Rmsss Module 3

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Food Safety Part 1: Hygiene & Sanitation

Practicing good hygiene and sanitation in your child care kitchen is crucial to prevent the spread of foodborne illness. The Food and Drug Administration lists poor
personal hygiene as one of five key factors implicated in foodborne illness outbreaks, along with food from unsafe sources, inadequate cooking, improper holding
temperatures, and contaminated equipment. Poor personal hygiene of workers causes 25 to 40 percent of foodborne-related illness in this country. Children,
especially young children, are at higher risk of experiencing serious health issues if they are exposed to foodborne pathogens. Therefore, knowing how to practice
good hygiene and sanitation is an essential skill for anyone working in a child care kitchen environment. This unit will cover the principles of good personal hygiene
and practices you can employ to have a properly cleaned and sanitized food preparation environment in your child care facility.

Objectives: 
 Explain the process for washing hands.
 List examples of how and when to wash hands.
 Differentiate between cleaning and sanitizing.
 List examples of how and when to clean and sanitize the kitchen.

Handwashing

Food handlers can be a significant source of harmful microorganisms that cause illness; thus, washing your hands regularly using proper techniques is one of the
most important aspects of working in food service. Doing so helps reduce the incidence of spreading germs, including viruses, bacteria, and other pathogens,
including those that might exist on raw foods as you prepare them.

While handwashing seems fairly straightforward, food handlers may not use the correct techniques or allow sufficient time to properly wash their hands. Anyone
who handles food must always wash their hands with soap and running water; hand sanitizers are not recommended as a substitute for handwashing. In fact, the
Centers for Disease Control and Prevention warns against using alcohol-based hand sanitizers in lieu of handwashing because these products do not adequately
reduce important foodborne pathogens on food handlers’ hands, especially bacterial spores, certain viruses, or other protein-based microorganisms. Also, the
ingredients in a hand sanitizer product must be approved food additives by the FDA, since the ingredients from the hand sanitizer can become part of the food in
trace amounts by a food handler. (The FDA defines indirect food additives as “those that become part of the food in trace amounts due to its packaging, storage or
other handling.” All materials coming in contact with food must be proven to be safe “before they are permitted for use in such a manner.”)

Handwashing should always be done at a designated handwashing sink once you have entered the kitchen (even if you washed your hands after using the restroom).
The handwashing sink should be labeled as such and stocked with hot and cold running water, hand soap, single-use paper towels or a hand dryer, and a garbage
can.

Wearing Single-Use Gloves

Food handlers should not touch ready-to-eat foods with bare hands because doing so can transfer pathogens to food. Thus, wearing single-use (disposable) gloves
that fit properly is another practice in the food service industry. Before wearing gloves, a food handler should wash their hands. Once gloves are on, they need to be
changed frequently. Never wash or reuse gloves. Some examples of when gloves should be changed include:
 Before handling any ready-to-eat foods
 If changing tasks (e.g., chopping lettuce, then moving on to making a sandwich)
 If the glove develops a tear
 After gloves become dirty
 After handling raw meat
 After handling money
 After taking out the trash

Proper Attire

Food handlers should come to work in clean clothes. Not only does this give a professional appearance, but dirty clothes carry pathogens that can transfer to food
and cause foodborne illness. Hair restraints (hat, hair net, or beard net) and clean aprons are staples for food handlers. Jewelry, including rings, watches, and
bracelets, should not be worn during food handling for several reasons. These items can harbor bacteria and viruses that could contaminate the food. Jewelry can
also fall into the food and present a choking hazard. A plain band ring is acceptable. Food handlers should also refrain from wearing nail polish or artificial nails
because these can hide dirt or contaminate the food.

Cleaning and Sanitation

Kitchen Surfaces

Cleaning food preparation surfaces is a necessary first step for effective sanitation. Cleaning refers to the removal of organic matter using appropriate cleaning
chemicals under recommended conditions. By removing organic matter through proper cleaning, sanitizers are able to make contact with more of the food contact
area.

After thorough cleaning, sanitation is the next step. Sanitizing includes applying chemicals or heat to a properly cleaned area, reducing pathogens by 99.999
percent. Sanitation is not the same as sterilization, which is the complete removal of all organisms. Chemicals approved as sanitizers for food-contact surfaces in
retail or food-service establishments are chlorine, iodine, and quaternary ammonium.

Be sure to store chemicals in their original containers away from food storage and food preparation areas. If you do transfer a chemical to a new container, label the
container with the chemical name, manufacturer's name and address, and potential hazards of the chemical.

Any surface that touches food must be cleaned and sanitized. This includes cooking equipment (pots, pans, spatulas, forks, knives, cutting boards, food storage
containers, plates, etc.) as well as food preparation surfaces, such as prep tables. Worn or cracked kitchen equipment should be replaced, as it cannot be adequately
cleaned or sanitized and thus harbor harmful pathogens.

Dishwashing

If your facility has a three-compartment sink, the correct setup is as follows:

Compartment 1

Fill with water at least 110 degrees Fahrenheit (43 degrees Celsius).
Add detergent.
Compartment 2

Fill with water.


(Leave this compartment empty if you spray-rinse items.)

Compartment 3

Fill with water. Add the sanitizing solution.


Important: be sure to check the product’s label to determine the proper temperature and concentration, as this varies among different types and brands of sanitizer
chemicals.

