Hospital food waste and environmental and economic indicators--A Portuguese case study

Generation rate of hospital solid waste from different services: A case study in the province of Bagua, northern Peru

The objective of this research was to evaluate the unit generation rate of solid hospital waste at the Gustavo Lanatta Lujan Bagua Support Hospital (HAB). The calculations were based on the weights of hospital waste disposed periodically to the biosafety cell located 7 km from the city of Bagua since 2015. Nineteen services were identified and grouped into three areas: hospitalization area, emergency area and gynecology area, studied according to the group classification of Peruvian regulations. The results show that 92.77 kg/day-1 are generated, 62.26 % are biocontaminated waste, 26.45 % are common waste, 7.7 % are sharp-sharp waste and 3.6 % are special waste. It was also found that only 73.56 % is disposed of in the hospital's biosafety cell. In this sense, this study will contribute to promote the reduction of the entry of hazardous substances into the stream of an adequate waste management and save workers and the environment in the Amazon Region. Therefore, awareness should be raised at all levels of society through various means of communication and education, so that the risks of spreading health hazards can be minimized by improving hospital waste management. In addition, healthcare waste management should be implemented, taking into account the parameters to be monitored, the economic resources to be managed and the national plans for healthcare waste.

Evaluating Patient Experience with Food in a Hospital-Wide Survey

Purpose: Patient dissatisfaction with hospital food is an important driver of poor food intake in hospitals. The objective of this study was to examine patient satisfaction with current menu offerings and explore patient preferences and values, in order to inform a patient-centred menu redesign.Methods: Between July and September 2021, a cross-sectional survey was distributed to inpatients receiving a lunch tray at Vancouver General Hospital, a large tertiary care centre in Vancouver, Canada. The survey was based on the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire, with additional questions on food experience, factors impacting preferences for hospital meals, interest in plant-rich diets, and demographics.Results: The response rate was 5.5%, with 271 patients completing at least part of the survey. On a 5-point Likert scale, (5 - highest score; 1 - lowest score) satisfaction with food quality (mean = 3.09, p < 0.001) and the overall experience (mean = 3.54, p < 0.001) was lower than industry benchmark of 4, and qualitative feedback was generally negative. Open-ended responses indicated patients were interested in expanded cultural diversity in food provision, more fresh produce and better flavours, and were generally open to trying plant-rich foods.Conclusions: A number of opportunities for improvement were identified in this survey, which will inform an upcoming menu redesign in this institution.

Eco-efficiency as a prioritization tool in the reduction of food waste in restaurants

Striving towards eco-efficiency means creating more value while generating a product or service with a reduced environmental impact. This quest makes it possible to link objectives associated with both the environmental and the economic pillars of sustainable development. Eco-efficiency could therefore be an interesting tool to evaluate the impacts of food waste (FW) and the potential of various food waste reduction strategies (FWRSs). However, the use of eco-efficiency to assess the interest in implementing FWRSs has never been explored in the foodservice sector. This work firstly aims to carry out an in-depth analysis of the costs of the FW generation of an independent restaurant. Secondly, based on these costs data and on some previously documented environmental impact data with a life cycle assessment according to ISO 14045:2012, this work also aims to model and evaluate the performance of FWRSs from a perspective of improving a restaurant eco-efficiency. The impact of each FWRS on the eco-efficiency of the restaurant under study was measured by modeling their economic and environmental net benefits over three implementation periods (one week, one month and six months) and under scenarios of strong and weak adherence. The study identified the most eco-efficient FWRSs to be implemented to reduce FW in the studied restaurant. In addition, key factors affecting eco-efficiency were raised, namely the period following the implementation of FWRSs, the FW reduction rate between FWRSs affecting the same type of FW, the specificity of the FWRSs and their ability to limit the waste of vegetables, meat, sea products and food requiring significant processing time by the cooks. Thus, these elements will guide foodservice managers in adopting FWRSs aimed at reducing FW generated in their restaurant and at improving its eco-efficiency. In addition, this work proposes a new methodology intended for the scientific community to identify FWRSs that have a strong impact on a restaurant eco-efficiency.

Implementation of sustainable food service systems in hospitals to achieve current sustainability goals: A scoping review

BACKGROUND

Food waste is a pivotal contributor to environmental degradation in the modern world. Vast amounts of food are wasted and many individual efforts and collective initiatives being underway to deal with this challenge. Hospitals are institutions that produce and provide food, but at the same time contribute greatly to food waste. The objective of this scoping review is to present available data regarding quantity of food waste generated in public hospitals and summarizes studies that assess and quantify the greenhouse gas emissions (carbon footprint) associated to food service management in hospitals.

METHODS

A systematic literature research was conducted by two qualified researchers in PubMed, Scopus, ISI Web of Science and Science Direct. The publication date was set to the last ten years, i.e., 2013-2023. All the abstracts retrieved were screened, and the eligible articles were selected after a two-step process. Abstracts from the retrieved full papers' references were also screened for eligibility. The selected papers were included in the final scoping review.

RESULTS

Overall, 2870 studies were identified and 69 were included in the review. Most of the studies (n = 33) assessed the causes and quantified the amount of food waste generated in hospitals. A small number of studies (5) estimated carbon dioxide equivalent (CO2-eq) produced by food waste. Although several studies suggested strategies and measures to reduce the environmental impact of foodservice operations, none of them implemented a comprehensive foodservice management system.

