Implementation of the FSA Listeriosis Guidance: Chapter 5: Controlling the risk of Listeria

This chapter details awareness of the risk of listeriosis, among HSC (non-NHS Trust) settings. It also covers the extent to which these settings implement the FSA guidance in three areas: control of contamination, control of growth, and management controls.

Awareness of the risk of Listeria

The vast majority of all settings were aware of at least some of the risks associated with chilled ready-to-eat foods from Listeria. Over half (54%) were fully aware of the risks, whilst 36% were aware of some of the risks, 7% knew little and 2% knew nothing about the risks.

Figure 5.1: Awareness of the risks associated with chilled ready-to-eat foods and Listeria

Healthcare settings were more likely to be fully aware of the risks (73% vs. 54% overall). Social care settings were more likely to know little about the risks (9% compared to 3% of healthcare and community care settings).

Settings that had a PA relationship with a local authority were more likely to be fully aware of the risks, compared to those who do not (70% vs. 51%). 

Implementing practice to control contamination

Almost all settings agreed that the cleaning of all food contact surfaces at their site controlled the risk of L. monocytogenes (98%), with 70% strongly agreeing. Similarly, the vast majority (98%) agreed that food safety controls on site were effective in stopping cross-contamination of food with Listeria, with 72% strongly agreeing.  

Figure 5.2: Extent to which settings agree with the statements relating to the control of growth

Social care settings were more likely than average to strongly agree that the cleaning of all food surfaces at their site controlled the risk of Listeria (73%) while community care settings were less likely to (61%).  Healthcare and social care settings were both more likely than community care to strongly agree that food safety controls on site were effective in stopping cross-contamination (77% and 79% vs. 56%).

Within social care settings, nursing homes (84%) were more likely than residential care homes (70%) and day centres for the elderly or vulnerable (65%) to strongly agree that cleaning of all food contact surfaces on the site controlled the risk of L. monocytogenes. Day care centres were less likely to strongly agree that food safety controls on site were effective in stopping cross-contamination of food with Listeria (64% compared to 77% of residential care homes and 80% of nursing homes).

Implementing practice to control growth

Temperature control of chilled ready-to-eat foods from supply to point of service on site

All settings were asked questions about temperature control. The FSA guidance states that “It is good practice for healthcare/social care organisations to maintain their cold chain of chilled ready-to-eat food at 5°C or below from delivery through to service”’. 56% of all settings reported that the maximum temperature that chilled ready-to-eat foods reached, from supply of chilled ingredients until the point of sale or service, was 5°C. However, 16% reported that the maximum temperature reached was 8°C, which is the legal requirement. Just under a quarter (23%) did not know the answer to this question. 

As can be seen in Figure 5.2, healthcare and social care settings were more likely to follow good practice, reporting that the maximum temperature that chilled ready-to-eat foods reached was 5°C (68% and 57% respectively vs. 50% of community care settings). Community care settings were most likely to answer ‘Don’t know’.

One per cent of settings reported reaching temperatures over 8°C for more than four hours. All of these settings were residential care homes.

Figure 5.3 Maximum temperature that chilled ready-to-eat foods can reach from supply chain of chilled food ingredients to point of service

Temperature control of chilled ready-to-eat foods during storage on site

The FSA guidance on temperature control during food service to the patient/resident states that it is good practice to “Hold chilled ready-to-eat foods transported to the service point in chilled equipment at 5°C or less or transfer to appropriate refrigeration at ward/pantry”. 

Just under half (46%) of all settings reported that the maximum temperature that chilled ready-to-eat foods reached during storage in areas for patients or residents was 5°C, which is in line with the FSA good practice.

Around one-fifth (21%) reported that the maximum temperature was 8°C. Just over a quarter (26%) did not know.

Two per cent of all settings reported that chilled ready-to-eat foods reached temperatures over 8°C for more than four hours. This represents 4% of community care settings and 2% of social care settings.

