in view of the fact that in the kitchens used for communal catering , microroganisms are often introduced through raw foodstuffs and personnel , several legal measures aimed at infection prevention have been enacted ( infection control policies , temperature control regulations for assurance of the cold - hot chain , regular information updates for personnel , supervision of working practices , etc . ) . however , my experiences from infection control inspections in hospitals , rehabilitation clinics and nursing homes show that the preventive measures intended to assure hygienic provision of foodstuffs are often patchy and poorly observed . note : the food in the central kitchen is not sterile . therefore when food is allowed to stand at room temperature for a long time , both in the case of food cooked for lunch and of food intended for supper which has been previously chilled , there is the possibility of massive spore germination or of dangerous toxin formation . formulation of an infection control policy that should be checked and updated at regular intervals . informing staff about the risk of spore germination and toxin formation in foods supplied ( often , mistaken views held by auxiliary staff have to be corrected ) . as borne out by table 1 ( tab . 1 ) , more stringent measures are needed for instant products that are not cooked.spot checks of temperature of supplied foods.specification of how long the supplied food , e.g. if the patient is absent , can be kept on the ward ( e.g. refrigerator , ward room , ward kitchen , patient s room).need for reheating , e.g. in microwave to a core temperature of above 65  c ( caution : fish and meat portions).preparation and storage of dispensed teas must also be borne in mind as regards brewing with boiling water and avoidance of long standing time in patient s or resident s room . formulation of an infection control policy that should be checked and updated at regular intervals .   informing staff about the risk of spore germination and toxin formation in foods supplied ( often , mistaken views held by auxiliary staff have to be corrected ) . as borne out by table 1 ( tab . 1 ) , more stringent measures are needed for instant products that are not cooked . specification of how long the supplied food , e.g. if the patient is absent , can be kept on the ward ( e.g. refrigerator , ward room , ward kitchen , patient s room ) . need for reheating , e.g. in microwave to a core temperature of above 65  c ( caution : fish and meat portions ) . preparation and storage of dispensed teas must also be borne in mind as regards brewing with boiling water and avoidance of long standing time in patient s or resident s room . note : the aim must be to maintain as far as possible the cold or hot chain on the ward . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency).cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen.hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation.cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency ) . cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen . hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation . cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery . as ward staff are well aware of , this presents a special hygienic and organizational problem . as shown in table 2 ( tab . 2 ) , already high baseline microbial counts can be expected in the case of inadequately baked fillings . often , pieces of cake at left in the patient s room and eaten only hours later . it is therefore the duty of the nursing staff or ward doctors to make patients , and possibly also visitors , aware of the problems involved . again , because of their underlying disease or for dietary reasons patients are often not supposed to eat foodstuffs with a very high fat . 3 ) , confectionery and ice cream with a score of 33.4% are the chief causes of foodborne disease . maintenance of the cold - hot chainnot only reheat food , but ensure it is well heated throughout avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery.cleanliness and minimal contamination of kitchen worktopscleanliness of crockery and kitchen towels do not allow food to stand at room temperature for a long time , in particular desserts and confectionery a standard policy must be enforced to define the hygienic status and organization for food distribution . maintenance of the cold - hot chain not only reheat food , but ensure it is well heated throughout   avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery . cleanliness and minimal contamination of kitchen worktops cleanliness of crockery and kitchen towels   do not allow food to stand at room temperature for a long time , in particular desserts and confectionery   a standard policy must be enforced to define the hygienic status and organization for food distribution . formulation of an infection control policy that should be checked and updated at regular intervals . informing staff about the risk of spore germination and toxin formation in foods supplied ( often , mistaken views held by auxiliary staff have to be corrected ) . as borne out by table 1 ( tab . 1 ) , more stringent measures are needed for instant products that are not cooked.spot checks of temperature of supplied foods.specification of how long the supplied food , e.g. if the patient is absent , can be kept on the ward ( e.g. refrigerator , ward room , ward kitchen , patient s room).need for reheating , e.g. in microwave to a core temperature of above 65  c ( caution : fish and meat portions).preparation and storage of dispensed teas must also be borne in mind as regards brewing with boiling water and avoidance of long standing time in patient s or resident s room . formulation of an infection control policy that should be checked and updated at regular intervals .   informing staff about the risk of spore germination and toxin formation in foods supplied ( often , mistaken views held by auxiliary staff have to be corrected ) . as borne out by table 1 ( tab . 1 ) , more stringent measures are needed for instant products that are not cooked . specification of how long the supplied food , e.g. if the patient is absent , can be kept on the ward ( e.g. refrigerator , ward room , ward kitchen , patient s room ) . need for reheating , e.g. in microwave to a core temperature of above 65  c ( caution : fish and meat portions ) . preparation and storage of dispensed teas must also be borne in mind as regards brewing with boiling water and avoidance of long standing time in patient s or resident s room . note : the aim must be to maintain as far as possible the cold or hot chain on the ward . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency).cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen.hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation.cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency ) . cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen . hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation . cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery .   