Food Service to Vulnerable Persons

Food contaminated by harmful microorganisms can make people very sick. The Government of Canada estimates that four million cases of food-borne illness occur in Canada every year, many of which are caused by unsafe food handling practices that allow bacteria, viruses and parasites (‘food-borne pathogens’) to enter food. 

BACTERIA 

Bacteria are common causes of food-borne illness. Under the right conditions, bacteria can multiply rapidly, doubling in number roughly every 20 minutes. 

The most common disease-causing bacteria in Canada are Salmonella, Campylobacter, Listeria and E. coli. The foods that most commonly harbour these dangerous bacteria include meat, poultry, eggs, unpasteurized milk and cheese, shellfish and leafy green vegetables. 

VIRUSES 

Viruses need a living host to survive and reproduce, but they can travel on any type of food, including traditionally low-risk foods like baked goods and dehydrated, preserved and processed foods (e.g. beef jerky, cookies, crackers, candy). 

Viruses can survive on virtually any surface and are extremely resistant to hot and cold temperatures, which means they aren’t destroyed or rendered inactive by cooking, refrigerating or freezing. 

Viruses are most often passed to customers from infected Food Handlers who don’t practice good hygiene — such as frequent and thorough hand washing — or who do not follow safe food handling procedures to prevent food contamination. 

PARASITES 

Parasites, such as tapeworms and roundworms, are organisms that live on or inside humans or animals. They are excreted in feces and can contaminate meat during slaughter and fruit and vegetables grown in soil fertilized with manure. 

People get parasites by consuming contaminated food or water, though transmission is rare because the majority of farm animals are treated to prevent parasitic infections. However, parasites such as anisakiasis — caused by eating parasite-contaminated seafood — is estimated to be on the rise in the Western world. 

SYMPTOMS OF FOOD POISONING 

Most people will begin to experience the symptoms of food poisoning quite quickly after eating the contaminated food. However, it can sometimes take days, weeks or even months for problems to arise, depending on the bacteria involved. 

Food poisoning usually causes symptoms such as vomiting, diarrhea or bloody stools, severe exhaustion or headaches, and fever. In high-risk groups, it can lead to organ failure, coma or death. This is why proper food service to vulnerable people is so important. 

All Canadian food businesses must comply with federal and provincial food safety laws, as well as local municipal legislation. Food businesses that process or serve food to vulnerable persons must uphold extremely high standards of food safety and hygiene to: 

• prevent food-borne infections, complications or death 
• comply with Canadian food safety laws and regulations 
• protect the business or organization from legal or financial consequences of causing illness 

It’s important that businesses and community organizations that cater to vulnerable populations understand their obligations under the law and comply with current food legislation requirements. 

FOOD SAFETY PLANS 

Food businesses in Canada are required to have a Food Safety Plan, which is a set of written procedures that help to eliminate, prevent or reduce food safety hazards that can cause vulnerable people to become ill. Your Food Safety Plan also helps to protect your business from: 

• the financial and legal consequences of causing food poisoning or a food-borne illness outbreak 
• the financial and legal consequences of causing a severe allergic reaction from improperly handling food allergens 
• losing clients as a result of a reputation for unsafe food handling or unhygienic premises 

A Food Safety Plan will help you to determine, implement and manage the critical food safety procedures and protocols required to ensure that only safe, healthy food is served to the vulnerable people in your care. 

Food Safety plans must: 

• systematically identify the potential hazards that may be reasonably expected to occur in all food handling operations of the food business 
• identify where, in a food handling operation, each identified hazard can be controlled and the means of control 
• provide for the systematic monitoring of those controls 
• provide for appropriate corrective action when that hazard, or each of those hazards, is found not to be under control 
• provide for the regular review of the program by the food business to ensure it is working 
• provide for appropriate records to be made and kept by the food business demonstrating action taken in relation to, or in compliance with, the food safety plan 

Food Safety Plans worldwide are based on the seven principles of HACCP. HACCP, which stands for ‘Hazard Analysis Critical Control Points’, is a systematic and preventative system developed in the 1960s by NASA and a team of food safety specialists at the Pillsbury Company. HACCP principles can be applied to processes at every stage of the food supply chain, including production, preparation, packaging and distribution, and is used to manage food safety across many types of food businesses. 

