Caring for Our Childen (CFOC)

Chapter 4: Nutrition and Food Service

4.9 Food Safety

4.9.0

4.9.0.1: Compliance with U.S. Food and Drug Administration Food Sanitation Standards, State and Local Rules


The facility should conform to the applicable portions of the U.S. Food and Drug Administration model food sanitation standards (1) and all applicable state and local food service rules and regulations for centers and large and small family child care homes regarding safe food protection and sanitation practices. If federal model standards and local regulations are in conflict, the health authority with jurisdiction should determine which requirement the facility must meet.
RATIONALE
Minimum standards for food safety are based on current scientific data that demonstrate the conditions required to prevent contamination of food with infectious and toxic substances that cause foodborne illness. Many of these standards have been placed in statutes and must be complied with by law.

Federal, state, and local food safety codes, regulations, and standards may be in conflict. In these circumstances, the decision of the regulatory health authority should prevail.

COMMENTS
The U.S. Food and Drug Administration’s (FDA) Model Food Code is a good resource to have on hand. The current Food Code is available at http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
REFERENCES
  1. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration (FDA). 2009. 2009 Food code. College Park, MD: FDA. http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.

4.9.0.2: Staff Restricted from Food Preparation and Handling


Anyone who has signs or symptoms of illness, including vomiting, diarrhea, and infectious skin sores that cannot be covered, or who potentially or actually is infected with bacteria, viruses or parasites that can be carried in food, should be excluded from food preparation and handling. Staff members may not contact exposed, ready-to-eat food with their bare hands and should use suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment. No one with open or infected skin eruptions should work in the food preparation area unless the injuries are covered with nonporous (such as latex or vinyl), single use gloves.

In centers and large family child care homes, staff members who are involved in the process of preparing or handling food should not change diapers. Staff members who work with diapered children should not prepare or serve food for older groups of children. When staff members who are caring for infants and toddlers are responsible for changing diapers, they should handle food only for the infants and toddlers in their groups and only after thoroughly washing their hands. Caregivers/teachers who prepare food should wash their hands carefully before handling any food, regardless of whether they change diapers. When caregivers/teachers must handle food, staffing assignments should be made to foster completion of the food handling activities by caregivers/teachers of older children, or by caregivers/teachers of infants and toddlers before the caregiver/teacher assumes other caregiving duties for that day. Aprons worn in the food service area must be clean and should be removed when diaper changing or when using the toilet.

RATIONALE
Food handlers who are ill can easily transmit their illness to others by contaminating the food they prepare with the infectious agents they are carrying. Frequent and proper handwashing before and after using plastic gloves reduces food contamination (1,2,4).

Caregivers/teachers who work with infants and toddlers are frequently exposed to feces and to children with infections of the intestines (often with diarrhea) or of the liver. Education of child care staff regarding handwashing and other cleaning procedures can reduce the occurrence of illness in the group of children with whom they work (1,2,4).

The possibility of involving a larger number of people in a foodborne outbreak is greater in child care than in most households. Cooking larger volumes of food requires special caution to avoid contamination of the food with even small amounts of infectious materials. With larger volumes of food, staff must exercise greater diligence to avoid contamination because larger quantities of food take longer to heat or to cool to safe temperatures. Larger volumes of food spend more time in the danger zone of temperatures (between 41°F and 135°F) where more rapid multiplication of microorganisms occurs (3).

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
3.2.2.1 Situations that Require Hand Hygiene
3.2.2.2 Handwashing Procedure
3.2.2.3 Assisting Children with Hand Hygiene
3.2.2.4 Training and Monitoring for Hand Hygiene
3.2.2.5 Hand Sanitizers
REFERENCES
  1. Cowell, C., S. Schlosser. 1998. Food safety in infant and preschool day care. Top Clin Nutr 14:9-15.
  2. U.S. Department of Agriculture (USDA), Food Safety and Inspection Service. 2000. Keeping kids safe: A guide for safe handling and sanitation, for child care providers. Rev ed. Washington, DC: USDA. http://teamnutrition.usda.gov/resources/appendj.pdf.
  3. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration (FDA). 2009. 2009 Food code. College Park, MD: FDA. http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.
  4. U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2010. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.

