Food Safety Conditions in Home-Kitchens: A Cross-Sectional Study in the Federal District/Brazil.

This study aimed to analyze the food safety conditions in home kitchens from the Brazilian Federal District. A previously validated instrument composed of 77 items (in four blocks) was used to evaluate the safety conditions in home kitchens. A survey was carried out with on-site application with 226 home kitchens' food handlers in the Federal District, Brazil to evaluate Brazilian home kitchens' good practices. Of the home kitchen food handlers, most of them were female (64.6%), had completed undergraduate education (29.2%), and were 45-59 years old (23.5%). The visited households had an average of 3.38 ± 1.48 residents that ate some of their meals at home, and 40% declared the monthly family income to be between 5 and 15 Brazilian minimum wages (MW). Regarding the reliability of the instrument, from the KR-20 test, it was verified that the instrument presents good internal consistency (α = 0.758). According to the instrument classification, the home kitchens' sample was considered as at a medium risk of food contamination (46.5% of them presented from 51 to 75% of conformities to the instrument). There was a statistical difference between house-kitchens with a family income from zero to one minimum wage (MW) and those receiving from 5 to 15 MW (p = 0.017), as well as between those from zero to one MW and who earn above 15 MW (p = 0.009). The result of the on-site evaluation shows that the instrument was able to measure food safety conditions in Brazilian Federal District domestic kitchens. Such findings can contribute positively to the development of actions in health education that help in the adoption of good practices of food manipulation and, consequently, in the reduction in foodborne disease outbreaks in residences.

Microbiological quality of enteral feeding and infant formula produced in dietary units, according to the triad of Donabedian.

INTRODUCTION AND AIMS: Microbial contamination of enteral feeding and infant formulas can result in a risk of worsening of the clinical condition of the patients, who are already weakened and susceptible to pathogens. The objective was to evaluate aspects of the management of quality hygienic - sanitary of enteral feeding and infant formulas in hospitals, focusing on the structure, process and outcome. METHODS: An observational, descriptive, prospective, with quantitative and qualitative variables study was done. The survey was conducted for 12 months and 227 samples of enteral feeding and 176 of infant formula were collected in Nutrition and Dietetic Services of Health Secretary / Federal District. In evaluating the operating conditions, the Tool 2 was applied to: Enteral Nutrition Preparation. Data were analyzed from the unified Donabedian's triad for evaluation of health services. RESULTS: The results obtained with the Tool 2 demonstrated that the Storage Block complies with legal requirements. Moreover, Dressing Block is a risk factor for the contamination. From the 403 samples, 56% corresponded to samples of Enteral Nutrition and 44% to samples of Infant Formulas. The data indicate that from 227 samples of Enteral Nutrition, 6.2% were in disagreement with the legislation, while from 176 samples of Infant Formulas, 4.6% were also in disagreement with the legislation. CONCLUSION: The ineffective implementation of the sanitary and hygienic requirements during the preparation results in a microbiologically unsafe product to patients in debilitated health state, and the count of mesophilic microorganisms can be a good indicator of microbiological safety.

Introducción y objetivo: La contaminación microbiológica de dietas enterales y fórmulas infantiles puede conducir a una situación de riesgo de agravación del cuadro clínico de pacientes, ya debilitados y susceptibles a los agentes patógenos. El objetivo fue evaluar aspectos de la gestión de calidad de condiciones sanitarias de dietas enterales y fórmulas infantiles en los hospitales, centrándose en estructura, proceso y resultado. Métodos: Fue hecho un estudio observacional, descriptivo, prospectivo, con variables cuantitativas y cualitativas. La encuesta fue por 12 meses y se recogieron 227 muestras de dietas enterales y 176 de fórmulas infantiles en los Servicios de Nutrición y Dietética de la Secretaría de Estado de Salud del Distrito Federal. Los datos fueron analizados a partir de la Tríada de Donabedian para la evaluación de los servicios de salud por medio de un cuestionario. Resultados: Los resultados obtenidos muestran que en Bloque Almacenamiento cumple con los requisitos legales. Por otro lado, el Bloque Vestuario es un factor de riesgo de contaminación. De las 403 muestras, 56% eran muestras de Nutrición Enteral y 44%, muestras de Fórmulas Infantiles. Los datos indican que de 227 muestras de Nutrición Enteral, un 6,2% estaban en desacuerdo con la ley, mientras que de las 176 muestras de las Fórmulas Infantiles, 4,6% también estaban en desacuerdo con la legislación. Conclusión: La falta de aplicación efectiva de requisitos higiénicos sanitários durante la preparación resulta en producto microbiológicamente inseguro para pacientes debilitados, y el recuento de mesófilos totales puede ser un buen indicador de la seguridad microbiológica.

