Hospital Kitchen Research Articles

Investigation of probable Salmonella outbreak in the National Cancer Institute, Sri Lanka

Abstract Background An outbreak is the occurrence of case of disease in excess of what would normally be expected in a defined community. Outbreaks in immune compromised population can lead to devastating morbidity and mortality. Infection prevention and control (IPC) team has a pivotal role in both averting and managing outbreaks in health care settings. There were 7 cases of Salmonella spp, isolated from blood and stools since 12th July 2023 up to 11th August. Assuming of a possible outbreak, IPC team decided to investigate in order to find a possible source for the outbreak. Methods As soon as the outbreak was confirmed, immediate relevant control measures were taken after studying the available information. Working case definitions was constructed with clinical criteria and laboratory criteria with restrictions by time, place and person. Different categories of case definitions were used as the diagnosis was uncertain, such as “confirmed”, “probable” and “possible”. Active surveillance was conducted to collect information on additional case. Data collection tool was prepared with demographic information, clinical information and risk factor information. Then more cases were detected and line listing was created to organize important information for the investigation. Epidemic curve was drawn to see the pattern of spread and it was an irregularly jagged curve which interprets as intermittent common source epidemic. Specific control and prevention measures were implemented. Inquiries were made regarding the dietary intake of the patients over the last seven days and it was difficult to find a common source of food item however, all patients have consumed food prepared in the hospital kitchen. Therefore an audit was conducted in the hospital kitchen to identify probable source. Kitchen staff was educated about the food safety measures and personal hygiene. Kitchen staff was screened for Salmonella carrier state in their stool. Quality of the water from the kitchen and wards was checked for fecal contamination. No residual food was available for microbiological testing. Hypothesis was formulated to gather information after discussion with patients and staff. Findings were communicated to all relevant parties including Director and clinicians in the hospital. Salmonella isolates were sent to the Enteric Reference Laboratory, Medical Research Institute, Colombo for serotype identification. Results It was difficult find a common source. There were some malpractices in the kitchen and those were corrected immediately. Water quality in the hospital was satisfactory. Kitchen staff were not colonized with salmonella. However egg supplier to the kitchen was changed recently and eggs were supplied last minute and the eggs were not washed prior to cooking. Three isolates sent to the reference laboratory were identified as Salmonella Weltevreden, one as Salmonella Enteritidis, while the remaining three isolates could not be identified to serotype level with the available resources. Conclusion The exact contributory factor to the outbreak remained elusive. However, numerous food safety issues which can lead to cross contamination during the preparation of food were identified. Consequently, prompt investigation and control measures are essential to prevent further food borne outbreaks.

Prevalence, Characterization, and Epidemiological Relationships between ESBL and Carbapenemase-Producing Escherichia coli, Klebsiella pneumoniae, and Acinetobacter spp. Isolated from Humans and the Kitchen Environment of Two Greek Hospitals.

Extended-spectrum-β-lactamase (ESBL) and carbapenemase-producing Enterobacterales and Acinetobacter spp. pose significant challenges as nosocomial pathogens, demonstrating resistance against various antimicrobials. Their presence in food suggests that hospital kitchens could serve as antibiotic resistance reservoirs leading to patients' infection. The aim of this study was to assess the prevalence and characteristics of β-lactam-resistant strains of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter spp. isolated from the kitchen environment and from the staff of two Greek hospitals. Strains were recovered after selective isolation with β-lactams and were identified with MALDI-TOF MS. Antimicrobial susceptibility and presence of common β-lactamase genes were evaluated. Protein profiles were examined to analyze potential relationships of the strain with those from hospital patients. E. coli strains were further categorized into phylogenetic groups. The overall prevalence in the kitchen environment was 4.5%, 1.5%, and 15.0% for E. coli, K. pneumoniae, and Acinetobacter spp., respectively, whereas the prevalence of Acinetobacter spp. in human skin was 4.0%. Almost all strains were multidrug-resistant. All E. coli strains were ESBL producers and belonged to phylogroups A and B1. All K. pneumoniae and seven Acinetobacter strains were carbapenemase-producers. A protein profile analysis showed relatedness between chicken and kitchen environment strains, as well as between kitchen environment and patient strains originated either from the same or from different hospitals. The results suggest that hospital kitchens may act as important pathogen hotspots contributing to the circulation of resistant strains in the hospital environment.

