Checklist to assess food safety when handling home enteral nutrition

BACKGROUND

Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN).

METHODS

This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases.

RESULTS

The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended.

CONCLUSION

The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.

Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review

CONTEXT

The safety of enteral formulas is important to restore and maintain the health of patients.

OBJECTIVE

A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home.

DATA SOURCES

A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature.

DATA EXTRACTION

Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used.

DATA ANALYSIS

Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent.

CONCLUSIONS

A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022367573.

MICROBIOLOGICAL QUALITY OF ENTERAL FORMULATIONS HANDLED AT HOME: A SYSTEMATIC REVIEW

BACKGROUND

Studies have shown an increase in the number of patients who use enteral nutrition at home, and the benefits of this type of nutritional care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations.

METHODS

This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies which microbiologically analyzed homemade enteral preparations (HEP), blended enteral preparations (BEP), and commercial enteral formulas (CEF) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies.

RESULTS

Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n=73) of the HEP; 81.96% (n=50) of the BEP; and 44.87% (n=35) of the CEF. The presence of ten different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples.

CONCLUSION

The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling. This article is protected by copyright. All rights reserved.

Macronutrients and energy in home-prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis

BACKGROUND

The effectiveness of home enteral nutrition depends on the supply and delivery of the prescribed nutrients. This study compared the macronutrient and energy values of home-prepared enteral tube feeding analyzed in the laboratory with the same information calculated from labels and food composition tables.

METHODS

A total of 107 enteral formulations were analyzed: 66 commercial enteral formulas (CEFs), 19 homemade enteral preparations, and 22 blended enteral preparations (BEPs). The values of macronutrients and energy and the ratio between the values found in the laboratory and the calculated values were all evaluated. The tolerance limit of acceptable variation was 20%. The results were subjected to chemometric methods using principal component analysis (PCA) and hierarchical cluster analysis (HCA).

RESULTS

In the three categories of the enteral formulations, the calculated values for protein and fat were higher than those obtained in the laboratory. The calculated values for energy were higher than those obtained in the laboratory for the BEPs and CEFs. The CEFs had the highest percentage within the limit of acceptable variation for carbohydrate and protein, whereas the BEPs presented the lowest values for fat and energy. In the exploratory analysis of data using PCA and HCA, it was possible to verify similarities and discrepancies between the enteral formulations analyzed in the laboratory with those calculated from the labels and food composition tables.

CONCLUSION

The enteral formulations showed differences between the values of macronutrients and energy analyzed in the laboratory and those calculated from labels and/or food composition tables.

Good hygiene practices in school canteens: evaluation between types of schools and administration as well as presence of technical professional

Abstract The aim of the study was to evaluate the school canteens located within different types of schools, together with their types of administration and the presence of a technical professional regarding Good Hygiene Practices (GHPs). The observational study was conducted in 111 school canteens, 35 from private and 76 public schools in Curitiba, Brazil. A checklist based on national and international legislation on good hygiene practices -GHP was elaborated and applied during the work routine. With the list, the information was gathered about the type of administration and the presence of a technical professional (nutritionist) in these canteens. Most school canteens were classified as Regular, comprising between 50% and 69% of adequate assessment in relation to GHPs. The most unsatisfactory criteria were related to food temperature control, training of food handlers and Manual of GHPs and Standard Operating Procedures (SOP). Private school canteens were better classified than public school canteens in most of the categories evaluated (p < 0.05). In addition, the school canteens that have been outsourced and have also had a person technically responsible (nutritionist) (p < 0.01) presented the best results. This shows the need for the public school canteens with self-management systems and no technical professional to re-evaluate the sanitary criteria and to implement new strategies, as well as improving procedures for food temperature control, training of food handlers and elaboration of Manual of GHPs and SOP. Improvement with respect to these procedures will assist in better control of food safety and prevent diseases in the student population, contributing to health promotion in the school environment.

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler

BACKGROUND

Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics.

METHODS

We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire.

RESULTS

82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training."