Development of a tool for quality control audits in hospital enteral nutrition.

BACKGROUND AND AIMS: Malnutrition is very prevalent in hospitals, causing physical capacity deterioration, increasing complications and raising mortality. This scenario overloads public health costs enormously. Enteral nutrition (EN) is the first option to fight against malnutrition. Nutrition support teams (NST) work combating such conditions, promoting humanization, but also analyzing the cost benefit of EN therapy. Brazil is one of the first Latin American countries to develop EN laws. Quality control it is in the core of this legal instrument, playing an essential role in NST`s task of providing care. Nowadays, tools to access quality control represent a gap in the area. The aim of this study was to develop a quality control tool, according to Brazilian law for EN Therapy regarding multidisciplinary approach, good practices, standard operating procedures, protocol implementation, proper registration and electronic health record. METHODS: A content validation method was utilized in this four stages development process: bibliographic research, expert opinion (subjective), semantic evaluation and expert opinion (objective). In the latter stage ten specialists, expressed their opinion, evaluating the tools by four different attributes: utility, simplicity, objective and low cost on a 5-point Likert scale (1-5). RESULTS: We elaborate three independent tools that together, represent the whole evaluation process, named: NST Activities, EN Preparation and EN Administration. Content Validation Index to the four different attributes ranged form 0,9 to 1. CONCLUSION: This tool had positive approval from experts and is of great value guiding hospital audits, or even serving as checklist to implement a plan on EN therapy.

Are fat acids of human milk impacted by pasteurization and freezing?

The Human Milk Bank undergo human milk to pasteurization, followed by storage in a freezer at -18° C for up to six months to thus keep available the stocks of this product in maternal and infant hospitals. The objective of this study was to evaluate the effects of processing on the lipid fraction of human milk. A sample of human milk was obtained from a donor and was subdivided into ten sub-samples that was subjected to the following treatments: LC = raw milk; T0 = milk after pasteurization; T30 = milk after pasteurization and freezing for 30 days; T60 = milk after pasteurization and freeze for 60 days, and so on every 30 days until T240 = milk after pasteurization and freezing for 240 days, with 3 repetitions for each treatment. Lipids were extracted, methylated and fatty acid profiles determined by gas chromatography. The fatty acids were characterized by nuclear magnetic resonance and functional groups were identified by infrared spectroscopy. There were variations in the concentration of fatty acids. For unsaturated fatty acids there was increasing trend in their concentrations. The IR and NMR analyze characterized and identified functional groups presents in fatty acids.

Los Bancos de Leche Humana someten la leche la pasteurización, seguido del almacenamiento en un congelador a -18 grados por até seis meses, para así disponerlo a los Hospitales Materno Infantiles. El objetivo de este estudio fue evaluar los efectos del procesamiento de la fracción lipídica de la leche humana. Para esto, una muestra obtenida de una donante y sometida a diez diferentes tratamientos: LC = leche cruda; TO = leche después de la pasteurización; T30 = leche después de la pasteurización y congelación por 30 días; T60 = leche después de la pasteurización y congelación por 60 días y así sucesivamente a cada 30 días hasta T240 = leche después de la pasteurización y congelación por 240 días, con tres repeticiones a cada tratamiento. Los lípidos fueron extraídos y los ácidos grasos metilados fueron determinados por cromatografía gaseosa. Los ácidos grasos fueron caracterizados por resonancia magnética nuclear y los grupos funcionales identificados por espectroscopia infrarroja. Hubo variaciones en las concentraciones de ácidos grasos. Para los ácidos grasos insaturados hubo un aumento en sus concentraciones. Sin embargo, los grupos funcionales se caracterizaron por espectroscopia infrarroja y resonancia magnética nuclear, RMN.