributes menus to the patients and allows them to make their own choices from a selective menu. A selective menu offers a choice of food items per meal. Your responsibility may include passing menus, assisting patients with marking their menus, and collecting menus. Menus may be passed for one day at a time or for several days at a time. Marked menus are returned to the dietary department and a staff member counts the number of servings to be prepared for each menu item. A spreadsheet breaks down the daily menu into portions of food items to be served per meal and extends the menu to any special or therapeutic diets. It indicates if a food item is to be served to everyone, or if the food item is to be substituted because a particular patient’s diet does not allow that food item. When the food item is not extended across a particular diet, an allowed food item is substituted in its place. Each day of the menu cycle has a corresponding spreadsheet. A sample of a spreadsheet is shown in Figure 3–2.

18

Sunday

Week 3

CHAPTER 3

Cycle Spring/Summer

RD/LD

Monday

Tuesday

Wednesday

Thursday

Orange Juice Hot/Cold Cereal Scrambled Eggs Bacon Toast/Margarine/Jelly Milk Beverage

Grape Juice Cooked Prunes Hot/Cold Cereal Scrambled Eggs Muffin Toast/Margarine/Jelly Milk Beverage

Apple Juice Hot/Cold Cereal Scrambled Eggs Bacon Toast/Margarine/Jelly Milk Beverage

Orange Juice Hot/Cold Cereal Margarine/Syrup Pancakes Milk Beverage

Grape Juice Hot/Cold Cereal Scrambled Eggs Toast/Margarine/Jelly Milk Beverage

Sliced Turkey Dressing with Gravy Harvard Beets Dinner Roll/Margarine Apple Pie Milk Beverage

Roast Pork Ham Slices Honey Mustard Chicken Tomato Soup Rice Pilaf Scalloped Potatoes Parslied Crackers Seasoned Spinach Seasoned Lima Beans Buttered Potatoes Cheeseburger on Bun Seasoned Peas/Carrots Dinner Roll/Margarine Dinner Roll/Margarine Pickle/Onion/ Pumpkin Pie Ice Cream Roll/Margarine Sliced Tomatoes Milk Milk Peach Slices Tater Tots Beverage Beverage Milk Fruit Cocktail Beverage Milk Beverage

Friday

Saturday

Apple Juice Hot/Cold Cereal French Toast Margarine/Syrup Milk Beverage

Orange Juice Hot/Cold Cereal Scrambled Eggs Sausage Link Toast/Margarine/Jelly Milk Beverage

Breaded Cod Macaroni and Cheese Seasoned Green Beans Dinner Roll/Margarine Pudding Milk Beverage

Oven Fried Chicken Creamed Potatoes Seasoned Mixed Vegetables Dinner Roll/Margarine Rainbow Cake with Icing Milk Beverage

Beef Stew Coleslaw Biscuit/Margarine Pineapple Chunks Milk Beverage

Meat Loaf Spanish Rice Seasoned Broccoli Dinner Roll/Margarine Pudding Milk Beverage

Vegetable Soup Crackers Tuna Salad Sandwich Potato Salad Cupcake with Icing Milk Beverage

Beef & Noodles Glazed Carrots Bread/Margarine Peach Crisp Milk Beverage

Turkey Tetrazzini Seasoned Peas Bread/Margarine Tropical Fruit Cup Milk Beverage

Cream Broccoli Soup Crackers Egg Salad Sandwich Tater Tots Fresh Fruit Cookie Milk Beverage

Salisbury Steak with Gravy Seasoned Noodles Italian Vegetable Mix Pears Milk Beverage

Fig Newton Milk or Juice

Peanut Butter/Crackers Milk or Juice

Graham Crackers Milk or Juice

Cookies Milk or Juice

Sherbet Milk or Juice

Peanut Butter/Crackers Milk or Juice

Graham Crackers Milk or Juice

Figure 3–1

Sample cycle menu. (Courtesy of Airaghi Group, Inc.)

Cycle Spring/Summer

Week 3

Regular

Day Sunday

RD/LD

Portion

Mech Soft

NCC Mech S.

Pureed

NCC Pureed

No Conc CHO

Grape Juice Cooked Prunes Hot Cereal (or) Cold Cereal Scrambled Eggs Muffin Toast Margarine Jelly Milk Beverage

4 oz 4 oz spoodle 4 oz ladle 3/4 cup #12 scoop 1 1 slice 1 tsp 1 tsp 8 oz as desired

X X X X X X X X X X X

X 3 medium X (or) X X no X X diet X X

X pur #10 scoop pur 6 oz. ladle no pur #12 scoop no in cereal in cereal X X X

X pur #10 scoop pur 6 oz ladle no pur #12 scoop no in cereal in cereal diet X X

X 3 medium X (or) X X no X X diet X X

Tomato Soup Crackers Cheeseburger on Bun Pickle/Onion/Tomato Slice Tater Tots Fruit Cocktail Milk Beverage

6 oz ladle 1 pkg of 2 3 oz 1 3 sl/1sl/1sl 4 oz spoodle 4 oz spoodle 4 oz as desired

X X grd #8 scoop X tomato only X X X X

X X grd #8 scoop X tomato only X X X X

Meat Loaf Spanish Rice Seasoned Broccoli Dinner Roll Margarine Pudding Milk Beverage

3 oz #8 scoop 4 oz spoodle 1 1 tsp/1 pat #8 scoop 4 oz as desired

X X X X X X X X

X X X X X diet X X

pur #8 scoop pur #8 scoop pur #8 scoop in veg in veg X X X

pur #8 scoop pur #8 scoop pur #8 scoop in veg in veg diet X X

X X X X X X X X X X X X X X diet X X

Sample spreadsheet for menus for specific days

continues

Plating and Portioning of Food

Figure 3–2

pur 6 oz ladle pur 6 oz ladle in soup in soup pur #6 scoop pur #6 scoop 1 sl brd in meat 1 sl brd in meat no no mashed pot #8 scoop mashed pot #8 scoop pur #8 scoop pur #8 scoop X X X X

19

20

Regular Peanut Butter/Crackers Juice or Milk Orange Juice Hot Cereal (or) Cold Cereal Scrambled Eggs Bacon Toast Margarine Milk Beverage Sliced Turkey Dressing Gravy Harvard Beets Dinner Roll1 Margarine Apple Pie Milk Beverage Beef Stew Biscuit Coleslaw Margarine Pineapple Chunks Milk Beverage Fig Newton Juice or Milk Figure 3–2

continued

Day Sunday

RD/LD

Portion

Mech Soft

NCC Mech S.

Pureed

NCC Pureed

No Conc CHO

1 pkg 4 oz 4 oz 4 oz 4 oz ladle 3/4 cup #12 scoop 2 strips 1 slice 1 tsp/1pat 8 oz. as desired

X X X X X X X no X X X X

2 crackers X X X X (or) X X no X X X X

2 crackers soak X X X pur 6 oz ladle no pur #12 scoop no in cereal in cereal X X

2 crackers soak X X X pur 6 oz ladle no pur #12 scoop no in cereal in cereal X X

2 crackers X X X X (or) X X X X X X X

3 oz. #8 scoop 1 oz ladle 4 oz spoodle X 1 tsp/1 pat 1 1/8 piece

grd #8 scoop X X X X X X

pur #8 scoop pur #8 scoop in dressing pur #8 scoop in veg in veg pur #8 scoop

X X

X X

pur #8 scoop pur #8 scoop in dressing pur #8 scoop X in veg applesauce #8 scoop X X

X X X X

4 oz as desired

grd #8 scoop X X X in veg X applesauce #8 scoop X X

X applesauce #8 scoop X X

6 oz spoodle 1 #8 scoop 1 tsp/1 pat 4 oz spoodle 4 oz as desired

grd #10 scoop X V8 juice - 4oz X X X X

grd #10 scoop X V8 juice - 4oz X X X X

pur #8 scoop in meat V8 juice - 4 oz. in meat pur #8 scoop X X

pur #8 scoop in meat V8 juice - 4oz in meat pur #8 scoop X X

X X diet X X X X

2 4 oz 4 oz

X X X

2 van wafers X X

soak X X

5 van wafers soak X X

5 van wafers X X

CHAPTER 3

Cycle Spring/SummerWeek 3

Plating and Portioning of Food

21

IMPORTANCE OF SANITATION Before plating and portioning food, it is important to be sure that all surfaces the food will contact are clean and sanitary. These surfaces include kitchenware such as: 1. Cutting boards 2. Knives 3. Serving utensils 4. Dishware 5. Flatware 6. Trays 7. Steam table/counter top Other surfaces that must be clean and sanitary include your hands. Be sure you have washed your hands thoroughly, following the steps described in Procedure 1. Your facility’s policy may specify that gloves are to be worn during direct handling of food. Your hands must be clean before you put on the gloves. While you are handling food that is being plated and portioned, you must avoid contaminating your hands or gloves in any of the following ways: 1. Touching a dirty surface or equipment 2. Touching your face or hair, or scratching your body If you contaminate your hands during plating and portioning, leave your task and wash your hands. If you are wearing gloves that become contaminated, leave your task, dispose of the gloves, wash your hands, and put on a clean pair of gloves.

SETUP OF THE TRAYLINE A trayline is an assembly line where food items are placed on a tray (Figure 3–3). There is a hot food side and a cold food side. To maintain appropriate temperatures, hot food is placed in a steam table; cold food is placed on a refrigerated or iced table or in an ice bath.

Figure 3–3

An example of a trayline

22

CHAPTER 3

PPE

PROCEDURE

2

STEPS FOR SETTING UP A TRAYLINE

Procedure

4. Gather appropriate serving utensils.

1. Turn on appropriate equipment, such as steam table, lowerators, (plate warmers), ice table.

5. Place pans of hot food items in the steam table (Figure 3–4).

2. Place spreadsheet at appropriate or designated trayline area.

6. Place cold food items on the ice table (Figure 3–5).

3. Set traycards at the beginning of the trayline. Another system might put traycards on trays, which are placed on traycarts prior to starting the trayline.