If your facility has a dishwasher, the following guidelines are recommended:


 Scrape, rinse, or soak items before washing; presoak items with dried-on food.
 Use the correct rack for the items you are washing. Do not overload the racks; allow space for water spray to reach all surfaces of the items.
 If any items come out still dirty, rewash them.
 Air dry all items once they come out of the dishwasher.
 Check the water temperature, pressure, and sanitizer levels frequently to ensure they are within the correct ranges.

If using heat sanitation methods, temperatures in a dishwasher must fall between 165 F and 194 F (74 C to 90 C) for stationary-rack, single temperature
dishwashers, or at least 180 F (82 C) in all other high-temperature machines. For a three-compartment sink, the water temperature must be at least 171 F (77 C).

Do

As a food handler, it is critical you know how to keep yourself and your work environment as clean as possible to minimize the transfer of pathogens to the food
you prepare. The two tables below provide detailed information on the “how and when” of handwashing and cleaning and sanitizing. Use the Food Safety Cleaning
and Sanitizing summary information from North Carolina State University Extension and familiarize yourself with the information about kitchen cleaning and
sanitizing.
Handwashing

How
1. Wet hands and arms. Use running water as warm as you can comfortably stand.
2. Apply soap. Use enough to build up a good lather.
3. Scrub hands and arms vigorously. Scrub for 20 seconds. Be sure to clean under fingernails and between fingers.
4. Rinse hands and arms thoroughly. Use warm running water and rinse for at least 10 seconds.
5. Dry hands and arms. Use single-use paper towels or a hand dryer. Do NOT use your apron or any other part of your uniform. Do NOT use a multiuse
kitchen towel.
6. Turn off faucet. Use a paper towel to turn off the faucet.
7. Throw paper towel away. Use a hands-free, covered, foot-peddled waste receptacle to throw away the paper towel.

When
 When you arrive to work
 Every time you return to the kitchen
 Before putting on single-use gloves
 Between different jobs in the kitchen
 Before or after handling raw, fresh, or frozen poultry, fish, or meat
 After taking out the garbage, handling dirty dishes, mopping, or sweeping
 After using the restroom
 After coughing, sneezing, wiping, or blowing your nose
 After handling chemicals that might make food unsafe
 After touching your hair or your face
 After using the telephone
 After handling money
 After eating, drinking, or smoking
 After touching anything that might contaminate your hands

Clean and Sanitize Surfaces and Equipment

How
1. Scrape or remove food and debris from the surface. Use towels or other equipment as necessary.
2. Wash the surface. Use the correct cleansing chemical for the job.
3. Rinse the surface. Make sure to thoroughly remove the detergent residue.
4. Sanitize the surface. Use a sanitation solution that has been properly mixed to the correct strength.
5. Allow the surface to air dry.

When
 After you are finished using the surface or equipment
 Before working with a different type of food
 Any time you have to step away from the task and there is potential for the surface to have become contaminated
 After four hours if the surface or equipment has been in constant use

GLOSSARY

INDIRECT FOOD “those that become part of the food in trace amounts due to its packaging, storage or other handling.” All materials coming in contact with food "must be proven to be safe" before they
ADDITIVES are permitted for use in such a manner (from USDA).

MICROORGANISM any living thing such as a bacterium, protozoan, and some types of algae or fungi that are too small to be seen by the unaided eye; they must be viewed under a microscope
PATHOGEN a microorganism that causes disease

Food Safety Part 2: Temperature Control

According to the Centers for Disease Control and Prevention (CDC), an estimated 48 million people get sick from foodborne-related diseases
each year, with 128,000 of them needing hospitalization. Keeping food at a proper temperature is one of the most important things a food handler
can do to prevent bacteria that cause foodborne illness from growing rapidly. Leaving certain foods out for a long time in certain temperatures
creates conditions for bacteria to grow, sometimes to dangerous levels. Limiting how long foods spend in growth-promoting temperatures
minimizes the risk of someone getting sick. This unit will cover which foods are most at risk for harboring pathogens, how to control time and
temperature to minimize bacterial overgrowth, and the proper way to take the temperature of foods throughout the food preparation process.
Objectives: 
 Define TCS food and name two examples of TCS foods.
 Describe the temperature “danger zone” and how exposure time can create an optimal environment for bacteria to grow.
 Identify four instances when controlling time and temperature is critical in the food preparation process.
 List three ways to properly thaw frozen foods.
 Demonstrate the proper way to take temperatures of various types of food.

TCS Food
All food can potentially carry harmful bacteria, but some foods are especially conducive to promoting bacterial growth. Several factors affect the
rate at which bacteria grow in food, but time and temperature are two of the most easily-controlled factors in a food service kitchen. Food that
requires time and temperature control for safety is referred to as TCS food. TCS food has several attributes that make it ideal for bacterial growth,
such as moisture, protein, and a neutral or slightly acidic pH.
TCS food can be whole food, or it can be food that has already been prepared, like a casserole. TCS food can be from animal or plant sources.
Foods that are considered TCS include:
 Milk and other dairy products
 Meat (beef, pork, lamb) or poultry (chicken, turkey)
 Fish and shellfish
 Eggs
 Baked potatoes
 Plant-based foods that have been heat-treated (cooked rice, beans, or vegetables)
 Soy foods (tofu, textured soy protein/meat alternatives)
 Sliced or cut fruits or vegetables (e.g. cantaloupe or melons, leafy greens, tomatoes, etc.)
 Bean sprouts and sprout seeds
 Untreated garlic-and-oil mixtures

