Ensuring food safety is important no matter who you serve, but it’s particularly important when serving nursing home residents.
This is because nursing home residents are a highly susceptible population, meaning they’re more likely than the general public to develop a foodborne illness and experience severe symptoms as a result.
Unfortunately, dietary workers don’t always follow the basics for keeping food safe.
This article lists eight common food safety mistakes in nursing homes and what you can do to prevent them.
Top 8 food safety mistakes in nursing homes
Throughout my years of working as a dietitian in dozens of nursing homes and providing operational support for one of the largest nursing home chains in the nation, I have witnessed a fair share of food safety no-nos.
Among the countless food safety woes I have witnessed or read about in hundreds of nursing home survey reports, there are eight that tend to happen the most.
Here are the eight most common food safety mistakes in nursing homes and what you should do instead.
1. Bare-hand contact with ready-to-eat food
Bare-hand contact with ready-to-eat (RTE) food is allowed in some instances but never when serving a highly susceptible population like nursing home residents (1).
This is because, even with proper handwashing, your hands can still carry enough bacteria to make nursing home residents ill.
RTE foods don’t require further preparation or cooking before serving.
Examples of RTE foods include:
- deli meats
- sandwiches and wraps
- burgers and hot dogs
- fruits and vegetables that have been washed and cut
To handle RTE foods safely, there must always be a barrier between your hands and RTE foods.
This barrier may be single-use gloves, deli tissue, or serving utensils like tongs or spatulas.
2. Improper glove use
Single-use gloves are commonly viewed as magical since they provide a barrier between your hands — which may carry bacteria and other contaminants — and the food you’re preparing or serving.
However, gloves are no different than your hands — they too can become contaminated and spread bacteria to food and food-contact surfaces.
Here are the instances in which you need to change your gloves (1):
- when they become ripped or torn
- when changing food preparation tasks
- when interruptions occur and you must change tasks
- after sneezing or coughing
- after touching your face or other non-sanitized surfaces
- when preparing a special order for someone with a food allergy
You also need to change your gloves every four hours after working on the same tasks since this is enough time for bacteria to grow to harmful numbers.
Wash your hands between each glove change, and never wash or reuse gloves — they are single-use only.
Because gloves provide a false sense of protection, using other barriers like deli tissue or serving utensils tends to be safer and leads to fewer citations from surveyors.
3. Forgetting to label and date food
Opened food or leftovers that are stored in the refrigerator must be labeled with the date they must be served or tossed if held for longer than 24 hours (1).
However, due to time constraints, forgetfulness, or another reason, many forget to do so.
You can store time-temperature control for safety (TCS) food for up to seven days, with the day you opened the container or package counting as day 1.
The same is true for leftovers, assuming you have cooled them safely.
Also, don’t forget to label items that you store outside of their original container to reduce the risk that you or someone else mistakes one ingredient or food for another, which could lead to cross-contact.
Cross-contact is the transfer of food allergens from one food or surface to another.
4. Improper fridge storage
Improper fridge storage can lead to cross-contamination — the transfer of pathogens or disease-causing organisms from one food to another.
Always store leftovers and other RTE foods on the top shelf in the refrigerator to prevent other foods from dripping or spilling on them.
Store other items in order of their minimum internal cooking temperature, with those that require the highest on the bottom.
Here is the proper storage order for refrigerated foods, in order from top to bottom (1):
- RTE foods and leftovers
- whole seafood
- whole cuts of beef and pork
- ground meats and seafood
- whole and ground poultry
5. Improper wound coverage
If you accidentally cut yourself — whether inside or outside the kitchen — your cut can become infected.
An infected wound can cause swelling, redness, and pus or fluid discharge or drainage.
With an infected wound, you must cover it with a waterproof bandage and a single-use glove if the wound is on your hands (1).
Wearing a single-use glove over the bandage ensures that the bandage doesn’t accidentally fall into food while also preventing any drainage that escapes the bandage and contaminates food.
Just remember to change the glove anytime it becomes contaminated or you switch tasks and wash your hands.
I know of at least one instance where a dietary aide used duct tape to cover the wound instead of a waterproof bandage.
Unsurprisingly, the center received a citation since duct tape isn’t an appropriate cover.
6. Handwashing station is blocked or low on supplies
Handwashing citations are common since many people don’t wash their hands properly or when they’re supposed to.
More common, however, is the mistake of blocking the handwashing station, such as by placing a garbage container or cart in front of the sink or placing items in the sink.
Doing so detours people from washing their hands while also potentially contaminating the handwashing area.
Empty soap or single-use towels is another common food safety mistake.
Both soap and a drying method like single-use towels are necessary components of proper handwashing and must be available at all times.
7. Poor record keeping
Temperature is an important metric for food safety.
Foods must be cooked to a certain temperature to kill pathogens and held at the proper temperature so it doesn’t slip into the temperature danger zone where bacteria grow rapidly.
Dishwashers must also reach a certain temperature to properly clean and sanitize.
Therefore, it’s important that you continuously monitor the temperature of food and devices like dishwashers and cold-storage units frequently.
While it’s not necessarily required that you document these temperatures, most centers have policies and procedures requiring documentation so you can identify food safety concerns and take corrective action.
However, it’s common for dietary workers to chart these temperatures infrequently or make them up entirely.
Without regular monitoring and documentation, you risk serving food that wasn’t cooked to a safe temperature or held at an improper temperature.
Poor documentation will also lead to a citation if you have policies and procedures in place that require it.
Thus, it’s essential that you monitor and document food cooking and holding temperatures as well as the temperature of machines like dishwashers and cold storage units.
8. Poor cleaning habits
It’s everyone’s responsibility to maintain a clean kitchen, but it, unfortunately, doesn’t always happen.
While the obvious places may appear clean, other places tend to go uncleaned since they are more difficult to reach or are less noticeable.
Places that tend to go uncleaned and can lead to food contamination include:
- inside the microwave
- shelves in cold storage
- range hood vents
- under equipment like stoves and cabinets
- vents and ceiling fans
Surveyors know that these places are often forgotten so they love to check them.
Make sure you have a cleaning checklist that details everything that needs to be cleaned, sanitized, or both, and when.
The bottom line
Nursing home residents are a highly susceptible population so it’s important to take extra food safety precautions to keep them safe.
Unfortunately, many dietary workers make these common — but easily preventable — food safety mistakes.
While these food safety mistakes occur the most often based on my experience, you should still conduct food safety and sanitation audits to identify additional training needs.
Earning your food handler card is a sure way to prove to health surveyors that you know how to keep your residents safe from foodborne illnesses.
Some states even require that dietary workers earn a food hander card before they can work in nursing homes.