Potential Hazard

Dietary employees must perform many lifting, reaching, and repetitive tasks as part of their job duties. Employee activities in this area, if occurring with sufficient duration, magnitude, and/or frequency, may create a musculoskeletal disorder (MSD).

	Reaching/lifting: Frequent elevated extended reaches for supplies or heavy containers can cause back and shoulder injury resulting in muscle strain, bursitis, tendinitis, and rotator cuff injuries.
		Kitchen worker using extended/elevated reach.
	Repetitive motions: Rapid hand and wrist movements from frequent cutting, chopping, or scooping may lead to hand disorders such as tendinitis, carpal tunnel syndrome, and tenosynovitis.
		Kitchen worker scooping ingredients with flexed wrist.

Possible Solutions

Assess worksites for ergonomic stressors and identify and address ways to decrease them such as:

Reaching/Lifting:

	Provide height adjustable workspaces appropriate for the task being performed, so that workers can keep elbows close to the body. For example, lower countertops, or use height adjustable countertops or stands, or provide work stands for employees.
	Redesign or reposition tasks to allow elbows to remain close to the body, (e.g., turn boxes over on side to allow for easier access).
	Avoid awkward postures (e.g., reposition work in front of worker rather than reaching above or behind to get supplies).	Box placed on side, allows for less reaching.  Keep most work activities within repetitive access area.

	Use mechanical aids to reduce the need to lift. Use a spring device to automatically lift a load (e.g., use automatic plate and cup riser dispensers).
	Lighten a load that needs to be lifted or get help when lifting.
	Train workers to use proper lifting techniques.

Repetitive motions 

• Rotate workers through repetitive tasks.
  
  

• Use mechanical aids for chopping, dicing or mixing foods (e.g., food processors, mixers).

Select and use properly designed  tools. For example, kitchen scoops or kitchen knives that allow the wrist to remain straight.	Bent Wrist	Straight Wrist
Maintain a neutral (handshake) wrist position.   Restructure jobs to reduce repeated motions, forceful hand exertions, and prolonged bending.	Kitchen knives
	30 degree bend	Upright Handle
	Pistol Grip	45 degree bend

Additional Information

• Ergonomics, Technical Links Page.

• Hospital Kitchen and Food Preparation. Ergonomic Report.

Potential Hazard

Kitchen equipment pose special hazards to the dietary worker. Some of these hazards include: hot surfaces, which may cause burns; cuts and lacerations from the use of sharp objects; becoming caught in walk-in freezers; electrical shocks from contact with frayed electrical cords, and amputations from unguarded equipment.

	Employers must assess tasks to identify potential worksite hazards and provide and ensure employee use of appropriate Personal Protective Equipment (PPE) [1910.132].
	Employers shall require employees to use appropriate hand protection when hands are exposed to hazards such as cuts, lacerations, and thermal burns. Examples include the use of oven mitts when handling hot items, and steel mesh or kevlar gloves when cutting [1910.138(a)].
	Walk-in freezers must have a panic bar or other means of exit on the inside of freezers to prevent trapping workers inside [1910.37].  Ensure electrical equipment shall be free from recognized hazards [1910.303(b)(1)]. See Electrical Safety.
	Good work practices include:  The safe handling, use, and storage of knives and other sharp utensils. Cutlery should be kept sharpened and in good condition: dull knives tend to slip and may cause injuries. The direction of the cut should always be away from the body. Knives, saws, and cleavers should be kept in a designated storage area when not in use. The blades should not be stored with the cutting edge exposed. Knife holders should be installed on work tables to prevent worker injury. Knives and other sharp object should not be put into sinks between periods of use. Newly purchased knives should be equipped with blade guards, knuckle guards, that protect the hand form slipping onto the blade. The wheels of food carts should be large, low rolling, low resistance wheels, that can roll easily over mixed flooring as well as gaps between elevators and hallways.
	Use appropriate PPE and training to avoid steam burns when working with hot equipment or substances.  When uncovering a container of steaming materials, the worker should hold the cover to deflect steam from the face. The handles of cooking utensils should be turned away from the front of the stove.

Additional Information

• For information on machine guards for large mixers, slicers, and peelers, see the Machine Guarding Section.

Potential Hazard

Possible Solutions

For additional information, see HealthCare Wide Hazards - Fire Hazard.

Potential Hazard

Employee exposure to possibly hazardous chemicals, such as pesticides, disinfectants, and hazardous drugs in the workplace for example:

• Ammonia, used as a cleaning agent, and chlorine solutions used as disinfectants in dishwashing, can cause skin, eye, and nose irritations. (Avoid mixing chlorine and ammonia solutions because a chemical reaction may occur and deadly chlorine gas may be released). 
  
  

• Drain cleaners, oven cleaners, and grill cleaners can be caustic solutions that can cause skin burns and eye and skin irritations. 

Possible Solutions

 

	Implement a written program which meets the requirements of the Hazard Communication Standard to provide for worker training, warning labels, and access to Material Safety Data Sheets (MSDS).
	Provide appropriate PPE (e.g., gloves, goggles, splash aprons) when handling hazardous detergents and chemicals [1910.132]. For more information see HealthCare Wide Hazards - PPE.
	Medical Services and First Aid: Where the eyes or body of any person may be exposed to corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use [1910.151(c)].
	To avoid employee contact with dishwashing detergents, good work practice recommends using dishwashing machines with automated detergent dispensers.  Workers must still be cautious and use appropriate PPE (e.g., goggles, and/or gloves) when changing out the containers of detergent.

For additional information, see HealthCare Wide Hazards - Hazardous Chemicals.

