Food safety risk factors in a hospital food service unit serving low microbial diets to immune-compromised patients

The objective was to investigate the food safety and hygienic status in a hospital food service unit (FSU) serving low microbial diets (LMDs) to immune-compromised patients, by means of an audit (questionnaire) and bacterial samples to validate the audit findings. The primary research was done in a FSU of a 350-bed hospital in Gauteng, South Africa. One audit was done in ten areas (for receiving, storage, preparation, serving/distribution, customer, premises and equipment hygiene, staff dress code, staff premises and rest areas, and quality assurance/records procedures) of the FSU using a pre-tested form based on Hazard Analysis Critical Control Points (HACCP) principles/standards. The audit form consisted of a set number of questions for each one of the ten areas, with a possible maximum score of two (2) for each question. A set of five (5) questions for the staff premises was set, with a possible maximum score of 10. If a score of only two (2) were then reached, a % was calculated to score the area, in this case 20%. In addition to the audit, four surface swabs (patient food serving tray, chef′s gloved hands, chopping board for salads and sandwiches, microwave oven door handle) and four food samples (green beans and potatoes, chicken gravy, cold meat cuts, quiche) were randomly taken during the survey. The samples were tested to assess the microbiological safety of the foods prepared for Total aerobic plate count (TAPC), Escherichia coli, total Coliforms, Staphylococcus aureus and Salmonella spp. The results of the audit, surface and food samples were used to evaluate possible food and safety risks in the FSU according to internationally approved HACCP standards. All ten areas audited were below the set standard (> 80% value) with an average score of 41.1%. The service and distribution area had the highest score (69.4%), while the quality procedures and records division had the lowest score (5.6%). The microbiological tests showed relatively high microbial counts for a number of samples. The results of this study suggests, that even though so called safety procedures were in place, they were not followed, which could have severe health implications for the critically ill. The results of the study support the important role of food and safety protocols in FSUs to lower food safety risks when providing food that is safe for immune-compromised patient use.