7. Take and record food temperatures.

Figure 3–4 Hot food items are placed into the steam table as part of the trayline setup. Figure 3–5 Cold food items are placed into the ice table as part of the trayline setup.

traycard: provides information such as patient name, room number, diet order, and individual food/beverage preferences; may be a plastic coated, washable card or a printed sheet of paper from a computerized traycard system

FOOD TEMPERATURES As discussed in Chapter 2, maintaining appropriate temperatures helps to prevent the growth of microorganisms in food. Hot food must be held at 140˚F or above, and cold food must be held at 40˚F or below. Thermometers are used to measure the temperature of food. The most common type of thermometer used in food service is a bimetal thermometer (shown in Figure 3–6 along with other types of thermometers that are used in food production). To ensure accurate food temperatures, thermometers must be checked periodically. Figure 3–7 illustrates how to calibrate a thermometer to maintain accuracy. Each facility will have its own policy regarding food temperatures and the times during food preparation and service when they are to be obtained. Refer to Figure 2–8 which is a food temperature log used to record food temperatures. The basic procedure for taking food temperature is outlined in Procedure 3.

Plating and Portioning of Food

Types of Thermometers

Speed

Placement

23

Usage Considerations

LIQUID-FILLED

1 to 2 minutes

At least 2 inches deep in the thickest part of the food

• Used in roasts, casseroles, and soups • Can be placed in a food while it is cooking • Cannot measure thin foods • Calibration cannot be adjusted • Possible breakage while in food • Heat conduction of metal shield can cause false high reading

BIMETAL (oven-safe)

1 to 2 minutes

2 to 21/2 inches deep in the thickest part of the food

• Can be used in roasts, casseroles, and soups • Can be placed in a food while it is cooking • Not appropriate for thin foods • Heat conduction of metal stem can cause false high reading

BIMETAL (instant-read)

15 to 20 seconds

2 to 21/2 inches deep in the thickest part of the food

• Can be used in roasts, casseroles, and soups • Use to check the internal temperature of a food at the end of cooking time • Can be calibrated • Cannot measure thin foods unless inserted sideways • Cannot be used in an oven while food is cooking • Temperature is averaged along 2–3 inches of probe • Readily available in stores

THERMISTOR (digital)

10 seconds

At least 1/2 inch deep in a food

• Gives faster reading • Can measure temperature in thin foods • Digital face easy to read • Cannot be used in an oven while food is cooking • Available in “kitchen” stores

5 seconds

1/4

• Fastest • Can quickly measure even the thinnest foods • Digital face easy to read • Can be calibrated • More costly, may be difficult for consumers to find in stores

-58 ˚ to

302

160 ˚F ˚

ON OFF

160˚ F

THERMOCOUPLE (digital)

deep, or deeper as needed

Figure 3–6 Types of thermometers used in food preparation. (Courtesy of USDA Food Safety and Inspection Service, Technical Information from FSIS, October 1997)

24

CHAPTER 3

Calibrating a Thermometer

There are two ways to check the accuracy of a food thermometer. One method uses ice water, the other uses boiling water. Many thermometers have a calibration nut under the dial that can be adjusted. Check the package for instructions. ICE WATER To use the ice water method, fill a large glass with finely crushed ice, add clean tap water to the top of the ice, and stir well. Immerse the thermometer stem a minimum of 2 inches into the mixture, touching neither the sides nor bottom of the glass. (For ease in handling, the stem of the thermometer can be placed through the clip section of the stem sheath and, holding the sheath horizontally, lowered into the water.) Without removing the stem from the ice, hold the adjusting nut under the head of the thermometer with a suitable toll and turn head so pointer reads 32˚F. Allow a minimum of 30 seconds before adjusting.

BOILING WATER To use the boiling water method, bring a deep pan of clean tap water to a full rolling boil. Immerse the stem of a thermometer in the boiling water a minimum of 2 inches and wait at least 30 seconds. (For ease in handling, the stem of the thermometer can be placed through the clip section of the stem sheath and, holding the sheath horizontally, lowered into the boiling water.) Without removing the stem from the pan, hold the adjusting nut under the head of the thermometer with a suitable tool and turn the head so the thermometer reads 212˚F. Head Stem

Hex Adjusting Nut

2" (5 cm) Minimum

Boiling Water (212˚ F, 100˚ C) Head

Stem

Hex Adjusting Nut

2" (5 cm) Minimum

Ice Water (32˚ F, 0˚ C)

For true accuracy, distilled water must be used and the atmospheric pressure must be one atmosphere (29.921 inches of mercury). A consumer using tap water in unknown atmospheric conditions would probably not measure water boiling at 212˚F. Most likely it would boil at least 2˚F and perhaps as much as 5˚F lower. Also, remember that water boils at a lower temperature in a high altitude area. Check with your local Cooperative Extension Service or Health Department for the exact temperature of boiling water in your area. Even if the thermometer cannot be calibrated, it should still be checked for accuracy using either method. Any inaccuracies can be taken into consideration when using, or the the thermometer can be replaced. For example, if the thermometer reads 214˚F in boiling water, subtract 2 degrees from the temperature registered when taking a reading in food.

Figure 3–7 Calibrating a thermometer. (Courtesy of USDA, Food Safety and Inspection Service, Technical Information from FSIS, October 1997)

Plating and Portioning of Food

PPE

PROCEDURE

3

TAKING FOOD TEMPERATURES

Procedure 1. Remove the protective shield from the thermometer probe, insert the thermometer into the clasp holder, and wipe the probe with an alcohol swab. 2. Insert the thermometer probe into the food item, such as sliced turkey, roast beef, meatloaf, or lasagna. Food items such as soup or vegetables, should be stirred before inserting the thermometer probe. Refer to Figure 3–8 for correct placement of the thermometer probe. 3. Allow the thermometer probe to remain in the food item until the needle stops moving.

4. Check the temperature reading and record the temperature on the appropriate food temperature log. 5. Hot food: If the temperature is below 140˚F, the food must be reheated to an internal temperature of at least 165˚F. (Refer to your facility’s policy for specific temperatures.) Cold food: if the temperature is above 40˚F, the food must be chilled in an ice bath or refrigerator until the internal temperature reaches 35˚F or below. (Refer to your facility’s policy for specific temperatures.) 6. When the temperatures have been taken, wipe the thermometer with an alcohol swab and cover with the protective shield.

Using the Thermometer Most thermometers available will give an accurate reading within 2°F to 4°F. The reading will only be helpful, however, if the thermometer is placed in the proper location in the product. If not inserted correctly, or if the thermometer is placed in the wrong area, the reading will not accurately reflect the internal temperature of the product. In general, the thermometer should be placed in the thickest part of the food, away from bone, fat, or gristle. CHECK THE MANUFACTURER’S INSTRUCTIONS FIRST Before using a food thermometer, read the manufacturer’s instructions. The instructions should tell how far the thermometer must be inserted in a food to give an accurate reading. Most thermometers also come with instructions on how to recalibrate the thermometer (see below for more information about calibrating a thermometer). If instructions are not available, check the stem of the thermometer for an indentation, or “dimple,” that shows one end of the location of the sensing device. Most digital thermometers will read the temperature in a small area of the tip. Dial types must penetrate about two to three inches into the food.

25

hamburgers, steaks, or chops, insert a thermistor or thermocouple in the thickest part, away from bone, fat, or gristle. If using a dial bimetal thermometer, see thin foods below. When the food being cooked is irregularly shaped, such as may be the case with a beef roast, check the temperature in several places.

POULTRY When cooking whole poultry, the thermometer should be inserted into the thickest part of the thigh. If stuffed, the center of the stuffing should be checked after the thigh reads 180°F (stuffing must reach 165°F). If cooking poultry parts, insert thermometer into the thickest area, avoiding the bone. The thermometer may be inserted sideways if necessary. When the food being cooked is irregularly shaped, the temperature should be checked in several places.

THIN FOODS When measuring the temperature of a thin food, such as a hamburger patty or chops, a thermistor or thermocouple thermometer should be used, if possible. A dial bimetallic-coil thermometer averages the internal temperature along the length of the sensor within its probe. Thin foods usually cannot accommodate the 2-inch probe if it is inserted from top to bottom and, thus, it will not give an accurate reading. For thin foods, the bimetal thermometer may be inserted sideways so that it will average the temperature in the center of the food. To avoid burning fingers, it may be helpful to remove the food from the heat source (if cooking on a grill or in a frying pan) and insert the thermometer sideways after placing the item on a clean spatula or plate.

COMBINATION DISHES For casseroles and other combination dishes, place the thermometer into the thickest portion of the food or the center of the dish. Egg dishes, and dishes made using ground meat and poultry, should be checked in several places.

WHERE TO PLACE THE THERMOMETER MEAT When taking the temperature of beef, pork, or lamb roasts, the thermometer should be placed midway in the roast, avoiding the bone. When cooking

Figure 3–8 Correct placement of the thermometer probe in various types of foods. (Courtesy of USDA, Food Safety and Inspection Service, Technical Information from FSIS, October 1997)

26

CHAPTER 3

SERVING UTENSILS AND PORTION SIZES

portion control: allows you to get the appropriate number of servings from a standardized recipe. It also helps to achieve established nutritional needs. By using serving utensils that measure a given amount of food, you maintain uniform portion sizes each time you plate a menu item

Recipes for menu items are designed to yield a consistent product as well as to specify the number of servings. Serving utensils are used to measure out each serving or portion and to guarantee the predicted number of servings. The appropriate serving utensil will be indicated on the spreadsheet. The purpose of using serving utensils is to maintain portion control. The most frequently used serving utensils are listed in Table 3–1. Certain menu items are not measured with serving utensils, but are instead portioned by cutting equal sized pieces. Examples are pies, cakes, and casseroles such as lasagna. Other menu items, such as meats, must be weighed to assure specified sized portions. Some meats are purchased in pre-portioned form, such as ground beef patties, breaded fish fillets, and chicken breasts. As cooks prepare roasts, they may pre-portion the servings and designate each serving by layering slices in a serving pan.