4.9.0.3: Precautions for a Safe Food Supply


All foods stored, prepared, or served should be safe for human consumption by observation and smell (1-2). The following precautions should be observed for a safe food supply:

  1. Home-canned food; food from dented, rusted, bulging, or leaking cans, and food from cans without labels should not be used;
  2. Foods should be inspected daily for spoilage or signs of mold, and foods that are spoiled or moldy should be promptly and appropriately discarded;
  3. Meat should be from government-inspected sources or otherwise approved by the governing health authority (3);
  4. All dairy products should be pasteurized and Grade A where applicable;
  5. Raw, unpasteurized milk, milk products; unpasteurized fruit juices; and raw or undercooked eggs should not be used. Freshly squeezed fruit or vegetable juice prepared just prior to serving in the child care facility is permissible;
  6. Unless a child’s health care professional documents a different milk product, children from twelve months to two years of age should be served only human milk, formula, whole milk or 2% milk (6). Note: For children between twelve months and two years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk is appropriate only with written documentation from the child’s primary health care professional (4). Children two years of age and older should be served skim or 1% milk. If cost-saving is required to accommodate a tight budget, dry milk and milk products may be reconstituted in the facility for cooking purposes only, provided that they are prepared, refrigerated, and stored in a sanitary manner, labeled with the date of preparation, and used or discarded within twenty-four hours of preparation;
  7. Meat, fish, poultry, milk, and egg products should be refrigerated or frozen until immediately before use (5);
  8. Frozen foods should be defrosted in one of four ways: In the refrigerator; under cold running water; as part of the cooking process, or by removing food from packaging and using the defrost setting of a microwave oven (5). Note: Frozen human milk should not be defrosted in the microwave;
  9. Frozen foods should never be defrosted by leaving them at room temperature or standing in water that is not kept at refrigerator temperature (5);
  10. All fruits and vegetables should be washed thoroughly with water prior to use (5);
  11. Food should be served promptly after preparation or cooking or should be maintained at temperatures of not less than 135°F for hot foods and not more than 41°F for cold foods (12);
  12. All opened moist foods that have not been served should be covered, dated, and maintained at a temperature of 41°F or lower in the refrigerator or frozen in the freezer, verified by a working thermometer kept in the refrigerator or freezer (12);
  13. Fully cooked and ready-to-serve hot foods should be held for no longer than thirty minutes before being served, or promptly covered and refrigerated;
  14. Pasteurized eggs or egg products should be substituted for raw eggs in the preparation of foods such as Caesar salad, mayonnaise, meringue, eggnog, and ice cream. Pasteurized eggs or egg products should be substituted for recipes in which more than one egg is broken and the eggs are combined, unless the eggs are cooked for an individual child at a single meal and served immediately, such as in omelets or scrambled eggs; or the raw eggs are combined as an ingredient immediately before baking and the eggs are fully cooked to a ready-to-eat form, such as a cake, muffin or bread;
  15. Raw animal foods should be fully cooked to heat all parts of the food to a temperature and for a time of; 145°F or above for fifteen seconds for fish and meat; 160°F for fifteen seconds for chopped or ground fish, chopped or ground meat or raw eggs; or 165°F or above for fifteen seconds for poultry or stuffed fish, stuffed meat, stuffed pasta, stuffed poultry or stuffing containing fish, meat or poultry.
RATIONALE
Safe handling of all food is a basic principle to prevent and reduce foodborne illnesses (14). For children, a small dose of infectious or toxic material can lead to serious illness (13). Some molds produce toxins that may cause illness or even death (such as aflatoxin or ergot).

Keeping cold food below 41°F and hot food above 135°F prevents bacterial growth (1,6,12). Food intended for human consumption can become contaminated if left at room temperature.

Foodborne illnesses from Salmonella and E. coli 0157:H7 have been associated with consumption of contaminated, raw, or undercooked egg products, meat, poultry, and seafood. Children tend to be more susceptible to E. coli 0157:H7 infections from consumption of undercooked meats, and such infections can lead to kidney failure and death.

Home-canned food, food from dented, rusted, bulging or leaking cans, or leaking packages/bags of frozen foods, have an increased risk of containing microorganisms or toxins. Users of unlabeled food cans cannot be sure what is in the can and how long the can has been stored.

Excessive heating of foods results in loss of nutritional content and causes foods to lose appeal by altering color, consistency, texture, and taste. Positive learning activities for children, using their senses of seeing and smelling, help them to learn about the food they eat. These sensory experiences are counterproductive when food is overcooked. Children are not only shortchanged of nutrients, but are denied the chance to use their senses fully to learn about foods.

Caregivers/teachers should discourage parents/guardians from bringing home-baked items for the children to share as it is difficult to determine the quality of the ingredients used and the cleanliness of the environment in which the items are baked and transported. Parents/guardians should be informed why home baked items like birthday cake and cupcakes are not the healthiest choice and the facility should provide ideas for healthier alternatives such as fruit cups or fruit salad to celebrate birthdays and other festive events.