Carbohydrate Estimation Accuracy of Two Commercially Available Smartphone Applications vs Estimation by Individuals With Type 1 Diabetes: A Comparative Study.

Despite remarkable progress in diabetes technology, most systems still require estimating meal carbohydrate (CHO) content for meal-time insulin delivery. Emerging smartphone applications may obviate this need, but performance data in relation to patient estimates remain scarce. The objective is to assess the accuracy of two commercial CHO estimation applications, SNAQ and Calorie Mama, and compare their performance with the estimation accuracy of people with type 1 diabetes (T1D). Carbohydrate estimates of 53 individuals with T1D (aged ≥16 years) were compared with those of SNAQ (food recognition + quantification) and Calorie Mama (food recognition + adjustable standard portion size). Twenty-six cooked meals were prepared at the hospital kitchen. Each participant estimated the CHO content of two meals in three different sizes without assistance. Participants then used SNAQ for CHO quantification in one meal and Calorie Mama for the other (all three sizes). Accuracy was the estimate's deviation from ground-truth CHO content (weight multiplied by nutritional facts from recipe database). Furthermore, the applications were rated using the Mars-G questionnaire. Participants' mean ± standard deviation (SD) absolute error was 21 ± 21.5 g (71 ± 72.7%). Calorie Mama had a mean absolute error of 24 ± 36.5 g (81.2 ± 123.4%). With a mean absolute error of 13.1 ± 11.3 g (44.3 ± 38.2%), SNAQ outperformed the estimation accuracy of patients and Calorie Mama (both P > .05). Error consistency (quantified by the within-participant SD) did not significantly differ between the methods. SNAQ may provide effective CHO estimation support for people with T1D, particularly those with large or inconsistent CHO estimation errors. Its impact on glucose control remains to be evaluated.

Feasibility of a Hospital-Based Kitchen Garden.

To explore the chef's experience with a newly implemented indoor hospital-based kitchen garden designed to supplement herbs ordered for patient meals and improve staff engagement. Hospital-based therapeutic and kitchen gardens have emerged as effective health-promoting tools in hospital healthcare environments. They promote emotional, mental, and physical well-being for patients, visitors, and staff. However, formal evaluations are limited, and studies focusing on indoor hospital kitchen gardens are noticeably absent in the literature. Qualitative evaluation of a hospital-based kitchen garden. Open-ended interviews were conducted approximately 6 months after garden implementation and explored key informants (n = 6) overall experience, engagement with the garden, perceived benefits, and opportunities for improvement. Interview data was analyzed using a thematic approach. The implementation of the kitchen gardens was met with overall acceptance among staff. However, the project's feasibility faced challenges related to local food service leadership, communication, and certain aspects of the garden setup. Despite these obstacles, the gardens contributed positively to the quality of meals by including fresh herbs and fostering greater staff engagement. The chefs viewed the concept of the hospital-based kitchen garden favorably, noting that it closely aligned with their mission of providing nutritious meals to patients. However, consideration of the broader issues facing hospital food services may be required to seamlessly integrate this task into the kitchen staff's daily routine. Further research is warranted to investigate the effective implementation and feasibility of indoor kitchen gardens in hospitals and their impact on patient menus, food service staff, and the workforce.

Bacteriological Analysis and Plasmid Profiles of Surfaces of Some Hospital Kitchen Equipment in Benin City, Nigeria

The surfaces of hospital kitchen equipment could be a major source of transmission of resistant pathogens to patients. Hence, the objective of this paper was to assess the bacteriological and plasmid profiles of surfaces of tables, sinks, chopping-boards, gas cookers and freezer handles hospital kitchen equipment in Benin City, Nigeria using appropriate standard microbiological techniques. Bacterial plasmids were isolated and separated using the agarose gel electrophoresis. Plasmid curing was performed using acridine orange. The antimicrobial sensitivity pattern showed that the bacterial isolates exhibited varying degree of resistance to the antibiotics. Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were highly resistant to the antibiotics, having multiple antibiotic resistances (MAR) index of 0.6. Micrococcus spp. and Klebsiella pneumoniae were the least resistant to the antibiotics. Plasmid analysis revealed the presence of single and multiple-banded plasmids with sizes ranging from 100-1000bp. After curing, all the isolates (except S. aureus, E. coli and P. aeruginosa) were sensitive to all the antibiotics, indicating a significant reduction in antibiotic resistance after curing. The results revealed that plasmids played a significant role in conferring resistance on the isolates. Regular cleaning and disinfection should be strictly observed in hospital kitchens to prevent outbreaks and spread of resistant pathogens in hospitals.

