Required Dietary Inservice Training for South Dakota Nursing Homes

Residents of nursing homes and other long-term care centers like assisted living facilities are a highly susceptible population.

This means they are more likely than the general public to develop a foodborne illness.

Foodborne illnesses are caused by consuming foods or beverages contaminated with a disease-causing organism known as a pathogen, such as bacteria, virus, or parasite.

To reduce the risk of foodborne illnesses among nursing home residents, South Dakota requires that the dietitian or person in charge provide inservice training to food handlers on important food safety topics.

This article lists the required dietary inservice training for South Dakota nursing homes and assisted living facilities.

Required dietary inservice topics

South Dakota requires that the dietitian or person in charge at nursing homes provide ongoing inservice training — usually within 30 days of hire and annually — to food handlers on various food safety topics (1, 2).

FoodSafePal’s food handler training program meets South Dakota’s required dietary inservice training requirements for all of these topics but nutrition and hydration.

Foodborne illnesses

Foodborne illnesses originate from food and are most commonly caused by pathogenic bacteria and viruses.

Of the more than 250 known pathogens that cause foodborne illnesses, there are six that spread easily through food.

These six pathogens are known as the “Big 6,” and include:

• Norovirus
• Hepatitis A
• Shigella
• Shiga toxin-producing Escherichia Coli (STEC)
• Salmonella Typhi
• Salmonella (nontyphoidal)

Educate your staff that they must report to you if they have been diagnosed with or exposed to these pathogens.

Your staff also must know that they need to report to you the following symptoms:

• vomiting
• diarrhea
• jaundice (yellowing of the skin and eye whites)
• sore throat with a fever

These symptoms may indicate a food handler has a foodborne illness.

Proper handwashing techniques

Proper handwashing is one of the best ways to prevent the spread of foodborne illnesses.

Unfortunately, most food handlers don’t wash their hands correctly or when or where they’re supposed to, promoting the spread of pathogens.

Educate your staff on the how, when, and where of handwashing.

Here are the proper handwashing steps:

1. Wet your hands with clean, running warm water.
2. Apply soap and rub all surfaces of your hands and fingers together vigorously for 10-15 seconds.
3. Don’t forget to scrub under your fingernails and between your fingers, thumbs, and palms.
4. Rinse your hands well.
5. Dry your hands with a single-use paper towel.
6. Use a single-use paper towel to turn off the faucet.

Food handlers must wash their hands anytime they become contaminated, such as:

• when entering a food preparation area
• before putting on single-use gloves and between glove changes
• before beginning food preparation
• before handling clean equipment and utensils
• after touching their face or other body parts
• when switching tasks, such as switching from handling raw animal foods to working with ready-to-eat (RTE) foods

Educate your staff that they can only wash their hands in a sink designated for handwashing — never sinks used to prepare foods, wash dishes, or dispose of mop water and other liquid waste.

Safe food handling and preparation techniques

Handling food safely starts with good hand hygiene, but you must also educate your staff on how cross-contamination occurs and what they can do to prevent it.

Cross-contamination is the transfer of pathogens from one food or surface to another.

It usually occurs when a food handler works with raw animal foods and then switches to handling RTE foods.

It can also occur when food handlers handle RTE foods like cooked hot dogs, washed fruits or vegetables, or sandwiches with their bare hands instead of using single-use gloves or some type of utensil. This is one of the most common mistakes food handlers make in nursing homes.

You should also educate your staff on how to prevent cross-contact, which is the transfer of food allergens rather than pathogens from one food to another.

Also, make sure that your staff knows the minimum internal temperature that they must cook various animal products to in order to make them safe as well as how to properly calibrate and use a food thermometer to verify the temperature.

Safe serving and distribution practices

Safe serving and distribution have largely to do with ensuring that your dietary staff holds food at the proper temperatures.

Holding food at the proper temperatures during serving is necessary to prevent food from slipping into the temperature danger zone where bacteria can multiply quickly and make food unsafe.

Ensure that your staff knows to hold hot food at 135ºF (57ºC) or higher, and cold food at 41ºF (5ºC) or lower.

You should also educate them to temp the food at least every four hours while it’s being hot or cold held and toss the food if it enters the temperature danger zone.

While not required, temping the food more often — for example, every two hours — allows your dietary staff to take corrective action if the food is within the temperature danger zone and recondition it to make it safe again.

Finally, your staff should know to not use the temperature gauge on the hot- and cold-holding equipment since this is the temperature of the device, not its internal temperature.

Safe leftover food handling

Your staff must handle leftovers properly and cool them properly to reduce the time they spend in the temperature danger zone.