CONCLUSION

This scoping review suggests that hospital diets contribute to food waste and may have a negative environmental impact. There are several internal and external factors and practices that influence positively or negatively the sustainability of hospital food service systems. Systematic efforts are needed to identify and enhance parameters that could improve the environmental footprint of hospitals in terms of more effective management of food waste.

Hospital food management: a multi-objective approach to reduce waste and costs

Food waste contributes significantly to greenhouse emissions and represents a substantial portion of overall waste within hospital facilities. Furthermore, uneaten food leads to a diminished nutritional intake for patients, that typically are vulnerable and ill. Therefore, this study developed mathematical models for constructing patient meals in a 1000-bed hospital located in Florida. The objective is to minimize food waste and meal-building costs while ensuring that the prepared meals meet the required nutrients and caloric content for patients. To accomplish these objectives, four mixed-integer programming models were employed, incorporating binary and continuous variables. The first model establishes a baseline for how the system currently works. This model generates the meals without minimizing waste or cost. The second model minimizes food waste, reducing waste up to 22.53 % compared to the baseline. The third model focuses on minimizing meal-building costs and achieves a substantial reduction of 37 %. Finally, a multi-objective optimization model was employed to simultaneously reduce both food waste and cost, resulting in reductions of 19.70 % in food waste and 32.66 % in meal-building costs. The results demonstrate the effectiveness of multi-objective optimization in reducing waste and costs within large-scale food service operations.

An in-depth analysis of hospital food waste in terms of magnitude, nutritional value, and environmental and financial perspectives: A cross-sectional study

Hospital food waste has nutritional, economic and environmental impacts, and halving food waste is a sustainable development goal. This study aimed to quantify hospital food waste and its nutritional, environmental and financial values in medical and surgical wards. In a cross-sectional study in three educational hospitals, nutritional and demographic data of adult inpatients were collected. The food waste was measured at breakfast, lunch and snack times, and a 24-hour food recall was fulfilled for each patient. Also, the nutritional, environmental and financial values of discarded food were calculated. Food waste contributors were determined using linear regression. Totally, 398 meals were evaluated. The average served food was about 1 kg patient-1 day-1, while 539.5 g patient-1 day-1(50.1% of the served food) was discarded. Mean food wastes were 148.9 g (standard deviation (SD): 130.1), 364.3 g (SD: 257.2) and 80.2 g (SD: 101.5) in breakfast, lunch and snacks, equal to 45.7% (SD: 36.9), 51.4% (SD: 36.1) and 62.4% (SD: 53.2) of the served food, respectively. Rice, soup, milk and fruits were mostly discarded. Severely malnourished patients had higher daily food waste. Food preparation and waste were estimated to cost on average US$1.8 and US$0.8 patient-1 day-1, respectively. Each kilogram of food waste resulted in 8.1 m2 of land use, 1.4 kg of CO2-equivalent gas emission, and about 1003 L of water wastage. Half of the hospital food was discarded which means waste of nutrients, environmental resources and money. Current data can help authorities to plan for reducing hospital food waste.

Identifying Environmental Impact Factors for Sustainable Healthcare: A Scoping Review

The healthcare industry has a substantial impact on the environment through its use of resources, waste generation and pollution. To manage and reduce its impact, it is essential to measure the pressures of healthcare activities on the environment. However, research on factors that can support these measurement activities is unbalanced and scattered. In order to address this issue, a scoping review was conducted with the aims of (i) identifying and organizing factors that have been used to measure environmental impact in healthcare practice and (ii) analyzing the overview of impact factors in order to identify research gaps. The review identified 46 eligible articles publishing 360 impact factors from original research in PubMed and EBSCO databases. These factors related to a variety of healthcare settings, including mental healthcare, renal service, primary healthcare, hospitals and national healthcare. Environmental impacts of healthcare were characterized by a variety of factors based on three key dimensions: the healthcare setting involved, the measurement component or scope, and the type of environmental pressure. The Healthcare Environmental Impact Factor (HEIF) scheme resulting from this study can be used as a tool for selecting measurable indicators to be applied in quality management and as a starting point for further research. Future studies could focus on standardizing impact factors to allow for cross-organization comparisons and on expanding the HEIF scheme by addressing gaps.

How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste

Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.

Sustainability in food service: A systematic review

The irrational functioning of the food sector can negatively impact the environment and resources for future generations. The aim of this study is to analyse the assessment of sustainability indicators related to meal production processes and waste in the food service through a systematic literature review. The hypothesis is that these indicators are still little explored. This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. The databases consulted were Lilacs, Science Direct, Scientific Electronic Library Online (SciELO), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, OpenGrey and Greylit. Six different search strategies were applied, combining the terms sustainability and food service, plus manual searches. The search took place until April 2020 and there was no language restriction of the studies. After removing duplicates, 770 publications were identified through the search process, with 44 having been included in this review. Most publications carried out the quantification of food waste (38/44), while in 7/44 there were questionnaires, checklists and water footprint assessments. Most studies identified high indicators of waste, as well as little awareness of sustainability. Factors such as controlled portioning, omnivorous menus and dissatisfaction with the menu were reported to have caused the greatest losses in the process. This review identified a restricted assessment of sustainability in food service, countering the need to deepen these indicators and the effect of meal production processes on sustainable development.

