A qualitative exploration of barriers, facilitators and best practices for implementing environmental sustainability standards and reducing food waste in veterans affairs hospitals.

BACKGROUND: To improve the healthfulness of foods offered while accelerating the use of environmental sustainability practices, it is important to engage hospital food service operators in the adoption of such practices. The purpose of this study was to explore barriers, facilitators and best practices for implementing environmental sustainability standards in food service among veterans affairs (VA) hospitals in the United States. METHODS: We conducted an online survey with 14 VA hospital food service directors and then 11 qualitative interviews. The survey assessed motivations for initiating sustainability standards and included a self-rating of implementation for each of five standards: increasing plant-forward dishes, procuring and serving sustainable foods that meet organic/fair trade and other certifications, procuring and serving locally produced foods, reducing food waste and reducing energy consumption. Interviews were transcribed verbatim. Qualitative analysis, including coding of themes and subthemes, was conducted by two coders to determine barriers, facilitators and best practices for each of these five standards. Quantitative methods (counts and frequencies) were used to analyse the survey data. RESULTS: Participants had an average of 5 years of experience implementing sustainability standards. The top three motivators cited were reducing food waste, serving healthier foods and increasing efficiency or cost savings. Barriers revolved around patient preferences, contractual difficulties and costs related to reducing waste. Facilitators included taste testing new recipes that include more sustainable food options and easy access to sustainable products from the prime vendor. Best practices included making familiar dishes plant-forward and plate waste studies to prevent overproduction. CONCLUSIONS: Although there were many barriers to implementation, food service directors had solutions for overcoming challenges and implementing food service sustainability standards, which can be tested in future sustainability initiatives.

Unwrapping nutrition: Exploring the impact of hospital food and beverage packaging on plate waste/intake in older people.

Food and beverage packaging is increasingly used in hospital food service provision. Previous research has identified that the packaging used in New South Wales hospitals can be difficult to open by older adults. As older adults experience high rates of malnutrition, it is important to understand the effects of packaging on actual consumption of food and fluids. The aim of this study was to explore the impact of hospital food and beverage packaging on dietary intakes of 62 independently living older people (65 years and over) in a university simulated hospital ward in NSW, Australia. Participants were allocated to either a breakfast and snack meal or a lunch and snack meal on two occasions one week apart. Meals were served in a shared ward environment and each participant experienced a 'sealed' and 'pre-opened' meal and snack condition. The nutritional status of participants was measured using the Mini Nutritional Assessment - Short Form (MNA®-SF) and intake was estimated through an aggregated plate waste method. Overall findings were not significant for dietary intakes and the 'sealed' versus 'pre-opened' conditions. However, for the seven participants classified by the MNA®-SF as 'at risk' of malnutrition, packaging impeded intake for breakfast (η2 = -0.34) and the high protein snack (cheese and biscuits) (η2 = -0.24) meals. This finding has implications for the provision of packaged high protein snacks (cheese portions) and breakfast meals for the older inpatient. Further research is required for nutritionally compromised and frail older people in the hospital environment to investigate the impact of packaging on food and beverage consumption in detail.

Personalization in mitigating food waste and costs in hospitalization.

BACKGROUND: Organization of food services within hospitals has been identified as a determinant of hospitalized patients' nutritional intake and associated food waste. Whereas hospital food service systems in the Netherlands traditionally consist of 3 fixed mealtimes each day, we recently implemented a new 3-channel concept that provides patients the opportunity to order extra meals or snacks in-between their 3 main mealtimes or even have dinner with their visitors in a bistro located on their ward. AIM: This study investigates the impact of transitioning from a traditional paper-based to a patient-centered, digital hospital food service system on food waste production patterns and its associated financial implications. METHODS: Plate waste (served but uneaten food) measurements were performed at baseline for all served meals during a one-week period within the traditional system and follow-up measurements were conducted annually after implementation of the new system during 3 consecutive years. Measurements were conducted at two hospital floors, each comprising four wards. Average grams of plate waste per served meal, daily meal frequency per patient and the associated production and disposal costs of the collected waste were calculated and compared between the two systems. RESULTS: A total of 4361 meals served within the traditional system were compared with 7815 meals served within the new digital system. Meal frequency increased from an average of 2.5 meals per patient per day in the old system to an average varying between 3 and 3.3 meals per patient per day in the consecutive years. Within the traditional system, average plate waste was 81 grams per served meal, whilst it ranged between 33 and 49 grams per served meal during the following years, with the 3-channel concept in place (p < 0.001, p = 0.010). Dinner demonstrated the largest reduction in plate waste at all measurement points. Following this reduction of plate waste, estimated associated costs of plate waste production and disposal decreased in a similar pattern. CONCLUSION: Transitioning from a traditional, paper based to a patient-centered and digital hospital catering system results in significantly higher daily meal frequency and less food waste per served meal.

