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Food Handling Safety for CNAs and HHAs

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Medical Assistant (MA)
This course will be updated or discontinued on or before Thursday, February 2, 2023
Outcomes

≥ 92% of participants will know how to handle food safely.

Objectives

After completing this continuing education course, the participant will be able to meet the following objectives:

  1. Identify three common symptoms of foodborne illness.
  2. Identify the characteristics of mold.
  3. Outline safe food shopping.
  4. Select safe food storage practices.
  5. Identify safe food preparation.
  6. Outline the caretaker’s role in special diets.
CEUFast Inc. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Diseases and Poisons in Food

If you work in a healthcare facility, food safety and diet is primarily done by another department. If you work in assisted living or home care, you may have a bigger responsibility for food safety. Diseases, metals, and poisons in food are called foodborne illness. These illnesses can cause harmful symptoms and death. The symptoms can be immediate or can happen after a long time. A foodborne illness that happens quickly after eating the food is sometimes called food poisoning. Foodborne illness symptoms include upset stomach, diarrhea, vomiting, fever, stomach cramps. Notify your supervisor if you see these problems because the person may need to see a doctor. Food can have metals and poisons that do not cause problems immediately but can build over time. Buy food from a trustworthy source to avoid metals and poisons.

Children and older people are more likely to be harmed by bad food. They also dehydrate more quickly. Older people may have problems getting food or may not know how to cook. Their sense of taste, smell, or vision can be bad, so they may not understand the food can be harmful to their health.

Safe handling of food stops illness. Washing your hands and keeping surfaces clean is very important. Sometimes food is obviously spoiled. But sometimes, metals, poison, and bacteria that can cause illness cannot be seen, smelled, or tasted.

Perishable foods are likely to spoil, decay, or become unsafe to eat if not refrigerated. Meats and cooked leftovers are examples of perishable foods. The FoodKeeper App, developed by FoodSafety.gov, can provide help with recommendations on storing food safely. This app can be downloaded here. It is not safe to store perishable food for more than an hour in areas where the temperature is over 90°F, or 32.2°C.

Non-perishable foods do not have to be refrigerated and are good for a long time. Some non-perishable food must be refrigerated after opening, like mayonnaise or salad dressing. The label will tell you if the open container needs to be refrigerated.

Mold

Molds are fungi that can live on foods that are plant or animal. Some molds cause allergic reactions and respiratory problems. Molds may not be visible. Even when you can see the mold, there are probably threads of the mold growing deep into the food that cannot be seen. Mold you can see can look like:

  • Gray fur on lunch meats
  • Fuzzy green dots on bread
  • White dust or black places on cheese
  • Coin-size velvety circles on fruits
  • Furry growth on jellies.

Do not smell mold because it can cause breathing trouble. When food is moldy, throw it away in a plastic bag or wrap to keep animals and children from getting into the harmful food. Clean the area and food around the area where the moldy food was found. Mold spreads quickly in fruits and vegetables.

Table 1: Moldy Food: When to Use, When to Discard. (Basics for Handling Food Safely, 2015)
FOODHANDLINGREASON
Luncheon meats, bacon, or hot dogsDiscardFoods with high moisture content can be contaminated below the surface. Moldy foods may also have bacteria growing along with the mold.
Hard salami and dry-cured country hamsUse. Scrub mold off the surface.It is usual for these shelf-stable products to have surface mold.
Cooked leftover meat and poultryDiscardFoods with high moisture content can be contaminated below the surface. Moldy foods may also have bacteria growing along with the mold.
Cooked casserolesDiscardFoods with high moisture content can be contaminated below the surface. Moldy foods may also have bacteria growing along with the mold.
Cooked grain and pastaDiscardFoods with high moisture content can be contaminated below the surface. Moldy foods may also have bacteria growing along with the mold.
Hard Cheese
(not cheese where mold is part of the processing)
Use. Cut off at least 1 inch around and below the mold spot (keep the knife out of the mold itself so it will not cross-contaminate other parts of the cheese). After trimming off the mold, re-cover the cheese in fresh wrap.Mold generally cannot penetrate deep into the product.
Cheese made with mold
(such as Roquefort, blue, Gorgonzola, Stilton, Brie, Camembert)
Discard soft cheeses such as Brie and Camembert if they contain molds that are not a part of the manufacturing process. If surface mold is on hard cheeses such as Gorgonzola and Stilton, cut off mold at least 1 inch around and below the mold spot and handle like hard cheese.Molds that are not a part of the manufacturing process can be dangerous.
Soft Cheese
(such as cottage, cream cheese, Neufchatel, chevre, Bel Paese, etc.) Crumbled, shredded, and sliced cheeses;(all types)
DiscardFoods with high moisture content can be contaminated below the surface. The cutting instrument can contaminate shredded, sliced, or crumbled cheese. Moldy soft cheese can also have bacteria growing along with the mold.
Yogurt and sour creamDiscardFoods with high moisture content can be contaminated below the surface. Moldy foods may also have bacteria growing along with the mold.
Jams and jelliesDiscardThe mold could be producing a mycotoxin. Microbiologists recommend against scooping out the mold and using the remaining condiment.
Fruits and vegetables, FIRM
(such as cabbage, bell peppers, carrots, etc.)
Use. Cut off at least 1 inch around and below the mold spot (keep the knife out of the mold itself so it will not cross-contaminate other parts of the produce).Small mold spots can be cut off FIRM fruits and vegetables with low moisture content. It is difficult for mold to penetrate dense foods.
Fruits and vegetables, SOFT
(such as cucumbers, peaches, tomatoes, etc.)
DiscardSOFT fruits and vegetables with high moisture content can be contaminated below the surface.
Bread and baked goodsDiscardPorous foods can be contaminated below the surface.
Peanut butter, legumes, and nutsDiscardFoods processed without preservatives are at high risk for mold.