CONCLUSION

Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Enterococci used as complementary indicator of fecal contamination to assess water quality from public schools in the city of Curitiba, Paraná, Brazil

Abstract The study evaluated the drinking water quality from 45 public schools in the city of Curitiba, Brazil. Water samples were harvested from two different points at each school: the first one, drinking fountain used by students (n=45) and the second, kitchen faucet (n=45), comprising 90 samples. The samples were submitted to analysis according to current legislation, such as: dosage of free chlorine; colony counts of heterotrophic bacteria; presence of total coliform bacteria and Escherichia coli. In addition, an enterococci analysis was also included as a complementary microbiological indicator of fecal contamination. The isolated strains of enterococci were identified and submitted to an antibiotic susceptibility test. In relation to the legal parameters, 35.5% (n=16) of the 45 schools evaluated did not meet the quality water standards set by the Brazilian legislation. Although none of the 90 samples exhibited the presence Escherichia coli, 6.6% (n=6) of the analyzed samples presented enterococci contamination. Regarding the antibiotic susceptibility test, the isolated strains demonstrated a similar behavior, became resistant to six antibiotics and had intermediate sensitivity to one (Streptomycin) of the nine antibiotics tested. The drinking water destined for human consumption in the public schools may pose health risks for students since the fecal contamination by enterococci was confirmed, and it could be observed that the water may be a source of genes from bacteria resistant to antimicrobials. This study reinforces the importance of monitoring complementary microbiological indicators to assure water quality, seeing that fecal contamination was detected only when alternative parameters were inserted, emphasizing the relevance of including microbiological indicators beyond what the legislation requires to evaluate the drinking water more effectively and to safeguard public health.

Comercialização de alimentos em cantinas no âmbito escolar

Resumo O estudo teve por objetivo avaliar a comercialização de alimentos em cantinas comerciais localizadas no âmbito escolar de diferentes redes de ensino, tipos de administração e presença ou não de profissional técnico (nutricionista). O estudo do tipo observacional foi realizado em 111 cantinas, sendo 35 estabelecimentos de ensino privado e 76 de ensino público de Curitiba, Paraná, Brasil. Para realizar estas avaliações, foi elaborada uma lista de verificação contendo um conjunto de condutas baseada nas legislações estaduais do Paraná. De acordo com as legislações vigentes, constatou-se que 97,37% das cantinas das instituições públicas e 94,29% das privadas comercializavam alimentos considerados proibidos por apresentarem baixo valor nutricional. Os principais alimentos proibidos comercializados nas cantinas foram os salgadinhos industrializados, os chocolates, as balas e os sucos artificiais. Esses também foram os alimentos e bebidas mais vendidos, segundo os responsáveis. Além disso, 73,87% das cantinas não possuíam supervisão técnica, 89,19% não disponibilizavam dois tipos de frutas e apenas 1,80% tinha mural educativo, conforme exigido pelas legislações vigentes. Conclui-se que as cantinas, independentemente da rede ensino e do tipo de administração, estão em desacordo com as legislações vigentes, tanto na comercialização de alimentos proibidos como na ausência de dois tipos de frutas e na ausência de mural educativo. Os resultados mostraram que a supervisão frequente do responsável técnico se faz necessária para contribuir nas escolhas dos alimentos comercializados e, consequentemente, melhorar a qualidade nutricional dos produtos expostos para venda.

Evaluation of the Implementation of Good Handling Practices in Food and Beverage Areas of Hotels

Because of the major international-level events that have recently been held in Brazil, concerns about the sensory and hygienic-sanitary conditions of food have increased. The objective of this study was to evaluate the implementation of good handling practices in food and beverage areas of hotels, with and without outsourced professional intervention. We evaluated 19 food and beverage areas in hotels in Porto Alegre, Rio do Sul, Brazil, using a checklist that was developed by a municipal surveillance team based on existing laws for good handling practices. The evaluation was done by a skilled professional in the food safety area on two occasions, at the beginning of the study (January to May 2013) and at the end (July to November 2014), and the establishments were classified as good, regular, or poor. After the baseline evaluation, an action plan listing the noncompliance found at each location was given to those responsible for the establishments, and a period of 1 year 6 months was stipulated for improvements to be made. In the repeat evaluation, those responsible for the establishments were asked whether they had hired an outsourced professional to assist them in the improvements. The hotels showed improvement during the repeat evaluation, but a significant increase in the percentage of overall adequacy was seen only in the food and beverages areas of the 12 hotels that used the intervention of an outsourced professional. The better percentage of adequacy in establishments with outsourced professional intervention underlines the importance of an external and impartial view of routine activities in the implementation of good handling practices.