They can do this through the two-stage cooling method.

Cool food from 135ºF (57ºC) — the minimum temperature at which foods must be hot held — to 70ºF (21ºC) within two hours in the first stage, and then cool from 70ºF (21ºC) to 41ºF (5ºC) within four hours to complete the second stage.

Educate your staff on how to properly cool foods by setting up an ice-water bath, stirring the food with an ice paddle, or using a blast chiller.

Separating dense or liquid items like casseroles or mashed potatoes into shallow pans and cutting thicker items like roasts into smaller pieces can speed up the cooling process.

For time-temperature control for safety (TCS) foods, educate your staff that they must label the food with the date or day by which the food needs to be served or thrown out if it will be held for longer than 24 hours.

You can store TCS foods for up to seven days.

Finally, educate your staff on the proper storage order for refrigerated foods.

Time and temperature controls for food safety

Foods that require time and temperature controls to keep them safe are known as TCS foods.

Examples of TCS foods include:

• milk and milk products
• meats, poultry, and seafood
• heat-treated plant foods, such as cooked onions, rice, baked potatoes, and soy protein products like tofu
• cut melons, tomatoes, carrots, and leafy greens
• raw seed sprouts
• RTE foods

The best way to keep TCS food safe is to limit the time they spend in the temperature danger zone.

That said, you should educate your staff on how to do so throughout each phase of food flow, from receiving to service.

Here are the topics to cover:

• Receiving. Educate on the proper temperature to receive food and how to inspect food to identify potential contamination.
• Thawing. Educate on the three techniques to thaw TCS food safely.
• Cooking. Educate on the minimum internal temperatures for animal products.
• Holding. Educate on the proper holding temperatures and the importance of regular temperature monitoring.
• Cooling. Educate on the two-stage cooling process and the safe methods they can use to cool foods quicker.
• Reheating. Educate on safe reheating methods and temperatures.

General cleaning and sanitation

Maintaining a clean work environment makes it much easier to prevent the spread of pathogens that cause foodborne illnesses.

Make sure that your staff knows the difference between cleaning and sanitizing.

Every kitchen surface should be regularly cleaned but not every surface needs to be sanitized.

Cleaning removes dirt, grease, and other contaminants from non-food contact surfaces like floors, walls, and equipment like refrigerators.

But when it comes to any surface that touches food like preparation tables, utensils, and dishes, cleaning isn’t enough to reduce bacteria that may be present to safe levels.

Ensure your staff knows the steps to properly clean and sanitize food-contact surfaces:

1. Remove any loose or caked-on food particles.
2. Scrub the surface using warm water and a detergent to remove stuck-on food particles, grime, and oils.
3. Rinse the surface with clean water to wash away any detergent residue.
4. Following the directions on the container, apply a sanitizing solution.
5. Allow the surface to air dry (never use a cloth or towel for drying since this can recontaminate the surface).

Your staff should also know how to clean and sanitize stationary equipment like ranges, grills, and microwaves:

1. Remove any loose or caked-on food particles.
2. Scrub the surface using warm water and a detergent to remove stuck-on food particles, grime, and oils.
3. Rinse the surface with clean water to wash away any detergent residue.
4. Following the directions on the container, apply a sanitizing solution.
5. Allow the surface to air dry (never use a cloth or towel for drying since this can recontaminate the surface).

Wiping cloths are convenient for cleaning and sanitizing tables and stationary equipment, while a dishwasher or 3-compartment sink is ideal for dishes, utensils, and removable equipment parts.

As such, make sure your staff also knows how to properly use your dishwasher and the temperatures it much reach to properly sanitize as well as how to use a 3-compartment sink.

Nutrition and hydration

The final dietary inservice training for South Dakota nursing homes is nutrition and hydration.

The dietary manager can cover this topic but it is best left to the dietitian since they are trained in the various factors that adversely affect the nutrition and hydration status of nursing home residents and the interventions to prevent or reduce the consequences of malnutrition and dehydration.

The bottom line

As a highly susceptible population, nursing home and assisted living residents are more likely to develop foodborne illnesses than the general public.

To reduce this risk, South Dakota requires the person in charge or a dietitian to provide inservice training on foodborne illnesses, proper hand washing, time and temperate controls for food safety, and safe food handling, preparation, and serving techniques to food handlers.

The remaining mandatory inservice topics include safe leftover food handling, general cleaning and sanitation, and nutrition and hydration.

FoodSafePal’s food handler training program meets South Dakota’s required dietary inservice training requirements for food safety.