Chapter 5: Food Safety

Organic Foods

• Organic standards do not specifically address safety issues such as microbial or chemical hazards.

• Foodborne illness outbreaks reported from ____________ have increased in recent years.

• Food safety precautions are necessary with all food— _______ and conventional foods.

• Raw milk and fresh produce, whether conventionally or __________ produced, are common vehicles for pathogens.

Antibiotics

• Are approved for use in food animals under specific situations:

  • to treat disease in animals that are sick

  • to control disease in a group of animals when some of the animals are sick

  • to prevent disease in animals that are at risk for becoming sick.

• Previously, routinely given in low doses to healthy animals, this contributed to the emergence of antibiotic-resistant bacteria.

• Currently, the use of _________ in healthy animals for the purpose of promoting weight gain is prohibited.

• Requires a veterinarian’s approval before using ___________ that are important for human health.

Food Safety Concerns

• Dysphagia (difficulty swallowing) increases risk for aspiration of food

• Reducing the risk of foodborne illness

• Assessing for food allergies

• Understanding food‑medication interactions

Speech Pathologist

Swallow evaluation for dysphagia is done by a…

Dysphagia

• Difficulty in one or more phases of the swallow.

• May result from a variety of disorders and medical conditions. A few include stroke, Parkinson’s disease, head and neck cancer, tracheotomy, and dementia.

• Depending on the type and severity of their dysphagia, some patients with dysphagia are at risk for aspiration, subsequent pneumonia, malnutrition and dehydration which can increase hospital length of stay and the patient’s risk for mortality

NPO

nothing by mouth

clear liquids

• light can pass through them

• grape juice, apple juice, cranberry juice, coffee, tea, clear broth, plain gelatin, ginger-ale

• contains primarily carbohydrates and water

full liquids

• any liquid

• any kind of liquid (coffee with creamer, ice cream, orange juice), fruit & vegetable juices, yogurt, pudding, and hot cocoa

Why someone would be on a clear/liquid diet

• Following surgery

• Replace fluids after vomiting or diarrhea

• Prior to exposure to certain types of x-rays

• Patients with digestive problems

• Patients with acute infections

thickened liquids

soups, pudding, ice cream

soft/dysphagia diet

• soft, low fiber food like mash potatoes, apple sauce, pureed soups, cooked fruits & vegetables.

purpose of a soft diet/ why someone would be on a soft diet

• Following surgery

• Patients with digestive problems

• Patients with problems chewing

• Patients with certain types of infections

Clinical Impact of Aspiration

• Respiratory Status Decline

• Acute airway obstruction

• Bacterial infections including pneumonitis, infiltrates, lung abscess

decreased respiratory status results in…

• Death

• Intubation

• Mechanical ventilation

• Patient discomfort and longer hospital stay

Treating Dysphagia

• Dietary modifications

• Dysphagia therapy including exercises, strategies to make eating/drinking safer, and postural modifications

• Medical or surgical interventions

Screening for dysphagia

testing gag reflex

General Aspiration Precautions

Taken to prevent aspiration and respiratory status compromise in any patient that is eating ORALLY or receiving ENTERAL feeding

• Monitor level of alertness, only feed patients who are FULLY alert.

• Position patients upright during P.O. or enteral feedings and for at least 30 minutes after.

  • This means as close to 90° angle between the top of the body and the bottom of the body as possible.

• Observe for any change in vital signs during feedings.

• Listen for cough, shortness of breath, or congestion during or after feeding

• Listen for any changes in vocal quality during and after eating.

• Be alert if the voice becomes wet, gurgly.

• Watch for any spikes in temperature.

• Be alert for non-cardiac chest pain.

• Listen for any changes in lung/chest sound auscultation.

• Be alert for any patient complaints of difficulty.

How to encourage safe swallowing

• Sit upright when eating, drinking, or taking medication and for at least a half hour after eating.

• Take one bite or sip at a time. Finish chewing and swallowing the first bite or sip before taking another.

• Do not talk while chewing and swallowing.

• Take small bites and sips and don’t go too fast.

• Clean the oral cavity after meals with a toothbrush or swab.

• If there is weakness on one side of the face, make sure no food or liquid is left on the inside of the weak side

Diet Modifications for Dysphagia Patients

• Thickened (nectar/honey) vs. thin liquids

  • Allows for adequate control to ensure the patient of a safe swallow

  • Thickened liquids can allow for increased control and coordination of a bolus to protect the airways

• Puree, ground, chopped, soft solid, regular solids

  • Allow for easier oral transit/propulsion of boluses to help initiate a swallow pending on the physiological impairment present

supervision during meals

for a patient with reduced attention, impulsivity, poor initiation, and confusion

alternate between liquids and bites

Allows for patient to self initiate liquid wash as necessary to prevent any residue build up

additional dry swallows

help eliminate residue build up and decrease the amount/size per swallow

eliminate use of straws

• Reduces risk of aspiration/ penetration

• Allows the patient to focus on small sips to ensure swallow safety

oral hygiene

• before and after meals

• helps to promote good oral hygiene and to eliminate unknown residue left behind at a meal

food safety for dysphagia patients

• To minimize the risk of aspiration, food should be consumed only by individuals who are conscious and have an intact gag or swallow reflex

• Monitor patients ability to swallow before eating

Diabetes

• A condition in which the body does not produce enough insulin to process carbohydrates.