Shopping

Buying small amounts of food and using food quickly can help prevent foodborne illness. Buy from a reliable place. The government has a labeling process enforced by the United States Department of Agriculture (USDA). Labeling is required to educate the buyer about the product. When shopping, select refrigerated or frozen food after you are done shopping for non-perishable food. Do not buy meat that has a torn or leaking package. Do not buy dented, rusted, or swollen cans. Do not buy damaged containers. The food inside may be spoiled. Check expiration dates. Discount stores and on-sell food items may be close to expiring. They are cheap and can be eaten but cannot be kept long. The definition of labels are (100+ Non-Perishable Foods - Foods That Don't Expire for a Long Time, 2021):

  • Best-By: suggested for the best quality and flavor. This has nothing to do with safety.
  • Use By: the last date recommended for eating. Infant formula should not be used past its use-by date.
  • Sell By: is an indication to a store for how long to have a product up for sale. This has nothing to do with safety.
  • Freeze By: manufacturer's suggestion to extend quality past a product's shelf life. If food is frozen in the original wrapping, additional wrapping with foil or plastic is recommended.

Fish and shellfish are easily contaminated with metals and poisons if caught in a place where the water is contaminated. Find out if fish or shellfish came from a safe place if not bought in a place that follows USDA food requirements. Do not fish in water where manufacturing waste, sewage, fertilizer, and pesticide runoff happens. Raw fish and shellfish can have bacteria even if bought in a reliable place. Some raw fish (sushi) are poisonous to eat if not prepared correctly.

Do not pick and eat wild mushrooms or berries without knowing which ones are safe and which ones are poisonous. Raw milk is more likely to be contaminated than pasteurized milk products bought in a store. Do not harvest wild shellfish if the shellfish is not entirely submerged all the time. The shellfish that is out of the water for parts of the day is bad.

Storage

Bacteria grow in warm moist places. Refrigeration slows bacteria growth but does not stop it. Refrigerate perishable food within 2 hours of buying. Refrigerate perishable food if it is too hot. The temperature of the refrigerator and freezer has factory settings and resets. They can be adjusted. The refrigerator should be set at 40°F or 4.4°C. The freezer should be set at 0°F or -17.7°C (Basics for Handling Food Safely, 2015). Wrap meats tightly to avoid leaking.

Proper non-perishable storage is in a cool, dark, dry area. The worst places to store non-perishable food is under a sink, near the stove, or in the garage because these places are more likely to be moist and have temperature changes that damage the food. Cans should be stored in temperatures less than 90°F or 32.2°C and above freezing (100+ Non-Perishable Foods - Foods That Don't Expire for a Long Time, 2021).

Canned food is good for a long time. High acid food like tomatoes and fruits should be used within 18 months. Low acid food can keep for 2-5 years. Do not use cans if they are dented, rusted, or swollen. Many foods are safe to eat past their expiration date if stored properly. Do not use anything that looks or smells bad. Bad appearance includes mold, dark or oily appearance, water damage, or pest infestation. Non-perishable food that lasts a very long time, if kept in an airtight container in a cool, dry, dark place include (100+ Non-Perishable Foods - Foods That Don't Expire for a Long Time, 2021):

  • Dried beans, peas, and legumes
  • Salt, sugar, vinegar, honey, sugar, molasses
  • White rice
  • Dried fruit and vegetables
  • Oatmeal, cornmeal, flour, wheat, millet
  • Mustard
  • Olives
  • Peanut butter
  • Popcorn
  • Powdered eggs, milk, potatoes
  • Wine, hard liquor
  • Cooking oils and lard
  • Dried nuts can last for two years, mostly if frozen

Cold Storage Chart

These short but safe time limits will help keep refrigerated food from spoiling or becoming dangerous to eat. Because freezing keeps food safe indefinitely, recommended storage times are for quality only (Basics for Handling Food Safely, 2015).