Several states allow the sale of raw milk or milk products. These products have been implicated in outbreaks of salmonellosis, listeriosis, toxoplasmosis, and campylobacteriosis and should never be served in child care facilities (7,8). Only pasteurized milk and fruit juices should be served. Foods made with uncooked eggs have been involved in a number of outbreaks of Salmonella infections. Eggs should be well-cooked before being eaten, and only pasteurized eggs or egg substitutes should be used in foods requiring raw eggs.

The American Academy of Pediatrics (AAP) recommends that children from twelve months to two years of age receive human milk, formula, whole milk, or 2% milk. For children between twelve months and two years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk is appropriate only with written documentation from the child’s primary health care professional (4). Children two years of age and older can drink skim, or 1%, milk (6,9-11).

Soil particles and contaminants that adhere to fruits and vegetables can cause illness. Therefore, all fruits or vegetables to be eaten and used to make fresh juice at the facility should be thoroughly washed first.

Thawing frozen foods under conditions that expose any of the food’s surfaces to temperatures between 41°F and 135°F promotes the growth of bacteria that may cause illness if ingested. Storing perishable foods at safe temperatures in the refrigerator or freezer reduces the rate at which microorganisms in these foods multiply (12).

COMMENTS
The use of dairy products fortified with vitamins A and D is recommended (4).

The FDA provides the following Website for caregivers/teachers to check status of foods and food products that have been recalled, see http://www.fda.gov.

Temperatures come from the FDA 2009 Food Code (12). Local or state regulations may differ. Caregivers/teachers should consult with the health department concerning questions on proper cooking temperatures for specific foods.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.3.1.7 Feeding Cow’s Milk
4.8.0.6 Maintaining Safe Food Temperatures
Appendix U: Recommended Safe Minimum Internal Cooking Temperatures
REFERENCES
  1. U.S. Department of Agriculture (USDA). 2002. Making nutrition count for children - Nutrition guidance for child care homes. Washington, DC: USDA. http://www/gpo.gov/fdsys/pkg/ERIC-ED482991/pdf/ERIC-ED482991.pdf.
  2. Enders, J. B. 1994. Food, nutrition and the young child. New York: Merrill.
  3. Potter, M. E. 1984. Unpasteurized milk: The hazards of a health fetish. JAMA 252:2048-52.
  4. Sacks, J. J. 1982. Toxoplasmosis infection associated with raw goat’s milk. JAMA 246:1728-32.
  5. Cowell, C., S. Schlosser. 1998. Food safety in infant and preschool day care. Top Clin Nutr 14:9-15.
  6. Dietz, W.H., L. Stern, eds. 1998. Guide to your child’s nutrition. Elk Grove Village, IL: American Academy of Pediatrics.
  7. U.S. Department of Agriculture (USDA), Food Safety and Inspection Service. 2000. Keeping kids safe: A guide for safe handling and sanitation, for child care providers. Rev ed. Washington, DC: USDA. http://teamnutrition.usda.gov/resources/appendj.pdf.
  8. Daniels, S. R., F. R. Greer, Committee on Nutrition. 2008. Lipid screening and cardiovascular health in childhood. Pediatrics 122:198-208.
  9. Kleinman, R. E., ed. 2009. Pediatric nutrition handbook. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  10. Pipes, P. L., C. M. Trahms, eds. 1997. Nutrition in infancy and childhood. 6th ed. New York: McGraw-Hill.
  11. Chicago Dietetic Association. 1996. Manual of clinical dietetics. 5th ed. Chicago, IL: American Dietetic Association.
  12. U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2010. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.
  13. Food Marketing Institute (FMI), U.S. Department of Agriculture, Food Safety and Inspection Service. 1996. Facts about food and floods: A consumer guide to food quality and safe handling after a flood or power outage. Washington, DC: FMI.
  14. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration (FDA). 2009. 2009 Food code. College Park, MD: FDA. http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.

4.9.0.4: Leftovers


Food returned from individual plates and family style serving bowls, platters, pitchers, and unrefrigerated foods into which microorganisms are likely to have been introduced during food preparation or service, should be immediately discarded.

Unserved perishable food should be covered promptly for protection from contamination, should be refrigerated immediately, and should be used within twenty-four hours. “Perishable foods” include those foods that are subject to decay, spoilage or bacteria unless it is properly refrigerated or frozen (1).

Hot food can be placed directly in the refrigerator or it can be rapidly chilled in an ice or cold water bath before refrigerating. Hot foods should be promptly cooled first before they are fully covered in the refrigerator. Prepared perishable foods that have not been maintained at safe temperatures for two hours or more should be discarded immediately. If the air or room temperature is above 90°F, this time is reduced to one hour after which the food should be discarded (2). “Safe temperatures” mean keeping foods cold (below 41°F) or hot (above 135°F) (4).

