Table of contentsIntroduction3Training guidelines4Recommended facilities and materials4Activities4Evaluations4Training tips4Module 1 – Food safety basics5Length5Audience6Purpose6PRE-TEST71. Why food safety is important when providing meals to older adultsa. What is foodborne illness?88b. How common foodborne illness is10c.Some common symptoms of foodborne illness11d. Where harmful bacteria and viruses come from11i.The food supply has changed11ii.How harmful bacteria and viruses contaminate food12e. Why older adults are at higher risk of foodborne illness14i.Weaker immune system14ii.Effects of health conditions15iii.Clients may not handle and store food properly162. Programs are responsible for delivering safe food16a. Cost of a foodborne illness outbreak16b. Programs need food safety policies and procedures17c. Staff and volunteers need to be trained in food safety18d. Temperature requirements191

e. Staff and volunteers need to be in good health and maintain goodpersonal hygiene20f. Programs need to monitor and keep records22Key points23Activity: Crossword puzzle24POST-TEST27Glossary29Food safety websites30Acknowledgments31References322

INTRODUCTION“Food Safety on the Go” is a food safety training program for staff, volunteers andclients of home-delivered meal programs. It is made up of 6 modules. Module 1, Foodsafety basics, is an overview of food safety for all staff and volunteers. Modules 2through 5 are for specific individuals within a program: Module 2 is for the programdirector, Module 3 is for the food service management staff, Module 4 is for food serviceworkers (staff and volunteers), and Module 5 is for drivers (staff and volunteers).Module 1Food safetybasicsModule 2Program directorModule 3Food servicemanagement staffModule 4Module 5Food service workers(staff and volunteers)Drivers (staff andvolunteers)Module 6Clients (education)All staff and volunteers should complete Module 1, as well as other relevant modules.Thank you for participating in the “Food Safety on the Go” training program.3

TRAINING GUIDELINESRecommended facilities and materials Meeting roomComputer with Microsoft PowerPoint softwareProjector and projection screen (or wall)PowerPoint files for the relevant modules (for the trainer)Trainer Guides for the relevant modules (for the trainer)Course Books for the relevant modules (one for each participant)Pre-tests and post-tests (one of each for each participant, for each relevantmodule) Pens/pencils (one for each participant)ActivitiesAn activity is included at the end of each module to help reinforce participants’knowledge of the material.EvaluationsA pre-test is given to participants at the beginning of each module, and a post-test at theend of each module, to help determine how useful the module is and what participantshave learned.Training tips If possible, set up the training area at least a half hour before the trainingsession. Make sure that the equipment is working properly, and that all materialsand supplies are ready. Prepare for the training session by reviewing the information in the trainerguide(s). Encourage participants to share their experiences and to ask questions. If possible, try to illustrate some points with your own experiences. Allow time for breaks if needed. Ask participants to turn off their cell phones during the training session. If you have time at the beginning of the training session, you can try to assessparticipants’ food safety knowledge by asking them if they have had food safetytraining, and if so, how much training. It can help to have an idea of the level offood safety knowledge of participants.4

MODULE 1 - FOOD SAFETY BASICSLength 30 minutesTrainer note Welcome participants, introduce yourself and have participants introducethemselves. Explain that “Food Safety on the Go” is a food safety course for home-deliveredmeal programs.Trainer: Go to slide 1.Trainer: Go to slide 2.5

Trainer note: Explain that this module covers basic food safety information.Trainer: Go to slide 3.AudienceThis module is for all staff and volunteers of a home-delivered meal program (programdirector, food service management staff, food service workers, and drivers).PurposeThis module explains why food safety is important when providing meals to older adults.It discusses the food safety responsibilities of home-delivered meal programs.Trainer note Explain that you will give participants a page with a few questions (pre-test) to try toanswer as best they can before the module, and then again after the module (posttest). Let them know that it will take about 5 minutes each time.Hand out the pre-test, and pens or pencils if needed. Give the participants 5 minutesto answer the questions, and collect the pre-tests.6