Factors that Affect Bacterial Growth


There are six factors that affect bacterial growth on food. These are food, acidity, time, temperature, oxygen, and moisture. How acidic a food is,
as measured by pH, can also influence how quickly bacteria can grow. Bacteria tend to grow in foods with a pH between 4.6 and 9.0. Low pH
foods—those that are more acidic—include things like pickled foods, jams or jellies, honey, and fruits. High pH foods—those that do not have
much acidity—include meats, milk, and vegetables. Most bacteria that cause foodborne illness grow well in conditions that do not have much
oxygen, which is why it is important to control other factors that promote bacterial growth in food. Bacteria need moisture to grow, and the
amount of moisture in a food is measured by water activity. The higher the moisture in a food, the better the conditions for bacterial growth. The
water activity scale ranges from 0 to 1.0, with distilled water being 1.0. Most foods have a water activity of at least 0.95, meaning that bacteria
have sufficient moisture to grow.
A food handler cannot control a food’s acidity, oxygen, or moisture; these properties are inherent to the food itself. However, in food service, the
remaining two factors, time and temperature, can be controlled. Time and temperature are closely related. Bacterial growth in ideal conditions
happen rapidly: the amount of bacteria can double every 15 to 20 minutes. This is especially true when the temperature of food falls in
the temperature danger zone. The temperature danger zone ranges from 41 F to 135 F (5 C to 74 C). The longer a food stays in this temperature
range, the higher the risk for bacteria to grow rapidly in a TCS food. It is recommended to limit the length of time a TCS food is in the
temperature danger zone to no more than four hours.

Controlling Time & Temperature from Receiving through Preparation

Receiving Food
It is important to make sure you check the temperature of TCS food during the receiving process. This will help you gauge whether food was
exposed to the temperature danger zone during transit. Document each food’s temperature on a designated temperature log. Refrigerated TCS
foods should arrive at 41 F (5 C) or colder. Frozen TCS food should arrive at 0 F (-18 C) or colder. Hot TCS food should be received at 135 F (57
C) or higher; as with cold or frozen TCS food, be sure to document the temperature of hot TCS food upon receipt using a designated temperature
log. Frozen TCS food with ice crystals or frozen liquid, fluids, or water stains should not be accepted. Additionally, any food that has passed its
use-by or expiration date, has an off odor, abnormal color, or mold, or any meat, fish or poultry that is slimy, sticky, or dry should be rejected.

Storing Food
Maintaining proper temperature during storage of TCS food is very important. Temperatures should be checked and recorded regularly. Food
storage time should be documented. This is accomplished through writing down the date a food was put into storage and when it should be used
directly on the food itself. Labels are a good way to do this. Here are some safety tips for safely storing TCS food:
 Refrigerated TCS food should be stored at 41 F (5 C) or colder so that the internal temperature of the food maintains this temperature.
 Keep frozen food frozen; do not allow it to thaw.
 Do not overcrowd freezers or refrigerators; this can cause the temperature inside the equipment to become warmer and expose the food to
dangerous temperatures.
 Minimize how often you have to open refrigerator and freezer doors.
 Label TCS food when it goes into storage. The label should include the name of the food, the date it went into storage, and the date it
should be used by. Ready-to-eat TCS food prepared on-site in your facility must be used within seven days if held at 41 F (5 C) or lower.
 Be sure to rotate food during storage so that the food with the earliest use-by date is in front of foods with later dates. (As discussed in
Lesson Four, this is called FIFO rotation, or first in, first out.)

The proper temperatures for kitchen equipment are as follows:


 Refrigerators: 40 F (4 C) or colder
 Freezers: 0 F (-18 C) or colder
 Dry storage: 50 F to 70 F (10 C to 21 C), with relative humidity of 50 to 60 percent

Record the temperature of your facility’s walk-in refrigerators and freezers on an approved temperature log. Your program may use a specific
form, or you can use the temperature log template below.

Thawing Food
There are four ways to properly thaw frozen food. Which method you use depends on the type of food you thaw. It is important to thaw food
properly to minimize how much time the food is in the temperature danger zone to inhibit bacterial growth.

Thawing Method

1. In the refrigerator
Thawing food in the refrigerator takes at least 24 hours, so this method requires planning ahead. Place the food on a tray in case any fluids
leak from the package. Food should be placed on the bottom shelf of the refrigerator to thaw. The temperature inside the refrigerator should
be 40 F (4 C) or colder.

The refrigerator method is the safest method for thawing meat and poultry.

2. In cold water
This method is quicker than the refrigerator method and usually takes several hours, depending on the weight of the food. Place the frozen
food item in a watertight plastic bag and completely submerge the bag under cold running water, 70 F (21 C) or colder. If thawing using this
method, the food must not be above 41 F (5 C) for more than four hours. Once thawed, food should be immediately cooked.

3. In the microwave
Use the microwave method for immediate thawing and cooking. To thaw food using the microwave, remove all original packaging and place
the food in a microwave-safe container. Follow the instructions in the microwave’s user manual for thawing foods (or defrosting foods) in
the microwave. (This method is not ideal for large meat items like roasts or turkey.)

Once thawed, the food should be cooked immediately.

4. As part of the cooking process


Food can be thawed as part of the cooking process, such as when you cook a frozen hamburger patty. Cooking frozen food directly does add
to the total cooking time required for the internal temperature of the food to reach the required temperature for that food.
Source: Academy of Nutrition and Dietetics, National Restaurant Association

Preparing Food
When preparing TCS food, make sure that the food is not exposed to the temperature danger zone for too long. The total amount of time that a
TCS food can be in the danger zone is fewer than four hours. During preparation of TCS food, pay attention to how long the food is in the danger
zone. Prepare TCS food in small batches, which helps prevent ingredients from being in the temperature danger zone for too long. Once the food
is prepared, return it to the refrigerator as quickly as possible.