PLATING THE FOOD ITEMS Food placement on a plate is important in achieving an attractive meal. Food items should not touch each other, as this is unappealing.

BREAKDOWN AND SANITATION After all patients have been served a tray, the breakdown of the trayline can begin (Procedure 4). Check your facility’s policy regarding how long food should remain on the trayline before initiating breakdown.

Table 3–1 Ser ving Utensils Serving Utensil

Function

Size/Volume

Ladle

Serve stews, soups, sauces, gravies, dressings, cream dishes, other liquids, semi-liquids.

2 oz = 1/4 cup 4 oz = 1/2 cup 6 oz = 3/4 cup 8 oz = 1 cup

Scoop/Dipper

Serve solid foods, such as mashed potatoes, bread dressing, ice cream, pudding, pureed foods, ground, or shredded meats.

#16 = 1/4 cup or 2–2 1/2 oz #12 = 1/3 cup or 21/2–3 oz #10 = 2/5 cup or 3–31/2 oz #8 = 1/2 cup or 4 oz #6 = 2/3 cup or 5 oz

Spoodle with holes

Serve vegetables or fruits that need to be drained.

4 oz = 1/2cup 6 oz = 3/4 cup 8 oz = 1 cup

Solid spoodle

Serve stews, casseroles, cream dishes.

4 oz = 1/2 cup 6 oz = 3/4 cup 8 oz = 1 cup

Plating and Portioning of Food

PPE

PROCEDURE

4

27

TRAYLINE BREAKDOWN

Procedure

4. Wipe down trayline with fresh soapy water.

1. Turn off the steam table (and ice table, if present).

5. Wipe down trayline with fresh warm water.

2. Remove all food items from the trayline.

7. Replace clean and sanitized lids over the steam wells.

3. Remove pans to dishwashing area.

6. Wipe down trayline with sanitizing solution.

REVIEW QUESTIONS Multiple Choice Questions

Brief Answer Questions

1. A spreadsheet consists of all of the following except: a. portions of food items to be served per meal. b. food items to be served to special diets. c. one day of the cycle menu. d. ingredients for menu items.

Critical Thinking Scenarios

2. Portion control is characterized by all of the following except: a. appropriate number of servings per recipe. b. quality maintenance of food items. c. specific utensils to use. d. assurance of nutritional standards.

10. The morning supervisor has been training Harriet, a new employee. The supervisor has asked you to work with Harriet today and show her what your position on the trayline does. Describe for Harriet what your routine might be if you were serving cold food on the trayline for lunch.

True/False Questions 3. _____ If you are wearing gloves and have touched your face, it is not necessary to change your gloves. 4. _____ A surface should be cleaned before it is sanitized. 5. _____ Food temperatures between 40˚F and 140˚F are safe temperatures.

Fill in the Blank Questions 6. Two serving utensils used to portion food are __________ and __________ . 7. A __________ menu is written to use seasonal foods at different times of the year.

8. Briefly describe the steps involved in setting up a trayline. 9. Briefly describe the steps involved in trayline breakdown.

11. While you are setting up the cold side of the trayline for lunch, you observe the cook taking temperatures of the hot foods. You notice that she is not taking the temperature correctly. You mention your observation to the supervisor. The next day the supervisor decides to do a review of temperature taking for all staff members and requests that you be the demonstrator. Describe the correct procedure for taking the temperature of roast beef, chili, and chicken.

CHAPTER

4 OBJECTIVES

The Importance of Cleaning and Sanitation of Kitchen Equipment and Areas After reading this chapter, you will be able to: Demonstrate how to set up a three-well sink. Define the terms clean and sanitize. List the various kinds of sanitizers used in a dietary department. Demonstrate the procedure for cleaning and sanitizing stationary kitchen equipment. Explain the purpose for testing chemical sanitizing solutions. Describe the correct way to store glassware, silverware, pots, and pans. Describe the procedure for testing a chemical sanitizing solution. Describe how cross-contamination could occur from improper cleaning and sanitizing of kitchen equipment.

OVERVIEW

clean: free of visible dirt, dust, and debris sanitized: to destroy microorganisms on a cleaned, rinsed surface. Sanitation can be accomplished by using hot water (170˚F or hotter) or chemical sanitizers. The most frequently used chemical sanitizers are chlorine, iodine, and quats

cleaning: the removal of dirt, dust, food particles, and debris from a surface by washing with a cleaning solution and then rinsing with water

As a dietary aide, one of your most important responsibilities is maintaining the cleanliness and sanitation of the food service department. You may think that cleanliness and sanitation mean the same thing, but there is a difference. When something is clean, it is free of visible dirt, dust, and debris. When something is sanitized, it has been cleaned first, and then a sanitizing solution has been applied to the surface. In this way, many microorganisms, which you cannot see, are destroyed. In this chapter, you will learn how to clean and sanitize kitchen equipment and food service areas. Following these guidelines as you complete your work will help protect everyone who comes into contact with the food your department stores, cooks, and serves.

CLEANING AND SANITIZING SOLUTIONS Dietary departments use cleaning and sanitizing products, which must be mixed with water to make solutions of the appropriate concentration. These products must meet certain specifications identified by the Environmental Protection Agency (EPA). Your dietary department supervisor has selected the products used in your facility, based on the EPA specifications. Check with your supervisor to determine the type of cleaning agent to use, depending on what you will be cleaning. Cleaning is the removal of dirt, dust, debris. It consists of two steps: 1. Washing with a cleaning solution. 2. Rinsing with water. After you complete the cleaning process, sanitation of the equipment or surface can occur. Remember, food-contact surfaces must be sanitized. Examples of

The Importance of Cleaning and Sanitation of Kitchen Equipment and Areas

29

food-contact surfaces are countertops, slicers, pots, pans, dishes, silverware, cooking utensils, and glassware. Nonfood-contact surfaces do not require sanitizing. There are two methods that may be used to sanitize. One method is by immersion in water, or spraying with water that is at least 170˚F, for at least 30 seconds. The other method is application of a chemical sanitizing solution for at least a minute. Sanitizing is not used in place of cleaning; it can only be accomplished after cleaning has occurred. Sanitation is the reduction of the number of microorganisms on a clean surface. The three most common chemical sanitizing agents are chlorine, iodine and quaternary ammonium compounds (quats). The type of chemical sanitizer used in your dietary department is determined based on the properties of the water in your geographical area. The recommended water temperature for chemical sanitizing agents is 75˚F to 120˚F. Regardless of which chemical sanitizing agent is used, it is imperative that equipment and surfaces be rinsed of cleaning agent residue before you apply the sanitizing agent. The correct proportions of the sanitizing agent and water must be mixed for the solution to be effective. Test kits are used to determine if correct proportions have been mixed. Testing the sanitizing solution consists of dipping a paper test strip into the solution and matching the test strip with a color chart to determine parts per million. Parts per million (ppm) refers to the concentration of sanitizing agent in the water. If the concentration of sanitizing agent is too high, it can cause an odd odor or taste, corrosion of metals and other materials, and even possible illness from ingestion of the agent from residue on cooking equipment or tableware. If the concentration of sanitizing agent is too low, it may not kill microorganisms, and thus the equipment or surfaces will not be sanitized. The recommended dilution for chlorine is 50 to 100 ppm; for iodine 12.5 to 25 ppm; for quats 200 ppm. Check with your supervisor, who will be familiar with local sanitation regulations, regarding the concentration of the chemical sanitizing solutions used in your facility.

parts per million (ppm): a measurement of the concentration of chemical sanitizing agent mixed in a water solution. The ppm range for chlorine is 50–100 ppm; for iodine, 12.5–25 ppm; for quats, 200 ppm

THREE-WELL SINK Every food service operation will have a three-well sink. If your facility does not have an automatic dishwasher, the three-well sink will be used not only for cleaning pots and pans but also for cleaning and sanitizing cups, plates, silverware, trays, and so on. The three-well sink consists of three compartments, each serving a specific purpose in the pot and pan or ware washing process. Refer to Figure 4–1, which shows the setup of the three-well sink. 3-Well Sink Washing Tableware and Kitchenware SCRAPE SORT PRE-RINSE AREA

A

1

2

3

WASH

RINSE

SANITIZE

DRAIN AREA

1

2

3

WASH in warm water with an appropriate amount of detergent added

RINSE in clean water

SANITIZE 30 seconds in water 170˚F or hotter or 1 minute in chemical solution 

 Test the concentration of the chemical solution: Minimum to maximum ppm Chlorine 50–100 Iodine 12.5–25 Quat. Amm. 200–400

Figure 4–1 well sink

B

A. Setting up a three-well sink for washing, rinsing, and sanitizing. (Courtesy of Airaghi Group, Inc.) B. A three-

30

CHAPTER 4

PPE

PROCEDURE

5

SETTING-UP A THREE-WELL SINK

Procedure 1. SCRAPE: Remove all food particles from the pot or pan by scraping them into a garbage disposal or garbage can. 2. RINSE: Rinse any loose food particles from the pot or pan. 3. WASH: In the first well of the sink, water should be warm, with an appropriate amount of detergent added. (Follow directions on the detergent container for the proper amount.) Pots and pans are washed or scoured using a dishcloth or brush. Change the wash water periodically, as it accumulates grease and food particles. 4. RINSE: The second (middle) well of the sink is filled with clean water. The rinse water should be changed often (when it starts looking like the first well of detergent water). Pots and pans are rinsed in this well by dipping them into the water. 5. SANITIZE: In the third well of the sink, hot water (170˚ F or hotter) or a chemical

sanitizer added to clean water is used to sanitize pots and pans. If you use hot water above 170˚F to sanitize, be sure to check the temperature frequently to ensure that it remains above 170˚F. If you use a chemical sanitizer, follow the directions on the sanitizer container to ensure that the proper amount has been added to the water. Most food service operations prefer a chemical sanitizer mixture with cooler water 75˚F–120˚F), which is a more comfortable temperature for workers’ hands, dipping and retrieving pots and pans. Remember to test the concentration of the chemical sanitizer with a paper test strip. 6. DRY: Cleaned and sanitized pots and pans should be allowed to air-dry on cleaned and sanitized drying racks. Drying racks usually consist of coated metal wire shelves (similar to food storage shelves). They usually rest on wheels, so the racks can be moved from the three-well sink area to the pot and pan storage area.