Food and food-related waste management strategies in hospital food services: A systematic review

AIM

This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation.

METHODS

Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively.

RESULTS

Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes.

CONCLUSION

This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.

Behavior of Polish Consumers in Relation to Meals Ordered in Food Service Establishments in the Context of Plate Waste

In the food service industry, food is wasted at every stage of the process. A significant part of food wastage is the so-called plate waste, i.e., food left by the consumer on the plate. The purpose of this research was to analyze the behavior of Polish consumers in relation to meals ordered in food establishments. The following issues were taken into account: leaving an unfinished meal on a plate and reasons for it, taking an unfinished meal home, and ordering half portions. The study was conducted on a representative group of 1115 adult Polish citizens using the CAPI method. Segmentation (cluster analysis) of respondents differing in their behavior in relation to ordered meals was carried out. It turned out that about 53% of Polish citizens do not use food services at all. Men with secondary and higher levels of education and other sources of income (cluster C) less frequently declared leaving unfinished meals on a plate and taking an unfinished meal home, especially in canteens, compared to other clusters. Few respondents declared buying half portions. Excessively large portions and inadequate taste of dishes were indicated by almost 50% of respondents as the main reasons for the generation of plate waste. Measures should be promoted to encourage consumers and food service providers to reduce the generation of plate waste.

Hospital waste generation during the first wave of COVID-19 pandemic: a case study in Delhi

In this study, the hospital waste generation rates and compositions in Delhi were examined temporally and spatially during the first COVID-19 wave of April 2020. A total of 11 representative hospitals located in five districts were considered. The pre-COVID hospital waste generation rates were relatively consistent among the districts, ranging from 15 to 23 tonne/month. It is found that the number of hospital beds per capita may not be a significant factor in the hospital waste quantity. Strong seasonal variations were not observed. All districts experienced a drastic decrease in generation rates during the 1-month lockdown. The average rates during the COVID period ranged from 12 to 24 tonne/month. Bio-contaminated and disposable medical product wastes were the most common waste in Delhi's hospitals, representing 70-80% by weight. The changes in waste composition were however not spatially consistent. The lockdown appeared to have had a higher impact on hospital waste generation rate than on waste composition. The findings are important as the design and operation of a waste management system are sensitive to both waste quantity and quality. Waste records at source helped to minimize waste data uncertainties and allowed a closer examination of generation trends.

Comparison of Plate Waste between Vegetarian and Meat-Containing Meals in a Hospital Setting: Environmental and Nutritional Considerations

Vegetarian diets can satisfy nutritional requirements and have lower environmental impacts than those containing meat. However, fruits and vegetables are wasted at higher rates than meat. Reducing both food waste (FW) and the environmental impacts associated with food production is an important sustainability goal. Therefore, the aim of this study was to examine potential tradeoffs between vegetarian meals’ lower impacts but potentially higher FW compared to meat-containing meals. To examine this, seven consecutive days of plate FW data from Loma Linda University Medical Center (LLUMC) patients were collected and recorded from 471 meals. Mean total FW and associated greenhouse gas emissions (GHGE) were higher among meat-containing meals (293 g/plate, 604 g CO2-eq/plate) than vegetarian meals (259 g/plate, 357 g CO2-eq/plate) by 34 g (p = 0.05) and 240 g CO2-eq (p < 0.001), respectively. Statistically significant differences were observed in both FW and associated GHGE across major food categories, except fruit, when comparing vegetarian and meat-containing meals. Overall, vegetarian meals were preferable to meat-containing meals served at LLUMC both in terms of minimizing FW and lowering environmental impacts. Other institutions serving vegetarian meal options could expect similar advantages, especially in reduced GHGE due to the high CO2 embodied in meat.

Food Waste Perception of Workplace Canteen Users—A Case Study

Background: Food waste occurs in all stages of the food supply chain, namely in the food service sector. Understanding how much and why food is wasted and whether consumers are aware of it is essential to design effective interventions in this setting. This case study aims to compare the food waste perception by consumers and measure plate waste in a Portuguese workplace canteen in order to recognize if trained consumers can estimate his/her food waste. Methods: Data were collected from 160 users randomly selected attending a workplace canteen during one month. Plate waste was evaluated by the weighing method. Visual estimation was performed by each participant to evaluate food waste perception at the end of the meal. Consumers were also asked about reasons for wasting food. Results: Plate waste was 8.4% for soup, 9.0% for the main course, and 4.0% for dessert. These values follow the same trend of waste perceived by consumers for soup (R = 0.722; p ˂ 0.001), main course (R = 0.674; p ˂ 0.001), and dessert (R = 0.639; p ˂ 0.001), showing a high relation between self-assessment and measured plate waste. Excessive portions (46.1%), dislike of meal flavor (18.6%), cooking method (8.8%), and texture (3.9%) were identified as the main causes for plate waste. Conclusions: Canteen users showed an accurate perception of their plate waste for all meal components. Excessive portions were identified by consumers as the main reason for plate waste.