RATIONALE
Served foods have a high probability of contamination during serving. Bacterial multiplication proceeds rapidly in perishable foods out of refrigeration, as much as doubling the numbers of bacteria every fifteen to twenty minutes.

The potential is high for perishable foods (food that is subject to decay, spoilage, or bacteria unless it is properly refrigerated or frozen) that have been out of the refrigerator for more than two hours to have substantial loads of bacteria. This time can be as short as one hour if the air temperature is above 90°F. When such food is stored and served again, it may cause foodborne illness.

COMMENTS
All food, once served or handled outside the food preparation area, should be discarded.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.8.0.6 Maintaining Safe Food Temperatures
REFERENCES
  1. U.S. Department of Agriculture, Food Safety and Inspection Service. Glossary:Perishable. http://www.fda.gov/downloads/Food/FoodScienceResearch/ToolsMaterials/UCM430363.pdf.
  2. U.S. Department of Agriculture, Food Safety and Inspection Service. 2006. Safe food handling, basics for handling food safelyhttp://www.fsis.usda.gov/PDF/Basics_for_Safe_Food_Handling.pdf.
  3. U.S. Department of Agriculture, Food Safety and Inspection Service. 2006. Safe food handling, how temperatures affect food. http://www.fsis.usda.gov/pdf/How_Temperatures_Affect_Food.pdf
  4. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration (FDA). 2009. 2009 Food code. College Park, MD: FDA.http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.

4.9.0.5: Preparation for and Storage of Food in the Refrigerator


All food stored in the refrigerator should be tightly covered, wrapped, or otherwise protected from direct contact with other food. Hot foods to be refrigerated and stored should be transferred to shallow containers in food layers less than three inches deep and refrigerated immediately. These foods should be covered when cool. Any pre-prepared or leftover foods that are not likely to be served the following day should be labeled with the date of preparation before being placed in the refrigerator. The basic rule for serving food should be, “first food in, first food out” (1-3).

In the refrigerator, raw meat, poultry and fish should be stored below cooked or ready to eat foods.

RATIONALE
Covering food protects it from contamination and keeps other food particles from falling into it. Hot food cools more quickly in a shallow container, thereby decreasing the time when the food would be susceptible to contamination. Foods should be covered only after they have cooled. Leaving hot food uncovered allows it to cool more quickly, thereby decreasing the time when bacteria may be produced.

Labeling of foods will inform the staff about the duration of storage, which foods to use first, and which foods to discard because the period of safe storage has passed.

Storing raw meat, poultry and fish on a dish or in a pan below ready-to-eat foods reduces the possibility that spills or drips from raw animal foods might contaminate ready-to-eat food.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.8.0.6 Maintaining Safe Food Temperatures
4.9.0.3 Precautions for a Safe Food Supply
Appendix V: Food Storage Chart
REFERENCES
  1. Benjamin, S. E., ed. 2007. Making food healthy and safe for children: How to meet the national health and safety performance standards – Guidelines for out of home child care programs. 2nd ed. Chapel Hill, NC: National Training Institute for Child Care Health Consultants. http://nti.unc.edu/course_files/curriculum/nutrition/making_food_healthy_and_safe.pdf.
  2. Enders, J. B. 1994. Food, nutrition and the young child. New York: Merrill.
  3. U.S. Department of Agriculture (USDA). 2002. Making nutrition count for children - Nutrition guidance for child care homes. Washington, DC: USDA. http://www/gpo.gov/fdsys/pkg/ERIC-ED482991/pdf/ERIC-ED482991.pdf.

4.9.0.6: Storage of Foods Not Requiring Refrigeration


Foods not requiring refrigeration should be stored at least six inches above the floor in clean, dry, well-ventilated storerooms or other approved areas (1,2). Food products should be stored in such a way (such as in nonporous containers off the floor) as to prevent insects and rodents from entering the products.
RATIONALE
Storage of food off the floor in a safe and sanitary manner helps prevent food contamination from cleaning chemicals or spills of other foods and keeps insects and rodents from entering the products.
COMMENTS
Storing food six inches or higher above the floor enables easier cleaning of the floor under the food.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
5.2.8.1 Integrated Pest Management
REFERENCES
  1. Food Marketing Institutes (FMI). 1996. Facts about food and floods: A consumer guide to food quality and safe handling after a flood or power outage. Washington, DC: FMI.
  2. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration (FDA). 2009. 2009 Food code. College Park, MD: FDA. http://www.fda.gov/downloads/Food/FoodSafety/RetailFoodProtection/FoodCode/FoodCode2009/UCM189448.pdf.