If your facility does not have an automatic dishwasher, the three-well sink is also used to clean dishes, cups, silverware, trays, and other items. To clean tableware, follow the procedures for pot and pan washing but add the following steps: 1. Dirty silverware should be soaked in warm water to loosen and soften any dried food particles. Check between the tines of forks for food particles. 2. Once silverware has been cleaned, rinsed, and sanitized in the three-well sink, it should be placed on clean, sanitized racks to dry. 3. Dried silverware should be put in holders and covered for storage. If the silverware is put in cylinder holders, the handles should be facing up. 4. Glassware and cups—after being cleaned, rinsed, and sanitized—should be dried and stored in racks, open side down. This prevents dust, dirt, and debris from falling into the glassware or cups. 5. DO NOT use drying cloths or rags to dry dishware or pots and pans. Drying cloths or rags are unsanitary, and they will contaminate the cleaned, sanitized surface of the pots and pans or tableware.

DISHWASHING MACHINE A dishwashing machine or automatic dishwasher is used to clean tableware, silverware, glassware, and cups (Figure 4–2). As racks of tableware are moved through the dishwashing machine, it automatically sprays the tableware with detergent water, then rinse water; and finally sanitizing solution or water. There are several different kinds of dishwashing machines, so check with your supervisor to learn how to operate the dishwashing machine in your facility.

The Importance of Cleaning and Sanitation of Kitchen Equipment and Areas

Figure 4–2

Dishwashing machine

PPE

PROCEDURE

6

31

AUTOMATIC DISHWASHING MACHINE USE

Procedure 1. SCRAPE: Remove all food particles from the tableware by scraping them into a garbage disposal or garbage can. Pre-soak silverware. 2. RINSE: Rinse any loose food particles from the tableware. 3. RACK: Place tableware, glassware, or eating utensils into the machine dish racks neatly so that the spray from the machine can touch all sides of the tableware. 4. ENGAGE: Move the dish rack into the dishwashing machine as indicated by the instructions for your facility’s equipment. 5. MONITOR: Monitor the machine system to be sure the proper amount of detergent is being used. Monitor the temperature gauges on the machine to be sure the water temperatures are correct for each step and stage of the cycle. Wash water should be

150˚F or hotter. Rinse water should be 160˚F or hotter. Final rinse water should be 180˚F or hotter. The rinse water can be cooler if a chemical agent is used to sanitize the tableware. (See figure 4–3A for a sample dishwashing machine temperature log and Figure 4–3B for the temperature gauges on the machine.) Figure 4–4 shows clean dishes on racks emerging from the dishwashing machine. 6. DRY: Allow tableware to air-dry on the dishwasher machine rack or remove items to a clean, sanitized drying rack/storage area. Plates, bowls and cups should be placed face down to air-dry to prevent airborne dust, dirt, and debris from coming into contact with those surfaces. For this same reason, glasses should be dried and stored in racks with the open side down.

continues

32

CHAPTER 4

PROCEDURE

6

continued

Temperature Log Dishwashing Machine

Date

Year Month Breakfast Wash Rinse

Month Lunch Wash Rinse

Supper Wash Rinse

Breakfast Wash Rinse

Lunch Wash Rinse

Supper Wash Rinse

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Figure 4–3A Sample temperature log for recording temperatures of the wash and rinse cycles of a dishwashing machine. (Courtesy of Airaghi Group, Inc.)

Figure 4–3B Temperature gauges on the dishwashing machine for wash water (left) and final rinse water (right)

The Importance of Cleaning and Sanitation of Kitchen Equipment and Areas

33

This procedure is repeated until all tableware has been cleaned and sanitized. When all tableware has been processed, the dishwashing machine must be “broken down” and cleaned. This involves removing the food basket and catcher basket from the bottom of the machine and emptying food particles into the garbage disposal or garbage can. Also, the water in the wash and rinse tanks should be flushed from those tanks. Again, check your dishwasher machine user’s manual for proper cleaning and care of the machine.

CLEANING AND SANITIZING KITCHEN EQUIPMENT, SURFACES, AND AREAS Each piece of equipment in your dietary department must be cleaned and sanitized after each use. Your supervisor will give you directions for cleaning various pieces of equipment that require special attention. Procedure 7 is a general guideline for cleaning and sanitizing equipment and surfaces.

PPE

PROCEDURE

7

CLEANING AND SANITIZING EQUIPMENT AND SURFACES

Procedure 1. CLEANING SOLUTION: Mix warm water and cleaning solution or detergent in a bucket. Follow directions on the cleaning solution or detergent container for correct proportions. 2. RINSE SOLUTION: Fill another clean bucket or container with fresh warm water. 3. SANITIZING SOLUTION: Fill a third clean bucket or container with fresh warm water and sanitizing agent. Follow directions on the sanitizing agent container for correct proportions. Be sure to use a paper test strip designed for testing the sanitizing solution to determine parts per million (ppm) of sanitizing agent to water. Chlorine should be

50–100 ppm, iodine should be 12.5–25 ppm, and quats should be 200 ppm. 4. CLOTH: A separate clean cloth should be used in each of the solutions to clean, rinse, and sanitize equipment. 5. Physically remove any dirt, food particles, and debris from the equipment or surface area using a cleaning cloth soaked with the cleaning solution. Follow by rinsing those same areas with fresh warm water. Finally, sanitize the equipment or surface area using a clean cloth soaked in sanitizing solution. Keep the cloths stored in their appropriate buckets when not in use.

Your dietary department will most likely have a cleaning schedule to determine what is to be cleaned, when it should be cleaned, and who is responsible for cleaning each surface area or piece of equipment.

Dining Room Area The dietary department may be responsible for maintaining the cleanliness of the dining area. This area must be kept clean because your facility’s patients and visitors will form an opinion of the whole facility’s cleanliness from what they can see. Dining room tables should be cleaned, rinsed, and sanitized not only after each meal but also after other use between meals. Chairs should be cleaned after each meal. Your facility’s housekeeping department may be responsible for cleaning the dining room walls, ceiling, ceiling fans, windows, window coverings, floors, table legs, and chair legs. Your dietary supervisor is responsible for communicating with the housekeeping department regarding routine cleaning procedures.

34

CHAPTER 4

Storage Areas Dry storage area floors should be swept and scrubbed routinely. Refer to Procedure 8 for floor care guidelines. Other surface areas, such as walls, ceiling, shelves, and light fixtures, should also be cleaned routinely. Containers holding food items, such as cans and boxes, should be dusted as needed. Spills in the dry storage area should be wiped up immediately. Refrigerated and freezer storage area floors should be swept and scrubbed routinely (see Procedure 8 for guidelines). The gaskets around the refrigerator and freezer doors should be cleaned routinely to maintain a better seal around the door and thus maintain the holding temperature of the unit. Other surfaces, such as walls, ceilings, and light fixtures, should be cleaned routinely. Shelves should be cleaned, rinsed, and sanitized weekly or more often, depending on how much they are used.

PPE

PROCEDURE

8

FLOOR CARE

Introduction Dietary department floors, both in the kitchen and in the dining area, should be cleaned frequently, usually after each meal, and spotcleaned when spills occur. Procedure 1. SWEEP: Sweep the floor to remove debris. 2. WASH SOLUTION: Fill two mop buckets (each with a wringer attachment) with warm water. Add detergent to one bucket, following the directions on the detergent container.

3. MOP: Dip a clean mop in the detergent solution. Squeeze out excess water in the wringer attachment and clean a small area of the floor, using “S” or figure-eight-shaped strokes. Rinse the dirty mop in the detergent solution frequently. 4. RINSE: Dip the mop in the clean water bucket. Squeeze out excess water in the wringer attachment and rinse the floor area you just cleaned. 5. DRY: Allow the floor to air-dry. For the safety of fellow workers and patients, place a “Wet Floor” sign in the area you have just cleaned.

REVIEW QUESTIONS Multiple Choice Questions 1. When using a chemical sanitizing solution, which of the following will reduce the effectiveness of the sanitizer? a. Using water temperature between 75˚F and 120˚F b. Inadequate rinsing c. Immersing tableware for a minute in the chemical sanitizing solution d. Air-drying on a clean and sanitized rack 2. The food preparation countertop should be cleaned and sanitized: a. at the beginning of each shift. b. at the start of the day and at the close of the day. c. after each use of the area. d. when the cook decides it is necessary.

3. Before pots and pans can be sanitized, they must be: a. washed and air-dried. b. scraped and rinsed. c. washed and rinsed. d. rinsed and air-dried.

True or False Questions 4. _____ It is not necessary to wash tableware before it is sanitized. 5. _____ Chicken pot pie prepared in a dirty pan is an example of cross-contamination. 6. _____ It is not necessary to wash your hands before washing pots and pans.

