Increasing recent investment in and focus on textured modified foods have led to significant improvement in the meals offered to patients with dysphagia (swallowing difficulties) in health and care settings. These include the development and implementation of the International Dysphagia Diet Standardisation System (IDSSI) - a framework that offers clear descriptors of varying levels of food modification, helping healthcare providers and caterers communicate clearly and meet the needs of their patients.

By its nature, textured modified food is often offered to some of the most vulnerable patients - so food safety has to be a key priority in its preparation. We look at some of the key challenges raised when preparing these foods.

Be aware of the Danger Zone

Pathogenic bacteria need food, moisture and warmth to thrive; the ideal temperature range for most pathogens is between 8°C and 63°C. In any food service, good food safety includes keeping food either above or below the Danger Zone as far as possible, and handling quickly and efficiently during preparation. The extra processes involved in textured modified food means it can spend longer in the Danger Zone, so it is important that food handling staff:

• are conscious of total preparation times
• work quickly and effectively to reduce times, for instance by working with smaller portions
• cool quickly and return to chillers or freezers as soon as possible

Correct times and temperatures

Ensuring that the times and temperatures advised by the Foods Standards Agency (FSA) or Foods Standards Scotland (FSS) are always met is a key factor in minimising the presence of pathogens.

Standard FSA advice (use in England, Wales and NI) is to cook food until it has reached a core temperature of 70°C for 2 minutes.

The other time and temperature combinations are:

• 60°C for 45 minutes
• 65°C for 10 minutes
• 70°C for 2 minutes
• 75°C for 30 seconds
• 80°C for 6 seconds

Hot food when held must be kept at 63°C or above. You can keep it below 63°C for up to two hours. If it has not been used within two hours, you should either:

• cool the food as quickly as possible to a temperature of 8°C or below
• throw it away

The FSS advice (use in Scotland) is:

• Cook foods to 75^oC or above
• Keep food hot at 63^oC or above
• Reheat foods to 82^oC or above

Portion control

Reheating food more than once increases the likely presence of pathogens. It can be tempting to re-chill uneaten food, especially modified food that has involved extra care and attention, but the risk is too great. Use careful portion control to suit the people you are catering for - this has the added benefit that a smaller portion can be more appealing to someone who has dysphagia.

Keep it clean

EHOs report that bulky kitchen equipment, such as bains-marie, food processors and industrial tin openers are commonly the most neglected items in the kitchen cleaning schedule. Warm, soft, moist, protein rich food that has lodged in hard to reach places can be especially hard to clean, but is the perfect breeding ground for bacteria. The extensive use of these types of equipment in food modification puts these foods at greater risk of contamination so ensure every piece of equipment in your kitchen is included in your HACCP cleaning schedule and the standards of cleaning are checked regularly.

None of the above food safety practices are unique to the preparation of texture modified foods, but they are areas that may require extra focus in this type of preparation. Always ensure that all food handler staff in health and care settings are suitably trained and / or supervised for their roles. The Safer Food Group offers a range of food safety training for food industry workers: www.thesaferfoodgroup.com.

This article was written in conjunction with Andy Cullum, The iddsi Guy, who offers comprehensive training in dysphagia modification of food and drink.