4.9.0.7: Storage of Dry Bulk Foods


Dry, bulk foods that are not in their original, unopened containers should be stored off the floor in clean metal, glass, or food-grade plastic containers with tight-fitting covers. All bulk food containers should be labeled and dated, and placed out of children’s reach. Children should be permitted to handle household-size food containers during adult-supervised food preparation and cooking activities and when the container holds a single serving of food intended for that child’s consumption.
RATIONALE
Food-grade nonporous containers prevent insect infestations and contamination from other foods and cleaning chemicals. By labeling and dating food, the food service staff can rotate the oldest foods to be used next and discard foods that have gone beyond safe storage times. Keeping bulk food containers out of the children’s reach prevents contamination and misuse. Young children cannot be expected to have learned safe food handling practices well enough to prevent contaminating the food supply of others.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
5.2.8.1 Integrated Pest Management

4.9.0.8: Supply of Food and Water for Disasters

 Content in the STANDARD was modified on 05/21/2019.


Disaster Preparedness
A minimum 3-day supply of nonperishable food and 1 gallon of water per person per day for 3 days should be kept in stock for each child and staff member.1,2 For programs with 100 children, this would mean 300 gallons of water and approximately 1,000 meals. Programs should consider appropriate and accessible storage for a large quantity of supplies.

For early care and education programs in areas at risk for hurricanes and other severe disasters, an additional 2-day supply (ie, supply for 5 days total) of nonperishable food and water may be needed. A written log detailing the expiration dates, as well as the amount and type of food, should be kept by early care and education staff and reviewed on a quarterly basis. Caregivers/teachers should review log/expiration dates on a quarterly basis; food and water supplies should be consumed and/or replaced from the emergency supplies to ensure usage before expiration.

Early care and education programs should accommodate children with special health care needs who require specialized diets. Appropriate, nonperishable food items should be kept and made available for these children in the event of a disaster.3

Disaster Response and Recovery

Early care and education programs should assess the emergency food supply and food preparation areas/equipment annually and after a disaster.

Early care and education staff should avoid serving food and beverages under the following circumstances4,5:

  • Food or beverages that have been exposed to floodwater or chemical agents. If unsure, throw them away.
  • Dispose of wooden cutting boards, bottle nipples, and pacifiers if they have been contaminated with floodwater, as they are difficult to properly clean.
  • Dispose of perishable foods, such as meat and eggs, that have been stored in temperatures above 40°F for longer than 2 hours. Foods stored at 40°F or below can be refrozen or cooked.
  • Food that is packed in plastic, paper, cardboard, cloth, or similar containers that have been water damaged.
  • Food that is stored in containers that cannot be disinfected. This would include foods in containers with screw caps, snap lids, crimped caps (soda bottles), twist caps, or flip tops, as well as home canned foods.

Water Safety

If there is any chance that tap water has been contaminated during a disaster, don’t use it. Listen to updates from emergency officials on the state of your community’s water supply and for instructions to boil tap water before use (to stay abreast of such updates, make sure your stockpile includes a battery-operated radio). Do not attempt to drink water you believe has been contaminated with fuel or toxic chemicals, as boiling and other disinfectants will not work to purify it.5

 

If bottled water is not available, boiling water is the best way to purify drinking supplies and kill disease-carrying bacteria, viruses, and parasites.5 If the water is cloudy, first filter it through a clean paper towel, cloth, or coffee filter before boiling. 6 Bring your water to a boil and allow it to boil for at least 1 minute.7 Store your boiled water in clean containers with tight lids.

If boiling your water is not an option, you can also use unscented household chlorine bleach, iodine, or chlorine dioxide tablets. Keep in mind that while such methods are effective at killing harmful bacteria and viruses, only chlorine dioxide tablets and boiling will kill disease-carrying parasites. To purify your water using unscented household chlorine bleach, add one-eighth of a teaspoon for every gallon of clear water and one-fourth of a teaspoon for every gallon of cloudy water. Stir the water and let it sit for 30 minutes before using it. To use iodine or chlorine dioxide tablets, follow the manufacturer’s instructions.

Early care and education staff should remove the labels of undamaged, commercially prepared foods in all-metal cans or retort pouches and thoroughly wash, rinse, and disinfect the cans. Lastly, relabel containers that had the labels removed, including the expiration date, with a permanent marker.3

RATIONALE

It may take 3 days or longer for nutrition assistance and food packages to arrive after a disaster strikes. Due to possible widespread damage, transportation disruptions, and supply shortages, it may not be possible for supplies to be brought into disaster locations until the following conditions are met:

     a) Efforts to rescue/save lives are completed.

     b) Needs of communities/populations are assessed.