The Importance of Cleaning and Sanitation of Kitchen Equipment and Areas

Fill in the Blank Questions 7. ____________________ is the removal of food particles and dirt from tableware. 8. Destroying many microorganisms on clean surfaces is called ____________________ . 9. The term used to describe the concentration of a chemical sanitizing solution is____________________ .

Brief Answer Questions 10. Describe the steps in setting up a three-well sink. 11. Explain the purpose of testing chemical sanitizing solutions. 12. Describe two ways cross-contamination can occur from improper handling of kitchen equipment.

Critical Thinking Scenarios 13. You are setting up the dining room for dinner. As you put the placemats on the tables, you realize

35

that the patients had an activity in the dining room earlier that afternoon. The supervisor walks into the dining room just as you stop to think about what you were observing. Your supervisor asks you if something is wrong. You reply that you have just realized that the patients used the dining room that afternoon and that you need to wash the tables before continuing. Overjoyed that you were aware of the situation,your supervisor compliments you and agrees. Describe what you will need to complete the task of setting up the dining room for dinner; include the directions for preparing the sanitizing water for wiping the tables. 14. Your supervisor assigned you to work in the dishroom today. As you enter the dishroom, you learn that the dishwashing machine is not working and that the unit cannot be repaired until 4:00 PM that afternoon. Explain the manual procedure for washing the tableware, silverware, and glasses used at lunch.

CHAPTER

5 OBJECTIVES

Safety Importance and Practices

After reading this chapter, you will be able to: Demonstrate proper body mechanics for lifting heavy objects. List three common kitchen safety hazards and how to avoid them. Describe how to follow universal precautions when handling meal trays. Define MSDS. Explain how an MSDS might be used by a dietary aide. Identify two ways the dietary department practices infection control. Describe what to do if a fire is discovered in the dietary department. Describe what to do if chemical cleaning solution splashes in your eyes. List the three elements needed for a fire to ignite and burn. Define what a disaster plan is.

OVERVIEW There are many opportunities for accidents and injuries to occur in a dietary department. Some of the most important aspects of your job as a dietary aide are the practice of safe procedures and prevention of accidents and injuries throughout your workday. This chapter will help you to become more aware of the potential safety hazards in a dietary department and what you can do to minimize the risk of accidents and injury. In addition, you will also learn about disaster planning and how your dietary department is prepared for disasters, should they occur.

PERSONAL SAFETY AND BODY MECHANICS The previous four chapters described many of the tasks that a dietary aide may perform or help with in the course of a workday. These tasks can put you at risk of accident or injury if you do not practice safe body mechanics and stay aware of your surroundings. Moving items such as containers of food and racks of dishes involves heavy lifting. The safe way to lift a heavy object is described in Procedure 9. Avoid stacking boxes too high (above shoulder height) because lifting cannot be safely completed.

Safety Importance and Practices

37

PROCEDURE

9

SAFE WAY TO LIFT HEAVY OBJECTS

Procedure

4. Ask for help if the object is too heavy, or use a cart to move the object.

1. Bend at your knees, facing the object.

5. Use the same procedure, in reverse, for setting the object down. Bend your knees and lower the object slowly, keeping your back straight.

2. Reach forward with your hands and grip the object. 3. Stand up slowly, letting your legs do the work, while keeping your back straight (Figure 5–1).

A

B

C

Figure 5–1 A. Bend knees to get close to object to be lifted. Keep back straight. B. Keeping back straight, use leg muscles to rise, holding object close to your body. C. Fully erect with object still close to the body

38

CHAPTER 5

Another personal safety issue, mentioned in Chapter 1, is safe shoes and clothing. One reason for not wearing loose clothing is the potential for catching it on fire. As mentioned in Chapter 1, an enclosed shoe protects the foot from falling objects and substances. Leather shoes provide more protection than canvas shoes and are usually the preferred footwear. Dangling jewelry that might get caught in moving parts of kitchen equipment is discouraged. Keep personal jewelry to a minimum during your workday to avoid accidental injury. Refer to your supervisor for specific policies regarding jewelry in your facility. Alertness to your surroundings is essential in the prevention of accidents and injuries. Because of the potential for accidents in a dietary department, interactions between staff members should not become silly, involve running, or become physically disruptive. People’s actions are the number one cause of accidents in a dietary department.

KITCHEN SAFETY The second most frequent cause of accidents and injuries in the dietary department is unsafe environmental conditions. Be alert to potentially dangerous situations and report them to your supervisor. Early reporting and quick action can prevent many accidents. Table 5–1 lists some common unsafe environmental conditions. Other unsafe conditions may exist in your facility. Be aware of your environment.

Table 5–1 Unsafe Environmental Conditions Commonly Obser ved in a Dietar y Department

1.

Cause

Description

Knives

Dull knives can result in cuts, and should be sharpened. Knives should always be returned to their proper storage place, such as a drawer, a knife block (Figure 5–2A), or a magnetized wall strip. Knives kept in a drawer should be placed blade first, with the handle closest to the drawer opening. Knives should be washed carefully by hand and never left in a sink full of water.

2. Meat slicer (Figure 5–2B)

Use all safety measures described in the user’s manual when slicing food and cleaning the equipment. Safety devices provided with the equipment must be used to prevent injury.

3. Cooking equipment (kettles, pots and pans, stoves, ovens, and steamers)

Lift kettle, pot, and pan lids away from your body. Use clean, dry potholders to lift or move hot containers of food. Stand to one side and turn your face away from the opening in an oven or steamer door; this allows the steam to escape without burning you. Pot and pan handles should be turned in, away from the aisle, to prevent accidental tipping or brushing against the handles that could cause the pots to fall (Figure 5–2C). Loose handles on pots and pans should be repaired, or the item discarded, because the contents could spill and burn you.

4.

A separate garbage container should be kept for broken glass and dishware, so that employees are aware of the container’s contents and take precautions when handling it. If glass breaks in dishwater, the sink should be drained and the broken pieces carefully removed.

Glass

continues

Safety Importance and Practices

39

Table 5–1 continued

Figure 5–2A Store knives in a knife block.

Figure 5–2B Meat Slicer

Figure 5–2C Turn pot handles away from aisles for safety.

Despite the best efforts and care of every employee, accidents will happen. Your dietary department should provide for basic first-aid needs and will most likely be equipped with a first-aid kit. Be sure you know both where the first-aid kit is stored and what it contains. Report any accident or injury as soon as possible to your supervisor. A record must be kept of all accidents and injuries that occur in the dietary department.

FIRE SAFETY Fires need heat, fuel, and air to burn. The removal of just one of these elements will cause a fire to go out. More fires occur in food service departments than any other business. Fires are caused by: 1. Faulty wiring within a building structure or within electrical equipment. Your supervisor should complete routine inspections of electrical equipment.

40

CHAPTER 5

2. Hot oil in fryers. Oil that reaches its flammable temperature (425˚F–500˚F) will spontaneously burst into flames. 3. Grease trapped in hooded vents above cooking areas. Vents should be included in the cleaning schedule. Reducing grease buildup will help to prevent fires. 4. Careless disposal of burning cigarettes into flammable materials. Cigarette smoking should take place in designated areas only, and a safe receptacle should be provided for used cigarettes. If you discover a fire, you should already know what to do. Therefore, be aware of the fire plan for your facility, and read it. Look around your dietary department and locate at least two exit doors or windows. Locate your dietary department’s fire extinguishers and learn how to use them (Figure 5–3). Your facility will probably conduct periodic fire drills, which allow staff to practice the fire and evacuation procedures. Figure 5–4 outlines the procedure for reacting to a fire.

MATERIAL SAFETY DATA SHEETS Material Safety Data Sheet (MSDS): an information sheet provided by the manufacturer of a chemical product that includes product ingredients and directions on what to do if the product is swallowed or comes into contact with skin or eyes. MSDS are to be displayed in an area in the dietary department for all dietary staff to see and have access to when needed

In the dietary department, many chemicals are used to clean and sanitize surfaces and equipment. These chemicals can be harmful when swallowed or when they come into contact with skin or eyes. Manufacturers are required to provide Material Safety Data Sheets (MSDS) for all chemical products. The MSDS include product ingredients and directions on what to do if the product is swallowed or contacts the skin or eyes. The MSDS should be stored in a visible location in the dietary department. This makes it easy to obtain information in an emergency. You should find where your dietary department stores the MSDS so you can reach them quickly when needed. You should also locate where the eyewash sink is in your dietary department, and learn how to use it. If your facility does not have an eyewash sink, you can wash your eyes by flushing them with cool running water for fifteen minutes, holding the eyelids apart. Because chemicals are potentially harmful, they must be stored away from food. Most dietary departments have a closet or room designated for the storage of chemicals. Be sure to return chemicals to this area after use, and be careful to use the products as directed. Chemicals should remain in their original containers. If they are repackaged in other containers, the new containers must be clearly labeled.

R.A.C.E. Quick Action for Fire Safety R = Rescue—Move patients from the fire area to a safe area within the building. A = Alarm—Pull the alarm. This not only notifies the Fire Department, but also alerts the other staff members that a fire has been sighted. C = Confine/Contain—Close the doors to the fire area to keep the fire in one area. This action may keep the fire from moving to other areas. E = Extinguish/Evacuate—Check the type of fire and extinguish it, if small, using proper procedures. Otherwise move the patients out to safer areas.

Figure 5–3 Fire extinguisher

Figure 5–4 The steps required to successfully manage a fire emergency in a health care facility.