Plate waste study among hospitalised patients receiving texture-modified diet

BACKGROUND/OBJECTIVES

While plate waste has been widely investigated in hospitals, there have been minimal studies specific to the texture-modified diet (TMD). This study aims to determine the percentage of plate waste among patients prescribed with TMD and its contributory factors.

SUBJECTS/METHODS

This was a single-centre study conducted in the university hospital on three types of TMD (blended diet, mixed porridge, minced diet) during lunch and dinner meals. Weighing method and visual estimation method assisted by digital photograph were adopted in this study. Face to face interview was carried out to investigate on 1) the food/food service quality factors in terms of patients' satisfaction level towards sensorial quality of food and food services provided and 2) the clinical/external factors including appetite, the provision of oral nutrition support, time taking the diet, the need for feeding assistance and the length of hospital stay.

RESULTS

The mean percentage of overall plate waste of 95 patients receiving TMD was high (47.5%). Blended diet was identified as the most wasted diet (65%) followed by minced diet (56%) and mixed porridge (35%). Satisfaction level among patients was moderate. Patients on TMD in general had higher satisfaction level on the aspect of food service as compared to food quality. Substantial association between sensorial qualities of food and plate waste were varied according to individual TMD type. A multiple linear regression showed that only the satisfaction level toward the aspects of appearance and variety of foods were the predictors of TMD plate waste (R² = 0.254, P < 0.05).

CONCLUSIONS

A significant relationship between the percentage of plate waste and the overall satisfaction level of patients receiving TMD suggests that vigorous strategies are needed to reduce the food waste of TMD which will lead to a better nutritional status and clinical outcomes among the patients.

Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM)

AIM

Hospital food provision is subject to multiple constraints (meal production, organization, health safety, environmental respect) which influence the meal tray offered to the patient. Multiple diets can add complexity and contribute to non-consumption of the meal. To avoid undernutrition, it appeared necessary to propose guidelines for foods and diets in hospitals.

METHODS

These guidelines were developed using the Delphi method, as recommended by the HAS (French Health Authority), based on a formal consensus of experts and led by a group of practitioners and dieticians from the AFDN (French Association of Nutritionist Dieticians) and SFNCM (French Society of Clinical Nutrition and Metabolism).

RESULTS

Twenty-three recommendations were deemed appropriate and validated by a panel of 50 national experts, following three rounds of consultations, modifications and final strong agreement. These recommendations aim to define in adults: 1-harmonized vocabulary related to food and diets in hospitals; 2-quantitative and qualitative food propositions; 3-nutritional prescriptions; 4-diet patterns and patient adaptations; 5-streamlining of restrictions to reduce unnecessary diets and without scientific evidence; 6-emphasizing the place of an enriched and adapted diet for at-risk and malnourished patients.

CONCLUSION

These guidelines will enable catering services and health-care teams to rationalize hospital food and therapeutic food prescriptions in order to focus on individual needs and tasty foods. All efforts should be made to create meals that follow these recommendations while promoting the taste quality of the dishes and their presentation such that the patient rediscovers the pleasure of eating in the hospital.

A systematic review of food waste audit methods in hospital foodservices: development of a consensus pathway food waste audit tool

BACKGROUND

To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food-related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting.

METHODS

Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool.

RESULTS

Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2-week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting and analysing data from a food waste audit.

CONCLUSIONS

This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.

Improving Nutrition Services to Reduce Plate Waste in Patients Hospitalized Based on Theory of Constraint

Background: Highly plate waste in hospitalized patients has become a problem in Hospitals’ nutrition service department, this causes adding treatment time for patient’s recovery and making the hospital service inefficient.Objectives: This research strives to develop a set of recommendations to improve the nutrition department service quality by reducing plate wastes in hospitals. Methods: This research uses a cross-sectional approach. The constraint causing analysis is done by observing dominant waste in each menu’s component and conducting FGD with the management team, nutrition department, and other related departments. The research population is 3000 plates.Results: One of the success indicators in the hospital’s nutrition services is less than 20% of plate waste. It was found that 26,65% or 327 of 1230 observed plates have more than 20% plate waste. The constraint was set with low scale value, food’s aroma, with 2,7 which make food’s aroma as a first priority problem to solve.Conclusions: The solution recommendation about constraint causes was sent to the nutrition department and hospital directors to review the hospital’s policies and SOP. The improvement can be focused on the hospital’s internal policies, Standard Operating procedures, employee competencies, obedience to set procedures, and also chefs and cooks skill

What influences consumer food waste behavior in restaurants? An application of the extended theory of planned behavior

Consumer food waste during the consumption stage is usually generated in different settings (at home or out-of-home). Consumer food waste behavior has been the focus of substantial investigation in the search for the mitigation of food waste in households. However, researchers have not treated consumer food waste behavior in restaurants in much detail. This study aims to test an extended Theory of Planned Behavior by including price consciousness and food taste to understand the antecedents of food waste behavior in restaurants. An online survey provided quantitative data from 329 participants. The results showed that (1) the extended TPB model is useful in predicting consumer food waste behavior in restaurants with an improved variance in food waste behavior from 13% to 15%; (2) intention to reduce food waste and perceived behavioral control had a significant negative effect on food waste behavior; (3) food taste exerted a significant positive effect on food waste behavior; (4) attitudes towards food waste, perceived behavioral control and price consciousness positively affected intention to reduce food waste. The current study represents a further step towards understanding consumer food waste behavior in restaurants.