Individualised nutritional treatment increases the positive effects of a novel á la carte hospital food service concept: Results of a quasi-experimental study.

BACKGROUND & AIMS: One-third of hospitalised patients are at nutritional risk, and limited choice regarding meals and meal times, and inadequate nutritional support may contribute to inadequate nutritional intake during hospitalisation. The aim was to test the effect of a novel á la carte hospital food service concept as a stand-alone intervention and combined with individualised nutritional treatment. METHODS: Medical inpatients at nutritional risk were recruited for this three-arm quasi-experimental study. The control group received meals from the traditional bulk trolley food service system. Intervention group 1 (IG1) received meals from a novel á la carte food service concept with an electronic ordering system, whereas intervention group 2 (IG2) in addition to this received individualised nutritional treatment by a clinical dietitian. Nutritional intake and length of stay was measured, and patient satisfaction was assessed with purpose-designed questionnaires. RESULTS: 206 patients were included: 67 in the control group, 68 in IG1, and 71 in IG2. The proportion of participants reaching ≥75 % of both their energy and protein requirement was higher in IG1 compared to the control group (34 % vs. 12 %, p = 0.002) and higher in IG2 compared to IG1 (53 % vs. 34 %, p = 0.035). Length of stay was shorter in IG2 compared to the control group (6.0 vs. 8.7 days, p = 0.005). It was important to participants to be able to choose when and what to eat, and this preference was met to a larger extent in the intervention groups. CONCLUSION: The novel á la carte concept increases energy and protein intake in hospitalised patients, and the positive effects are increased, when the concept is used in combination with individualised nutritional treatment.

Identifying solutions to minimize meal tray waste: A mixed-method approach.

BACKGROUND & AIMS: Over $150,000 are lost annually due to meal tray waste in a large hospital in the United States. This study aims to explore the root causes of meal tray waste within a decentralized foodservice model and strategies to mitigate waste. METHODS: A mixed methods sequential explanatory design was used by first identifying hospital units high and low in meal tray waste using recorded food management data from January 2021 through September 2022, then conducting observations, mobile-interviews (n = 16), and in-depth interviews with hospital foodservice staff (n = 6) and nurses (n = 6) in each unit. Lastly, hospital and topic experts (n = 10) were engaged in strategizing solutions to reduce meal tray waste. RESULTS: Findings indicate meal tray waste is increased when patients discharge and when standard trays (i.e., also known as house trays, which include items not requested by patients) are provided. Meal tray waste points to the unpredictability in a hospital that often arises due to patient circumstances, lack of coordination between nursing and foodservice staff, patients' food preferences, and the need for system and workflow improvements in a decentralized foodservice model. CONCLUSIONS: Findings highlight considerations that may be applicable across diverse medical institutions seeking to reduce meal tray waste. Hospitals should choose the best foodservice model that suits their institution to manage operations efficiently, focusing on reducing waste, cost optimization, patient satisfaction, and sustainability.

The association between patient-reported experiences with hospital food services and recovery outcomes - A population survey of patients from 75 public hospitals.