Controlling Time & Temperature during Cooking, Holding, Cooling, and Reheating

Cooking Food
To reduce the risk of foodborne illness, TCS food should be cooked to an internal temperature specific to the type of food item it is. The table
below lists the minimum internal temperature for various TCS food categories, as well as how long each food should be at that temperature.

Rest
Category Food Temperature
Time

Ground meat & mixed Beef, pork, veal, lamb 160 F for 15 seconds None
dishes

Chicken, turkey 165 F for 15 seconds None


Rest
Category Food Temperature
Time

Fresh beef, veal, or lamb Steaks, chops, roasts 145 F for 15 seconds 3 minutes

Poultry Whole or cut up chicken, turkey, duck, 165 F for 15 seconds None
or goose

Stuffing (cooked alone or inside a bird) 165 F for 15 seconds None

Pork or ham Fresh pork or ham 145 F for 15 seconds 3 minutes


Rest
Category Food Temperature
Time

Precooked ham 140 F for 15 seconds None

Eggs & egg dishes Eggs Cook until yolks and whites are firm None

Egg dishes 160 F for 15 seconds None

Leftovers & casseroles Any leftover dish being reheated 165 F for 15 seconds None

Casseroles 165 F for 15 seconds None


Rest
Category Food Temperature
Time

Seafood Fin fish 145 F for 15 seconds None

Shrimp, lobster, or crabs Cook until flesh is pearly and opaque None

Clams, oysters, or mussels Cook until shells open None

Scallops Cook until flesh is milky white or opaque None


and firm

Holding Food
Once a TCS food has been cooked, it must be held at the correct internal temperature for that food. Cold TCS food must maintain a temperature
of 41 F (5 C) or colder, while hot TCS food must maintain a temperature of 135 F (57 C) or hotter. Using covers whenever possible helps to
maintain the proper temperature of TCS food. Temperatures of held TCS food should be taken every two hours. Any prepared food that falls in
the temperature danger zone (41 F - 135 F) for more than four hours should be thrown out.

Cooling Food
Guidelines for cooling TCS food are as follows: first, bring the food down from 135 F (57 C) to 70 F (21 C) within two hours. If the food does
not reach 70 F within two hours, it will need to be reheated to 135 F (57 C) and then cooled again. Next, bring the temperature down from 70 F
(21 C) to 41 F (5 C) within four hours. The total cooling time should not exceed six hours. The best ways to cool foods rapidly include using an
ice bath, transferring the food to a shallow pan, and dividing dense foods, like lasagna or casserole, into smaller portions. Record the temperature
of the food during the cooling process on a temperature log to ensure that it cools properly.

Reheating Food
When reheating food, the internal temperature of the food must reach 165 F (74 C) within two hours. Take the temperature to ensure the food has
reached 165 F (74 C) for 15 seconds. Once this minimum temperature has been reached, the food should be held at 135 F (57 C) or warmer.

What Does Temperature Control and Proper Cooling Look Like?


Controlling how long TCS food is in the temperature danger zone is critical to minimizing the risk of foodborne illness. Make sure to properly
and rapidly cool down hot TCS food to minimize foodborne illness. Watch the following video, which discusses the importance of temperature
control in commercial food preparation.

eFoodHandlers Basic Food Safety Chapter 3: Temperature Control video: https://www.youtube.com/watch?v=0dL9et91nJA

Different foods need to reach certain temperatures during the cooking process. How do you take the temperature to ensure you are getting an
accurate read on the thermometer? The answer depends on the type of food you cook. For meat and poultry, insert the thermometer into the food
in the thickest part for at least 15 seconds. If the meat or poultry has a bone, make sure the thermometer does not touch the bone—the bone holds
more heat than the surrounding muscle tissue and thus might not indicate that the edible part of the food has reached the correct temperature. For
meats like hot dogs or hamburgers, you will need to stick the thermometer through the vertical end. For casseroles and mixed dishes, insert the
thermometer into the center of the dish.

The video below demonstrates the proper way to take temperatures of different foods during the cooking process. Watch the video, and discuss
the process with your supervisor. Hang the Use That Thermometer mini-poster in your kitchen facility.

GLOSSARY

HACCP - a preventative food safety control system that takes into account the hazards in food
HAZARD
ANALYSIS
CRITICAL
CONTROL
POINTS

TCS FOOD any food that requires time and temperature control to minimize the growth of bacteria.

WATER the ratio of vapor pressure in a food relative to that of distilled water. (Pure distilled water has a water
ACTIVITY activity of 1.0.) It gives an indication of how much moisture is available to bacteria in the food to grow.
Most foods have a water activity of at least 0.95, meaning that conditions are ideal for growth of
bacteria, yeast, or mold.
TEMPERATURE the temperature range at which bacteria most readily grow; this range is 41 F to 135 F (5 C to 57 C).
“DANGER
ZONE”

Food Safety Part 3: Pathogens and Allergens

People often interchange the terms “cross-contamination” and “cross-contact.” They are very different. Cross-contamination affects the transfer of food pathogens
(such as bacteria, viruses, or fungi), whereas cross-contact refers to the transfer of food allergens. Allergens only affect people who have sensitivities to them,
whereas anyone can get sick if they eat food that has been contaminated with a pathogen. Understanding the steps for preventing both cross-contamination and
cross-contact is useful for people who handle food in child care centers. Food service employees should know the major food allergens and also how to respond to
an allergic reaction. This lesson will give you the background needed to differentiate between pathogens and allergens and how to reduce the risk of illness in your
facility.