Preparing for disasters by keeping an emergency supply of food and water can prolong the health of children and staff in disaster-impacted areas.8

COMMENTS
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
3.4.3.1 Medical Emergency Procedures
3.5.0.1 Care Plan for Children with Special Health Care Needs
4.2.0.1 Written Nutrition Plan
4.2.0.10 Care for Children with Food Allergies
5.2.6.2 Testing of Drinking Water Not From Public System
5.2.6.5 Emergency Safe Drinking Water and Bottled Water
5.6.0.1 First Aid and Emergency Supplies
REFERENCES
  1. Federal Emergency Management Agency, US Department of Homeland Security. Emergency supply list. https://www.fema.gov/media-library-data/1390846764394-dc08e309debe561d866b05ac84daf1ee/checklist_2014.pdf. Accessed December 20, 2018

  2. Federal Emergency Management Agency, US Department of Homeland Security. Water. Ready website. https://www.ready.gov/water. Accessed December 20, 2018

  3. Singh SN. Nutrition in emergencies: issues involved in ensuring proper nutrition in post-chemical, biological, radiological, and nuclear disaster. J Pharm Bioallied Sci. 2010;2(3):248–252

  4. Wolfram T. Food safety in the home after a hurricane and flooding. Academy of Nutrition and Dietetics Eat Right website. https://www.eatright.org/homefoodsafety/safety-tips/food-poisoning/food-safety-in-the-home-after-a-hurricane-and-flooding. Published September 10, 2018. Accessed December 20, 2018

  5. American Public Health Association. Keeping food and water safe in an emergency. http://aphagetready.org/foodwatersafety.htm. Accessed December 20, 2018

  6. Federal Emergency Management Agency, US Department of Homeland Security. Fact sheet: How to make your water safe to drink. https://www.fema.gov/news-release/2017/10/08/fact-sheet-how-make-your-water-safe-drink. Accessed May 2, 2019

  7. Centers for Disease Control and Prevention. Making water safe in an emergency. https://www.cdc.gov/healthywater/emergency/drinking/making-water-safe.html. Updated September 21, 2017. Accessed May 2, 2019

  8. Pradhan PM, Dhital R, Subhani H. Nutrition interventions for children aged less than 5 years following natural disasters: a systematic review. BMJ Open. 2016;6(9):e011238

NOTES

 Content in the STANDARD was modified on 05/21/2019.

4.9.0.9: Cleaning Food Areas and Equipment


Areas and equipment used for storage, preparation, and service of food should be kept clean. All of the food preparation, food service, and dining areas should be cleaned and sanitized before and after use. Food preparation equipment should be cleaned and sanitized after each use and stored in a clean and sanitary manner, and protected from contamination.

Sponges should not be used for cleaning and sanitizing. Disposable paper towels should be used. If washable cloths are used, they should be used once, then stored in a covered container and thoroughly washed daily. Microfiber cloths are preferable to cotton or paper towels for cleaning tasks because of microfiber’s numerous advantages, including its long-lasting durability, ability to remove microbes, ergonomic benefits, superior cleaning capability and reduction in the amount of chemical needed.

RATIONALE
Outbreaks of foodborne illness have occurred in child care settings. Many of these infectious diseases can be prevented through appropriate hygiene and sanitation methods. Keeping hands clean reduces soiling of kitchen equipment and supplies. Education of child care staff regarding routine cleaning procedures can reduce the occurrence of illness in the group of children with whom they work (1).

Sponges harbor bacteria and are difficult to clean and sanitize between cleaning surface areas.

COMMENTS
“Clean” means removing all visible soil. Routine cleaning of kitchen areas should comply with the cleaning schedule provided in Appendix K or local health authority regulations.

“Sanitize” means using a product to reduce germs on inanimate surfaces to levels considered safe by public health codes or regulations.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
REFERENCES
  1. Cowell, C., S. Schlosser. 1998. Food safety in infant and preschool day care. Top Clin Nutr 14:9-15.

