The risk facing vulnerable groups from Listeria Monocytogenes (LM) is ever-present in hospitals. It is not possible to totally eliminate listeria from chilled foods, even in hospital kitchen environments, as it is present naturally in the environment.
And while reputable sandwich and chilled food suppliers go to considerable lengths to eliminate listeria from their products, it is still impossible to completely eradicate it, particularly where specific ingredients are known to be carriers.
Low levels of listeria are not considered a risk to most consumers. However, the high temperatures in many healthcare environments, and the time that products may be out of chill during distribution within a hospital before reaching patients, means that even very low levels can grow to become more challenging.
Restricting shelf-life to two days, maintaining temperatures at or below 5C (five degrees Celsius) during distribution, and removing higher risk ingredients are key factors in controlling the risks.
And so on October 6th new guidelines for patient safety in this food category, meaning a safer supply of sandwiches, salads and other chilled ready-to-eat foods, were rolled out to patients
To achieve these new standards NHS Supply Chain: Food worked with the BSA, which represents businesses in the manufacture, retailing and supply of ingredients and equipment for the sandwich and food to go markets, and includes food-to-go suppliers.
Summary of the changes
The new standards say that products must not have a shelf life that exceeds production plus two days. This is in line with advice issued by NHS Estates and Facilities in 2019 and aligns with Food Standards Agency advice.
They specifically excluded certain ingredients that are known to be potential carriers of listeria:
- Raw onions, spring onions and chives
- Fermented meats – chorizo and salami
- Cold smoked salmon
- Cooked shellfish
- Cheese, mould-ripened and veined cheeses
- Pâté
The standards also demand clear temperature labelling - all sandwich packs supplied for patients must be clearly marked.
Kirstin Morris, our business director, says “We put patient safety at the centre of everything we do. Our partnership with the BSA, and the work we have done together to put these restrictions in place, represents a very positive and welcome step change towards driving patient safety within NHS sites.”
And Phil Shelley, senior operational and policy manager from NHS England, is equally pleased with the move: “Patient safety is our highest priority. We have a shared responsibility through our suppliers and healthcare teams, to manage food safety with strict and consistent standards.
“These changes bring together our collective expertise to ensure that the purchasing, preparation, and service of high-risk foods are carried out responsibly and collaboratively,” he says.
Manufacturing standards
It is equally important that those supplying sandwiches and chilled foods into hospital and healthcare settings meet the standards necessary to provide the assurances needed to minimise the risks to patients.
At a minimum these should include all of the following:
- A BRCGS audit standard of at least A grade
- An STS healthcare audit, conducted by Micron2, including the new Listeria Management Module
- Evidence of sufficient (at least weekly) and regular planned testing for listeria over at least three months
The new standards ‘strongly recommend’ that suppliers can provide evidence that they meet the above standards before being allowed to submit tenders for patient feeding.
Effective Delivery
All BSA members must ensure that sandwiches and chilled foods are delivered to hospital and healthcare customers at a maintained temperature at or below.
Each delivery must be signed for by an authorised representative of the customer to confirm the delivery is not damaged and is at or below 5C.
At this point the customer needs to immediately take responsibility and ensure the products are placed in a chiller operating at or below 5C, and that this temperature is maintained until eaten by the patient.
Advice on frozen sandwiches
To allow the recent patient sandwich guidance to settle in, and to encourage complete safety standards on temperature control across healthcare sites, it is advised not to agree to a frozen sandwich concept from suppliers.
There may come a time when this advice changes, but we advise that going forward there should be a focus on current supply and improving the quality of services.
Christmas Deliveries
All parties to the new standards have recognised the challenge posed by reducing the available shelf life of sandwiches for patients over the Christmas period at relatively short notice.
So we have agreed that deliveries on the 24th December this year by default have an extra, third, day of shelf life because there will be no deliveries on Christmas Day. This will allow them to be consumed until midnight on 26th December. However, this reverts to two days only for deliveries from 27th December.
For more information on this or any other food hygiene issue you can email: food@supplychain.nhs.uk or visit: https://www.supplychain.nhs.uk/categories/food/