Assessment of Air Quality Containing Fungi in Al-Nu'man Teaching Hospital

Background: Fungi are widespread in indoor environments and contribute to various diseases in patients with compromised immune systems. Objective: This study aims to assess air quality containing fungi in the indoor environments of Al-Nu'man Teaching Hospital. Materials and Methods: The study involved 210 environmental samples collected from various selected parts of the hospital. The samples were carried out on a monthly basis by open plate technique, and then the cultures were examined and evaluated according to morphological and microscopic examination criteria. Results: The results showed that the percentage of fungal contamination was 140/210 (66.66%). The highest fungal contamination was recorded in hospital wards 27 (90%), followed by emergency unit 20 (76.92%), burn unit 16 (72.72%), operating theaters 14 (70%), neonatal unit 13 (65%), dialysis unit 12 (63.15%), obstetrics theaters 10 (58.82%), coronary care unit 9 (56.25%), respiratory care unit 8 (53.33%), hospital kitchen 6 (46.15%), and the lowest contamination was in endoscopy unit 5 (41.66%). Moreover, a total of 137 fungal isolates were obtained, with the highest occurrence and frequency percentages of fungi recorded for Penicillium spp. reaching 13.13% and 8.57%, respectively, followed by Aspergillus niger reaching 10.21% and 6.66%, respectively, and the lowest occurrence and frequency percentages recorded for Curvularia spp. reaching 0.72% and 0.47%, respectively. Conclusion: These results demonstrated that all wards and units were heavily contaminated with different types of fungi. Hence, it is essential to take urgent steps to enhance indoor air quality to prevent possible hospital infections.

Providing a catering liaison service between inpatient families and the hospital kitchen

Jo Wray and colleagues use a case study to outline an innovative approach to hospital catering, proposing the introduction of a catering liaison role to improve patient nutrition, reduce length of stay and save resources.

Rats! Infection prevention's journey during a hospital kitchen infestation

Infection Prevention and Control programs have the inherent authority to institute extreme measures when an infection is a threat to wellness. This report describes an Infection Prevention and Control program's collaborative approach when a hospital kitchen was closed due to rodents, how infection risks were mitigated, and practice revisions were made to avoid future infestations. Learnings from this report can be adopted acrosshealth care settings to encourage reporting vectors and promote transparency.

Carriage of Enterotoxigenic Staphylococcus Aureus and Hygiene Practices of Food Workers

To determine the enterotoxigenic Staphylococcus aureus carriage rates and personal hygiene practices a total of 300 food workers participated, with 228 working in food businesses and 72 in hospital kitchens in Canakkale, Turkey. 
 Participants completed a questionnaire about sociodemographic characteristics, hygiene practices, and food safety. Hand/nasal swabs were collected from the food workers. Inoculums were seeded on Baird Parker Agar. Multiplex PCR and ELISA methods were used.
 The enterotoxigenic S. aureus carriage rate was 14% of food workers. Out of the 125 S. aureus strains, 42 (33.6%) were positive for one or more SE genes. Furthermore, sea, seb, sec, sed, and sea+sed were found in 16.0%, 6.4%, 9.6%, 6.4%, and 4.8% respectively. SEA, SEB, SEC, SED, and SEE were found at rates of 14.4%, 7.2%, 12.8%, 11.2%, and 20.8%. It was determined that as the education level of food workers increased, the S. aureus carrier rate decreased. The carrier rate was found to be higher in those who use gloves than those who do not. Hand carriers were determined more in nasal carriers (p

The Role of Cook-Chill and Cook-Freeze Methods as Indicators of Quality of Nutrition Services in Hospital

