Critical Control Points of Hospital Foodservice Operations

Abstract

Hazard analyses were made of hospital dietary cook/freeze, cook/chill, assemble/serve, and cook/hold-hot operations. These analyses consisted of measuring temperatures of foods during thawing, cooking, hot-holding, chilling, transporting foods to hospital units, reheating, and delivery to patients and observing food-handling activities for sources and modes of contamination. Identified critical control points in the cook/freeze and cook/chill operations were cooking, cooling, and handling after cooking; in the assemble/serve operation was the incoming foods, and in the cook/hold-hot operation was cooking and hot-holding. No hazards were observed during thawing. Foods were usually cooked to temperatures that would have killed vegeta-tive forms of foodborne pathogens. Either the periods of hot-holding were short or the temperatures were high enough to preclude multiplication of these bacteria. Cooling of foods of similar kind, size, and weight was much more rapid in a rapid-chill refrigerator than in walk-in refrigerators. In the cook/hold-hot operations, temperatures of foods continued to decrease in spite of attempts to keep them hot by placing heated metal pellets under plates and covering the dished-up meal in covered carts during transport from kitchen to patients. Microwave reheating could be a critical control point whenever used, but monitoring is difficult because of considerable variation of temperatures throughout a serving of a particular food and differences between different foods on the same plate. The hazard analysis critical control point (HACCP) method consists of (a) assessment of microbiological hazards associated with processing or preparing foods, (b) determination of critical control points at which to control the hazards that have been identified, and (c) establishment of procedures through which critical control points can be monitored (7). This method has application to food safety and quality assurance in foodservice opera-'Centers for Disease Control. 2 Mary land State Department of Health and Mental Hygiene. ^Temperatures were recorded on chart 5270 (type T), 0 to 500°F range in an Electronik 16 Multipoint Recorder, Honeywell, Fort Washington, Pa. tions (3-12,17-21,34). It is a more effective way to control microbiological hazards than traditional inspection and quality control procedures because specific hazards are identified and control measures are instituted and either continuously or periodically monitored. The objectives of this study were to evaluate hazards associated with foods which are served hot, and to determine critical control points for different kinds of hospital foodservice operations. Practical ways to monitor these critical control points were sought so that each kind of operation would be able to provide safe food at an optimal temperature for enjoyable eating. MATERIALS AND METHODS Hot food operations of four hospital foodservice operations were evaluated; the essential operations were: Hospital A (cook/freeze system). Foods were cooked and otherwise prepared and then rapidly chilled. They were then dished-up, wrapped and frozen. At the scheduled time, meals were thawed and delivered to each hospital unit, where they were reheated in microwave ovens and served to patients. Hospital B (cook/chill system). Foods were cooked and otherwise prepared and chilled in a walk-in refrigerator. They were dished-up and delivered to each hospital unit where they were reheated in microwave ovens and served to patients. Some of these cooked foods were also held hot and delivered to one hospital unit where they were plated and served to patients (conventional; cook/hold system). Hospital C (assemble/serve system). Commercially pre-cooked frozen foods were stored frozen and thawed in a walk-in refrigerator a day or two before scheduled for service. They were then dished-up and delivered cold to each hospital unit where they were reheated in microwave ovens and served to patients. Hospital D (conventional: cook/hold system). Foods were cooked and otherwise prepared, held hot, dished-up, heated metal pellets put under plates and plates covered and delivered to patients. Hospitals A, B, and D were surveyed for a duration of 3 d so that the complete food preparation, cooking, cooling, and reheating cycle was evaluated at least once. Hospital C was evaluated for a duration of 1 d. Foods examined where those that have a history of being vehicles implicated in outbreaks of foodborne disease and which were prepared on the days of the survey. Thermocouples were used to measure temperatures of internal and surface regions of various foods and of air in ovens, hot-holding equipment , refrigerators, thawing units, freezers, steam-table water, and rooms in which foods were stored. Type-T thermocouples 3 were in