Table 2: Freezing Recommendations to Keep Foods Safe
ProductRefrigerator
40°F (4.4°C)
Freezer
0°F (-17.7°C)
Eggs
Fresh, in shell3 to 5 weeksDo not freeze
Raw yolks & whites2 to 4 days1 year
Hard cooked1 weekDoes not freeze well
Liquid pasteurized eggs, egg substitutes
Opened3 daysDoes not freeze well
Unopened10 days1 year
Mayonnaise, Commercial
Refrigerate after opening2 monthsDo not freeze
Frozen Dinners & Entrees
Keep frozen until ready to heat3 to 4 months
Deli & Vacuum-Packed Products
Store-prepared (or homemade) egg, chicken, ham, tuna, & macaroni salads3 to 5 daysDoes not freeze well
Hot dogs & Luncheon Meats
Hot dogs
  • Opened package
1 week1 to 2 months
  • Unopened package
2 weeks1 to 2 months
Luncheon meat
  • Opened package
3 to 5 days1 to 2 months
  • Unopened package
2 weeks1 to 2 months
Bacon & Sausage
Bacon7 days1 month
Sausage, raw — from chicken, turkey, pork, beef1 to 2 days1 to 2 months
Smoked breakfast links, patties7 days1 to 2 months
Hard sausage — pepperoni, jerky stick2 to 3 weeks1 to 2 months
Summer sausage labeled "Keep Refrigerated"
Opened3 weeks1 to 2 months
Unopened3 months1 to 2 months
Corned Beef
Corned beef, in a pouch with pickling juices5 to 7 daysDrained, 1 month
Ham, canned labeled "Keep Refrigerated"
Opened3 to 5 days1 to 2 months
Unopened6 to 9 monthsDo not freeze
Ham, fully cooked
Vacuum sealed at the plant, undated, unopened2 weeks1 to 2 months
Vacuum sealed at the plant, dated, unopened"Use-By" date on the package1 to 2 months
Whole7 days1 to 2 months
Half3 to 5 days1 to 2 months
Slices3 to 4 days1 to 2 months
Hamburger, Ground & Stew Meat
Hamburger & stew meat1 to 2 days3 to 4 months
Ground turkey, veal, pork, lamb, & mixtures of them1 to 2 days3 to 4 months
Fresh Beef, Veal, Lamb, Pork
Steaks3 to 5 days6 to 12 months
Chops3 to 5 days4 to 6 months
Roasts3 to 5 days4 to 12 months
Variety meats — tongue, liver, heart, kidneys, chitterlings1 to 2 days3 to 4 months
Pre-stuffed, uncooked pork chops, lamb chops, or chicken breasts stuffed with dressing1 dayDoes not freeze well
Soups & Stews
Vegetable or meat added
3 to 4 days2 to 3 months
Fresh Poultry
Chicken or turkey, whole1 to 2 days1 year
Chicken or turkey, pieces1 to 2 days9 months
Giblets1 to 2 days3 to 4 months
Cooked Meat and Poultry Leftovers
Cooked meat & meat casseroles3 to 4 days2 to 3 months
Gravy & meat broth3 to 4 days2 to 3 months
Fried chicken3 to 4 days4 months
Cooked poultry casseroles3 to 4 days4 to 6 months
Poultry pieces, plain3 to 4 days4 months
Poultry pieces in broth, gravy3 to 4 days6 months
Chicken nuggets, patties3 to 4 days1 to 3 months
Other Cooked Leftovers
Pizza, cooked3 to 4 days1 to 2 months
Stuffing, cooked3 to 4 days1 month

Preparation

Wash your hands with warm water and soap for 20 seconds before and after handling food. Fresh food and vegetables should be washed to remove pesticides and dirt. Keep raw meat and their juices away from other food. After cutting raw meats, wash the cutting board, utensils, and countertops with hot, soapy water. Marinating meat should be placed in a covered dish and kept in the refrigerator.

The refrigerator allows slow, safe thawing of frozen food items. Make sure thawing meat and poultry juices do not drip onto other food. Frozen food can be put in cold tap water in a leak-proof container or plastic bag for faster thawing. Be sure to change the water every 30 minutes. The microwave can also be used for thawing. The food should be cooked immediately after thawing (Basics for Handling Food Safely, 2015). Meat and poultry defrosted in the refrigerator may be refrozen before or after cooking. Do not refreeze if thawed another way; cook before refreezing (Basics for Handling Food Safely, 2015).