An outbreak of COVID-19 cases among food and nutrition department employees at a hospital kitchen occurred because it was difficult to maintain physical spacing between staff. There is a lack of people during self-isolation. However, the kitchen hospital must still operate 24 hours to provide meals. This study aimed to comprehensively evaluate plate waste, and patient satisfaction, associated with cook-serve methods compared to cook-chill and cook-freeze methods. The first stage of this study is to determine nutritionally appropriate, microbiologically safe foods stored after the cook-chill and cook-freeze process and customer preferences through sensory aspects using CATA. The menu that has been chosen is three protein dishes and one vegetable dish. The second stage was an experimental study conducted in a general ward at an Indonesian private hospital. Two hundred ten patients (expected admittance ≥ two days) were served meals from cook-serve, cook-chill, and cook-freeze. Patients' satisfaction and food waste were measured. Intake at mealtimes was assessed through a visible portion size assessment method. Conclusion: The results show no significant difference in satisfaction and food waste in hospitalized patients between cook-serve and cook-c, hill, and cook-freeze methods for protein dishes and a significant difference for vegetable dishes. Cook-chill and cook-freeze potential to be implemented in a hospital kitchen.

Packaged hospital food appears safe and feasible to reuse.

To determine the safety, operational feasibility and environmental impact of collecting unopened non-perishable packaged hospital food items for reuse. This pilot study tested packaged foods from an Australian hospital for bacterial species, and compared this to acceptable safe limits. A waste management strategy was trialled (n = 10 days) where non-perishable packaged foods returning to the hospital kitchen were collected off trays, and the time taken to do this and the number and weight of packaged foods collected was measured. Data were extrapolated to estimate the greenhouse gasses produced if they were disposed of in a landfill. Microbiological testing (n = 66 samples) found bacteria (total colony forming units and five common species) on packaging appeared to be within acceptable limits. It took an average of 5.1 ± 10.1 sec/tray to remove packaged food items from trays returning to the kitchen, and an average of 1768 ± 19 packaged food items were per collected per day, equating to 6613 ± 78 kg/year of waste which would produce 19 tonnes/year of greenhouse gasses in landfill. A substantial volume of food items can be collected from trays without significantly disrupting current processes. Collecting and reusing or donating non-perishable packaged food items that are served but not used within hospitals is a potential strategy to divert food waste from landfill. This pilot study provides initial data addressing infection control and feasibility concerns. While food packages in this hospital appear safe, further research with larger samples and testing additional microbial species is recommended.

Fungal contamination of Azadi Teaching Hospital and Hevi Paediatric Hospital Environments, Duhok, Iraq

This survey study was undertaken to find out the prevalence and distribution of fungi occupying the residential surfaces in Azadi Teaching Hospital and Hevi Paediatric Hospital in Duhok province, Iraq. Three hundred samples were collected from randomly selected areas in laboratories, wards, consultation rooms, operating theatres and hospital kitchen by swabs. These samples were cultured on two selective fungal media (PDA and SDA) and also samples from air were cultured on PDA in order to determine the genus or species of the agents in the samples. The results found microorganisms that were identified included forty eight isolates in addition to non identified yeasts and sterile mycelium also detected. From 300 samples collected from period January to May 2016, molds comprised 60% and yeasts comprised 40%. All fungal isolates were identified depending on the morphological and microscopic examinations as well as biochemical tests. The environmental contaminations in Azadi Teaching and Hevi Paediatric Hospitals with fungi (Aspergillus) were the highest fungal isolates whereas Candida sp. was the highest yeast isolate

Chronic Kidney Disease in Hospital Cooks

Chronic kidney disease is still a concern for health problems in Indonesia. Complications of chronic kidney disease include hypertension, cardiovascular disease, decreased kidney function to the end stage and even death. One of the potential dangers is heat, which not only causes the risk of kidney and cardiovascular health problems but it can also worsen the condition of the disease. Workplaces such as hospital kitchens have a risk of heat exposure. This shows the importance of fit-to-work assessment based on occupational medicine management. A 55-year-old cook worker with stage IV chronic kidney disease came to the hospital. The result from the last visit suggested that she had dyslipidemia and uncontrolled hypertension. We recommend the worker with job restrictions. She can still work in the nutrition department of the hospital but with restrictions on cooking duties. She can still work in the food filter and serving area. The goal of limiting work assignments is to maintain chronic kidney failure at stage IV. In addition, the hospital is also required to take control measures so that other workers do not have the risk of kidney disease health problems.
 Keywords: chronic kidney disease, cook, occupational medicine management

Formic acid, an organic acid food preservative, induces viable-but-non-culturable state, and triggers new Antimicrobial Resistance traits in Acinetobacter baumannii and Klebsiella pneumoniae.