WHAT ARE THE SEVEN PRINCIPLES OF HACCP? 

Think of HACCP principles as the steps you need to take to manage and control food safety risks in your business. 

The seven principles of HACCP are: 

1. Conduct a Hazard Analysis 
2. Identify Critical Control Points 
3. Establish Critical Limits 
4. Monitor Critical Control Points 
5. Establish Corrective Actions 
6. Establish Record Keeping Procedures 
7. Establish Verification Procedures 

1. CONDUCT A HAZARD ANALYSIS 

Hazard analysis is a two-step process which involves identifying and evaluating all of the food safety hazards in your food business. 

A food safety hazard is anything that causes food to become contaminated (and therefore harmful or unsafe). There are three types of food contamination: 

1. biological contamination (e.g. bacteria, viruses) 
2. physical contamination (e.g. pieces of broken glass, metal staples) 
3. chemical contamination (e.g. detergent, sanitizer) 

To properly identify a hazard, you need to be knowledgeable about the food (e.g. its properties and characteristics) and the steps that it goes through on its way to your customer’s plate (e.g. receiving, storage, prepping, cooking). A flow diagram can help you to visualize your product as it moves through your business. 

First, make a list of all biological, chemical and physical hazards that could occur as a result of: 

• ingredients or additives in the food 
• a step in your production / preparation process (e.g. receiving food deliveries, cooking food, serving food, disposing of waste) 

For example, you may identify that the following hazards could occur during the cooling step in your food production process: 

• biological (growth of food poisoning bacteria) 
• biological / physical (contamination of food by objects, e.g. hair, broken glass) 

Next, evaluate each hazard based on: 

• how likely it is to occur 
• how serious the consequences of it happening could be (e.g. Is it a public health risk? Could somebody get hurt?) 

Setting this information out in a table can help you to visualize and structure data so that it is easy to follow and understand. 

2. IDENTIFY CRITICAL CONTROL POINTS (CCPS) 

Now that you have identified all of the food safety hazards in your business, you need to identify your critical control points (CCPs). CCPs are the steps in your process where a control measure is applied and is necessary to prevent, eliminate or reduce a food safety hazard (or hazards) to an acceptable level. 

Identifying CCPs will help you to reduce the risk of food-borne illness in your business by helping you to prevent the growth of dangerous bacteria and other microorganisms, as well as to prevent cross-contamination between different types of food, which can trigger life-threatening allergic reactions in some people. 

Some examples of CCPs could be: 

• the sign-off step when receiving deliveries 
• cooking food to a specific temperature 
• checking the temperature of food before serving 

If you identify a food safety hazard at a step where a CCP is necessary but does not exist, then the process must be modified to include a control measure. 

3. ESTABLISH CRITICAL LIMITS 

A critical limit is the maximum or minimum value to which a food safety hazard (biological, chemical or physical) must be controlled to prevent, eliminate or reduce the hazard to an acceptable level. Each CCP must have one or more critical limits for each hazard. 

Critical limits are generally concerned with parameters that are measurable with equipment or can be answered with a yes or no answer, such as: 

• time 
• temperature 
• acidity 
• best before / expiry dates

Critical limits must be assigned an actual value (e.g. high-risk foods must be cooked to a minimum internal temperature of 74°C/165°F*). Determining or assigning actual values to critical limits can be challenging, as there is such a wide variety of hazards, each with different acceptable values. 

In some cases, you may need to conduct tests or obtain information from outside sources (e.g. regulatory guidelines, expert opinions) to get the information you need. If information is not available, make a judgement call — be sure to err on the side of caution, and keep your reasons for making the decision and any reference materials you used in your Food Safety Plan. 