4.9.0.10: Cutting Boards


Cutting boards should be made of nonporous material and should be scrubbed with hot water and detergent and sanitized between uses for different foods or placed in a dishwasher for cleaning and sanitizing. The facility should not use porous wooden cutting boards, boards made with wood components, and boards with crevices and cuts. Only hard maple or an equivalently hard, close-grained wood (e.g. oak) may be used for cutting boards.
RATIONALE
Some wood boards and boards with cracks and crevices harbor food or organic material that can promote bacterial growth and contaminate the next food cut on the surface.
COMMENTS
Heavy duty plastic and Plexiglas cutting boards can be placed in dishwashers. Programs should check with their local health department with questions regarding the proper hard wood for an allowable wood cutting board in child care facilities.
TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

4.9.0.11: Dishwashing in Centers


Centers should provide a three-compartment dishwashing area with dual integral drain boards or an approved dishwasher capable of sanitizing multi-use utensils. If a dishwasher is installed, there should be at least a two-compartment sink with a spray unit. If a dishwasher or a combination of dish pans and sink compartments that yield the equivalent of a three-compartment sink is not used, paper cups, paper plates and plastic utensils should be used and should be disposed of after every use.
RATIONALE
These are minimum requirements for proper cleaning and sanitizing of dishes and utensils (1).

A three-compartment sink is ideal. If only a single- or double-compartment sink is available, three freestanding dish pans or two sinks and one dish pan may be used as the compartments needed to wash, rinse, and sanitize dishes.

An approved dishwasher is a dishwasher that meets the approval of the regulatory health authority. Dishwashers should be carefully chosen. Depending on the size of the child care center and the quantity of food prepared, a household dishwasher may be adequate. Because of the time required to complete a full wash, rinse, and dry cycle, household domestic dishwashers are recommended for centers that do only one load of dishes after a snack or meal. Commercial dishwashers are required for some sizes of centers in some locales. Centers are responsible to comply with the requirements of the local regulatory health agency.

The length of time to wash dishes in commercial dishwashers is three to four minutes. Commercial dishwashers that operate at low water temperatures (140°F to 150°F) are recommended because they are more energy-efficient. These would be equipped with automatic detergent and sanitizer injectors. When choosing a dishwasher, caregivers/teachers can consult with the local health authority or state/local nutritionist/registered dietitian to ensure that they meet local health regulations.

COMMENTS
Household dishwashing machines can effectively wash and sanitize dishes and utensils provided that certain conditions are met. The three types of household dishwashers are:
  1. Those that lack or operate without sanitizing wash or rinse cycles;
  2. Those that have sanitizing wash or rinse cycles and a thermostat that senses a temperature of 150°F or higher before the machine advances to the next step in its cycle;
  3. Those that have a sanitizing cycle and a thermostat as in (b) but advance to the next step in its cycle after fifteen minutes, if the temperature required to operate the thermostat is not reached.

All three types of household dishwashers are capable of producing the cumulative heat factor to meet the National Sanitation Foundation time-temperature standard for commercial, spray-type dishwashing machines. Dishwasher types (a) and (c) are capable of doing so only if the temperature of their inlet water is 155°F or higher.

The temperature of a hot water supply necessary for operating a dishwasher conflicts with what is considered a safe temperature to prevent scalding (no higher than 120°F). Installing a separate small hot water heater exclusively for dishwasher type (a) or (c) is a way to meet this requirement.

TYPE OF FACILITY
Center, Early Head Start, Head Start
RELATED STANDARDS
5.2.1.14 Water Heating Devices and Temperatures Allowed
REFERENCES
  1. U.S. Department of Agriculture (USDA). 2002. Making nutrition count for children - Nutrition guidance for child care homes. Washington, DC: USDA. http://www/gpo.gov/fdsys/pkg/ERIC-ED482991/pdf/ERIC-ED482991.pdf.

4.9.0.12: Dishwashing in Small and Large Family Child Care Homes


Small and large family child care homes should provide a three-compartment dishwashing arrangement or a dishwasher. At least a two-compartment sink or a combination of dish pans and sink compartments should be installed to be used in conjunction with a dishwasher to wash, rinse, and sanitize dishes. The dishwashing machine must incorporate a chemical or heat sanitizing process. If a dishwasher or a three-compartment dishwashing arrangement is not used, paper cups, paper plates and plastic utensils should be used and should be disposed of after every use.
RATIONALE
These are minimum requirements for proper cleaning and sanitizing of dishes and utensils (1). The purpose is to remove food particles and other soil, and to control bacteria.
TYPE OF FACILITY
Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.9.0.11 Dishwashing in Centers
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
REFERENCES
  1. U.S. Department of Agriculture (USDA). 2002. Making nutrition count for children - Nutrition guidance for child care homes. Washington, DC: USDA. http://www/gpo.gov/fdsys/pkg/ERIC-ED482991/pdf/ERIC-ED482991.pdf.

