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Office lunches: The danger zone
Physicians are not immune to diseases in their own offices.
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We learned about them in microbiology — Staphylococcus aureus, Clostridium perfringens, Listeria monocytogenes and others. Who would think that as we are attempting to treat disease in those entering the front of our offices that we might be spreading disease in the back of our offices? Beware of the office lunch.
In the United States, there are approximately 76 million cases of food poisoning each year, with 325,000 requiring hospitalization, of which 5,000 people die. How quickly we physicians forget these facts.
Enter a typical doctor’s office and you will find the “break room.” At first glance, it may look more like a home kitchen than a business cafeteria. The room is usually cramped and the staff can often be seen eating around a table, like a family at home. As at home, the food is typically plentiful and free. Staff, visitors and patients may bring in food from home.
Looks can be deceiving
Food consumed at a business site, like a doctor’s office, should not be treated like food that is prepared at home, even if it came from a home. There are many differences. Foods brought to the office are usually transported from a home refrigerator, but may not be kept at a proper temperature during transport. Additionally, food prepared at home is usually stored in the refrigerator at the end of a meal, which may last about 20 to 30 minutes; but, food at work may stay out for hours at room temperature so that those who are running late from an overworked schedule can have some, too. At home, only a few family members typically touch the food; at work, many hands may touch the food.
The danger involves not only the infecting agents, but also the time and temperature that foods are stored. C. perfringens is known as the “cafeteria germ” because many outbreaks caused by this organism are related to food that has been left out at room temperature for an extended period of time. L. monocytogenes can not only contaminate lunchmeats that have been stored at room temperature but can continue to grow at refrigerator temperatures. L. monocytogenes poses a risk to all, but especially women who are pregnant. S. aureus easily contaminates foods made by hand that require no cooking, such as sandwiches, a mainstay of office lunches.
The “danger zone” exists at temperatures between 40·F and 140·F. At 40·F, bacteria double every 6 hours; at 60·F, every 2 hours; and at 90·F, every 30 minutes. At home, this is usually not much of a problem because of the relatively short time that the food spends in the danger zone as it transits from the refrigerator, to the stove, to the table and then back again to the refrigerator. In the office, these times are much longer, especially when lunches are catered. This food is typically transported from the catering business to the office in a warm car. Travel times can vary, but 30 minutes is not unusual. Also, food is usually timed to arrive at least 30 minutes early so that the food is available when the staff is done seeing patients.
The US Department of Agriculture’s Food Safety and Inspection Service recommends discarding perishable foods that have been left at room temperature for 2 hours or more. The exception to this rule involves perishable foods that have been exposed to weather temperatures of at least 90·F; these should be discarded after 1 hour. However, with summer temperatures that enter into the 90s and 100s in many parts of the country, temperatures inside vehicles are much higher. That first hour can be easily exceeded before a staff member takes his first bite of food. Thus, foods not properly protected can pose a real risk to the office staff.
Tips to follow
You and your staff should know and practice safe food-handling techniques to reduce the risk of sickness caused by contaminated food. There are several recommendations:
- Discard perishable food if left at room temperature for more than 2 hours.
- Keep hot food hot and cold food cold.
- Maintain hot foods at 140·F or more, with chafing dishes, slow cookers, warming trays or preheated ovens.
- Maintain cold foods at less than 40·F.
- Place food containers in ice on the serving table.
- Use food thermometers often to check food temperatures.
- Refrigerate or freeze leftovers within 2 hours.
- Rotate food when reheating via microwave to eliminate “cold spots.”
- Reheat leftovers to 165·F, maintain at 140·F.
- Always remember the golden rule: When in doubt, throw it out. Do not even taste it because many of the very serious pathogens cannot be detected by sight, smell or taste.
- Lastly, practice safe food-handling not only at work but also at home. Remember, one of every four hamburgers turns brown before it reaches a safe internal temperature of 160·F. Always use a thermometer to confirm.
If the health department conducted a food inspection of your office, would it pass?
Richard Dolinar, MD, is a senior fellow in health care policy at Heartland Institute in Chicago and a clinical endocrinologist in private practice in Phoenix. Disclosure: Dr. Dolinar reports no relevant financial disclosures.
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