NAMEMODULE 1: FOOD SAFETY BASICSPRE-TESTPlease check “true” or “false” for each sentence.TRUE FALSE1. Home-delivered meal clients are at higher risk of foodborneillness than the general population.2. Foodborne illness can always be traced to the last food aperson ate.3. You can tell if a food is contaminated by harmful bacteria orviruses by how it looks, smells or tastes.4. Two of the main causes of foodborne illness outbreaks are notcooking food properly and holding food at unsafe temperatures.5. Most bacteria that cause foodborne illness grow fastest attemperatures below 41 degrees Fahrenheit.6. A foodborne illness outbreak can cause a home-delivered mealprogram to close.7. Most foodborne illness cases are part of a large outbreak.8. Adults age 50 and over are more likely to be hospitalized anddie of foodborne illness than the rest of the population.9. Cooking food gets rid of any bacterial spores or toxins that arein the food.10. Viruses that cause foodborne illness mainly come from the soil.Trainer: Go to slide 4.7

1. Why food safety is important when providing meals to older adultsa. What is foodborne illness?Foodborne illness, often called “food poisoning,” is any illness that is caused byeating food that is contaminated. A foodborne illness outbreak is when two ormore people get the same illness after eating the same food. Bacteria andviruses are the most common causes of foodborne illness. Bacteria that cancause foodborne illness include Salmonella, Shigella, E.coli, and Campylobacter,and viruses that can cause foodborne illness include Norovirus and Hepatitis A.Trainer: Go to slide 5.In the U.S. in 2015, a Salmonella Poona outbreak caused 907 illnesses in 40 statesafter they ate contaminated cucumbers imported from Mexico. 204 people werehospitalized and 4 people dead8

Trainer: Go to slide 6.In 2017, an E. coli outbreak from romaine lettuce caused 25 illnesses in 15states. Of these, nine people were hospitalized and 1 people dead (2).Trainer: Go to slide 7.E. coli was also the culprit for a 2019 outbreak, caused by contaminatedground beef. Approximately 209 people were infected in 10 states – ofthese 29 were hospitalized. No deaths were reported. (3)While outbreaks like these often make the news, they make up only a smallpercent of the foodborne illness cases in the U.S. every year. Most foodborneillness cases are not part of a recognized outbreak.Trainer: Go to slide 8.9

b. How common foodborne illness isEvery year, about 48 million Americans, or one in six Americans, gets afoodborne illness. Approximately 128,000 of them go to the hospital and 3,000die (4). Adults age 50 and older are more likely to be hospitalized and die offoodborne illness than the rest of the population (5). The health-related cost offoodborne illness in the U.S. is thought to be about 15.6 billion per year (6).Trainer: Go to slide 9.c. Some common symptoms of foodborne illnessHarmful bacteria and viruses in food go to the stomach and intestines wherethey can cause the first symptoms of foodborne illness. Symptoms offoodborne illness symptoms can include vomiting, diarrhea or bloody diarrhea,abdominal pain, fever, and chills. Other health conditions can also cause thesesymptoms (7).10

Some symptoms of foodborne illness may not appear for days or even weeksafter a person eats a contaminated food. People with foodborne illness may thinkthey have the “stomach flu” or the “24 hour flu.” However, “the flu,” or influenza, ismainly a respiratory illness caused by influenza viruses, which are often spreadfrom person to person through coughing or sneezing. Foodborne illness, on theother hand, is mainly an intestinal disease caused by eating food that containsharmful bacteria or viruses.Foodborne illness can lead to serious complications, including kidney failure,arthritis, meningitis, paralysis, or even death.Trainer: Go to slide 10.d. Where harmful bacteria and viruses come fromi. The food supply has changedThe food supply in the U.S. is one of the safest in the world. However, nowadaysmany foods are produced on a larger scale than they were before, go throughmore processing, and come from further away, which has raised the chance offood contamination. A few decades ago, food was grown, produced, anddistributed locally. Now, many foods travel over 1,000 miles to get from a farm toa person’s plate.About 15% of all foods eaten in the U.S. come from other countries, which mayhave different food production practices (8). These days, foods are often handled11

