The HPA Guidelines for Assessing the Microbiological Safety of Ready-to-eat Foods placed on the market and. Hospital Guidelines

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1 The HPA Guidelines for Assessing the Microbiological Safety of Ready-to-eat Foods placed on the market and Hospital Guidelines HPA FW&E Microbiology Service

2 Developing Guidelines in Partnership FSA, Defra, DoH, DWI, EFSA Local Authorities, Port Health Authorities HPA has a major role in controlling human infections cause by exposure to Food and Water contaminated with pathogens by: Providing diagnoses Controlling incidents and outbreaks Providing an evidence base to inform interventions and prevent further infections

3 Functions Expert advice and access to laboratory services for food, dairy, environmental and water microbiology National microbiological survey and surveillance data (LGR) Early recognition, notification, investigation and control of unusual events and outbreaks An evidence base to inform the actions of HPA and others Training of staff in the HPA and external partners Applied R&D to support and progress all of the above

4 Guidance Documents Ready-to-Eat Microbiology Guidelines Revised 2008, consultation , issued 2009 Guidelines for Handling food, water and environmental samples from healthcare environments (consultation 2010) s/1012examiningfwesamples/ Guidelines for Environmental sampling (in progress due to be completed spring 2012) Microbiological Test Parameters (completed)

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6 Revision of the PHLS Guidelines: Why? Need for interpretation of results from single samples collected during: Predefined surveys Food inspections Follow-up from adverse findings or complaints Investigation of outbreaks

7 HPA Guidelines for assessing the microbiological safety of ready-toeat foods placed on the market Issued November 2009 Available from:

8 HPA Guidelines for Assessing the Microbiological Safety of Ready-to-Eat Foods Placed on the Market : 2009 Do not take precedence over microbiological criteria within European or national legislation Serve to complement legally enforceable standards and provide an indication of the microbiological safety of foods where standards currently do not exist. For use by Food Examiners and enforcement officers in identifying situations requiring investigation for public health or food safety reasons.

9 HPA Ready-to-eat Guidelines: 2009 Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Glossary References Introduction Pathogens Hygiene Indicator Organisms Aerobic Colony Counts Supplementary Advice on the Use of the Guidelines Tables Pathogens in Foods Placed on the Market Hazard Result in 25g Risk Category Interpretation Likely cause Suggested action Laboratory specialist and reference tests

10 Interpretation used in HPA Readyto-eat Guidelines:2009 The terms used to express the microbiological quality and/or safety of the ready-to-eat foods are: Satisfactory Test results indicating good microbiological quality Borderline Test results that are not satisfactory or unsatisfactory, are at the upper limits of acceptability and which indicate the potential for development of public health problems and of unacceptable risk.

11 Interpretation used in HPA Readyto-eat Guidelines:2009 UNSATISFACTORY/Potentially injurious Pathogens Test results indicate a product that is potentially injurious to health and/or unfit for human consumption and require immediate remedial action. UNSATISFACTORY Hygiene indicator Test results that require remedial action. Prosecutions based solely on aerobic colony counts or indicator organisms, even when unsatisfactory, are unlikely to be successful.

12 Examples of guidance on the interpretation of results for detection of pathogens (the hazard) in ready-to-eat foods placed on the market: 2009 Hazard Result/ 25g Risk Category Interpretation Likely cause Suggested action Laboratory specialist and reference tests Campylobacter spp. (thermotolerant) Detected High UNSATISFACTORY and Potentially injurious to health and/ or unfit for human consumption Inadequate processing Cross contamination Immediate investigation of: the food origin, production process and environment; take investigative food samples and consider environmental monitoring. Confirmation of identity, molecular typing. Not detected Low SATISFACTORY N/A

13 Examples of guidance on the interpretation of results for hygiene indicator organisms in ready-to-eat foods placed on the market: 2009 Hygiene Indicator Results (cfu/g) Interpretation Comment Likely cause Suggested action Enterobacteriaceae >10 4 UNSATISFACTORY Members of this group occur in the environment as well as the gut of man and animals. Their presence at these levels suggests an overall poor general hygienic status of a food product. These bacteria are not reliable indicators of contamination by faecal pathogens in a food. Poor hygiene due to undercooking, or cross contamination from raw meat, staff or food contact surfaces as well as poor temperature and time control. Review cooking and all hygiene procedures including cleaning. Take investigative samples of food and undertake environmental monitoring of food preparation environment BORDERLINE Interpret in conjunction with test results from other microbiological parameters but detection in several foods or other areas of the food production environment should be investigated. Possible evidence of poor hygiene due to undercooking, or cross contamination from raw meat, staff or food contact surfaces as well as poor temperature and time control. Review cooking and all hygiene procedures including cleaning. Consider taking investigative samples of food and the food preparation environment. Action should be proportional to levels detected. <10 2 SATISFACTORY N/A None