Potential Hazard

Commercial dough mixers and other kitchen equipment pose a hazard to workers from being caught in or by rotating blades and can present various hazards to the employee such as amputations, strangulations, burns, cuts, broken bones, and other injuries. These machines must have guards in place to protect the worker form reaching in, or being pulled into, these hazards.

Possible Solutions

	OSHA Machine Guarding Standard [1910.212], requires that: Machine guards are provided to protect the operator and other employees in the machine area from hazards [1910.212(a)(1)].
	Meat slicers must be properly guarded and operated by workers trained in safe work practices to avoid cuts and amputations. Use Tamps or push sticks or other handtools to feed or remove food from grinders, slicers, or choppers [1910.212(a)(3)(iii)].
	Continuous feed dishwashers should be properly guarded to prevent accidental scalding of workers by steam and hot water, and possible nip-point injuries from rollers and conveyors.
	Machine guarding can be accomplished by isolating hazards  (e.g., providing barrier guards over a mixer when it is in use to prevent strangulation or amputations). Other methods of machine guarding include: Two-handed tripping devices. Electronic safety devices. Examples of machine guarding for General Industry-Bakery equipment can be found in [1910.263]. Paragraph (c) addresses general requirements for machine guarding in Bakeries.

Additional Information

• Machinery and Machine Guarding, 1910 Subpart O.

• Machine Guarding, Technical Links Page.

• Machine Guarding, OSHA Publication 3067.

• 1910.212, OSHA Machine Guarding Standard.

Foodborne Disease

Foodborne diseases, including foodborne intoxications and foodborne infections, are illnesses contracted by eating contaminated food. Contamination can arise from toxins and bacterial growth that can occur before the food is eaten, or after the food is ingested, and are caused by such organisms as Escherichia coli (E-coli), Salmonella, Staphylococcus Aureus, and Clostridium Perfringens. 

OSHA Standard 1910.141(h) states "In all places of employment where all or part of the food service is provided, food must be handled processed, prepared and stored in such a manner as to protect against contamination". However, foodborne disease is primarily a public health concern and in most instances is regulated by local health authorities who enforce their own specific requirements.

Potential Hazard

Employees may develop foodborne illness from eating or handling contaminated food.

Possible Solutions

Contact local public health authorities for specific requirements in your area. Recommended good work practices help ensure effective handwashing techniques, good personal hygiene, and safe food handling/preparation. Food Safety: Government food safety information site. Food Code: FDA published 1999 reference guide. Provides guidance on how to prevent foodborne illnesses in facilities such as nursing homes.

Additional Information

• Assessing the Problem of Foodborne and Waterborne Diseases. CDC/NCID.
  

Potential Hazard

Employee exposure to wet kitchen floors or spills and clutter can lead to slips, trips, falls, and other possible injuries.

Possible Solutions

	Floors shall be kept clean and dry [1910.22(a)(2)]. In addition to being a slip hazard continually wet surfaces promote the growth of mold, fungi, and bacteria which can cause infections.
	Keep aisles and passageways clear and in good repairs, with no obstruction across or in aisles that could create a hazard [1910.22(b)(1)]. Provide floor plugs or ceiling plugs for equipment, so power cords do not run across pathways.

For additional information, see HealthCare Wide Hazards - Slips/Falls.

Potential Hazard

Electrocution or shock from unsafe work practices, faulty electrical equipment, or wiring.

Possible Solutions

Employers must:

• Ensure that all electrical service near sources of water is properly grounded [1910.304(f)(5)(v)].
  
  

  • Grounding requirements for equipment connected by cord and plug. Interpretation letter, (12/21/1999).
    
    

• Ensure electrical equipment shall be free from recognized hazards [1910.303(b)(1)].
  
  

• Tag out and remove from service all damaged receptacles and portable electrical equipment [1910.334(a)(2)(ii)].
  
  

• Repair all damaged receptacles and portable electrical equipment before placing them back into service[1910.334(a)(2)(ii)].
  
  

• Ensure that employees are trained to not plug or unplug energized equipment when their hands are wet [1910.334(a)(5)(i)].
  
  

For additional information, see HealthCare Wide Hazards - Electrical Hazards.

Additional Information

• OSHA Construction eCat: Ground-fault Circuit Interrupters.

• Preventing Electrocution of Workers in Fast Food Restaurants. NIOSH Pub No. 85-104 (1984, December).

• Preventing Electrocutions from Damaged Receptacles and Connectors. NIOSH Pub No. 87-100 (1986, October).

Infectious Materials in Isolation Rooms

Potential Hazard

Dietary employees may be exposed to respiratory hazards, blood or OPIM, if they are required to take dietary trays to patients in isolation rooms. Exposure to infectious materials may also occur when handling red bagged contaminated food trays that have come from isolation rooms, to the kitchen to be sterilized.

Possible Solutions

• Establish Universal Precautions:
  
  

  • Universal Precautions: An approach to infection control which treats all human blood and other potentially infectious materials (OPIM), as if they were infectious for HIV and HBV or other bloodborne pathogens [1910.1030(b)].

  • Universal Precautions 1910.1030(d)(1) in the bloodborne Pathogens Standard requires:
    
    

    • Treat all blood and other potentially infectious materials with appropriate precautions such as: Use gloves, masks, and gowns if blood or OPIM exposure is anticipated. 
      
      

    • Use engineering and work practice controls to limit exposure.
      
      

• Educate and train all exposed employees to safely enter and exit isolation rooms and to safely handle food trays coming from isolations rooms.
  
  

• Encourage staff to special bag contaminated trays coming from isolation rooms and label the bag with what precautions are necessary to safely handle the contents (e.g., use universal precautions).
  
  

• Use only disposable trays and plasticware in isolation rooms.
  
  

For additional information, see HealthCare Wide Hazards - Tuberculosis, Bloodborne Pathogens, and Universal Precautions.