Information about Infection Control in Hospital Kitchen and NABH Standards for Hospital Kitchen & Dietary Services

Infection Prevention and Control in Hospital Kitchen:

All the patients receive food from a single kitchen in the hospital, hence, if the hygiene of the kitchen is not maintained, it can lead to outbreaks of infection involving the whole hospital. infection from contaminated food is particularly hazardous in debilitated or elderly people, and can cause severe illness or even death.

It is also important to prevent food borne infection among the staff, as subsequent transfer to patients would have similar unfortunate results.

Outbreaks of food poisoning are usually caused by Salmonella species, or the toxins of certain strains of Staphylococcus aureus, Clostridium perfringens and Bacillius cerus. 

 Sources of contamination:

• Most viruses and bacteria that cause colds, flu and food borne illness are spread by hand or hand to food contact. 
• Raw meats, poultry, and fish carry a large variety of harmful bacteria. 
• Sea food particularly oysters, calms and other shell fish, can be contaminated with Vibrio species of bacteria that causes diarrhoea, or with hepatitis A virus.
• Unpasteurised cheese and some meat can be contaminated with Listeria monocytogenes, a strain of bacteria   that can cause disease in people and miscarriage or damage to the fetus in pregnant women. Listeria is often found in soft cheese. Listeria is one of the few bacteria that grow well at 4 °C temperature of the refrigerator.
• Contaminated vegetables and fruits can carry a variety of organisms and parasites, depending on where they were grown and how they were processed.

 Contaminated Kitchen Gadgets:

Items in the kitchen become contaminated by contact with contaminated people, food pets or other environmental sources.

The first and foremost suspect "gadget" in the kitchen is the human hand. Too, often people do not wash their hands before preparing food. More often people do not wash their hands between handling contaminated  foods like meat and other foods that are less likely to be contaminated like vegetables. The cross contamination is the leading cause of food borne disease according to CDC.

Kitchen items that often become contaminated include:

• Can openers
• Cutting boards
• Countertops: Most people use countertops not only for food preparation, but also for possibly contaminated items like grocery bags, mail, or household objects.
• Towels, sponges and scrubbers
• Garbage disposals
• Sink drains and P-traps: This is the J shaped pipe under the sink that retains a quantity of water to block sewer gas from seeping back up through the sink.
• Refrigerators
• Complex appliances like food processors, blender and egg beaters.

Safety, hygiene and maintenance:

Health check-ups of food handling staff:

• Any staff who handle food (cooking, serving, cleaning etc.) must be medically screened to check for presence of any contagious disease.
• Screening of parasites and Salmonella Typhi should be done every 6 month and whenever a staff re-joins after taking 15 days or more leave. For other tests annual check ups can be done.
• Record of health check-up with findings should be maintained for each staff.
• Staff in which any contagious or infectious disease is found should not be allowed to handle food, till the time the infection subsides
• All areas within the kitchen should be clean at all the time.
• The food handlers should be clean, wear clean uniform, gloves, caps and masks (as required). A personal hygiene checklist must be given to each food handlers and should be monitored periodically
• Plates, utensils and trolleys which are used for serving should be cleaned regularly and should be free from dirt or stink
• Cold storage refrigerators should receive preventive checks to ensure that that temperature is maintained
• Raw materials and prepared food should not be stored on floor
• The housekeeping materials like, broom, mops, cleaning agents etc. must be stored in separate location away from food
• Regular pest control measures should be undertaken.
• Kitchen waste should be disposed off regularly

Staff awareness: 

• Each staff working in food department must be aware about following:
• Personal hygiene to be maintained
• Hand hygiene practices
• Hygiene practices to be maintained in Kitchen and while delivering food
• Practices to prevent error in serving  
• Occupational health hazards of working in 
• Health check-ups required and policy on 
• Safe handling of LPG 
• Other general topics like,employee rights, use of fire extinguisher, emergency codes etc.

Quality Indicators Hospital Kitchen and Dietary Services:

• % of time food was not delivered within the time-frame
• % of food wastage (raw material and cooked food)
• Diet distribution error per 1000 patient days
• Patient satisfaction rating to quality of food 

NABH Standards for Hospital Kitchen and Dietary Services:

COP.21. Documented policies and procedures guide nutritional therapy.

List of Objective Elements:

a. Documented policies and procedures guide nutritional therapy including assessment and reassessment.

Interpretation:

This shall at a minimum incorporate as to in whom nutritional assessment will be done, how the type of diet is planned, prepared and delivered to the patient. The process ensures that the patient receives food as per the diet order. Nutritional assessment shall be done by a dietician for all patients found at risk during nutritional screening.

b. Nutritional therapy is planned and provided in a collaborative manner.

Interpretation:

The dietician shall ensure that this is planned in consultation with the treating doctor and the patient/patient’s relative after taking into regard the patient’s food habits (veg/non-veg) and likes and dislikes.

c. There is a written order for the diet.

Interpretation:

The dietician shall prepare this in the form of a diet sheet and patient shall receive food accordingly. This shall be written in a uniform location in the medical record.

d. Patients receive food according to their clinical needs.

Interpretation:

A dietitian shall do the assessment of the patient in consultation with the clinician and advice regarding food. For example, diabetic diet, high protein diet, total parenteral nutrition, etc.

e. Food is prepared, handled, stored and distributed in a safe manner.

Interpretation:

The dietary services to be designed in a manner that there is no criss-cross of traffic. All the activities fall in a sequence. The organisation shall ensure that hygienic conditions are followed all throughout. Other indicative points are:

• Dedicated food storage/refrigeration areas exist to ensure food preservation;
• Food storage areas/refrigerators are maintained appropriately;
• All food products are stored off the floor;
• Cleaning supplies stored in a separate location way from food;
• Separate dedicated food preparation areas exist;
• Measures are in place to ensure that flies and insects do not come in contact with prepared/stored food;
• Food distribution to patients occurs where possible in temperature appropriate
• Food service trolleys (hot food kept hot and cold food kept cold).

 f. When families provide food, they are educated about the patient’s diet limitations.

Interpretation:

The dietician/nurse shall ensure this during planning.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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