Potential of Sustainable Concept for Handling Organic Waste in Tunisia

Nowadays, Tunisia is seeking to implement cost-efficient and sustainable solutions in relation to the treatment of organic waste which, at up to 65%, makes up the largest proportion of total waste generated in the country. Therefore, an efficient tool for decision makers is needed to provide a clear approach about the potential of organic waste as well as the treatment concept, which can be adapted based on technical requirements and local conditions. Results revealed that there is a high variation in terms of the nature of the collected biowaste, which affects the selection of the adopted bioprocess for each geographical zone of the study area. Three main categories of biowaste are produced along the coastline of Tunisia: food waste (FW) (102.543 t/a); green waste (GW) (1.326.930 t/a); and cattle manure (CM) (1.548.350 t/a). Based on the results of similar projects and laboratory-scale research work, anaerobic and aerobic digestion were examined. Regarding aerobic digestion, the monitoring of several physicochemical parameters ascertained that the co-composting of FW and GW at different ratios (GW: FW = 100:0, 75:25, 50:50, and 25:75) allowed the production of a stable and mature compost. A highly qualified end-product was generated from each trial categorized as a finished compost of class V with reference to German Standards of compost. Regarding the anaerobic process, different feedstock mixtures (FW:CM = 0:1, 1:1, 2:1, and 3:1) were prepared to feed semi-continuous anaerobic reactors. However, a significant improvement in the process development was recorded for digesters including a higher fraction of FW, which produced 0.846 LN/kg VSin as the maximum biogas production. Therefore, biological treatments of food waste and different co-substrates seems to be a suitable technique for Tunisia in terms of waste management, environmental, and energy aspects. However, the evaluation of the efficiency of the proposed biological treatments was also verified by a draw-up of a technical and economic feasibility analysis. Although the cost–benefit estimations proved that the profits from both the compost and biogas plants would be very modest, the feasibility of such sustainable projects should not only be evaluated on an economic basis, but also by taking into account socio-environmental considerations including decreasing environmental threats, providing work opportunities, increasing incomes, stimulating public awareness as well as reducing the operating costs linked to landfilling.

Gambaran Sisa Makanan Pasien Rawat Inap RSUD Kabupaten Sidoarjo

ABSTRACTBackground: The quality of nutrition services can be seen through the patient's leftovers as the result of hospital food system management. High food waste could impact on increasing the risk of malnutrition in hospitalized patients.Objective: This study aimed to determine the food waste description among patients in Sidoarjo General Hospital. Method: This was a descriptive study used a cross-sectional design with a total sample of 150 patients selected by proportional sampling in each in patient room during September 2019. Data was taken using the comstock form and then translated into percent of food waste and lost of food costs.Results: The highest percentage of leftovers from hospitalized patients was found in vegetable side dishes (30.72%) and the lowest was in animal side dishes (21.81%). The higher class of inpatient room, the lower the percentage of food waste. Foods that were intact by patients were highest during dinner (38.0%). The highest loss due to costs lost from whole food came from inpatient class I which amounted to IDR 1,680,000.Conclusion: The food waste of inpatients at Sidoarjo General Hospital was still quite high. Evaluation of factors causing high food waste in inpatients can be done to reduce percent of food waste and food cost efficiency.ABSTRAK Latar Belakang: Kualitas mutu pelayanan gizi dapat dilihat melalui sisa makanan pasien hasil manajemen penyelenggaraan makanan rumah sakit. Tingginya sisa makanan dapat berdampak pada peningkatan risiko malnutrisi pada pasien rawat inap.Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran sisa makanan pasien rawat inap di RSUD Kabupaten Sidoarjo.Metode: Penelitian deskriptif ini menggunakan desain potong lintang dengan jumlah sampel sebanyak 150 pasien dipilih secara proportional sampling di masing-masing ruangan rawat inap pada bulan September 2019. Data diambil menggunakan formulir comstock lalu diterjemahkan dalam bentuk persen sisa makanan dan foodcost yang hilang. Tingginya persentase makanan ditentukan dengan standar Depkes 2013 yaitu apabila melebihi 20%.Hasil: Persentase sisa makanan pasien rawat inap tertinggi ditemukan pada lauk nabati (30,72%) dan terendah pada lauk hewani (21,81%). Semakin tinggi kelas rawat inap, maka semakin rendah persentase sisa makanan. Makanan yang utuh atau tidak tersentuh oleh pasien paling tinggi terjadi saat makan sore (38,0%). Kerugian tertinggi akibat biaya yang hilang dari makanan utuh berasal dari rawat inap kelas I yaitu sebesar Rp. 1.680.000,00.Kesimpulan: Sisa makanan pasien rawat inap di RSUD Kabupaten Sidoarjo masih tergolong cukup tinggi. Evaluasi faktor penyebab tingginya sisa makanan pada pasien rawat inap dapat dilakukan untuk menurunkan persen sisa makanan dan efisiensi foodcost.