*Cooking high-risk foods to an internal temperature of 74°C/165°F is a general rule, but different types of high-risk foods have different minimum cooking temperatures (and these can vary from province to province). If you are unsure about the minimum cooking temperature of a particular high-risk food (e.g. beef, pork, poultry, eggs), refer to your local legislation. 

4. MONITOR CRITICAL CONTROL POINTS 

Monitoring must be done to ensure that food remains within the critical limits determined for each critical control point (CCP). Put simply, monitoring means performing an action to check that food is safe. 

Monitoring techniques can be broken down into four different categories: 

• observation monitoring (e.g. checking cleaning schedules, monitoring delivery checklists) 
• sensory monitoring (using taste, smell, touch and/or sight to check whether food is within critical limits) 
• chemical monitoring (e.g. checking acidity levels, conducting a nutritional analysis) 
• physical monitoring (e.g. checking food temperature, pressure, weight, etc.) 

The best way to make sure (and confirm) that monitoring is being done regularly in your establishment is by using checklists and other documentation to record the results. 

5. ESTABLISH CORRECTIVE ACTIONS 

Corrective actions are the actions that must be taken if a deviation from an acceptable critical limit occurs. These are either immediate or preventative. 

An immediate corrective action is stopping a breach that is happening now. For example: 

• throwing out contaminated food 
• rejecting a food delivery with signs of pest infestation 
• refrigerating food to keep it out of the Temperature Danger Zone (4°C–60°C/40°F–140°F*) 

A preventative corrective action is stopping a breach from occurring in the future. For example: 

• performing routine maintenance on equipment 
• changing work procedures 
• training staff to follow food safety best practices 

If corrective action must be taken, remember to record and communicate it to the appropriate person (or people) in the business. 

*In Manitoba, the Temperature Danger Zone is 5°C–60°C/41°F–140°F.

6. ESTABLISH RECORD KEEPING PROCEDURES 

Record keeping is essential to the effective operation of your Food Safety Plan and must include an up-to-date hazard analysis and details of any corrective actions that have been taken in your food business. 

There are many day-to-day records associated with your Food Safety Program. For example: 

• delivery checklists 
• signed-off cleaning schedules 
• temperature recordings 
• pest inspection results 
• staff training records 

All employees should know where the Food Safety Plan is located, what they are responsible for doing (e.g. updating cleaning schedules, filling out temperature logs), when they need to do it and who to report issues to. It’s common for Health Inspectors to ask for these types of documentation during a food safety inspection, so be sure to store them in a safe place. 

7. ESTABLISH VERIFICATION PROCEDURES 

It’s important that you perform an audit of your Food Safety Plan at least once a year to verify that it is working as expected, and to identify opportunities to improve it. Once you have identified these opportunities (and you will), adjust your Food Safety Plan and implement the necessary changes. 

During an audit, it is common for food businesses to: 

• perform internal inspections 
• enlist the services of an external auditor 
• ask for employee feedback 

During an audit, ask yourself the following questions: 

• Have we added any new products/dishes or changed any recipes? 
• Have we changed any processes or food preparation steps? 
• Have there been any changes to food safety laws or regulations that will impact operations? 
• Are there any patterns in the records that point to an opportunity to improve? 

If you answered yes to any of these questions, you need to update your Food Safety Plan.

There are a number of things that must be considered in a business or facility that processes or serves food to vulnerable populations. These include: 

• control measures for potentially hazardous foods (also called ‘high-risk foods’) 
• management of food allergies 
• adhering to modified diet requirements 
• controlling food brought in from outside the facility 

POTENTIALLY HAZARDOUS FOOD 

Some foods are more prone to contamination than others; nutrient-rich foods like meat, poultry, dairy and seafood provide the ideal conditions for food-borne bacteria like Listeria to live and multiply. 

Anyone can get sick with food poisoning from contaminated food, but vulnerable populations are less able to fight off these infections and more likely to develop serious complications like kidney failure, pneumonia or worse. 