1. Objectives: 
 Name two pathogens that cause foodborne illness and list measures that can be taken to minimize the risk of foodborne illness.
 Describe how to prevent cross-contamination during food preparation and food storage.
 Differentiate between food intolerance and food allergy.
 List three best practices for preventing cross-contact during food preparation.
 Explain how children with food allergies can be accommodated in the child care environment.

Food Pathogens
Food pathogens are microorganisms like bacteria, viruses, and to a lesser extent, fungi, that cause disease when ingested. When someone eats a food contaminated
with a pathogen, they become sick. This is known as foodborne illness. According to FoodSafety.gov, the top foodborne-illness-causing pathogens that require
hospitalization in the U.S. are:
 Salmonella
 Norovirus (Norwalk virus)
 Campylobacter
 E. coli
 Listeria
 Clostridium perfringens

A summary of each of these pathogens, their common food sources, and how to minimize the risk of contamination for them is presented in the following table:

Pathogen Food Sources Minimizing Risk

Salmonella Any raw food of animal origin (e.g., meat, poultry, milk and dairy Safe food handling practices are necessary to prevent
products, eggs, seafood) and some fruits and vegetables may bacteria on raw food from causing illness. This includes
carry salmonella bacteria. The bacteria can survive to cause illness proper, frequent handwashing; avoiding cross-contamination
if meat, poultry, and egg products are not cooked to a safe with other foods during all parts of the food-preparation
minimum internal temperature, or if fruits and vegetables are not process; and cooking foods to a safe minimum internal
thoroughly washed. Salmonella can also contaminate other food temperature.
that comes in contact with raw meat and poultry. 

Norovirus Any food served raw or handled after being cooked can become Norovirus is the leading cause of foodborne illness in the
contaminated with norovirus. Other sources include contaminated U.S. Most outbreaks occur in food service settings; food
foods, such as oysters, fruits, or vegetables that may have already handlers are often the source of the outbreaks. Safe food
been contaminated during production. handling practices (e.g., frequent handwashing using proper
techniques, wearing clean disposable gloves when handling
food, and changing gloves often) can minimize most risk of
norovirus transmission. Also, making sure to properly wash
fresh fruits and vegetables and cooking other foods to a safe
minimum internal temperature can help reduce the incidence
of norovirus.

Campylobacter Meat and poultry can contain campylobacter. The bacteria can be Campylobacter bacteria are extremely fragile and are easily
found in almost all raw poultry because it lives in the intestinal destroyed by cooking to a safe minimum internal
track of healthy birds. temperature. Freezing cannot be relied on to destroy the
bacteria.
E. coli Contaminated foods (e.g. undercooked ground beef, unpasteurized Wash hands often, especially after changing diapers or any
milk and juice, soft cheeses made from unpasteurized milk, and contact with animals. Wash hands before preparing or
raw fruits and vegetables), untreated water, and any foods handled touching food. Cook foods to a safe minimum internal
with unclean hands can be sources of E. coli. temperature. Avoid eating high-risk foods that are sources of
potential E. coli contamination.

Listeria Foods that are sources of potential Listeria contamination include The risk of Listeria contamination can be reduced through
ready-to-eat deli meats and hot dogs, refrigerated meat spreads, proper washing of fresh produce, storing raw animal-
unpasteurized (raw) milk and dairy products, soft cheese made based food products separately from other foods, washing
with unpasteurized milk (queso fresco, feta, Brie, Camembert), hands and cleaning and sanitizing food preparation surfaces
refrigerated smoked seafood, or raw sprouts. Foods processed in and equipment after handling uncooked foods, eating
facilities without adequate sanitation practices in place can also perishable and ready-to-eat foods as soon as possible,
harbor Listeria. avoiding consuming unpasteurized dairy products, and
heating hot dogs and deli meats prior to consumption.

Clostridium Beef, poultry, and gravy—and any mixed dishes made with these Clostridium perfringens is one of the most common causes
perfringens foods—are the most common food sources for Clostridium of food poisoning in the United States. Cooking kills
perfringens. Additionally, foods prepared in large batches and held growing Clostridium perfringens cells that cause food
or warmed for a long time before serving can cause Clostridium poisoning, but not necessarily the spores that can grow into
perfringens infections. new cells. If cooked food is not promptly served or
refrigerated, the spores can grow and produce new cells.
Thoroughly cooking food and keeping food out of the
temperature danger zone minimizes the risk of
contamination.

Sources: USDA Food Safety & Inspection Service, Centers for Disease Control & Prevention, and FoodSafety.gov.

Factors that Affect Bacterial Growth

As mentioned in Lesson Six, there are six factors that affect bacterial growth on food. These include food, acidity, time, temperature, oxygen, and moisture. This is
sometimes referred to by the acronym “FAT TOM.” Some foods are more prone to bacterial contamination due to their characteristics. These include foods like
meat, poultry, and seafood products; dairy products like milk and cheese; fresh produce like fruits and vegetables; soy products like tofu; and flavored oil
immersions. Cooking destroys many of these bacteria, but not all food is cooked prior to serving. When preparing these foods, the food handler should always take
proper precautions to avoid transferring the bacteria from these foods to other foods that will be served ready-to-eat or that are already fully cooked.