Towards Sustainable Food Services in Hospitals: Expanding the Concept of ‘Plate Waste’ to ‘Tray Waste’

Early debates on the sustainability of food-plating systems in hospitals have concentrated mostly on plate waste food served, but not eaten. This study aims to address the need for more comprehensive studies on sustainable food services systems by expanding the concept of plate waste, to that of tray waste (organic and inorganic materials), through a case study of a hospital in Saudi Arabia. Tray waste arising at the ward level was audited for three weeks, covering 939 meals. It was found that, on average, each patient threw away 0.41, 0.30, 0.12, and 0.02 kg of food, plastic, paper, and metal, respectively, each day. All this equated to 4831 tons of food, 3535 tons of plastic, 1414 tons of paper, and 235 tons of metal each year at hospitals across Saudi Arabia. As all of this waste ends up in landfills, without any form of recycling, this study proposes the need for a more comprehensive, political approach that unites all food system stakeholders around a shared vision of responsible consumption and sustainable development.

Patient Satisfaction and Food Waste in Obstetrics And Gynaecology Wards

INTRODUCTION

Patient satisfaction is an indicator of healthcare quality, and expectation is an important determinant. A component of patient satisfaction is the quality of foodservice. An indicator of this quality is the food wasted by hospitalised patients. In the present study, we investigated patient satisfaction regarding food and foodservice, the expectation on food quality and the amount of food wasted in two obstetrics and gynaecology wards in Northern and Southern Italy.

PATIENTS AND METHODS

A questionnaire, including sociodemographic data, rate of food waste, expectations of food quality and characteristics of food and foodservice, was administrated to 550 inpatients in obstetrics and gynaecology wards (275 for each hospital). Univariate analysis was performed to describe the results, and multivariate analysis was carried out to control for sociodemographic data.

RESULTS

Northern patients were more satisfied with the quality of food (54.2% vs 36.0%) and foodservice (54.5% vs 38.2%) than southern patients. Northern patients had more positive expectations about the quality of food (69.5% vs 31.6%), whereas southern patients stated that they had no expectations. Southern patients gave more importance to mealtime (72.7% vs 26.2%), and many of them brought food from home to the hospital (30.2% vs 2.2%) through relatives who came to visit them. Southern patients discarded about 41.7% of food served, whereas northern patients discarded only about 15.3%.

DISCUSSION

Food waste is a worldwide problem due to its economic, social and environmental effects. Especially in hospitals, food waste could have a negative impact on the overall patient satisfaction.

Quantities and Quantification Methodologies of Food Waste in Swedish Hospitals

To move towards a sustainable food system, we cannot continue to waste substantial amounts of the food produced. This is especially true for later stages in the food supply chain, where most sub-processes consume resources in vain when food is wasted. Hospitals are located at the end of the food supply chain and the sector has high levels of food waste. This study investigated food waste quantification practices in Swedish hospitals, examined whether a questionnaire is an appropriate methodology for such mapping, and compiled data for the sector in order to determine the amount of food waste and its composition. A questionnaire was sent to all 21 regional authorities, formerly known as county councils, responsible for hospitals in Sweden. The questionnaire responses were supplemented with food waste records from three regions that organize the catering in a total of 20 hospitals. The results showed that it is common practice in most hospitals to quantify food waste, with quantification focusing on lunch and dinner in relation to the number of guests served. It was also clear that waste quantification practices have been established for years, and in the majority of the hospitals studied. The data revealed that, in comparison with other sectors, food waste was still high, 111 g guest−1 meal−1, consisting of 42% plate waste, 36% serving waste, and 22% kitchen waste. However, there was great variation between hospitals, which, in combination with well-established, standardized waste quantification routines, meaning that this sector has strong potential to spread best practices and improve overall performance in reducing food waste generation.

Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review

BACKGROUND

Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal).

OBJECTIVE

To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice.

METHODS

Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively.

RESULTS

From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients' intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this.

CONCLUSION

The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.

Health and Sustainability in Public Meals-An Explorative Review

The world is facing a number of challenges related to food consumption. These are, on the one hand, health effects and, on the other hand, the environmental impact of food production. Radical changes are needed to achieve a sustainable and healthy food production and consumption. Public and institutional meals play a vital role in promoting health and sustainability, since they are responsible for a significant part of food consumption, as well as their “normative influence” on peoples’ food habits. The aim of this paper is to provide an explorative review of the scientific literature, focusing on European research including both concepts of health and sustainability in studies of public meals. Of >3000 papers, 20 were found to satisfy these criteria and were thus included in the review. The results showed that schools and hospitals are the most dominant arenas where both health and sustainability have been addressed. Three different approaches in combining health and sustainability have been found, these are: “Health as embracing sustainability”, “Sustainability as embracing health” and “Health and sustainability as separate concepts”. However, a clear motivation for addressing both health and sustainability is most often missing.

