Most hospitals and social care sites are aware of Listeria guidance from the Food Standards Agency (FSA) but an analysis has found several challenges around implementation.
In a 2019 outbreak associated with pre-packed sandwiches supplied to hospitals in England, seven patients died of listeriosis.
Following this incident, the FSA said it would review its 2016 listeriosis guidance. The research was commissioned to look at awareness, implementation, and perceived effectiveness of the guidance, including barriers to implementing it in full.
The recent report covers findings from 39 respondents within National Health Service (NHS) Trusts and 445 from Health and Social Care (non-NHS Trust) settings, such as nursing homes, home care service providers and hospices, in England, Wales, and Northern Ireland.
An online survey was sent to all NHS Trusts in the three nations between November and December 2021. In the majority of cases, the survey was completed by the catering manager, who was responsible for food safety. IFF Research carried out the survey of non-NHS settings by telephone. Fieldwork took place in August and September 2022. IFF Research interviewed the person with overall responsibility for food safety — this was often the general manager.
Health and social care findings
In non-NHS Trust settings, 63 percent had some knowledge of the guidance. However, 36 percent did not know anything about the document or were not aware of it.
More than half trained kitchen staff (57 percent), nurses, midwives or carers (55 percent) and management personnel (52 percent) in controlling the risk of Listeria monocytogenes. About a third trained staff who sell or serve food as their main role.
The majority were aware of at least some of the risks associated with chilled ready-to-eat foods from Listeria. Almost all agreed that cleaning of all food contact surfaces at their site controlled the risk of the pathogen.
Just less than half reported the maximum temperature that chilled RTE foods reached during storage in areas for patients or residents was 5 degrees C (41 degrees F), which is in line with FSA guidelines. About one-fifth said the max temperature was 8 degrees C (46.4 degrees F), which is the legal requirement, and just over a quarter did not know. Two percent reported that these foods reached temperatures over 8 degrees C for more than four hours.
A high proportion, 80 percent, agreed the maximum shelf-life for RTE sandwiches sold or distributed on their site was day of production plus two days, although 14 percent disagreed. Only 54 percent said they carried out regular sampling for Listeria.
A fifth reported they were not registered with their local authority. They were compared with the Food Hygiene Rating Scheme (FHRS) listings to ensure the reliability of this finding but results were inconclusive, according to the report.
Parts of the guidance mentioned as being useful in reducing the risk of listeriosis included temperature control and fridges, checklists for preventative practice, information on cross-contamination/infection control, and content on cleaning standards. Some would appreciate it being easier to read, updated more often, or being made more accessible.
A lack of control over the kitchen area was frequently mentioned as a difficulty, followed by 30 percent who found it challenging to ensure good practice in clients’ homes or residents’ rooms. In total, 38 percent of participants said residents’ lack of understanding of the risks was a barrier to implementing good practice.
Including food safety requirements in contracts for onsite retailers or caterers was not always easy. A quarter reported a lack of control over their supply chain. The most difficult area of Listeria control was to check food safety at suppliers by carrying out unannounced visits every six to 12 months.
Overall, 92 percent of NHS Trusts said they had been using the FSA guidance on listeriosis before taking part in the survey.
Nearly all trusts said their kitchen staff received training on how to control the risk of Listeria monocytogenes. Slightly fewer said service and food retail staff had this training whilst 55 percent of ward staff and 21 percent of volunteers were trained.
Things that made it difficult to implement the guidance in full included a lack of control over food service and their supply chains, high staff turnover and a lack of control over food storage. Other factors were it was not a legal requirement, poor maintenance of equipment and money.
More than half of NHS trusts reported the maximum temperature foods reached during service or storage on wards or other patient areas was 5 degrees C (41 degrees F). A quarter said it was 8 degrees C (46.4 degrees F), with 11 percent reporting it could go beyond 8 degrees C for up to four hours.
A total of 84 percent agreed cleaning of all food contact surfaces controlled the risk of Listeria effectively. About eight in 10 agreed that the maximum shelf-life for RTE sandwiches sold or distributed in the trust was day of production plus two days. Only 13 percent disagreed. Half of respondents said their trust carried out regular sampling for Listeria while almost 40 percent reported this was not the case.
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