4.9.0.13: Method for Washing Dishes by Hand

Frequently Asked Questions/CFOC Clarifications

Reference: 4.9.0.13

Date: 8/19/2012

Topic & Location:
Chapter 4
Nutrition and Food Service
Standard 4.9.0.13: Methods for Washing Dishes by Hand

Question:
I am hoping to get some clarification on the amount of bleach to use when washing dishes in a three compartment sink. I see in Appendix J the chart indicates 1 tablespoon of bleach + 1 gallon of cool water as a sanitizing solution. While the standard says:

 
If the facility does not use a dishwasher, reusable food service equipment and eating utensils should be first scraped to remove any leftover food, washed thoroughly in hot water containing a detergent solution, rinsed, and then sanitized by one of the following methods:

a.    Immersion for at least two minutes in a lukewarm (not less than 75°F) chemical sanitizing solution (bleach solution of at least 100 parts per million by mixing 1 1/2 teaspoons of domestic bleach per gallon of water). The sanitized items should be air-dried;
 
Can you clarify which measurement needs to be used in the three compartment sink method?
 

Answer:
The sanitizing solution referenced in Standard 4.9.0.13 (1 ½ Teaspoons of bleach per gallon of water, ) is from the 2009 Food Code and this section has remained the same in the 2011 Food Code which came out after the publication of CFOC 3.  The key words in the above Standard are “at least.”  If you were to use the sanitizing solution referenced in Appendix J (1 Tablespoon of bleach per gallon of water) you would still be meeting this requirement since that solution is 200 parts per million.  Using a higher concentration of bleach is not a problem as the 2011 Food Code requires “at least” 100 parts per million but does not provide an upper limit.

Content in the STANDARD was modified on 8/6/2013.


If the facility does not use a dishwasher, reusable food service equipment and eating utensils should be first scraped to remove any leftover food, washed thoroughly in hot water containing a detergent solution, rinsed, and then sanitized by one of the following methods:

  1. Immersion for at least two minutes in a lukewarm (not less than 75°F) chemical sanitizing solution. Bleach may be used as a sanitizing solution when diluted according to manufacturer's instructions. The sanitized items should be air-dried; or
  2. Immersed in an EPA-registered sanitizer following the manufacturer’s instructions for preparation and use; or
  3. Complete immersion in hot water and maintenance at a temperature of 170 °F for not less than thirty seconds. The items should be air-dried (1);
  4. Or, other methods if approved by the health department.
RATIONALE
These procedures provide for proper sanitizing and control of bacteria (2-4).
COMMENTS
To manually sanitize dishes and utensils in hot water at 170°F, a special hot water booster is usually required. To avoid burning the skin while immersing dishes and utensils in this hot water bath, special racks are required. Therefore, if dishes and utensils are being washed by hand, the chemical sanitizer method will be a safer choice.

Often, sponges are used in private homes when washing dishes. The structure of natural and artificial sponges provides an environment in which microorganisms thrive. This may contribute to the microbial load in the wash water. Nevertheless, the rinsing and sanitizing process should eliminate any pathogens contributed by a sponge. When possible, a cloth that can be laundered should be used instead of a sponge.

The concentration of bleach used for sanitizing dishes is much more diluted than the concentration recommended for disinfecting surfaces elsewhere in the facility. After washing and rinsing the dishes, the amount of infectious material on the dishes should be small enough so that the two minutes of immersion in the bleach solution (or treatment with an EPA-registered sanitizer) combined with air-drying will reduce the number of microorganisms to safe levels.

Air-drying of surfaces that have been sanitized using bleach leaves no residue, since chlorine evaporates when the solution dries. However, other sanitizers may need to be rinsed off to remove retained chemical from surfaces.

TYPE OF FACILITY
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.9.0.12 Dishwashing in Small and Large Family Child Care Homes
REFERENCES
  1. Bryan, F. L., G. H. DeHart. 1975. Evaluation of household dishwashing machines, for use in small institutions. J Milk Food Tech 38:509-15.
  2. Benjamin, S. E., ed. 2007. Making food healthy and safe for children: How to meet the national health and safety performance standards – Guidelines for out of home child care programs. 2nd ed. Chapel Hill, NC: National Training Institute for Child Care Health Consultants. http://nti.unc.edu/course_files/curriculum/nutrition/making_food_healthy_and_safe.pdf.
  3. Enders, J. B. 1994. Food, nutrition and the young child. New York: Merrill.
  4. U.S. Department of Agriculture (USDA). 2002. Making nutrition count for children - Nutrition guidance for child care homes. Washington, DC: USDA. http://www/gpo.gov/fdsys/pkg/ERIC-ED482991/pdf/ERIC-ED482991.pdf.
NOTES

Content in the STANDARD was modified on 8/6/2013.