Patient Evaluation of Food Waste in Three Hospitals in Southern Italy

In recent years, food waste has received great attention and is now considered the cause of many negative effects, including health, economic, social and environmental issues. A cross-sectional study was conducted among a sample of 762 inpatients at three hospitals of Campania region in Italy. The purpose of this study was to evaluate the amount of food waste occurring in these hospitals using a structured questionnaire and asking inpatients about the average percentage of food they had disposed of in the previous three days. The overall food wasted amounted to 41.6%. The main plates, first (pasta or rice), second plate (meat or fish), resulted in similar amounts of waste (38.5% and 39.7%, respectively). The side plate (vegetable or potatoes), however, generated the greatest amount of waste (55.0%); 40.7% of patients totally discarded this part of their meals. The type of food wastage among the three hospitals reflected similar patient behaviours, with the amount of food wasted never falling below 30%. Females tended to waste more food than males (59.1% vs. 38.2%; p = 0.000). Other variables were correlated with less food waste, such as having a good opinion of the food's quality (RR = 1.91; 95% C.I. = 1.68-2.17) and satisfaction with the foodservice in general (RR = 1.86; 95% C.I. = 1.64-2.10). Poor quality, different eating habits and the feeling of satiety were the main reasons patients gave for food waste. Our study suggests that the most promising way to reduce food waste in hospitals is to improve the quality of meals and to establish an individual, simplified and flexible meal reservation process based on specific needs and preferences.

Patterns and Causes of Food Waste in the Hospitality and Food Service Sector: Food Waste Prevention Insights from Malaysia

Food waste has formidable detrimental impacts on food security, the environment, and the economy, which makes it a global challenge that requires urgent attention. This study investigates the patterns and causes of food waste generation in the hospitality and food service sector, with the aim of identifying the most promising food waste prevention measures. It presents a comparative analysis of five case studies from the hospitality and food service (HaFS) sector in Malaysia and uses a mixed-methods approach. This paper provides new empirical evidence to highlight the significant opportunity and scope for food waste reduction in the HaFS sector. The findings suggest that the scale of the problem is even bigger than previously thought. Nearly a third of all food was wasted in the case studies presented, and almost half of it was avoidable. Preparation waste was the largest fraction, followed by buffet leftover and then customer plate waste. Food waste represented an economic loss equal to 23% of the value of the food purchased. Causes of food waste generation included the restaurants’ operating procedures and policies, and the social practices related to food consumption. Therefore, food waste prevention strategies should be twofold, tackling both the way the hospitality and food service sector outlets operate and organise themselves, and the customers’ social practices related to food consumption.

Jadwal Distribusi dan Citarasa Makanan Berhubungan dengan Sisa Makanan Pasien di Ruang Perawatan Obgyn dan Bedah RSD. dr. Soebandi Jember

Background : The hospital food acceptance is still a serious problem. The patient’s acceptance is indicated by the least amount of plate waste. High plate waste causes an intake incompatibility with nutritional needs, which ultimately affects malnutrition. The patient’s plate waste in obstetric and surgical room is still high ≥20%. The distribution timetable and food taste maybe a contributing factor.Objectives : To analyzed the correlation of distribution timetable and food taste with patient’s plate waste at obstetric and surgicall room in dr. Soebandi Hospital, JemberMethods: This study was an analytical survey with a cross sectional design. The sample was 51 subjects, taken by a purposive sampling. Sample were obstetric and surgical patients aged 18-60 years, received regular food and were in a conscious. The distribution timetable was obtained by observing the accuracy of food distribution time span from the kitchen of nutrition instalation untill food arrived at the patient for 3 days. Food taste was obtained through interviews and questionnaires. Plate waste was measured by visual comstock. Data were analyzed by Rank Spearman test.Results : The average plate waste of patients is 27.6%. The plate waste in male and female patient was significantly different (p=0.001). 52.9% subjects with large amounts of plate waste, get hospital food with the right distribution time. The distribution timetable wasn’t significantly correlated with plate waste (p=0.218). Subjects who considered their food taste good, almost all (71.4%) left little food. There was a significant positive correlation between taste of food and plate waste (p=0.001; r=0.471).Conclusions: Food distribution timetable isn’t related to patient’s plate waste. However, food taste is correlated with plate waste. The better of taste food, the less plate waste.ABSTRAK Latar Belakang : Penerimaan makanan rumah sakit masih menjadi masalah serius. Daya terima pasien ditunjukkan dengan banyak sedikitnya makanan tersisa. Tingginya sisa makanan menyebabkan ketidaksesuaian asupan dengan kebutuhan gizi yang akhirnya berdampak malnutrisi. Sisa makanan pasien di ruang obgyn dan bedah masih tinggi ≥20%. Jadwal distribusi dan citarasa makanan kemungkinan menjadi faktor penyebabnya.Tujuan : Menganalisis hubungan jadwal distribusi dan citarasa makanan dengan sisa makanan pasien di ruang perawatan obgyn dan bedah RSD. dr Soebandi Jember.Metode : Jenis penelitian ini survey analitik dengan rancangan cross sectional study. Sampel berjumlah 51 orang, diambil dengan teknik purposive samping. Sampel adalah pasien obsgyn dan bedah berumur 18-60 tahun, mendapat makanan biasa dan kondisi sadar. Jadwal distribusi didapatkan dengan mengamati ketepatan waktu distribusi makanan mulai dari dapur instalazi gizi hingga makanan sampai kepada pasien selama 3 hari. Citarasa makanan diperoleh melalui wawancara dan kuesioner. Pengukuran sisa makanan menggunakan visual comstock. Data dianalisis dengan uji korelasi Rank Spearman.Hasil : Rata-rata sisa makanan pasien di ruang obgyn dan bedah 27,6%. Sisa makanan pada pasien laki-laki dan perempuan berbeda signifikan (p=0,001). Sebanyak 52,9% pasien yang sisa makanannya banyak, mendapatkan makanan dengan jadwal distribusi yang tepat. Jadwal distribusi tidak berhubungan signifikan dengan sisa makanan (p=0,218). Subyek yang menilai citarasa makanannya baik, hampir semuanya (71,4%) menyisakan sedikit makanan. Terdapat korelasi positif yang signifikan antara citarasa makanan dengan sisa makanan (p=0,001; r=0,471).Kesimpulan : Jadwal distribusi makanan tidak berhubungan dengan sisa makanan pasien. Namun, citarasa makanan berhubungan dengan sisa makanan. Semakin baik citarasa makanan semakin sedikit sisa makanan.