by many people, using many types of equipment, so there are many possiblesources of food contamination.Trainer: Go to slide 11.ii. How harmful bacteria and viruses contaminate foodHarmful bacteria and viruses that contaminate food can come from manydifferent sources. Bacteria that cause foodborne illness can come from the soil,water, air, plants, animals and humans. Food can be contaminated duringgrowing, harvesting, processing, storing, shipping, preparation in a kitchen,holding, or meal delivery.Viruses that cause foodborne illness mainly come from humans, and can betransmitted to food by an infected person who handles the food. Healthy peoplecan also carry harmful viruses or bacteria in their feces and can transfer them totheir hands after using the restroom. If they do not wash their hands properly,they can then spread the harmful viruses or bacteria to food.Trainer: Go to slide 12.12

Most bacteria and viruses that cause foodborne illness go unnoticed becausethey don’t change the way food looks, smells or tastes. Some people even claimthat the potato salad or other food that made them sick was the best they evertasted. Bacteria that spoil food and change its smell, taste or texture aregenerally different from the bacteria that cause foodborne illness.Trainer: Go to slide 13.Bacteria can multiply in food, while viruses can only multiply inside living cells,such as in a person’s body. Bacteria grow best in certain conditions. Mostharmful bacteria grow best at temperatures between 41 and 135 degreesFahrenheit. When conditions are right, some bacteria can double in number in ashort time, as low as every 20 minutes. Within two hours, one bacterium canmultiply into 64 bacteria. Within ten hours, one bacterium can multiply into abillion bacteria.13

Some bacteria can produce toxins, either in food or in people’s intestines, whichcan cause foodborne illness. Some bacteria can also change into a differentform, called spores. Spores can survive in difficult conditions such as at hightemperatures or freezing temperatures. When conditions get better, spores canchange back into active bacteria, which can cause foodborne illness.Trainer: Go to slide 14.e. Why older adults are at higher risk of foodborne illnessi. Weaker immune systemOlder adults are especially vulnerable to foodborne illness. With age, the immunesystem can become weaker and have a harder time fighting off harmful bacteriaand viruses. Stomach acid, which limits the number of harmful bacteria andviruses that enter the intestines, often decreases with age. Many older adultsalso take medications which lower the amount of stomach acid.A certain number of harmful bacteria or viruses are needed to cause foodborneillness, and this amount is called the infectious dose, which varies from bacteriato bacteria and can be as low as only 2 cells. The infectious dose can be muchlower for people with weak immune systems. Older people with less stomachacid can become infected by lower numbers of harmful bacteria and viruses.Trainer: Go to slide 15.14

ii. Effects of health conditionsHealth conditions such as diabetes, arthritis, cancer, heart disease, and kidneydisease, as well as the side effects of some medications for these conditions, canweaken the immune system and increase a person’s risk of getting a foodborneillness. According to national surveys, home-delivered meal clients have muchhigher rates of these health conditions than the general population. Homedelivered meal clients are therefore at substantially higher risk of foodborneillness than the general population.Trainer: Go to slide 16.iii. Clients may not handle and store food properlyStudies have found that in the general population, most people do not handleand store meals and leftovers safely, which increases their risk of foodborneillness (9). Home-delivered meal clients, and especially those with limited cookingexperience, may not know how to handle and store food safely. Teaching clients15

how to handle and store home-delivered meals safely is key to lowering theirchance of getting a foodborne illness (see Module 6 for clients).Trainer: Go to slide 17.2. Programs are responsible for delivering safe fooda. Cost of a foodborne illness outbreakA foodborne illness outbreak can cost a home-delivered meal program muchmore than the cost of properly training staff and volunteers in food safety. It onlytakes one minor mistake for an outbreak to happen. Besides causing illness, oreven death, of clients, an outbreak can lead to lawsuits against the program, lowmorale among staff and volunteers, negative