Numerous human pathogens, especially Gram-negative bacteria, are able to enter the viable-but-non-culturable (VBNC) state when they are exposed to environmental stressors and pose the risk of being resuscitated and causing infection after the removal of the trigger. Widely used food preservatives like weak organic acids are potential VBNC inducers in food processing and packaging facilities but have only been reported for food-borne pathogens. In the present study, it is demonstrated for the first time that one such agent, formic acid (FA), can induce a VBNC state at food processing, storage, and distribution temperatures (4, 25, and 37°C) with a varied time of treatment (days 4-10) in pathogenic Gram-negative bacteria Acinetobacter baumannii and Klebsiella pneumoniae. The use of hospital-associated pathogens is critical based on the earlier reports that demonstrated the presence of these bacteria in hospital kitchens and commonly consumed foods. VBNC induction was validated by multiple parameters, e.g., non-culturability, metabolic activity as energy production, respiratory markers, and membrane integrity. Furthermore, it was demonstrated that the removal of FA was able to resuscitate VBNC with an increased expression of multiple virulence and Antimicrobial Resistance (AMR) genes in both pathogens. Since food additives/preservatives are significantly used in most food manufacturing facilities supplying to hospitals, contamination of these packaged foods with pathogenic bacteria and the consequence of exposure to food additives emerge as pertinent issues for infection control, and control of antimicrobial resistance in the hospital setting.

Microbiological contamination of commercial enteral feeding and blenderized tube feeding: A systematic review

Background: All types of enteral feeding (EF) formulations, whether blenderized tube feeding (BTF) at hospital kitchen, or commercial enteral feeding (CEF), contains nutrients. The nature of these foods (in terms of pH, nutrient contents, water activity, etc.) is so that if they become contaminated, would immediately grow pathogens inside and put the patient at the risk of infection. This systematic review aimed to investigate the microbial safety of BTF and CEF used in hospitals. Methods: Literature search was conducted in four English databases, including Scopus, PubMed, Science Direct, and Google Scholar, using multiple keywords, such as enteral nutrition, blenderized formulas, home enteral nutrition, enteral formula, EF, blenderized enteral formula, blended feeds, blenderized home-made food, CEF, microbial contamination, and bacterial contamination. Finally, 16 eligible studies were selected for the systematic review. Results: Out of 132 retrieved articles, 16 were selected and reviewed CEF was mostly exposed to contamination with total coliforms, Staphylococcus aureus, mesophilic bacteria, and Escherichia coli. In addition, contamination with gram-negative bacteria, Bacillus cereus, mold, and yeast was detected. Most BTF contamination was caused by total coliforms, mesophilic bacteria, Listeria spp., B. cereus, mold, and yeast. Conclusion: Due to the nonconformity of hygienic guidelines, the microbial safety of EF solutions in hospitals and homes are relatively low, which may lead to foodborne diseases. Therefore, a hazard analysis and critical control point (HACCP) system is essential in every hospital kitchen.

The role of the dietitian in the hospital team. The current situation in Poland in relation to the needs of society

Background: Nutrition that is adequate to the patient’s health status is a component of co-determining factors in improving the patient’s health. Moreover, appropriate activities of a dietician, such as assessing the nutritional status or educating patients, are counted among the determinants conditioning the effectiveness of the conducted treatment. The number of employed dietitians in hospitals is low, which results in 76-740 patients per one specialist, which in turn makes effective education impossible. The aim of this study was to compare the duties of dietitians working in Polish hospitals in relation to the needs of the society. Material and methods: The research tool consisted of two original, anonymous questionnaires, addressed to the Polish public and to active dietitians. The analysis of results was based on 595 questionnaire results, including 93 from nutritionists. Results: Of the respondents who were admitted to the hospital ward, 83.3% had no contact with a nutritionist (N=347). The surveyed dietitians most often declared that there were two dietitians working at the health care provider employing them, with the smallest number being 1 and the largest number being 55. Only one in three respondents received dietary recommendations upon discharge from the hospital (N=133; 32.1%). Nearly half of dietitians do not prepare menus (48.4%). According to the public, a dietitian should be involved in nutritional counseling, developing menus for the hospital kitchen or catering, and nutritional recommendations for patients discharged from the hospital. Conclusions: Dietitians with the right qualifications and specialties, integrated into the health care workforce, can have a huge impact on the proper dietary therapy of patients. As a result, there is a high probability of increasing the effectiveness of treatment, resulting in health service savings and support for the medical community.