14 Examples of guidance on the interpretation of results for hygiene indicator organisms in ready-to-eat foods placed on the market: 2009 Hygiene Indicator Results (cfu/g) Interpretation Comment Likely cause Suggested action Escherichia coli >10 2 UNSATISFACTORY Originates from the intestinal tract of man and animals indicating contamination and growth (depending on the level detected) at some stage of the process. The detection of E. coli is not a reliable indicator that faecal pathogens are present in the food and results should be interpreted in conjunction with test results from other microbiological parameters. Repeated or widespread detection in several foods or environmental sites highlights an increased food safety risk. Poor hygiene due to undercooking, or cross contamination from raw food especially meat, staff or food contact surfaces as well as poor temperature and time control. Review cooking and all hygiene procedures including cleaning. Take investigative samples of food and undertake environmental monitoring of food preparation environment BORDERLINE Although E. coli should not be detected in ready-to eat foods, low levels may occasionally be found. Repeated or widespread detection in several foods or areas of the food production environment suggests an increased food safety risk. Possible evidence of poor hygiene due to undercooking, or cross contamination from raw food especially meat, staff or food contact surfaces, as well as poor temperature and time control. Review cooking and all hygiene procedures including cleaning. Consider taking investigative samples of food and the food preparation environment. Action should be proportional to levels detected. <20 SATISFACTORY N/A None

15 HPA Ready-to-eat Guidelines: 2009 Aerobic Colony Counts 13 food categories Categorised based on processes used during preparation and storage. Category 1-9 ACC result can give useful information about the microbiological quality of food. Category ACC not routinely performed but may be useful if investigating spoilage.

16 Aerobic Colony Counts Food Categories 1-9: (Satisfactory) 1. Ambient stable, canned, bottled, carton, pouched (<10) 2. Recently cooked (<10 3 ) 3. Cooked chilled minimum handling (<10 4 ) 4. Bakery (no cream), powdered foods after reconst n (<10 4 ) 5. Cooked chilled some handling (<10 5 ) 6. Non-fermented dairy products, mayonnaise, cooked sauces (<10 5 ) 7. Food mixed with dressings and dips (<10 6 ) 8. Extended shelf-life refrigerated products (<10 6 ) 9. Raw RTE meat/fish, cold smoked fish (<10 6 )

17 Food Categories 10-13: ACC test not applicable 10. Pickled, Marinated, salted 11. Dried foods 12. Fresh fruit and vegetables or any product containing these products 13. Fermented meat and vegetables, cured and dried meats, ripened cheese

18 FOOD, WATER AND ENVIRONMENTAL MICROBIOLOGY SERVICES, XXXXXXXXX ADDRESS, POSTCODE a UKAS Accredited Testing Laboratory No. XXXX Tele: 0XXXX XXXXXX Fax: 0XXXX XXXXXX XXXXXXXXXXXXXX@hpa.org.uk Sender s sample reference number: Premises ID (if known): Premises type (producer, retailer): Sample point: Premises address: Postcode: FOOD SAMPLE REQUEST FORM AFFIX LABORATORY NUMBER HERE Name and contact details of authority/customer: Contact telephone number: Purchase order number: Sample collected by: Cool box ID number: Date collected: Cool box security tag number(s): / Time collected: Sample security tag number Temperature at collection: SAMPLE DETAILS Please tick all boxes that apply and complete all sections with as much information as possible. It will not be possible to interpret results from samples that have not been adequately described. Ready to Eat Food by Sample Category Sample Composition (tick all that apply) Reason for Testing 1. Ambient stable food (cans, bottles, jars, etc) 2. Freshly cooked 3. Chilled with minimum handling 4. Bakery/Confectionary products (non dairy) 5. Chilled with handling inc. hot smoked fish 6. Non-fermented dairy products, products with cream, mayo & cooked sauces 7. Dressings, dips and pastes 8. Vacuum packed and MAP foods 9. Raw RTE meat & fish inc.cold smoked fish 10. Preserved products 11. Dried foods 12. Fresh RTE fruit & vegetables, and products containing them 13. Fermented foods, and products containing them Foods that are Not Ready to Eat Raw products to be cooked prior to consumption Cook chill (prior to reheating) Food to be regenerated before consumption Meat and/or fish Shellfish/crustaceans Eggs >5% herbs or spices Rice Raw RTE fruit or veg (including salad) Dried nuts or seeds Other: Sample description (eg Chicken salad sandwich): Additional information: Routine screening Complaint Recent failure (state reason in Additional information below) Formal food (supplementary form required) Food safety Process hygiene Outbreak (supplementary form required): ILOG number: Local survey: Survey number: Other: B/B or Use by date: Batch number: Country of origin: UK Other (specify): TICK BOX IF HIGH RISK SAMPLE (E.G. FOR E.COLI O157 TESTING) LABORATORY USE ONLY (Record details of unsatisfactory findings in comments) o C Date received: / /20 Data logger / probe ID: Comments: Time received: Air / In between pack (delete as appropriate) Received by: Temp. on receipt: o C Received from:..... Samples & Receipt Form ID : Routine Food Version 2.0 Issue Jan 2012 SATIS UNSATS R IG Page 1 of 1