Preventing Cross-Contamination

During Storage

Cross-contamination occurs when pathogens in one food are transferred to another food, either directly or indirectly through contaminated surfaces. This transfer
can happen at many different points in the food preparation process. While it is always best to strive to keep contaminated food out of the kitchen to begin with, it’s
not always possible to do this. Thus, safe food-handling practices become essential to minimizing the transfer of pathogens from contaminated (or potentially
contaminated) foods.
Storage is one place where cross-contamination can occur. Proper storage practices include storing food in designated areas only and not with nonfood items,
including chemicals. All food (and nonfood) items should be stored at least 6 inches off the floor and away from walls and ceilings. Food should be stored in
wrapped or closed containers to prevent contaminants from getting in. Do not reuse nonfood containers to store leftover food; instead, food should only be stored in
equipment designated for food.

If your facility has the space and equipment, it is ideal to store raw or uncooked food separately from ready-to-eat food in the refrigerator. If not, though, the
recommended storage practice is as follows:
 Top shelf (ready-to-eat foods): milk, fresh produce, cheese, salads, yogurt
 2nd shelf (cook to 140 F): reheated foods (precooked), such as ham or breaded chicken
 3rd shelf (cook to 145 F): fresh beef (not ground beef) or pork, seafood
 4th shelf (cook to 160 F): ground beef or pork, eggs
 Bottom shelf (cook to 165 F): raw chicken or turkey (including ground), leftovers, casseroles

During Preparation

Another opportunity for cross-contamination to occur is during food preparation. Doing things like properly washing hands, washing hands often, and wearing and
changing disposable gloves can prevent the transfer of pathogens. Make sure the food prep area, including surfaces and equipment, are thoroughly cleaned and
sanitized. Another good practice is to prepare raw or uncooked meat, poultry, and seafood at a different time than ready-to-eat foods, and then clean and sanitize the
surfaces and equipment when you are done. Never allow ready-to-eat foods to touch surfaces that have come into contact with raw or uncooked meat, poultry, or
seafood.

Not all foods that are at risk for harboring pathogens are meats. Fresh fruits and vegetables can also carry pathogens from growing conditions or handling before
they arrive at your facility. Thoroughly wash all fresh produce under warm, running water to remove any dirt or residue. Foods like lettuce and spinach should have
each leaf washed separately. Remember to scrub the peels or rinds of fruits and vegetables before cutting them, because if there are pathogens on the outside of the
food, cutting them will transfer the pathogens inside as the food is cut. Once fresh produce has been prepped, it needs to be stored, wrapped and labeled in the
refrigerator until served. Use the Preventing Contamination During Food Preparation Fact Sheet below from the National Food Safety Management Institute
and make this resource available to all food service staff at your facility.
 National Food Safety Management Institute’s  Preventing Contamination During Food Preparation Fact Sheet

Cross-Contamination from Chemicals

The chemicals used to clean and sanitize the kitchen can be another source of contamination. Although this type of contamination is not from pathogens, it can still
make people sick. Chemicals used in food service should be stored in their own area, away from food and nonfood-related supplies and equipment. Chemicals
should be stored in proper containers, which are those labeled with the information about the chemical. Do not reuse old food containers to store chemicals.

Towels used for cleaning and sanitizing should be kept in their respective pails when not in use. Towels used to clean food spills should not be used for any other
purpose; doing so can cause cross-contamination. Make sure that all cleaning agents and sanitizing solutions are used in the proper concentrations and that residues
are rinsed or wiped clean.

Food Allergens

Food Allergies vs. Food Intolerances—What’s the Difference?

Many people get food allergies confused with food intolerances. While both conditions can cause adverse symptoms as a result from exposure to a trigger
food, food intolerances only involve the digestive system and do not involve an immunological response from the body. Common food intolerances include gluten,
milk and dairy, and monosodium glutamate. Although food intolerances do not cause life-threatening symptoms, they can still be very uncomfortable for the food-
intolerant child, and considerations should be made when menu planning.

Food allergies, on the other hand, occur when certain foods are ingested, triggering an immune response by the body. When a person with a food allergy is exposed
to the trigger food, their body starts producing a specific antibody, called immunoglobulin E, that binds to a protein in the food that is responsible for the allergy.
This, in turn, causes allergic symptoms such as hives, rashes, and restricted breathing.
Children may not be good at articulating their symptoms, especially young children. A child experiencing symptoms from an allergic response to a food might say
things like:
 My throat is itchy/scratchy/puffy/feels tight
 My tongue is hot/itchy/tingly
 There’s something stuck in my throat
 My mouth feels funny
 This food is spicy (especially when not eating a spicy food)

Symptoms of an allergic response can be mild or severe. Mild symptoms can include hives or rash, nausea or vomiting, stomach pain, nasal congestion, or a runny
nose. Severe allergic response includes symptoms like swollen or puffy lips, tongue, or throat; shortness of breath; tightness in the chest; dizziness; rapid heartbeat;
a drop in blood pressure; or anaphylaxis. Severe allergic symptoms need to be addressed right away, as death can occur if not treated promptly. If a child exhibits
symptoms of anaphylaxis, he or she will require immediate medical treatment, including an epinephrine injection and a trip to the emergency room. Check your
center’s policy for storage, administration, and training related to epinephrine medications. An allergic child should have a designated person to administer
emergency medication in her or his food allergy action plan on file at the center.

While the supervision of children during mealtimes is primarily the responsibility of direct care staff, it is important for all program staff to be aware of the signs of
an allergic reaction and the necessary steps for addressing the situation.  Check with your program’s specific protocols for handling food allergies.