Safety Importance and Practices

41

HANDLING INFECTIOUS MATERIAL AND UNIVERSAL PRECAUTIONS

universal precautions: practices, used at all times, designed to prevent transmission of infectious diseases

The patient who is infected with a bloodborne pathogen, such as hepatitis or human immunodeficiency virus (HIV), presents a risk to all health care providers, including dietary aides. Generally, dietary staff do not come into immediate contact with infected patients. However, if you do, wash your hands thoroughly at the nearest handwashing station immediately after contact. If your uniform comes into contact with an infected patient, change into a clean uniform before returning to the dietary department. As a dietary staff member, you must be careful to avoid carrying microorganisms on your uniform from patient care areas to the dietary department. Therefore, if you work both as a dietary aide and as a patient caregiver, you must change into a clean uniform when going from patient care to dietary. Universal precautions is a term frequently used to describe practices designed to prevent transmission of infectious diseases. Like other health care workers, the dietary aide should assume that all patients are infected with bloodborne pathogens. Therefore, handle trays or dirty dishware as they are returned to the dietary department using universal precautions. Universal precautions implemented by dietary staff include guidelines such as: 1. Never eat food left on a tray or plate that is returned to the dietary department. 2. Never “recycle” unopened packages of food or condiments that are returned on a patient tray. 3. Wear disposable gloves and aprons when scraping and rinsing dirty dishware, to provide protection. Your supervisor will inform you of your facility’s policy regarding protective practices. 4. If a patient is in isolation due to a bloodborne pathogen, meals should be served on disposable trays using paper plates and cups and plastic eating utensils. The used trays and uneaten food should be disposed of in the patient’s room in a red biohazard bag. If, by mistake, a regular tray using regular dishware is served to a patient in isolation, all the items should be returned to the dietary department in a red biohazard bag. The dietary aide should use universal precautions when scraping and rinsing the tray and dishware. Check with your supervisor for specific instructions regarding this type of situation.

DISASTER PLANNING disaster plan: a plan of action to be followed when an emergency or disaster occurs. In a dietary department, a disaster plan includes a planned menu, food and water reserves, and an action plan describing how the food will be prepared and served

A disaster is a sudden misfortune in which unexpected destruction of property and possible loss of life occurs. Your facility will have developed a disaster plan, which outlines what should be done in the event of a disaster. Disaster drills may be conducted in your facility to allow staff and patients to practice safety procedures. The dietary department must have a disaster plan that includes a planned menu, food reserves, and an action plan describing how the food will be prepared and served. As a dietary aide, you may be asked to work extra hours and take on extra responsibilities following a disaster. During this time of crisis, patients still need to eat. In addition, staff and volunteers who are responding to the disaster will also need to be nourished. Safety Is Everyone’s Concern!

REVIEW QUESTIONS Multiple Choice Questions 1. Which of the following are not required for a fire to burn?

a. Hydrogen b. Heat c. Fuel d. Air

42

CHAPTER 5

2. Which of the following is not a safe practice to follow in the dietary department? a. Storing knives in a knife block b. Using a damp dish towel for removing a hot pan from the stove c. Wiping up a spill immediately after it occurs d. Draining water from a sink before removing broken glass

True/False Questions 3. _____ People’s actions are the number one cause of accidents in a dietary department. 4. _____ Chemicals used in the dietary department can be safely stored anywhere as long as the caps are on tight. 5. _____ Dietary staff need not be concerned with universal precautions.

Fill in the Blank Questions 6. What do the following letters describing fire safety stand for: R = ____________________________________________________________ A = ____________________________________________________________ C = ____________________________________________________________ E = ____________________________________________________________ 7. A Material Safety Data Sheet includes ____________________ and ____________________.

Brief Answer Questions 8. Describe the steps involved in safely lifting a heavy object. 9. Identify two ways the dietary department practices infection control. 10. List two common safety hazards in a dietary department and how to avoid them.

Critical Thinking Scenarios 11. You have been asked to wash and sanitize some knives and put them away. What are some safety precautions to consider in completing this task? 12. You are putting today’s delivery of goods away. The delivery includes four cases of canned goods and a fifty-pound sack of flour on the dock. Describe how you will carry the items from the dock into the storeroom. 13. The cook has asked you to refill the cleaned and sanitized flour bin. Demonstrate how you will safely deposit a fifty-pound sack of flour into the bin. 14. You are in the dishwashing area and another employee tells you she has just splashed a solution into her eyes. Describe the steps you would take to assist your fellow employee.

CHAPTER

6 OBJECTIVES

Patient Contact

After reading this chapter, you will be able to: Demonstrate several ways to initiate a dialogue with a patient. Describe appropriate ways to assist patients with meals. Describe approaches for follow-up communication with information obtained during contact with the patient. Explain the importance of maintaining confidentiality. Demonstrate several ways to end a conversation with a patient.

OVERVIEW As a dietary aide, you may occasionally be asked to visit with or assist patients with their meals. You might be assigned to help deliver trays to the patients who take their meals in their rooms. You might be asked to assist in the dining room by passing trays to other patients who take their meals in the dining room. The responsibilities of the dietary aide vary from facility to facility, but interaction with the patients is something everyone does in the health care field. Communication is easy—try it, you’ll feel comfortable in no time!

INITIAL CONTACT WITH PATIENTS When you approach a patient, identify yourself and what department you are from. One example of this approach is: “Hello Mrs. Smith, my name is Martha Jones and I am from the dietary department.” Be pleasant in your approach, and smile. This will help to put the patient at ease and make her more receptive to talking with you. Be sure to address the patient by the surname, such as “Mrs. Smith,” rather than by the given name, such as “Mary.” This shows the patients that you respect them. A patient might ask you to call him by his given name or a nickname; you should address patients by the names they want you to use. Again, this shows your respect for the individual. Speak clearly and slowly while facing the patient, so that he or she can understand you. Use language that the patient is familiar with rather than slang or technical words. If the patient is sitting down or in bed, get a chair and sit down next to him so that you are not towering over him. By facing the patients and getting on the same level with them, your body position will communicate to the patients that you are ready to listen and are interested in what they have to say.

WAYS IN WHICH THE DIETARY AIDE MAY INTERACT WITH PATIENTS Sometimes you may be summoned or beckoned by a patient and asked a question or asked to provide assistance of some sort. Acknowledge the request and

44

CHAPTER 6

honor it if appropriate. Appropriate means within the scope of your job and department responsibilities. If it is not appropriate to honor a request, tell the patient what you will do to meet the need. This may involve notifying another department’s staff member of the patient’s request. For example, a patient sees you in the hallway with a cart of room trays and asks you for a glass of water. This sounds harmless, doesn’t it? But this patient may have a swallowing disorder that could cause her to choke, or she may be on fluid restrictions due to her medical condition. Check with the nurse who is responsible for that patient to find out if she may have a glass of water. If it is appropriate for that patient, then you may give her a glass of water. Another example is a patient who asks you to help him move from his wheelchair to a chair or bed. Acknowledge the patient’s request and inform him that you will get someone to help. Remember, as a dietary aide, you should not be coming into contact with patients further than touching them lightly on the shoulder or shaking their hands. Also remember to wash your hands after contact with a patient and before making contact with another patient. You are responsible for keeping the food they eat safe and this means minimizing your exposure to potentially infectious microorganisms. Refer to the section on infection control in Chapter 5 for further guidance. If you are required, as a dietary aide, to provide dining room service or to serve room trays to patients, remember that it is your job to give the best service you can in a pleasant manner. A patient may voice an opinion or complain to you about the food or the service he or she is receiving. Again, be pleasant and respond politely to the patient. If there is something you can do for the patient, do it! If an opinion or a complaint has been expressed, be sure to communicate it to your supervisor, and tell the patient that you have done so. When passing meal trays to patients, it is helpful to know ahead of time what alternative menu choices are available for that meal in case the patient does not like or want what is served. Be sure to check with your dietary supervisor before providing a substitute food item, to ensure that the patient’s diet order is followed. If a patient refuses meals, be sure to inform your dietary supervisor. After you have placed a meal tray on the table in front of a patient, offer to assist with opening packages such as condiments and beverage cartons. Offer to spread butter on bread or rolls and cut up meat to enable the patient to eat the meal as independently as possible. If a patient requires assistance with eating, notify nursing staff. In some states, only certain staff members, such as a nurse or certified nurse aide, may feed patients. Check with your supervisor for the policy followed in your facility. Table 6–1 summarizes good practices for serving patients in the dining room or in their rooms. Table 6–2 lists suggestions to consider when feeding patients (if this is permitted in your facility).

Table 6–1 Good Practices to Use When Ser ving Patients 1.

Acknowledge the presence of the patient when presenting the tray, with a cheery “Hello” or “Good Morning,” and include the name of the patient in your greeting.

2.

Offer to assist the patient with the tray setup so that the patient may eat independently.

3.

If beverages are served separately, ask what beverage the patient would like to have and serve the beverage to the right of the patient.

4.

Be informed before serving the patients of the substitutes available should a patient not like or want what is being served for the meal. continues

Patient Contact

45

Table 6–1 continued 5.

Check back with the patient to see if everything is all right or if something is needed.

6.

Record patient food and fluid intake on the appropriate form.

7.

If the patients share information with you regarding their likes or dislikes, if you observe that they need further assistance with the tray setup, or if you observe that they have difficulty chewing, report the information to the appropriate health care team member.

8.

Remember always to be friendly and courteous.

If your job responsibility includes picking up trays after patients have finished their meals, remember to be pleasant. Ask if they are finished and if you may remove the tray. Look at the tray and note if the patient has eaten anything. If she didn’t, ask if you can get her something else or if there is a problem. Maybe she just needs more time because she is a slow eater. Report your observation and conversation to the appropriate staff member.

Table 6–2 Suggestions for Feeding Patients 1.

Check with your facility before feeding patients. Some states have specific rules for this activity.

2.

Check with the nurse to see if any specific feeding instructions have been recommended by the speech therapist; for example, perhaps straws are to be used with the patient. Also ask if any specific adaptive equipment is to be used. An example of adaptive equipment is a nosy cup, which has part of the cup cut out so the head does not have to be tilted back to drink from it.