• Patients use exchange lists and are allowed a certain number of foods from each group on the list.

  • Exchange list groups include starch, fruit, milk, meat, and fat.

  • Candy, cookies, syrup, honey, desserts, and other sugar-heavy foods should be limited.

unsafe practices for blood glucose testing

• Using fingerstick devices for more than one person

• Using blood glucose meter for more than one person without cleaning and disinfecting after every use, per the manufacturer’s instructions.

• Using insulin pens for more than one person

• Failing to change gloves and perform hand hygiene between fingerstick procedures

blood sugar

provides energy to the cells in the body, primary sugar in the body that is made from foods eaten

when to check blood glucose levels

before or after meals or exercise, prior to going to bed, during times of illness, with the start of new medications, or when the patients daily routine changes

fasting glucose

taken after a client has been NPO for at least 8 hours

normal blood glucose levels

• less than 140 mg/dL after eating 2 hours prior

• less than 100 mg/dL

hypoglycemia occurs when…

blood glucose level is less than 70 mg/dL

s/s of hypoglycemia

• shaky

• confusion

• diaphoretic (cool, gray, clammy, slimy fingers)

• passing out

treatment of hypoglycemia

• glucose tablets

• glucose IV

if a patient is experiencing hypoglycemia, the goal is to…

increase blood glucose level back to the normal range

how to raise someone’s blood glucose if they are experiencing hypoglycemia

• providing client with food that contains at least 15 grams of carbs

  • ex: 4 ounces of soda or juice, 1 TBSP of honey, 5-6 hard candies

• clients blood glucose level should be checked 15 minutes later and this should be repeated until blood glucose level is above 70 mg/dL

• once blood glucose is normal, give patient complex carb and protein

hand hygiene

• Wear gloves during blood glucose testing and during any other procedure that involves potential exposure to blood or body fluids

• Change gloves between resident contacts.

• Change gloves that have touched potentially blood- contaminated objects or fingerstick wounds before touching clean surfaces.

• Discard gloves in appropriate receptacles.

• Perform hand hygiene immediately after removal of gloves and before touching other medical supplies intended for use on other persons.

low calorie diet

• Contains between 800 and 2,000 total calories.

• Food examples include skim milk, lean meats, fresh fruits and vegetables, and clear soups.

• Used with overweight patients.

high calorie diet

• Contains >2,000 total calories.

• All foods may be considered for this diet.

• Used with patients who are 10 percent or more below their normal body weight.

  • For example, patients with anorexia nervosa may be prescribed a high-calorie diet.)

low cholesterol diet

• Controls the amount of cholesterol in the blood.

• Food sources:

  • Lean meats, fish, poultry, and fresh fruits and vegetables.

  • Cheeses, whole milk, egg yolks, and high-fat meats should be avoided.

• Purposes:

  • Patients with atherosclerosis (hardening of the arteries)

  • Patients with heart disease

Fat restricted diet

• also known as a low-fat diet.

• food sources:

  • foods high in carbs & protein, including skim milk products, fish, fruits and vegetables, and poultry.

  • whole milk, cheeses, fried foods, and salad dressings should be avoided.

• Purposes:

  • Patients with gall bladder problems

  • Obese patients

  • Patients with liver disease

  • Patients with atherosclerosis

sodium-restricted diets

• low-sodium or a low-salt diet.

• food sources:

  • consists of fresh fruits and vegetables and any foods without added salt.

  • pickles, olives, processed cheeses, and smoked meats should be avoided.

• Purposes:

  • Patients with heart disease, including hypertension (high blood pressure)

  • Patients with kidney disease

  • Patients with fluid retention problems

Protein Diets

• Controls the amount of protein in the diet, either high or low.

• Food sources:

  • Meats, milk, fish, eggs, and dairy products.

purpose of a high protein diet

(1) Children with delayed growth

(2) Pregnant women

(3) Burn victims

(4) Prior to and/or following surgery

purpose of a low protein diet

(1) Patients with kidney disease

(2) Certain allergic conditions

bland diets

• Easily digested foods that do not irritate the GI tract.

• Food sources:

  • applesauce, pudding, yogurt, milk, cheese, decaffeinated coffee (plain).