The 8 Major Food Allergens

The proteins of specific kinds of foods are responsible for food allergies. While there are more than 160 types of foods that can cause an allergic response in
sensitive individuals, these eight foods account for 90 percent of food allergy reactions:
1. Milk
2. Eggs
3. Fish
4. Crustacean shellfish (e.g. crab, lobster, shrimp)
5. Tree nuts (e.g., almonds, walnuts, pecans)
6. Peanuts
7. Wheat
8. Soybeans

These foods—and any food containing them—by law must be identified on the food product’s label. The allergen can be identified in the ingredients list, or at the
end of the ingredients list, with a statement such as “Contains wheat, soy, and milk ingredients.” Some companies may also opt to use precautionary labeling, in
which they voluntarily disclose when a food product that does not contain any of the eight major food allergens is produced in a facility where these allergens are
also processed. An example of a statement might read, “Processed in a facility that also processes peanuts and tree nuts.” Precautionary labeling is not required by
law and can vary widely in its use. Make sure to check the labels of all food products for the presence of allergens during the receiving process. When you serve the
food, a recommended practice is to keep the labels of all foods prepared for 24 hours in the event a child suffers an allergic reaction. You might even consider
keeping a “label library,” where you retain all actual food labels (or scan them and save them electronically).

Avoiding Cross-Contact

Child care centers are responsible for promoting a safe physical environment that protects children with food allergies. State and local health regulations outline
requirements governing the cleaning and sanitizing of surfaces and other practices that can protect against cross-contact during food preparation. Cross-contact
refers to the unintentional transfer of an allergen from a food containing that allergen to a food that does not contain the allergen. It is important to understand
that cooking does not reduce or eliminate the chances of a person with a food allergy having a reaction to the food eaten.

Some practices to reduce the incidence of cross-contact include:


 Clean and sanitize—with soap and water or all-purpose cleaning agents and sanitizers that meet state and local food-safety regulations—all surfaces that
come into contact with food in kitchens, classrooms, and other locations where food is prepared or eaten.
 Clean and sanitize food preparation equipment, such as food slicers, and utensils before and after use to prevent cross-contact.
 Clean and sanitize trays and baking sheets after each use. (Oils can seep through wax paper or other liners and cause cross-contact.)
 Use proper handwashing procedures that emphasize the use of soap and water. Hand sanitizers are not effective in removing food allergens, which are
protein-based substances.
Other best practices that food service staff can use to reduce the incidence of cross-contact when preparing food include:
 Prepare and store allergen-free foods separate from other foods.
 Label foods with stickers, color coding, or other methods to indicate whether a food is allergen-free.
 Store allergen-containing foods away from other foods to prevent cross-contact.
 Prepare allergen-free menu items first. These foods may need to be prepared on a separate, clean pan to avoid cross-contact.
 Wear a new pair of disposable gloves when preparing and handling allergen-free foods.
 Thoroughly wash any work surface with detergent solution using a clean towel. Rinse with clean water. Sanitize surface and allow to air dry
 Change your water and obtain a different cleaning towel before cleaning any other area of the kitchen, serving, or dining area.
 Be certain that all utensils, knives, cutting boards, or other equipment are cleaned and sanitized before use on next product. Change apron as needed to
prevent cross-contact.
 Familiarize yourself with the children who have food allergies.
 Train staff and other personnel to recognize symptoms and monitor the area surrounding the child with allergies.
 Designate an allergy-free area and or table (note that children cannot be required to use these designated allergen-free zones because of privacy laws).
 Clean all tables and chairs thoroughly with soap and water and sanitize with approved sanitizing agent. Use a dedicated bucket for both cleaning and
sanitizing a peanut-free area.

Accommodating Children with Food Allergies in Child Care Centers

The National Food Safety Management Institute identifies four strategies or steps to accommodate children with food allergies.

Step 1: Be aware of the food allergies in your child care center; consider the various allergies as you go about menu planning, reading labels, and following safe
food-handling principles. 

Step 2: Know the requirements for serving food to students with special dietary needs. This information is in the USDA guidance, and if your child care center has
a food allergy policy, the information would be there, as well.
Step 3: Develop a partnership with open communication and education for all those involved with the child’s care. Parents of students with food allergies have a lot
of experience and expertise in the topic, so they can be an asset to the child care center’s team.

Step 4: Implement the directives of a licensed physician, physician assistant, or nurse practitioner. If a child has a form on record with the center that indicates the
student has a food-related disability as defined by the Americans with Disabilities Act Amendment Act of 2008, food services is required to make the
accommodation. If there is no disability, the accommodation is not required, but can be made as a gesture of support and customer service.

Because food allergies can be severe—and potentially life-threatening—child care providers must be aware of all allergies in the children in their classroom or care
group. Proper and accurate documentation and regular communication between parents, child care center directors, classroom staff, and food service personnel can
help to keep everyone in the loop about food allergies. For instance, the child care center’s director should discuss allergies with the child’s family when the child is
being enrolled. Any information about the child’s allergies, including treatment plans, should be documented in the child’s file. As food service personnel, your
responsibility is to know which allergies, restrictions, and preferences are present at your center so that the menu planning process can account for these situations.