Analisis Penyelenggaraan Makanan Di Instalasi Gizi RSUD Besemah Pagar Alam Tahun 2021

According to the Minister of Health Regulation Number 7 of 2019 concerning the health of the hospital environment, ready-to-eat food in hospitals is all food and drinks served from the hospital kitchen for patients and employees, as well as food and drinks sold within the hospital environment. This study aims to obtain in-depth information about food administration from the aspect of the process (planning, procurement, receipt, storage, processing and distribution of food) at the nutrition installation of Besemah Pagar Alam Hospital in 2021. The type of research used is a qualitative descriptive study with a phenomenological approach with technical techniques. interviews of informants or direct sources and secondary data with 9 respondents. This research was conducted on 5 – 20 July 2021. Data were collected using recording, then the data that had been carried out was analyzed. The results of this study on the process aspect of planning obtained information that aspects of the food ingredient planning process were not in accordance with PGRS guidelines. Then the process aspect of the procurement of foodstuffs includes ordering and purchasing foodstuffs, information is obtained that the procurement activities of foodstuffs are guided by PGRS. In the process aspect of receiving food ingredients, information was obtained that the activities of receiving food ingredients were not in accordance with PGRS guidelines. In the aspect of the food storage process, information was obtained that the storage of foodstuffs was not in accordance with the standards in the PGRS. In the process aspect of food processing, information is obtained that the food processing activities have been carried out according to the prerequisites of the PGRS guidelines, namely the availability of menus, menu guidelines, menu cycles, food ingredients to be cooked, cooking utensils, cooking assessments, availability of cooking SOPs, and regulations. use of food additives. In the process aspect of food distribution, information was obtained that the food distribution activities were not in accordance with PGRS guidelines.

Knowledge, Attitude and Practices of Food Handlers in a Hospital Kitchen- an Administrator’s Perspective

Hospital food hygiene plays an important role in patients’ health. Studies have proved that improper practices and lack of knowledge are major contributing factors of foodborne diseases. This study has been conducted with an aim to determine knowledge, attitude and practices of hospital kitchen staff towards safe food handling in a tertiary care teaching hospital in Pune. A cross sectional study was conducted in the central kitchen of the hospital.Data was collected from 20 food handlers (the entire staff working in the central kitchen) through a pre- validated questionnaire. Data was collected in May- June 2022. Most of food handlers had studied up till high school and their mean age group was 36.2 years. The average work experience of respondents was 16.5 years. The result of the questionnaire showed that majority of food handlers have a fair knowledge in safe food handling procedures, have a good attitude and practices. However, the results also strongly emphasize the need of more frequent food hygiene training of hospital food handlers. It also suggests that non-food handlers such as the nursing staff or kitchen supervisor should also be involved in the training. Some aspects of food handlers’ safety behaviour also needs to be emphasized.

Relating Food Handlers’ Knowledge, Attitude, and Self-reported Practices on Food Safety and Hygiene to the Performance of Food Safety Assurance System: A Multiple Case Study in Government Hospital Kitchens