In a ‘vulnerable persons business’ or facility, the menu should be designed with this in mind. 

All high-risk foods and ingredients should be received through approved suppliers, and specific control measures must be implemented when handling potentially hazardous foods to minimize the potential risks. 

FOOD ALLERGIES 

Food allergy is one of the leading causes of anaphylaxis, an acute and potentially life-threatening allergic reaction, and an important public health concern in Canada. Over 2.6 million Canadians, including 500,000 children, live with food allergies that must be managed on a daily basis. 

Microscopic amounts of a particular food allergen can cause a life-threatening reaction. ‘Vulnerable persons businesses’ and facilities must implement effective controls to manage food allergies and train food handling employees to prevent cross-contamination. 

This is especially important in any facility where food is served to young children, who are at greater risk of dying from a severe allergic reaction. 

MODIFIED DIETS 

Where modified diets are required — to manage certain medical conditions, improve health outcomes or increase quality of life — clinicians should be consulted on dietary recommendations. 

For highly susceptible persons, a low microbial diet may be required. Low or no-sodium diets are frequently recommended for persons with high blood pressure, heart disease, diabetes or kidney disease. 

FOOD BROUGHT IN FROM OUTSIDE THE FACILITY 

Vulnerable persons businesses and facilities should implement effective policies and procedures to manage food that is brought into the facility. 

This could be food that is brought in by friends and family of the person in the facility’s care, or it could be food that is sent into a controlled environment by parents or caregivers. A nut-free policy in a child care centre would be an example of this. 

Once you have developed your policy, you must also consider how you will: 

• communicate the policy; 
• enforce the policy; 
• handle any transgressions; and 
• regain control of the hazard. 

Tips for managing high-risk foods for vulnerable persons include (but are not limited to): 

1. Cook all meat, poultry and seafood thoroughly. 
2. Buy packaged, whole portions of ready-to-eat meats and slice in a central processing unit or purchase meats pre-sliced from a licensed manufacturer with a Listeria management program. 
3. Serve dairy products made from pasteurized milk. 
4. Do not use any cracked or dirty eggs. 
5. Cook eggs until the white is firm and the yolk thickens. 
6. Use pasteurized egg in dishes which will not be cooked. 
7. Inspect all fresh produce prior to use and remove dirty, cut, mouldy and bruised stock. 
8. Wash all fruit and vegetables under running potable water. 
9. Serve seed sprouts only if they are cooked. 
10. Use any foods that could support the growth of Listeria monocytogenes (e.g. luncheon meat, soft cheeses, pre-cut vegetables, fruit and salads) within seven days. 

Of course, this is not an exhaustive list of all the food safety controls that must be in place to protect vulnerable groups from food poisoning and other health risks. 

The best way to ensure food safety in any food business or related organisation is to commit to food safety training and education. 

In food businesses and related organizations in Canada, especially those that serve vulnerable persons in a private or public facility, food service employees need to complete nationally recognized food safety training. 

Food safety training teaches food workers about critical food safety concepts, such as: 

• causes of food-borne illness 
• time and temperature control of food 
• safe food handling practices 
• preventing cross-contamination 
• managing food allergies 
• health and hygiene requirements 

There is no substitute for a skillful, engaged and well-informed staff when it comes to protecting vulnerable people and your business from food safety risks. 

Fundamental food safety concepts and safe food handling procedures must be taught and repeated until they become second nature. Visual aids like posters, videos and checklists are a great way to reinforce food safety training. 

Contact the Canadian Institute of Food Safety for details about food safety training and our extensive library of food safety resources. 

At the Canadian Institute of Food Safety (CIFS), our mission is to reduce food-borne illness in Canada through education, promotion and advocacy for better food safety. 

To improve food safety in Canada, we want to make it as easy as possible for businesses to do the right thing. We strive to protect both business owners and consumers from the consequences of food-borne illness. 

We work with the public, as well as small, medium and enterprise food businesses in every industry that is regulated by the Canadian government.