3.

Sit the patient upright at a 90˚ angle. Body in midline (support affected side with pillow if patient leans to one side).

4.

Seat yourself at the patient’s eye level in order that the patient can see you. This approach is less intimidating to the person being fed and could prevent the patient from choking if he looks toward you while you are feeding him.

5.

Remember to check the food temperature before feeding the patient. This can be done by placing a drop or two of food on the inside of your wrist to check the temperature. Cold foods are easier to swallow than hot foods.

6.

Interact with the patient—let her know what is on the tray and what you will be serving. Converse with the patient since eating is always a socializing event. Be aware that conversation for some patients may need to be limited because their response to questions would cause them to choke.

7.

Alternate liquids and solids. Be sure the mouth is clean before giving the next bite.

8.

Make sure food is cut into bite size pieces and is of the right consistency.

9.

After eating, clear the patient’s mouth of food (patients with decreased sensation and motor ability tend to squirrel foods in the cheek) and the patient should remain upright for 15 to 30 minutes to prevent later aspiration.

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CHAPTER 6

In health care facilities, the amount of food and/or liquid the patient has eaten must be recorded. Each facility has its own form and procedure for evaluating and recording intake; your supervisor will instruct you on your facility’s approach. By keeping a record of food intake, the staff can monitor the patient and spot a potential problem before it becomes serious. For example, if the patient is eating very little of the food on his tray, he may lose weight. Looking back over several meals, seeing such a pattern, and reporting it to the appropriate staff member may prevent that patient from losing too much weight and developing other health problems.

BRINGING A CONVERSATION TO A CLOSE Pleasant—that’s the word to remember! When it is time to end a conversation with a patient, be polite and pleasant. Let him know that you will be going. Don’t just walk away—that is extremely rude. If you have discussed things that need to be reported to other staff members, let the patient know what you plan to do. If you need to get something for the patient from another part of the facility, let her know that you will get the item and return later. In a friendly way, say “goodbye,” “see you later,” or use your own friendly exit phrase.

CONFIDENTIALITY As a dietary aide and as a health care employee, it is your responsibility to keep the information you obtain from a patient conversation confidential. However, it is important to share some information with the appropriate health care team member(s), such as the nurse and/or the dietitian. How you report the information to the health care team member is also important. Shouting the information across the nurse’s station is not appropriate, but talking in a soft voice at one side of the nurse’s station is acceptable. Repeating information to other health care team members in the hallways, cafeteria, elevators, or other open areas indicates disrespect for the privacy of patients and their families. The person who overhears you talking may just be the patient’s family member! What you hear and see should stay in the facility and not become part of a conversation in the locker room, break room, or outside the work environment. Confidentiality applies not only to patient information, but also to other issues in the dietary department or any department in the facility. A conversation you may overhear between a supervisor and another employee is not to be repeated to other staff members. Inappropriate behavior by staff members should be reported to your supervisor. Your supervisor will follow the procedure set up by the facility for disciplinary action to be taken, and is responsible for reporting the incident to the employee’s supervisor in another department. Again, what you see or hear in the facility should stay in the facility; do not share it in the locker room, break room, or outside the work environment. Communication is easy. Patients are people who like you, like to talk, and like to be recognized. In fact, a patient is a person just like you, with many of the same interests. Try your communication skills now. Remember to be pleasant and smile.

REVIEW QUESTIONS Critical Thinking Scenarios Let’s try your patient contact skills. Listed here are several scenarios. Select a partner or two and try roleplaying to test your level of comfort and build your skills when communicating and interacting with patients.

1. Mrs. Green is a resident in a long-term care facility and does not receive many visitors. You are delivering lunch trays on her wing and will be taking her tray to her. Mrs. Green has the reputation of talking too much because she is lonely. As you enter the room, you can hear her

Patient Contact

asking questions already. Your challenge here is to deliver the tray, assist with tray setup, and exit the room without being rude or unkind to Mrs. Green and still deliver other lunch trays promptly. 2. Mr. Putman has poor-fitting dentures. You observed this when you picked up his dinner tray—in fact, his upper denture fell out when he was chewing his meat and fell in the mashed potatoes and gravy! He picked up the denture and tried to put it back in his mouth. Mr. Putman was embarrassed when he saw you watching. You asked if you could get him something else to eat and told him you would mention the problem of the poor-fitting dentures to his nurse. Your challenge is to relay the incident and problem to his nurse. Actually, you have a

47

double challenge: present the situation first in a manner that violates confidentiality and then in a manner that respects Mr. Putman’s confidentiality. 3. Mrs. Jones has beckoned you over to her wheelchair and asks you to push her over to the table in the lounge area. She asks your name and says that she does not remember meeting you—she was admitted only yesterday. Your supervisor has asked you to obtain beverage choices from Mrs. Jones, so you are happy for the opportunity to speak with her. Your challenge here is to meet a new patient and discuss her beverage choices to make her feel more at home.

APPENDIX

A

Procedure Checklists

PROCEDURE

1

CHECKLIST

HANDWASHING Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice 1. Check the paper towel dispenser to be sure clean paper towels are available to dry your hands when you are finished washing and rinsing them. 2. Turn the water on to a comfortable temperature and force. The force of the water should not be so strong that it splashes the surrounding areas. 3. Wet your hands thoroughly, and lather well with soap. Make sure you have carefully washed all areas on your hands and fingers, including under your fingernails. The friction of rubbing your hands together and over each other is an important part of this cleansing action. This process should last for at least 20 seconds. Hands should be kept pointed down at all times. This prevents the water from running up the arms and recontaminating the hands. 4. Rinse well. Do not turn water off. 5. Dry your hands, using clean paper towels. 6. Turn the water off using a clean paper towel, so you do not contaminate your hands from the dirty faucet . ■■ Note: Frequent handwashing can dry out your skin. Hand lotion or creams may be used after handwashing only if the next activity does not involve direct food contact, because the lotion or cream could contaminate the food. Also, do not use oil-based lotions before putting on gloves. ■■

Satisfactory

Comments

Procedure Checklists

PROCEDURE

2

49

CHECKLIST

STEPS FOR SETTING UP A TRAYLINE Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. Turn on appropriate equipment, such as steam table, lowerators (plate warmers), ice table. 2. Place spreadsheet at appropriate or designated trayline area. 3. Set traycards at the beginning of the trayline. Another system might put traycards on trays, which are placed on traycarts prior to starting the trayline. 4. Gather appropriate serving utensils. 5. Place pans of hot food items in the steam table. 6. Place cold food items on the ice table. 7. Take and record food temperatures.

PROCEDURE

3

CHECKLIST

TAKING FOOD TEMPERATURES Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. Remove the protective shield from the thermometer probe, insert the thermometer into the clasp holder, and wipe the probe with an alcohol swab. 2. Insert the thermometer probe into the food item, such as sliced turkey, roast beef, meatloaf, or lasagna. Food items, such as soup or vegetables, should be stirred before inserting the thermometer probe. 3. Allow the thermometer probe to remain in the food item until the needle stops moving. 4. Check the temperature reading and record the temperature on the appropriate food temperature log. 5. Hot food: If the temperature is below 140˚F, the food must be reheated to an internal temperature of at least 165˚F. continues

50

APPENDIX A

PROCEDURE

3

CHECKLIST Needs practice

continued

Satisfactory

Comments

(Refer to your facility’s policy for specific temperatures.) Cold food: if the temperature is above 40˚F, the food must be chilled in an ice bath or refrigerator until the internal temperature reaches 35˚F or below. (Refer to your facility’s policy for specific temperatures.) 6. When the temperatures have been taken, wipe the thermometer with an alcohol swab and cover with the protective shield.

PROCEDURE

4

CHECKLIST

TRAYLINE BREAKDOWN Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. Turn off the steam table (and ice table, if present). 2. Remove all food items from the trayline. 3. Remove pans to dishwashing area. 4. Wipe down trayline with fresh soapy water. 5. Wipe down trayline with sanitizing solution. 6. Replace clean and sanitized lids over the steam wells.

PROCEDURE

5

CHECKLIST

SETTING UP A THREE-WELL SINK Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. SCRAPE: Remove all food particles from the pot or pan by scraping them into a garbage disposal or garbage can. continues

Procedure Checklists

PROCEDURE

5

CHECKLIST Needs practice

2. RINSE: Rinse any loose food particles from the pot or pan. 3. WASH: In the first well of the sink, water should be warm, with an appropriate amount of detergent added. (Follow directions on the detergent container for the proper amount.) Pots and pans are washed or scoured by using a dishcloth or brush. Change the wash water periodically, as it accumulates grease and food particles. 4. RINSE: The second (middle) well of the sink is filled with clean water. The rinse water should be changed often (when it starts looking like the first well of detergent water). Pots and pans are rinsed in this well by dipping them into the water. 5. SANITIZE: In the third well of the sink, hot water (170˚F or hotter) or a chemical sanitizer added to clean water is used to sanitize pots and pans. If you use hot water above 170˚F to sanitize, be sure to check the temperature frequently to ensure that it remains above 170˚F. If you use a chemical sanitizer, follow the directions on the sanitizer container to ensure that the proper amount has been added to the water. Most food service operations prefer a chemical sanitizer mixture with cooler water (75˚F–120˚F), which is a more comfortable temperature for workers’ hands, dipping and retrieving pots and pans. Remember to test the concentration of the chemical sanitizer with a paper test strip. 6. DRY: Cleaned and sanitized pots and pans should be allowed to air-dry on cleaned and sanitized drying racks. Drying racks usually consist of coated metal wire shelves (similar to food storage shelves). They usually rest on wheels, so the racks can be moved from the three-well sink area to the pot and pan storage area.

continued

Satisfactory

Comments

51

52

APPENDIX A

PROCEDURE

6

CHECKLIST

AUTOMATIC DISHWASHING MACHINE USE Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice 1. SCRAPE: Remove all food particles from the tableware by scraping them into a garbage disposal or garbage can. Presoak silverware. 2. RINSE: Rinse any loose food particles from the tableware. 3. RACK: Place tableware, glassware, or eating utensils on the machine dish racks neatly so that the spray from the machine can touch all sides of the tableware. 4. ENGAGE: Move the dish rack into the dishwashing machine as indicated by the instructions for your facility’s equipment. 5. MONITOR: Monitor the machine system to be sure the proper amount of detergent is being used. Monitor the temperature gauges on the machine to be sure the water temperatures are correct for each step and stage of the cycle. Wash water should be 150˚F or hotter. Rinse water should be 160˚F or hotter. Final rinse water should be 180˚F or hotter. The rinse water can be cooler if a chemical agent is used to sanitize the tableware. 6. DRY: Allow tableware to air-dry on the dishwasher machine rack or remove items to a clean, sanitized drying rack/storage area. Plates, bowls, and cups should be placed face down to airdry to prevent airborne dust, dirt, and debris from coming into contact with those surfaces. For this same reason, glasses should be dried and stored in racks with the open side down.

