A lot, it seems!
When The Lantern Project decided to explore soft eggs in aged care, who would have thought about the complexities, variance and struggles residential facilities face?
We found that one risk averse person can affect the outcome for residents. And there are many points between the hen and resident where risk aversiveness can creep in.
The Main Issue of Salmonella:
- The common bacteria Salmonella can cause food-borne illness and is often associated with eggs and egg products.
- Illness can be severe or even fatal, especially for at risk groups. Aged care residents are considered an “at risk” group.
- Cracked or dirty eggs can cause Salmonella to enter and grow inside an egg.
- Cross-contamination can occur when handling and preparing eggs.
- Cross-contamination can occur if eggs and raw egg product touch hands, clothing, cloth-ware, utensils, equipment and surfaces like benches.
Cracked and/or dirty eggs
The risk of salmonella on clean, uncracked eggs from A grade producers is very small, however can have major consequences. The Australian Egg Corporation (AECL) suggested about 1 in 13,000 clean, uncracked eggs may be infected with salmonella. When you receive a cracked egg, there are many opportunities for infection to occur, including from transport, handling, storage, the air, etc. Risk increases to 1 in 1,300 eggs.
Recommended advice is do not use cracked or dirty eggs. Throw them out and the container they came in. Thoroughly wash hands after touching eggs and clean/sanitise all surfaces the eggs and container have touched.
Not cooking eggs long enough to kill the Salmonella
The egg yolk has no antimicrobial properties and is susceptible to Salmonella. As a whole egg, the yolk is protected by the shell, membrane and white. When eggs are not cooked to a time and temperature to kill the salmonella, it may cause a salmonella outbreak. The infected egg can affect the whole batch of egg product that is cooked at the one time.
Food handling and preparation
According to the AECL, there are always food handling issues with salmonella outbreaks. From my own research and questioning kitchen staff, there is not the realisation of the significance of washing hands thoroughly after touching eggs, egg products and egg containers.
The same goes for anything else the infected egg and now infected hands touch – bench, preparation boards, equipment, utensils, gloves, clothing, dish cloths, tea towels. Washing hands thoroughly with hot soapy water before and after handling eggs will reduce risk. Wearing gloves is not a substitute for good hand washing practice.
Other food products, such as fruits and salad, can also become infected by coming in contact with hands, equipment and surfaces the infected egg has touched. Thorough cleaning and sanitisation of all surfaces that eggs, egg product and containers have touched is essential.
Raising staff awareness and effective training, ongoing reminders and poster displays will help to mitigate the food handling risk.
Why facilities struggle
Some providers spoken to feel conflict between their obligation to keep residents safe, and allowing them to exercise choice about their food preferences. Providers must consider:
Quality of Care Principles 2014 – providers are to actively work to provide a safe and comfortable environment with health promoted and achieved at the optimum level. Residents are enabled to exercise choice and control over their lifestyle.
State & Territory Health Departments – has recommendations (not enforceable) on food safety. Eg on reducing Salmonella for “at risk groups”, Qld Health recommends using pasteurised egg or egg products.
FSANZ Standard 3.3.1 – a requirement for aged care providers to have a Food Safety Program in place because potentially hazardous food is served to vulnerable populations.
Food Safety Program – specific to each facility and details how hazardous foods, including eggs, will be managed. Assessed for compliance at the state and territory government level.
Many residents love soft cooked eggs. Many providers would like to give eggs to their residents just the way they like them. Solutions I have seen and heard that are working well include:
- Cook the eggs as close in time and place to the resident as possible. Little or no hot hold time will ensure tasty palatable eggs, even if cooked to the specified requirement.
- Serve eggs to dining rooms on different days so the kitchen is not preparing eggs for the total facility at the same time.
- Cook in small batches at the dining room and manage the risk through your Food Safety Program. If less than 6 people want soft cooked eggs, this is achievable even with the Vulnerable Persons requirement. Use your Food Safety Manual as a way to document your innovative solutions.
- Purchase pasteurised egg product from reputable distributors, eg scrambled egg mix. The pasteurisation process kills salmonella, making the product safe to consume even partially cooked.
- Allow residents to cook their eggs themselves or with the assistance of staff. Low-cost small appliances are available and can be placed at or near the table for residents to cook their eggs just the way they like them.
- Rotate egg dishes that are manageable for the staff and cook eggs to the requirement that will kill salmonella. Eg frittata, egg muffins, bacon & egg pie, etc.
Some managers find innovative solutions and choose to manage the risk through their Food Safety Program. Other managers aim to reduce their risk by reducing hazardous foods at their facility and don’t allow soft eggs at all.
In conclusion, there is nothing to stop you serving soft cooked eggs to your residents. Your residents will increasingly expect it. The Salmonella risk is small but the consequences can be severe. While safe food handling will go a long way to mitigate the risk, ongoing training and reminders to staff about the hazards of eggs is essential.