  • Fried foods, raw fruits and vegetables, whole-grain foods, and highly seasoned foods should be avoided.

• Purposes:

  • Patients with colitis (inflammation of the colon)

  • Patients with an ulcer

  • Patients with other GI tract disorders

low residue diet

• Reduces foods high in fiber or bulk.

• Food sources:

  • Milk, cereals, tender meats, cooked vegetables, and canned fruits.

  • Raw fruits and vegetables, whole-grain foods, beans, peas, and fried foods should be avoided.

• Purposes:

  • Patients with digestive problems (e.g., colitis, diarrhea)

  • Patients with rectal diseases

how long can meat be stored

raw: 1-2 days

cooked: 2-3 days

refrigerator temp

40 degrees or colder

how long can fish be stored

1-2 days

Storage of fruits & veggies

Refrigerate perishable fruits and vegetables. All pre-cut and pre-peeled fruits and vegetables should also be refrigerated.

Storage of perishables

Do not leave at room temperature for more than 2 hours (1 hour if temp. is 90° F or above).

storage of canned foods

Check for rusting, crushing, and denting. Observe for stickiness on the outside of can, which can indicate leakage. Do not use any canned foods that are damaged.

botulism

• A rare but serious illness that occurs when the body's nervous system is attacked by a toxin.

• Symptoms include muscle paralysis, difficulty breathing, and death.

• Can happen when food is improperly canned, preserved, or fermented. 

• If a baby eats raw honey then they develop this

sell by date

the final recommended day of sale

use by date

how long the product will remain top quality

expiration date

the final day the product should be used or consumed

foodborne illnesses are transmitted to people from

• within food

• on food

• unsafe water

• human or animal feces

cause of foodborne illnesses

improper storage of food or unsafe handling & preparation

education of foodborne illnesses by nurses

• Proper handing and preparation is simple and includes performing frequent hand hygiene.

• Refrigerate food products when necessary and avoid cross-contamination when preparing food.

• Food should be heated to recommended temperatures to kill unwanted bacteria

people at risk for foodborne illnesses

children, older adults, immunocompromised clients, and pregnant clients

foods most commonly associated with foodborne illnesses

• Raw or undercooked foods of animal origin

• Raw fruits & vegetables contaminated with animal feces

• Raw sprouts

• Unpasteurized fruit juice and milk products

• Uncooked food handled by someone who is ill

s/s of foodborne illnesses that warrant medical attention

bloody diarrhea, a stiff neck with severe headache and fever, excessive diarrhea or vomiting, and any symptoms that persist for more than 3 days.

Bacterial Salmonella

Undercooked or raw meat, poultry, eggs, fish, fruit, and dairy products.

• headache, fever, abdominal cramping, diarrhea, nausea & vomiting.

• This condition can be fatal.

Escherichia coli

• Raw or undercooked meat, especially ground beef.

• Severe abdominal pain & diarrhea.

• Hemolytic uremic syndrome, which manifests as severe anemia and kidney failure.

Listeria monocytogenes

• Soft cheese, raw milk products, undercooked poultry, processed meats, and raw vegetables

• Causes significant problems for newborns, pregnant clients, & immunocompromised clients.

• Onset occurs with the development of a sudden fever, diarrhea, headache, back pain, and abdominal discomfort.

• It can lead to stillbirth or miscarriage.

Viral norovirus

• Caused by consuming contaminated fruits & vegetables, salads prepared by someone who is infected, oysters, and contaminated water.

• Very contagious, and has an onset of 24 to 48 hr.

• Manifestations include projectile vomiting, fever, myalgia (muscle pain/soreness), watery diarrhea, and headache

common food allergies

• Milk, peanuts, fish, eggs, soy, shellfish, tree nuts, and wheat are the most reported food allergies in adults.

• Some infants exhibit an allergic reaction to cow’s milk and/or soy but typically outgrow this by 4 yrs of age

manifestations of food allergies

• nausea, vomiting, diarrhea, abdominal distention, and pain.

• some reactions are severe and can cause anaphylaxis.

GI irritation

ibuprofen, amoxicillin, some anti-depressants

grapefruit

interferes with metabolism of medication, resulting in an increased blood level of the medication

parkinson’s

take meds with low protein meals

vitamin k

decreases anticoagulant effects

tyramine

• hypertensive effect

• similar to norepinephrine

• foods high in this: age cheese, smoked meats, chocolate, alcohol, soy sauce, overripe avocadoes, cheese, sauerkraut

• metabolized by MAO

MAO inhibitor

• cannot breakdown tyramine causing a hypertensive crisis

protein

Increases the metabolism of the anti- Parkinson’s medication levodopa, which decreases the meds absorption and amount transported to the brain.