Efficacy and Efficiency of Nutritional Support Teams

Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients’ quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient’s individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.

Towards a Baseline for Food-Waste Quantification in the Hospitality Sector—Quantities and Data Processing Criteria

There is an urgent need for primary data collection on food waste to obtain solid quantification data that can be used as an indicator in the goal of halving food waste by 2030. This study examined how quality baselines for food waste can be achieved within the different segments of the hospitality sector, encompassing establishments such as canteens, elderly care units, hospitals, hotels, preschools, primary schools, restaurants, and upper secondary schools. The empirical material comprised food-waste quantification data measured in 1189 kitchens in Sweden, Norway, Finland, and Germany for 58,812 quantification days and 23 million portions. All the data were converted to a common format for analysis. According to the findings, around 20% of food served became waste. Waste per portion varied widely between establishments, ranging from 50.1 ± 9.4 g/portion for canteens to 192 ± 30 g/portion for restaurants. To identify the measurement precision needed for tracking changes over time, we suggest statistical measures that could be used in future studies or in different food-waste tracking initiatives.

Impact of type, size and shape of plates on hospital patients' perceptions of the quality of meals and satisfaction with foodservices

Hospital meals are important for supporting nutrition goals and the overall hospital experience. The aim of this study was to assess if patients' perceptions of quality attributes of hot meals were impacted by the type of plate on which the meal was served. Eligible patients selected from medical and/or surgical wards at a 929 bed acute care hospital were randomised to receive hot meals served on either ceramic or disposable plates at eight evening meals. Patients from a multi-centre trial of pre-packaged meals where re-thermalised meals were presented on a variety of colour and shaped disposable plates were included in a second phase. Patient assessment of meal quality was undertaken using the Meal Assessment Tool (MAT)(Hannan-Jones & Capra, 2017) with data collected by interview. In phase one, 137 eligible patients competed the MAT (response 46.8%), with results showing no significant difference in the rating of appearance, quality, expectations or satisfaction when meals were served on disposable or ceramic plates. In phase two data were collected from 6189 patients (response 47.4%). No practical difference in rating of meals was found in relation to colour and sectioning of plates, however a statistical but non-practical difference was found regarding plate shape, with meals served on oblong/rectangular plates rated more positively. Of 3078 comments made concerning the meals, 99 (3.2%) concerned the plates on which the meals were served. This study has shown that quality, appearance and taste of meals, rather than the serving ware are important to patients. Findings suggest that attending to other quality aspects of meals may be far more important than the plate itself, and deserve attention.

Missing Food, Missing Data? A Critical Review of Global Food Losses and Food Waste Data

Food losses and food waste (FLW) have become a global concern in recent years and emerge as a priority in the global and national political agenda (e.g., with Target 12.3 in the new United Nations Sustainable Development Goals). A good understanding of the availability and quality of global FLW data is a prerequisite for tracking progress on reduction targets, analyzing environmental impacts, and exploring mitigation strategies for FLW. There has been a growing body of literature on FLW quantification in the past years; however, significant challenges remain, such as data inconsistency and a narrow temporal, geographical, and food supply chain coverage. In this paper, we examined 202 publications which reported FLW data for 84 countries and 52 individual years from 1933 to 2014. We found that most existing publications are conducted for a few industrialized countries (e.g., the United Kingdom and the United States), and over half of them are based only on secondary data, which signals high uncertainties in the existing global FLW database. Despite these uncertainties, existing data indicate that per-capita food waste in the household increases with an increase of per-capita GDP. We believe that more consistent, in-depth, and primary-data-based studies, especially for emerging economies, are badly needed to better inform relevant policy on FLW reduction and environmental impacts mitigation.

Elements affecting food waste in the food service sector

Avoidable food waste is produced in the food service sector, with significant ecological and economical impacts. In order to understand and explain better the complex issue of food waste a qualitative study was conducted on the reasons for its generation in restaurants and catering businesses. Research data were collected during three participatory workshops for personnel from three different catering sector companies in Finland. Based on synthesized qualitative content analysis, eight elements influencing production and reduction of food waste were identified. Results revealed the diversity of managing food waste in the food service sector and how a holistic approach is required to prevent and reduce it. It is crucial to understand that food waste is manageable and should be an integral component of the management system. The model of eight factors provides a framework for recognition and management of food waste in the food service sector.