Government hospital kitchens in Malaysia have been certified with Good Manufacturing Practices (GMP) and Hazard Analysis Critical Control Point (HACCP) to ensure that cooked food is clean and safe for consumption. However, the performances of the Food Safety Assurance System (FSAS)-certified government hospital kitchens have not been evaluated. Although researchers in Malaysia have assessed the knowledge, attitude, and self-reported practices (KAP) on food safety (FS) and hygiene among food handlers, they did not relate the influence of food handlers’ KAP on the performance of the FSAS. The objective of the study was to relate food handlers’ KAP on FS and hygiene to the FSAS performance in government hospital kitchens in Selangor and Kuala Lumpur, Malaysia. Four government hospital kitchens implementing different kinds of FSAS certification were evaluated. Critical sampling locations were identified, and samples were taken and examined for Escherichia coli, Total Yeast and Mould Count (TYMC), Staphylococcus aureus, Total Plate Count (TPC), and Salmonella. The average scores of knowledges on FS and hygiene for ≤ 30 years age group, ≤ 5 years in the employment group, and food handlers with tertiary education were the highest and significantly different compared with the other groups. The FS output of government hospital kitchens implementing stringent FSAS was better (score of 2–3) than kitchens implementing less stringent FSAS (score of 2). The multinomial logistic regression analysis showed that the correlations among the overall percentage scores of KAP and the FS output were not significant (p > 0.05). Therefore, it appeared that food handlers’ KAP on FS and hygiene did not influence Salmonella, E. coli, and S. aureus levels and, therefore, the FSAS’ performance.

Surveillance Plan for L. Monocytogenes Post a Hospital Kitchen Outbreak

Background Listeria monocytogenes is a serious infection that is especially dangerous for the immunocompromised patient population. In the hospital kitchen environment, there are many opportunities for introduction and contamination of food contact surfaces which can lead to transmission to patients. Following a November 2019 clinical outbreak of L. monocytogenes with concurrent positive cultures in our hospital kitchen, the Infection Control Department at a tertiary cancer center created a cohesive surveillance strategy. Methods Immediately following the conclusion of outbreak mitigation, the Infection Control Department, in accordance with the New York State Department of Health, performed biweekly environmental sampling of the kitchen. Environmental samples were collected over 6 months, using sponge swabs that were tested by polymerase chain reaction (PCR) and microbiologic culturing. Additionally, our Infection Control and Environmental Services Departments partnered to review and revise cleaning and disinfection methods. Results At the end of the 6-month environmental surveillance, there were no positive environmental samples. Thereafter, testing frequency was reduced to monthly. A total of 504 environmental samples, including food contact and non-food contact surfaces, were collected. Only 2 swabs have resulted in positive cultures for L. monocytogenes, both non-contact, and neither were linked to any clinical infections. The kitchen cleaning protocol was overhauled with increased frequency of deep cleaning, identification and inclusion of overlooked areas, and acquisition of new and improved products (with activity against L. monocytogenes) and cleaning equipment. Conclusions Continued environmental sampling of a hospital kitchen provides an effective way to ensure patients are not exposed to potentially severe foodborne illnesses, such as Listeria monocytogenes, and keeps a keen focus on hospital wide-infection control practices. Coordination and collaboration with interdisciplinary departments is essential to provide continued focus on risk mitigation in the complex hospital kitchen environment. Listeria monocytogenes is a serious infection that is especially dangerous for the immunocompromised patient population. In the hospital kitchen environment, there are many opportunities for introduction and contamination of food contact surfaces which can lead to transmission to patients. Following a November 2019 clinical outbreak of L. monocytogenes with concurrent positive cultures in our hospital kitchen, the Infection Control Department at a tertiary cancer center created a cohesive surveillance strategy. Immediately following the conclusion of outbreak mitigation, the Infection Control Department, in accordance with the New York State Department of Health, performed biweekly environmental sampling of the kitchen. Environmental samples were collected over 6 months, using sponge swabs that were tested by polymerase chain reaction (PCR) and microbiologic culturing. Additionally, our Infection Control and Environmental Services Departments partnered to review and revise cleaning and disinfection methods. At the end of the 6-month environmental surveillance, there were no positive environmental samples. Thereafter, testing frequency was reduced to monthly. A total of 504 environmental samples, including food contact and non-food contact surfaces, were collected. Only 2 swabs have resulted in positive cultures for L. monocytogenes, both non-contact, and neither were linked to any clinical infections. The kitchen cleaning protocol was overhauled with increased frequency of deep cleaning, identification and inclusion of overlooked areas, and acquisition of new and improved products (with activity against L. monocytogenes) and cleaning equipment. Continued environmental sampling of a hospital kitchen provides an effective way to ensure patients are not exposed to potentially severe foodborne illnesses, such as Listeria monocytogenes, and keeps a keen focus on hospital wide-infection control practices. Coordination and collaboration with interdisciplinary departments is essential to provide continued focus on risk mitigation in the complex hospital kitchen environment.