Food Allergy Action Plans

The Centers for Disease Control and Prevention published a resource in 2013 called Voluntary Guidelines for Managing Food Allergies in Schools and Early Care
and Education Programs. This is a comprehensive resource for food service personnel when it comes to procedures for addressing food allergies. One outcome of
the CDC’s work was the recommendation for each facility to develop a food allergy management plan with these five priority areas:
1. Ensure the daily management of food allergies in individual children.
2. Prepare for food allergy emergencies.
3. Provide professional development on food allergies for staff members.
4. Educate children and family members about food allergies.
5. Create and maintain a healthy and safe educational environment.
Does your center have an allergy plan? If so, are any of these five areas in your plan? Make the following resource, CDC Voluntary Guidelines for Managing Food
Allergies in Schools and Early Care and Education Programs available for use at your facility.
 CDC  Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs

See

How do Department of Defense child care centers handle food allergies? What are some of the steps involved in documenting and tracking food allergies? What are
some of the processes used when preparing food for food-allergic children? How is cross-contact minimized? Watch these video clips, in which a registered dietitian
(or food service director) explains best practices to track and manage food allergies in child care kitchens.
Allergens
Watch this video to learn how to best manage and track food allergies in your child care kitchen.

Do

How much do you know about preventing foodborne illness from unsafe food handling in your facility? Use the Foodborne Illness Self-Assessment Tool below to
determine your facility’s risk. Answer each item on the survey. If you do not know an answer, check with your supervisor. Later, discuss with your supervisor how
you can adapt your practices to better prevent foodborne illness.
 Foodborne Illness Self-Assessment Tool

EXPLORE

In the following video, a food service employee goes about the food preparation process for making lunch. Write down each point where cross-contamination could
occur. Make a note of instances when the employee does something right to minimize the occurrence of cross-contamination.
Cross Contamination
Look for potential points of cross-contamination and quality practices to minimize contamination.
APPLY

Two key skills of food service workers in child care centers is to know how to address food allergies and how to respond when a child suffers from an allergic
reaction. Use the Food Allergens at My Center checklist to see where you may need to make changes. Then, meet with the child care center director and find out
what allergies are present at your center. Does each child with an identified allergy have an allergy care plan on file? How does it compare to the Food Allergy
Research & Education’s (FARE) Food Allergy & Anaphylaxis Emergency Care Plan (see below)?

What allergies are present at your facility?

Go through the food inventory you have in your kitchen. Check the labels on each package. How many foods did you find that are referred to in allergy care plans
on file with the center?

Discuss with your supervisor your center’s protocol for addressing food allergies. If training is required to respond to food allergies, arrange to schedule that
training.

GLOSSARY

ANAPHYLAXIS a severe, and potentially life-threatening, allergic reaction that involves multiple body systems, such as the respiratory system,
digestive system, circulatory system, or skin.

CROSS-CONTACT the unintentional transfer of an allergen from a food containing that allergen to a food that does not contain the allergen

CROSS- the transfer of a pathogen (such as bacteria, viruses, or fungi) or chemical from a food or surface to another food or surface
CONTAMINATION

FOOD ALLERGY a reaction to a food that results in an immune response by the body

FOODBORNE sickness caused by ingesting a foodborne pathogen, such as a bacteria, virus, or fungus
ILLNESS

FOOD when a person has difficulty digesting certain foods and can result in symptoms such as intestinal gas, abdominal pain, or diarrhea;
INTOLERANCE food intolerances involve the digestive system but do not invoke an immune response

FOOD PATHOGEN microorganisms like bacteria, viruses, and to a lesser extent, fungi, that cause disease when ingested

FOOD-RELATED the Americans with Disabilities Act Amendments Act of 2008 broadened the definition of disability to include “Major Bodily
DISABILITY Functions,” which includes “functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain,
respiratory, circulatory, cardiovascular, endocrine, and reproductive functions.” Children who have a medical form signed by a
licensed physician stating that the child has a food-related disability that requires a food substitution must be accommodated under
this amendment of ADA. If a required meal component is substituted with a non-creditable food to accommodate a child with a
food-related disability, that meal remains reimbursable to the child care institution.

DEMONSTRATE

Q1

Which of the following is not a best practice for preventing cross-contact during food preparation?

a) Preparing and storing allergen-free foods separate from other foods.

b) Labeling foods by using stickers, color coding, or other methods to indicate whether a food is allergen-free.
c) Preparing allergen-free menu items first.

d) None of the above

Q2

True or false? Food intolerances are the same as food allergies.

True

False

Q3

What is the difference between "cross-contamination" and "cross-contact"?

Cross-contamination affects the transfer of food pathogens (such as bacteria, viruses, or fungi), whereas cross-contact refers to the transfer of a food
allergens.

Cross-contamination and cross-contact are roughly equivalent.

Cross-contamination only occurs in large food production facilities, while cross-contact occurs in both large and small facilities.

Cross-contamination refers to food products derived from livestock, whereas cross-contact refers to non-perishable food products.
References & Resources: 
American College of Allergy, Asthma, and Immunology. (2014). Retrieved from https://acaai.org/allergies/anaphylaxis
(2013). Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and
Human Services. Retrieved from https://www.cdc.gov/healthyschools/foodallergies/pdf/13_243135_A_Food_Allergy_Web_508.pdf
Eller, P. & Skolmowski, J. (n.d.). Food Allergies: Think Smarter, Not Harder. Washington, D.C.: U.S. Department of Agriculture. 
Food Allergy Research & Education. (n.d.). Retrieved from https://www.foodallergy.org/
National Food Service Management Institute. (2014). Managing Food Allergies in School Nutrition Programs online training module.
National Restaurant Association’s ServSafe Course Book, 6th edition. 2014.
University of Mississippi. (2016). Food Safety in Child care: Instructor’s manual.
USDA Food and Nutrition Service. (2017). Accommodating Children with Special Dietary Needs in the School Nutrition Programs. Guidance for School Food
Service Staff. Retrieved from https://www.fns.usda.gov/2017-edition-accommodating-children-disabilities-school-meal-programs

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