Satisfactory

Comments

Procedure Checklists

PROCEDURE

7

53

CHECKLIST

CLEANING AND SANITIZING EQUIPMENT AND SURFACES Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. CLEANING SOLUTION: Mix warm water and cleaning solution or detergent in a bucket. Follow directions on the cleaning solution or detergent container for correct proportions. 2. RINSE SOLUTION: Fill another clean bucket or container with fresh warm water. 3. SANITIZING SOLUTION: Fill a third clean bucket or container with fresh warm water and sanitizing agent. Follow directions on the sanitizing agent container for correct proportions. Be sure to use a paper test strip designed for testing the sanitizing solution to determine parts per million (ppm) of sanitizing agent to water. Chlorine should be 50–100 ppm, iodine should be 12.5–25 ppm, and quats should be 100–200 ppm. 4. CLOTH: A separate clean cloth should be used in each of the solutions to clean, rinse, and sanitize equipment.

PROCEDURE

8

CHECKLIST

FLOOR CARE Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice

Satisfactory

Comments

1. SWEEP: Sweep the floor to remove debris. 2. WASH SOLUTION: Fill two mop buckets (each with a wringer attachment) with warm water. Add detergent to one bucket, following the directions on the detergent container. 3. MOP: Dip a clean mop into the detergent solution. Squeeze out excess water in the wringer attachment and clean a small continues

54

APPENDIX A

PROCEDURE

8

CHECKLIST Needs practice

continued

Satisfactory

Comments

area of the floor, using “S” or figureeight-shaped strokes. Rinse the dirty mop in the detergent solution frequently. 4. RINSE: Dip the mop in the clean water bucket. Squeeze out excess water in the wringer attachment and rinse the floor area you just cleaned. 5. DRY: Allow the floor to air-dry. For the safety of fellow workers and patients, place a “Wet Floor” sign in the floor area you have just cleaned.

PROCEDURE

9

CHECKLIST

SAFE WAY TO LIFT HEAVY OBJECTS Successful completion of this procedure will be determined by satisfactory performance of each step in this checklist. All steps must be performed to the satisfaction of your instructor. Needs practice 1. Bend at your knees, facing the object. 2. Reach forward with your hands and grip the object. 3. Stand up slowly, letting your legs do the work, while keeping your back straight. 4. Ask for help if the object is too heavy, or use a cart to move the object. 5. Use the same procedure, in reverse, for setting the object down. Bend your knees and lower the object slowly, keeping your back straight.

Satisfactory

Comments

References and Further Reading

55

REFERENCES AND FURTHER READING References: Food and Drug Administration. 1997. Food Code: Recommendations of the U.S. Department of Health and Human Services. U.S. Public Health Service.

Further Reading: The Educational Foundation of the National Restaurant Association. 1992. Applied Foodservice Sanitation. 4th ed. Dubuque, IA: Kendall Hunt Publishing Co. Kobriger, A. Keeping the Lid on Sanitation Sites with H.A.C.C.P. Bossier City, LA: Professional Printing & Publishing, Inc.

LaVella, B., and Bostic, J. L. 1994. HACCP for Food Service: Recipe Manual and Guide. St. Louis, MO: LaVella Food Specialist. Loken, J. K. 1995. The HACCP Food Safety Manual. New York: John Wiley & Sons, Inc. Molt, M. 1997. Food for Fifty. 10th ed. Columbus, OH: Prentice-Hall. Puckett, R. P., and Miller, B. B. 1988. Food Service Manual for Health Care Institutions. Chicago: American Hospital Publishing. Sizer, F. S., and Whitney, E. N. 1997. Nutrition Concepts and Controversies. 7th ed. Cincinnati, OH: West/Wadsworth.

56

Index

INDEX A

Accidents, 36, 38–39 Allergies, 2 Appearance, 1

B

Badges, 2 Batch method, 13 Bathing, 2 Body mechanics, 36

C

Canned goods, 6 Chemicals, 40 Chlorine, 29 Clean/cleaning, 28 Cleaning equipment/surfaces, 21, 33–34, 53 Cleaning products/solutions, 28, 29, 33, 40 Cleanliness, 2, 28 Clostridium, 11 Clothing, 1, 38. See also Uniforms Communication, 43, 44–46 Confidentiality, 46 Cooking equipment, 38, 39 Cosmetics, 2 Cross-contamination, 8, 9, 21, 41, 44 Cycle menus, 17, 18

D

Dating food items, 7, 9, 15 Delivering food, 43, 44 Diets, 17 Dining room area, cleaning/sanitizing, 33, 34 Disaster plan, 41 Dishwashing machine, 29, 30–33, 52 Dry goods, 6 Dry storage, 7–8, 34 Drying, 30

E

Emergencies, 41 Expiration dates, 7

F

Feeding patients, 43, 44, 45 FIFO. See First In, First Out Fire, 38, 39–40 First aid, 39 First In, First Out (FIFO), 7, 8 Floor care, 34, 53–54 Food, potentially hazardous, 11 Food contact surfaces, 29 Food handling, 6, 44 during preparation, serving, and holding, 9, 11–13, 26. See also Trayline prepared foods, 13, 15 receipt into kitchen, 6–7 Food preparation, 13 Food quality, 6, 9 Food service department, 28 Food service items, 41 Food storage, 7–9, 37 Food temperature, 6, 22 cold foods, 13, 22 cooked foods, 12–13, 22 danger zone, 11–12 frozen, 9 monitoring, 9 prepared foods, 15 refrigerated, 8 during storage, 7 taking, 22, 25, 49–50

Foodborne illness, 6, 9, 11, 15 Freezer storage, 9, 34 Frozen foods, 6

R

G

Glass, 38 Glove use, 21 Grooming, 1

Received date, 15 Recipes, 26 Refrigerated storage, 8, 34 Repackaging, 8, 40 Returning food items, 6–7 Rinsing, 28, 29

H

S

Hair care, 2–3 Handwashing, 3–4, 9, 21, 48 after patient contact, 41, 44 Holding time, 12 Housekeeping department, 33

I

Ice baths, 15, 21, 22 Infection control, 41, 44. See also Food handling; Food temperature; Safety Injuries, 36, 38–39 Iodine, 29 Isolation patients, 41

J

Jewelry, 1–2, 38

K

Kitchen, 6–7, 34, 38–39 Knives, 38, 39

L

Labeling, 15 Leftovers, 8–9, 13 Lifting, 37, 54

M

Makeup, 2 Material Safety Data Sheets (MSDS), 40 Meat slicers, 38, 39 Menus, 12, 17 Milk coolers, 9 Mouth care, 3 MSDS. See Material Safety Data Sheets

P

Parts per million (ppm), 29 Patient contact, 43–46 food/liquid intake records, 46 infection risk, 41 serving meals, 44–45 Patient requests, 43–44 Personal hygiene, 2–3 Plating food, 21, 26 Politeness, 43, 46 Portion control, 26 Portioning food, 21, 26 Potentially hazardous food, 11 ppm. See Parts per million Preparation date, 15 Prepared foods, 13, 15 Procedure checklists, 48–54 Procedures cleaning/sanitizing equipment and surfaces, 33 dishwashing machine use, 31–32 floor care, 34 food temperature taking, 25 handwashing, 3–4 lifting, 37 sink setup, 30 trayline breakdown, 27 trayline setup, 22 Produce, 6

Q

Quaternary ammonium compounds (quats), 29

Safety, 36–41. See also Food handling Safety hazard, 2 Salmonella, 11 Sanitation, 2, 21, 28, 29 Sanitizing equipment/surfaces, 28–29, 33, 53 Sanitizing products/solutions, 29, 33, 40 Seasonal food items, 17 Selective menus, 17 Serve date, 15 Serving utensils, 26 Shoes, 1, 38 Sink, three-well, 29–30, 50–51 Snood, 3 Special (therapeutic) diets, 17 Spreadsheets, 17, 19–20 Staphylococcus, 11 Steamtables, 12, 21, 22 Storage areas, 34, 37 Substitute foods, 44, 45

T

Temperature danger zone, 11–12. See also Food temperature Temperature log, 9, 10, 13, 14, 22 dishwashing machine, 32 Thaw date, 15 Therapeutic (special) diets, 17 Thermometers, 9, 10, 22–23, 25 calibrating, 22, 24 dishwashing machine, 32 Traycards, 22 Trayline, 13, 21 breaking down, 26, 27, 50 setting up, 22, 49 Trays, handling/serving, 41, 43, 44

U

Uniforms, 1, 41 Universal precautions, 41

V

Vendors, 6

W

Watches, 2 Water, 29