19 Interpretation of ACC results based on HPA RTE Guidelines: 2009 Satisfactory No action required Borderline Consider source of food and stage in shelf life. Further investigate if other samples from the same source are also borderline Unsatisfactory Investigate

20 Example; Chicken roll (no salad) : Sandwich bar (routine inspection) Aerobic Colony Count 9x10 5 cfu/g Enterobacteriaceae 3x10 5 cfu/g* Escherichia coli 6x10 3 cfu/g* Listeria spp. (total) <10 cfu/g Staphylococcus aureus <20 cfu/g Salmonella spp. Not detected in 25g Campylobacter spp. Not detected in 25g UNSATISFACTORY based on HPA RTE Guidelines: 2009 Unsatisfactory due to Enterobacteriaceae and Escherichia coli counts. Note: if this sample contained salad ACC and Enterobacteriaceae tests would not have been performed.

21 1. Likely causes Poor hygiene due to undercooking, or cross contamination from raw meat, food handlers or food contact surfaces as well as poor temperature and time controls. Suggested actions (not exclusive) Review cooking and all hygiene procedures including cleaning. Take investigative samples of food and undertake environmental monitoring of food preparation environment. Inspection of food preparation areas Poor level of hygiene and cleaning

22 HPA Guidelines for Assessing the Microbiological Safety of Ready-to-Eat Foods paced on the market: 2009 Summary; Concentrates on the Public Health aspects of the microbiological results. Emphasis on food-borne pathogens. Are evidence and risk based. Provide interpretation of results and suggested actions.

23 HPA Guidelines for Examining food, water and environmental samples from healthcare environments Issued 2010

24 Development of Hospital Guidelines In the 1980 s Routine microbiological sampling of food, water and the environment in hospitals was rarely indicated Sampling during the investigation of outbreaks was carried out General lack of consensus about the best way to proceed and how to interpret results once obtained. Lessons learned - development of numerous pieces of legislation and expert guidance that address specific aspects of hospital microbiology.

25 Development of Hospital Guidelines Aim of the guidelines; to summarise the available legislation and guidance Produced by a working group; from HPA F.W.E. Microbiology Service with consultation process with stakeholders/hpus/clinical Micro/NHS and Estates etc Target audience; primarily microbiologists and infection control nurses and others inc HPA and LAs Provides additional clarification and guidance; on sampling and result interpretation where currently lacking. Future revisions as required; will update information and provide additional guidance in response to demand.

26 Contents of the Guidelines Sampling Procedures Health and Safety Considerations General Equipment Requirements Food Sampling Water Sampling Environmental Sampling Air Sampling Testing parameters and interpretation of results

27 Contents - Sampling Procedures Food No specific requirement for routine sampling of food in healthcare settings. Food Business Operators must have robust food safety management systems in place, such as HACCP, FBOs must demonstrate due diligence Guide suggests; that when catering services are contracted out, healthcare providers may require certain levels of microbiological monitoring service specification For in-house catering facilities, a rolling monitoring programme may be agreed locally. Use of Official Control Laboratories!

28 Contents - Sampling Procedures Food 2 Levels of bacteria - which may be acceptable for healthy adults may present an unacceptable risk to those with compromised immunity, Tolerances should set very low in the healthcare setting. Liaison with local environmental health department (EHD) to ensure best practice is essential Food items sampled microbiologically unchanged (refer to transport protocols) Investigation of outbreaks - it is essential to ensure chain of evidence and retention of information etc Essential to involve Env Health in the inspection and sampling

29 Contents - Sampling Procedures Food 3 Food sampling - based upon FSA and other existing guidelines Liaison with FW&E laboratory essential 100 grams of food - usually required. Consumables available to EH services from FW&E Samples bagged and tagged chain of evidence Transport at 1 C - 8 C to FW&E laboratory; data logger

30 HPA Guidelines for; Examining food, water and environmental samples from healthcare environments; 2010 Summary Guidelines aim to increase consistency in Sampling technique Tests performed Interpretation of results Will increase confidence of lab staff, infection control teams and other hospital staff to carry out appropriate tests and take corrective action when necessary

31 Forthcoming Guidelines; DRAFT Guidelines for the interpretation of the microbiological results from environmental samples collected from food premises; (2012) Overview of contents; Purpose of guidelines Contaminated food-contact surfaces as contributory factors in transmission of disease Cleaning methods and frequency Sampling and the rationale for sampling Identification of sampling sites Interpretation of microbiology

32 Questions