Cook the food thoroughly to kill bacteria and parasites. Cook food at the recommended sage internal temperature (Table 3). Use a meat thermometer to check the internal temperature if needed. Do not eat cooked meat if there is blood when cut. If you see blood, cook the meat more. Some people prefer rare beef or raw seafood. That is a choice, but there is a risk of infection, parasites, and poisoning. Pork and chicken are likely to have parasites if not thoroughly cooked. Refrigerate cooked food promptly. Cook or freeze fresh poultry, fish, ground meat, and variety meats within two days of purchasing. Use cooked leftovers within four days. Reheat leftovers to 165 °F (73.9 °C). Beef, veal, lamb, or pork should be cooked or frozen with 3-5 days. Fish and shellfish from a contaminated source are dangerous. Do not eat them because they are caught in a water source with a large drain off chemical or animal waste.

Safe Internal Temperatures

Table 3: USDA Recommended Safe Internal Temperatures (Older Adults and Food Safety, 2013).
Cook foods to the following safe internal temperatures as measured with a food thermometer:
FOODTEMPERATURE
Fresh ground beef, pork, lamb, veal160°F
Beef, pork, lamb, and veal (roasts, steaks, chops)*145°F
*as measured with a food thermometer before removing meat from the heat source. For safety and quality, allow the meat to rest for at least three minutes before carving or consuming. For reasons of personal preference, consumers may choose to cook meat and poultry to higher temperatures.
Ham, cook before eating*145°F
Ham, fully cooked, to reheat140°F
Poultry, whole, parts or ground165°F
Fish145°F
Egg dishes, casseroles160°F
Leftovers, to reheat165°F
Hot dogs, luncheon meats, bologna, and other deli meats165°F or until steaming hot

When serving food in a buffet style, hot food should be kept at a temperature of 140 F (60°C) or warmer and cold food should be kept at a temperature of 40°F (4.4ºC) or colder. To keep food hot, use chafing dishes, slow cookers, and warming trays. Food can be kept cold by nesting dishes in ice or replacing the cold dish often. Perishable food cannot be out for more than 2 hours at room temperature or 1 hour if the temperature is above 90°F (32.2ºC).

Hot food that is bought or delivered needs to be eaten within two hours. If that cannot happen, refrigerate the food.

Reheating food to a temperature that is not hot enough can cause foodborne illness. Reheat food thoroughly to a temperature of 165°F or until hot and steaming. Check microwave directions for cooking time and power level.

Throw out any food left out at room temperature for more than 2 hours or 1 hour if the temperature is above 90°F (32.2ºC).

Special Diets

Some people have special diets because of medical conditions. The most common are diabetic, cardiac, and renal diets. Special diets may also have limits on the amount of fluid. You should have access to a written list of foods and fluids that meet the special diet. If not, ask the supervisor or patient. Some patients need to have their fluid intake and urine output (I&O) measured. Tracking I&O is important because the nurses and doctors make decisions based on this information. If the I&O is not accurate, the patient may receive treatment or have treatment held back that can cause harm or death.

You are responsible for making accessible, providing, and recommending allowable foods and fluids from the list. You are never responsible for policing the patient's diet. Individuals have the right to choose not to follow the diet. A gentle reminder is allowable, but it is the patient's choice. Report non-compliance to your supervisor so they can educate the patient further or expect patient problems.

Case Study

You enter a new homecare assignment for a 78-year-old person. When you enter, you notice the temperature in the home is very hot. The patient is in the living room with the windows open and a fan on the patient. You see a package of ground beef on the kitchen counter. The kitchen has no open windows and no fan. The ground beef is leaking bloody fluid and looks whitish gray. In discussion with the patient, you mention that the ground beef is not refrigerated and looks spoiled. The patient agrees with you but says there is no more meat in the house, and the patient cannot move around to put food in the refrigerator. You tell the patient the meat looks spoiled and recommend the meat be thrown away. The patient agrees, and you dispose of the meat. You call your supervisor about the situation. The RN makes an emergency visit to do a safety assessment and arrange meals. It is good that the patient agreed to throw away the meat. The patient may not have agreed because of the lack of funds to buy more food.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

  • 100+ Non-Perishable Foods—Foods That Don't Expire for a Long Time. (2021). Parade. Visit Source.
  • Basics for handling food safely. (2015). Department of Agriculture. Visit Source.
  • Older Adults and Food Safety. (2013). Department of Agriculture. Visit Source.