as ward staff are well aware of , this presents a special hygienic and organizational problem . as shown in table 2 ( tab . 2 ) , already high baseline microbial counts can be expected in the case of inadequately baked fillings . often , pieces of cake at left in the patient s room and eaten only hours later . it is therefore the duty of the nursing staff or ward doctors to make patients , and possibly also visitors , aware of the problems involved . again , because of their underlying disease or for dietary reasons patients are often not supposed to eat foodstuffs with a very high fat . 3 ) , confectionery and ice cream with a score of 33.4% are the chief causes of foodborne disease .   maintenance of the cold - hot chainnot only reheat food , but ensure it is well heated throughout avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery.cleanliness and minimal contamination of kitchen worktopscleanliness of crockery and kitchen towels do not allow food to stand at room temperature for a long time , in particular desserts and confectionery a standard policy must be enforced to define the hygienic status and organization for food distribution . maintenance of the cold - hot chain not only reheat food , but ensure it is well heated throughout   avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery . cleanliness and minimal contamination of kitchen worktops cleanliness of crockery and kitchen towels   do not allow food to stand at room temperature for a long time , in particular desserts and confectionery   a standard policy must be enforced to define the hygienic status and organization for food distribution . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency).cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen.hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation.cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery . kitchen workstations : regular cleaning is necessary ( cleaning policy ! ) bacteriological spot checks advisable after cleaning ( check of efficiency ) . cleaning cloths : if disposable wipes , the best solution , are not available for the worktops and equipment coming into direct contact with foodstuffs , cleaning cloths ( ideal breeding ground thanks to humidity , contamination , room temperature and time ) . such cloths are no longer suitable for cleaning but rather for uniform distribution of any pathogenic microbes present in the kitchen . hygienic hand disinfection is needed after performing any care / nursing activities and before handing out or preparing food in the ward kitchen . refrigerators should be available for storage of foodstuffs on the wards if this is warranted by the hygienic or organizational situation . cleaning crockery : occasional microbiological spot checks , e.g. with rodac plates , of the cleaned crockery advisable . this is all the more needed if there is visible evidence of inadequate cleaning or drying . the aim aspired to must be not to exceed a maximum count of 50 cfu / dm for clean crockery . as ward staff are well aware of , this presents a special hygienic and organizational problem . as shown in table 2 ( tab . 2 ) , already high baseline microbial counts can be expected in the case of inadequately baked fillings . often , pieces of cake at left in the patient s room and eaten only hours later . it is therefore the duty of the nursing staff or ward doctors to make patients , and possibly also visitors , aware of the problems involved . again , because of their underlying disease or for dietary reasons patients are often not supposed to eat foodstuffs with a very high fat . 3 ) , confectionery and ice cream with a score of 33.4% are the chief causes of foodborne disease . maintenance of the cold - hot chainnot only reheat food , but ensure it is well heated throughout avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery.cleanliness and minimal contamination of kitchen worktopscleanliness of crockery and kitchen towels do not allow food to stand at room temperature for a long time , in particular desserts and confectionery a standard policy must be enforced to define the hygienic status and organization for food distribution . maintenance of the cold - hot chain not only reheat food , but ensure it is well heated throughout   avoid situations giving rise to spore germination in foodstuffs brought in by visitors , in particular of confectionery . cleanliness and minimal contamination of kitchen worktops cleanliness of crockery and kitchen towels   do not allow food to stand at room temperature for a long time , in particular desserts and confectionery   a standard policy must be enforced to define the hygienic status and organization for food distribution . walter steuer was reading medicine in munich , where he did his doctorate in 1959 and received his licence to practice medicine . as a young doctor he worked in hospitals and runs a doctor s practice in stuttgart . from stuttgart he moved to the institute for hygiene in tbingen , took his federal medicinal test in 1959 and became public health officer at the public health department bblingen . 1968 he was head of the medicinal testing laboratory of stuttgart and furthermore president of the federal health authority of baden - wurttemberg in 1991 . his retirement has become a real turbulent one : professor steuer is still consultant hygienist for the technical control board and the federal insurance institution for employees , he is director of the institute for hygiene of the research institute hohenstein as well as external consultant for hospitals , rehab - hospitals and nursing homes ; he is also member of numerous committees , commissions and managing boards . in addition he acts as author and editor and recently added his publications and books to a new important one :  hygiene in nursing care  . walter steuer was reading medicine in munich , where he did his doctorate in 1959 and received his licence to practice medicine . as a young doctor he worked in hospitals and runs a doctor s practice in stuttgart . from stuttgart he moved to the institute for hygiene in tbingen , took his federal medicinal test in 1959 and became public health officer at the public health department bblingen . 1968 he was head of the medicinal testing laboratory of stuttgart and furthermore president of the federal health authority of baden - wurttemberg in 1991 . his retirement has become a real turbulent one : professor steuer is still consultant hygienist for the technical control board and the federal insurance institution for employees , he is director of the institute for hygiene of the research institute hohenstein as well as external consultant for hospitals , rehab - hospitals and nursing homes ; he is also member of numerous committees , commissions and managing boards . in addition he acts as author and editor and recently added his publications and books to a new important one :  hygiene in nursing care  .