As can be seen in Figure 5.4, healthcare and social care settings were more likely to follow good practice, reporting that the maximum temperature that chilled ready-to-eat foods reached during storage in areas for patients or residents was 5°C (64% and 50% respectively vs. 32% community care settings). Community care settings were more likely to say ‘don’t know’ (43% vs. 23% social care and 15% healthcare).

Figure 5.4: Maximum temperature that chilled ready-to-eat foods reach during storage in areas for patients or residents

 

Further practice around the control of growth

Respondents were also asked to what extent they agree or disagree with three statements in relation to their own site:

• Across the site, we monitor and record temperatures throughout the cold chain, consistently and accurately.
• The maximum shelf-life for ready-to-eat sandwiches sold or distributed on site is day of production plus 2 days.
• Across the site, we carry out regular sampling for Listeria to verify compliance with microbiological criteria regulations.

Almost all (98%) settings agreed that across their site temperatures were monitored and recorded throughout the cold chain, consistently and accurately, with 68% strongly agreeing. There were also a high proportion of settings (80%) who could agree that the maximum shelf-life for ready-to-eat sandwiches sold or distributed on their site was day of production plus two days, although 14% disagreed. Only 54% of settings agreed that they carried out regular sampling for Listeria and 29% disagreed.

Figure 5.5: Extent to which settings agree with the statements relating to control of growth

Healthcare settings were significantly more likely (64%) to strongly agree that the maximum shelf-life for ready-to-eat sandwiches was the day of production plus two days, than social care (47%) and community care (36%) settings. Community care settings were less likely to agree with the two statements relating to monitoring the cold chain (86% vs. 98% overall).

Settings with a PA relationship were more likely to agree that they carried out regular sampling (70% vs. 50% without). Settings registered with a local authority agreed more frequently than those reporting to not be registered (58% vs. 45% without).

Implementation of management controls

Whether HSC settings have food safety management systems based on HACCP principles

Just over three-quarters (77%) of all settings reported having a food safety management system based on HACCP principles in place. 13% reported not having such a system in place and a further 10% were unsure. However, settings may have been unfamiliar with the HACCP terminology, but they still followed guidance based on HACCP principles, e.g., the Safer Food, Better Business resource pack.

Figure 5.6: Whether settings have food safety management systems based on HACCP principles in place

As seen in Figure 5.6, community care settings were much more likely to report not having a food safety management system based on HACCP principles in place (45% vs. 5% of healthcare and social care settings). 

Within social care settings, both nursing homes and residential care homes were more likely to have a food safety management system based on HACCP principles compared to day centres for the elderly or vulnerable (87% and 88% respectively vs. 64%). 

Settings that had a PA relationship were more likely to have a food safety management system based on HACCP principles in place, compared to those without a PA (91% vs. 74% without). 

Further practice around management systems and overall risk monitoring/controls

Respondents were asked about three statements on their food management systems. There were similar levels of agreement on all three statements: 

• ‘the site's food safety management system covers all food pathways’ (92% agreed).
• ‘across the site, we monitor and record the performance of all our controls for L. monocytogenes effectively and take effective action when required as a result’ (91% agreed).
• ‘across the site, we ensure that the risk of L. monocytogenes is controlled effectively in the whole supply chain’ (91% agreed).

Between 3-4% disagreed with each of the statements.

Figure 5.7: Extent to which settings agree with the statements relating to management controls

Community care settings were significantly less likely to agree that their food safety management system covered all food pathways than social care and healthcare settings (79% vs 95% and 94% respectively). They were also more likely not to know about this statement than social care settings (12% vs. 3%).

Within social care settings, nursing homes and residential care homes (95% and 92% respectively) were both more likely to agree that ‘they control for Listeria effectively and take effective action when required as a result’ than day centres for the elderly or vulnerable (82%). Nursing homes were also more likely than day centres to agree that the risk of Listeria was controlled effectively in the whole supply chain (95% vs. 80%).