CMS Revises F341 Guidance on Preparation of Eggs in NFs

A May 20th S&C Memo to State Survey Agency Directors revises guidance and procedures for Sanitary Conditions (F371) clarifying the use and serving of soft-cooked, undercooked or sunny-side up eggs to nursing facility residents.  Facilities should use pasteurized shell eggs or liquid pasteurized eggs to eliminate the risk of residents contracting Salmonella Enteritidis (SE).  The use of pasteurized eggs allows for resident preference for soft-cooked, undercooked or sunny-side up eggs while maintaining food safety.  In accordance with the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) standards, skilled nursing and nursing facilities should not prepare nor serve soft-cooked, undercooked or sunny-side up eggs from unpasteurized eggs.

Following are key points in the guidance:

  • A nursing center that uses and serves unpasteurized eggs must ensure the eggs are fully cooked until both the yolk and white are completely firm.
  • If a nursing center uses pasteurized eggs, they may serve them as “soft-cooked”, “soft-scrambled”, or sunny-side up”.
  • The use of signed agreements between the nursing center and a resident/patient (or the resident’s/patient’s legal representative) releasing the nursing center of liability if the patient/resident becomes ill due to eating unpasteurized eggs prepared by the nursing center that are  not cooked until the yolk and white are completely firm are not permitted. 

The surveyor interpretive guidance in Appendix PP at F371 provides additional clarification:  (1) unpasteurized eggs must be cooked until both the yolk and white are completely firm; and (2) deletion of the example of a negative outcome that could rise to the level of immediate jeopardy.  For all other forms of egg preparation, including hot holding of eggs, and pooling (combining) of eggs for recipes where more than one egg is broken and the eggs are pooled and used as an ingredient immediately before baking, such as in a meat loaf mixture, muffins or cake, the eggs must be pasteurized or thoroughly cooked to an internal temperature of 160°F (71°C).