Nourishing change. Partnership enlists dozens of hospitals to put healthier food on their menus and kick junk food out of the cafeteria

More than 150 hospitals have signed on to the Partnership for a Healthier America's push to ditch the deep-fat fryer in their cafeterias and bulk up on fruit and veggies. "Our focus is to ensure that if people want to make a healthy choice, they can," says Larry Soler, left, president and CEO of the partnership, which is working to reduce childhood obesity.

National monitoring study on microbial contamination of food-contact surfaces in hospital kitchens in Poland

INTRODUCTION AND OBJECTIVE

The risk of food-borne infections in hospitalized patients with compromised immune systems is much higher and can also lead to more serious health consequences than among other population groups. Therefore, food hygiene within the hospital setting, should be handled in an appropriate manner. In 2008, there were 732 hospitals in Poland. It was estimated that 7.2 million hospitalized patients, with an average hospital stay of 5.9 days, benefited from hospital meals. On average, nearly half of the hospitals (ranging from 30%-50%, depending on the province) outsourced the preparation and delivery of meals to external service providers. The objective of this study was to survey the bacteriological contamination of selected food production and processing areas in hospital kitchens in Poland.

MATERIALS AND METHODS

The nationwide microbiological examination of food contact surfaces was performed in 10% of randomly selected hospital kitchens in all 16 provinces in Poland. A total of 3,277 samples were scientifically examined for hygiene indicator micro-organisms; namely, for Total Viable Count (TVC), Enterobacteriaceae count and coliforms, as well as for the presence of coagulase-positive staphylococci. The environmental samples were collected and examined according to European and Polish standards. All analyses were performed using Statistica version 6 software.

RESULTS

The results revealed that food hygiene within the test sample was poor. Of the total samples taken for testing, 25.5% failed. The most common failures were related to excess TVC in swabs.

CONCLUSION

Testing shows that there is a need to improve the standard of hygiene in food handling areas of Polish hospitals.

The meal makeover

Nurses at Basildon and Thurrock University Hospitals NHS Foundation Trust are leading a project to put nutrition at the heart of patient care. Their efforts are being lauded as an example for other hospitals to follow.

Survey serves up food for thought

An independent survey into hospital food standards in England conducted earlier this year for the Soil Association saw over half of those patients surveyed admit they would not be happy serving the meals they received during a recent hospital stay to a child, while 29% said the food was so bad that, at times, they could not recognise what was on their plate. Nearly of quarter of the 1,000 indviduals questioned by OnePoll, meanwhile, had opted out of hospital catering altogether--choosing to have every meal brought in to them by visiting relatives; nor, the Soil Association says, is enough English hospital food being locally or sustainably sourced.

A cluster of Listeria monocytogenes infections in hospitalised adults, Midlands, England, February 2011

Hospital-acquired listeriosis cases are not commonly reported but remain a significant public health problem. We report on three cases in patients with underlying conditions occurring during one week in February 2011. The cases had common exposure to pre-packed sandwiches and salads manufactured in compliance with regulations. Breaches in cold chain and shelf life controls at hospital level were identified as key contributing factors. Rigorous hospital food management systems remain important for patient safety.

Hospital catering systems and their impact on the sensorial profile of foods provided to older patients in the UK

Impaired sensorial perception is very common in older people and low sensorial quality of foods is associated with decreased appetite and dietary intake. Hospital undernutrition in older patients could be linked to sensorial quality of hospital food if the quality were low or inappropriate for older people. The aim of this study was to examine changes in the sensorial quality of different foods that occur as a result of the food journey (i.e. freezing, regeneration, etc.) in the most common hospital catering systems in the UK. A trained sensory panel assessed sensorial descriptors of certain foods with and without the hospital food journey as it occurs in the in-house and cook/freeze systems. The results showed effects of the food journey on a small number of sensorial descriptors related to flavour, appearance and mouthfeel. The majority of these effects were due to temperature changes, which caused accumulation of condensation. A daily variation in sensorial descriptors was also detected and in some cases it was greater than the effect of the food journey. This study has shown that changes occur in the sensory quality of meals due to hospital food journeys, however these changes were small and are not expected to substantially contribute to acceptability or have a major role in hospital malnutrition.

