Food allergen Best Practice Guidelines developed for Qld Health facilities

QUEENSLAND HEALTH’S Statewide Food Service Network has responded to growing awareness about the need for effective food allergen management by developing a best practice guideline (BPG) and a guide for its implementation in Queensland Health facilities.

Troy Litzow, Food Safety Auditor at Queensland Health Statewide Food Services, worked with Denise Cruickshank, Statewide Foodservices Dietitian to develop the guideline and explains how it came about: “Some time ago there had been some patient deaths in hospitals because they had received foods which contained allergens, and the coronial inquests made a number of recommendations regarding food allergen management. Additionally, a few years back Statewide Food Services had conducted a workshop at one of our annual conferences and brainstormed with participants regarding the issues around effective allergen management and what they saw as the deficits in their current practices. So we had a wealth of information and decided to establish a working party which comprised both internal staff and external professionals to draft up some best practice guidelines.

“This doesn’t only apply to staff in the institutional sector - foodservice workers generally need to know how to prepare food so it doesn’t have any traces of an allergen in it. They need to understand, for example, issues around cross-contamination – that the smallest trace of an allergen can provoke a reaction. Sometimes this can lead to anaphylaxis, which is a life-threatening condition. And regardless of whether you’re working in a hospital or in commercial premises, the death of a customer is the last thing anyone wants.”

Troy emphasises that education about effective allergen management is the key to minimising risk. “The level of education that someone in retail environment might need is a bit different to someone in a hospital, but there are areas in common. For example, you might have a customer with a seafood allergy who orders beef bourguignon. This is often made with Worcestershire sauce which contains anchovies as an ingredient, and that could potentially cause an allergic reaction. So staff need to be across these kinds of potential risks and one way to do that is to have an allergen matrix which they can consult.

“For the BPG we developed an audit tool which could be used across our sites. This is designed to cover all the best practice guideline points in a simple question and answer format, ensuring that all areas relating to allergen management are being adequately addressed. For example, there need to be ingredients and allergen lists available for all menu items and food allergy management flow charts need to be on display in all appropriate areas. The audit tool is basically a gap analysis which our staff can undertake to identify how far they have progressed along the journey to best practice allergen management and what they need to do to bring themselves up to best practice standard.”

Troy says the audit tool has been very effective in identifying gaps in allergen management and the resources needed to fill them. “Contract management was an issue – not being aware of allergens being present in products or raw materials when they came in to the hospital.

Preparation areas was another area of concern – it’s preferable to have a separate preparation area or diet kitchen space where allergen free food can be prepared, so as to protect against cross-contamination. If there’s no space for separation, then time needs to be the separator – if you only have one bench to work on, you need to clean it down thoroughly, change all utensils and cutlery over, change your aprons and gloves, and then undertake the preparation of the allergen free food.”

Appropriate meal identification and labelling is also essential. “This is a concern which really goes across the spectrum of foodservice, not just hospitals. There’s no point going to all the trouble of preparing allergen free food if you don’t have a system to ensure the right meal goes to the right patient or customer. So it’s very important that there’s a system in place to make sure that doesn’t happen. In hospitals we assign diet codes to patients so it’s a question of ensuring that the correct code is allocated and then communicated to all relevant staff.”

Queensland Health has distributed both the BPG and the guide for its implementation to all its hospital and health services and it has since attracted broader interest. “I presented the BPG and associated documentation at a Victoria Health training day for its accredited auditors,” Troy tells us, “and the National Allergy Strategy has also shared the BPG on its website. Recently we had feedback from two hospitals who have used the audit tool and came up with some results which reaffirmed our research. 

“We are also keen to make the implementation guide component more widely available, as currently it’s only being used internally by Queensland Health. Having said that, hospitals generally are certainly aware of the importance of best practice allergen management. It’s something we all have to work towards, not only in healthcare but across the board in foodservice. 

A copy of the BPG is available for download from the National Allergy Strategy website.