Dialysability of magnesium and calcium from hospital duplicate meals: influence exerted by other elements

Total and dialysable magnesium and calcium levels and corresponding dialysabilities were measured in duplicate meals (n = 108) during 36 consecutive days. The interaction exerted by other nutrients and energy on them was also performed. Total mean magnesium and calcium fractions of 113.9 +/- 98.3 and 337.2 +/- 278.9 mg/meal respectively, were found. The Mg and Ca levels supplied by meals are positively (p < 0.05) correlated with macronutrient contents (carbohydrates and proteins). The mean dialysable Mg and Ca fractions were 56.9 +/- 36.3 and 127.4 +/- 112.3 mg/meal (50.4 +/- 13.2 and 37.8 +/- 10.7% as dialysabilities, respectively). Total Mg and Ca levels are significantly correlated with corresponding element dialysabilities (p < 0.05). For both minerals, significant correlations between their total and dialysable fractions and between their dialysable level and dialysabilities were noted (p < 0.01). The mean Mg and Ca daily dietary intakes (DDI) were 341.7 +/- 68.0 and 1,011.6 +/- 424.4 mg/day, respectively. For Ca and Mg the existence of similarities in their behaviour in meals and absorptive processes has been found. Duplicate meals with raw vegetables are good sources of bioaccessible Mg. High Ca dialysability has been found in the analysed meals. The fish and products constitute a good source of bioaccessible Ca. Mg, Ca, zinc, and chromium levels enhanced significantly the Mg dialysability. The Ca dialysability rose significantly with dialysable Ca and chromium fractions (p < 0.05).

[A survey on diet manuals in Italian hospitals]

Hospital catering is very important to counteract the onset of malnutrition due to either undernutrition or overnutrition and for dietetic treatment. The aim of the study was to evaluate nutritional quality of the hospital dietetic manual used in some Italian hospitals and to analyze the role of the institutional Catering Service and of the Department of Clinical Nutrition. A survey has been carried out, in some Italian hospitals, using a questionnaire to point out the characteristics of hospitals, the typology of catering service, of the diets and of the staff of the Department of Clinical Nutrition. Only 22% of the hospitals has answered; three Italian regions (Umbria, Molise, Basilicata) are completely missing; -each hospital has a specific dietetic manual in most cases completely different from structure and nutritional quality point of view; the staff acting in this field is absolutely insufficient in term of numerousness and of professional typologies. Hospital in-patients are not homogeneous as for age, dietary needs and diseases, so it's necessary to treat them with an ad hoc nutritional intervention not established in advance in a dietetic manual; if from an organisation point of view it is necessary to have such a dietetic manual, it has to be based on nutritional guidelines and recommended dietary allowances.

[Evaluation of customer satisfaction with the hospital catering system in the city of Palermo (Italy)]

The aim of the study was to evaluate patients' customer satisfaction with the hospital catering services of two public hospitals and one private sector hospital in the city of Palermo (Italy). A multiple choice questionnaire was administered by face-to-face interview to 207 of 227 hospitalized patients. Positive responses regarding the perceived quality of food were given especially by patients of the private sector hospital, 80% of which reported being satisfied with the catering service. A higher percentage of patients in the private sector hospital were satisfied with the food distribution modalities with respect to the two public hospitals. Only 3% of patients in the private sector hospital required their families to bring food from home, with respect to 7.9% and 30% respectively in the two public hospitals. Private sector patients also reported appreciating the wide availability of food and the help given by health care workers (79% vs a mean of 55% in the two public hospitals). No differences were found amongst hospitals with regards to the hygienic characteristics of meals. The results of this study indicate the need to make changes in the management of the catering service of one of the involved public hospitals especially.

Evaluation of strategies to improve nutrition in people with dementia in an assessment unit

OBJECTIVES

To evaluate strategies designed to improve nutrition in elderly hospitalised patients with dementia.

DESIGN

Observation phase followed by sequential interventions.

SETTING

A Short stay assessment unit.

PARTICIPANTS

Hospital Inpatients with a variety of conditions causing dementia.

INTERVENTIONS

Phase 1: Observation. Phase 2: Encouraging dietary, 'Grazing'. Phase 3: Using volunteers to feed patients. Phase 4: Improving dining room ambience by playing soothing music.

MEASUREMENTS

Body Mass Index (BMI), mid arm circumference, mini nutrition index and caloric intake by plate waste measurement.

RESULTS

BMI fell in the Observation phase 0.6 +/- 0.68 kg/m2 (p < 0.001), but increased in each of the Intervention phases. Phase2 0.3 +/- 0.86 kg/m2 (p < 0.04), Phase 3 0.37 +/- 0.4 kg/m2 (p < 0.04), Phase 4 0.39 +/- 0.7 kg/m2 (p < 0.007). Caloric intake increased in the intervention phases.

CONCLUSIONS

Simple, inexpensive and easy to implement strategies can improve nutrition in hospital inpatients with dementia.

Nutrition now. Ripe for reform

Levels of nutritional care for patients in the community are difficult to gauge, but community nurses can make a difference to those at risk.