BACKGROUND: The quality of food service is vital to patients' experiences in care and recovery in hospitals. This study aimed to identify opportunities for improving hospital food services to enhance overall patient experiences and outcomes. METHODS: This retrospective cross-sectional study uses the Adult Admitted Patient Survey in 2019. Adult patients discharged from acute or rehabilitation care across 75 public hospitals were surveyed about their in-hospital experiences, including ratings of hospital food services, overall ratings of hospital care, complications acquired, and delayed discharge due to feeling unwell. Population weighting was applied in descriptive and multivariable logistic regression analyses. We used adjusted odds ratios (AORs) and 95% confidence intervals (CIs) to estimate the association between hospital food service and the overall rating of hospital care and two recovery outcomes. RESULTS: Eight in ten participants (weighted, 16,919/21,900) consumed food in a hospital [mean age: 60.6 years (SE:0.5; SD: 18.3), 53% female]. Compared to a fair rating, adults who rated "poor/very poor" of hospital food service were 2.7 times more likely to report dissatisfaction with overall care in the hospital [Adjusted Odds Ratio (AOR) (95% CI): 2.73 (1.49, 4.99)], 1.4 times more likely to report complications [AOR:1.43 (1.11, 1.83)] and 1.9 times more likely to report delayed discharge [AOR 1.85 (1.30, 2.62)]. More moderate ratings were associated with attenuation of risk for these outcomes. Furthermore, the magnitude of the effect for these associations was more substantial among patients from non-English-speaking backgrounds (n = 1,759) after controlling for patient characteristics. Food service attributes, including received food as ordered, food delivered within reach, the taste of the meals, and meal interruption, were significant factors for the outcomes assessed. CONCLUSION: These findings underscore the importance of patients' positive experiences of hospital food service in recovery outcomes and identify several food service indicators that can be used to monitor and improve patient experiences and recovery outcomes in hospitals.

Hospitals' Food Services Quality and Factors Associated with Patients' Satisfaction in University Hospitals in the North of Iran.

This cross-sectional study evaluated patients' satisfaction with hospital meals in seven urban public hospitals using a validated questionnaire. The quality of food services based on the hospital standards was assessed using a checklist prepared by Iran's ministry of health. Of 800 subjects, the quality and quantity aspects of hospital meals, in general, were nearly satisfactory to the patients (mean score: 2.13, range: 1-3, SD: 0.39, 40% good and 36% moderate). The mean score of hospitals' food service quality based on hospital standards was 2.17 (range: 0-4, SD: 0.59). Females, younger patients and those with higher education level reported to be less pleased with hospital meal services. No relationship between patients' satisfaction and hospital food quality assessment based on hospital standards was found.

Assessment of the quality of inpatient meals and nutrition and dietetics service processes in select Philippine public hospitals.

AIMS: The nutrition and dietetics service in Philippine public hospitals was implemented by the Department of Health in 2016 to standardise the daily allowance and nutritional content of inpatient meals. Five years later, it is timely for the Department of Health to assess the quality of inpatient meals and mandated nutrition processes in areas such as staffing, food service, and outcomes monitoring. METHODS: A mixed-method sequential explanatory design was employed using (1) quantitative assessment through a facility survey (n = 193 hospitals) and (2) qualitative exploration of quantitative results through 6 focus group discussions (n = 36 hospitals). RESULTS: Philippine public hospitals were unequipped with the inputs necessary to implement processes that produce high-quality meals for patients. The hospitals were unable to comply with the required minimum meal allowance (51%), nutritional content of meals (40%), and food service standards. Moreover, they had insufficient human resources and inefficient food procurement practices. CONCLUSIONS: The quality of nutrition care and inpatient meals in Philippine public hospitals, who serve mostly people on low incomes, is a neglected problem in the Philippines. Moving forward, a systems approach involving the Department of Health, its regional offices, and hospital management is necessary to equip Philippine public hospitals with the inputs and structures necessary to provide high-quality nutrition care and inpatient meals that will facilitate patient recovery and overall patient health.

From Evidence to Clinical Practice: Positive Effect of Implementing a Protein-Enriched Hospital Menu in Conjunction With Individualized Dietary Counseling.

BACKGROUND: The aim of this study was to investigate if a protein-enriched menu in conjunction with individualized dietary counseling would increase energy and protein intake in hospitalized patients at nutrition risk compared with providing the protein-enriched menu as a stand-alone intervention. METHOD: Data from medical and surgical hospitalized patients were prospectively collected and compared with a historical intervention group (HIG). Primary outcome was the number of patients achieving >75% of energy and protein requirements. Secondary outcomes included mean energy and protein intake (adjusted for body weight [ABW]), readmission rate, and the number of patients with a baseline intake <50% of energy and protein requirement, who increased to ≥50%. RESULTS: In the intervention group (IG), 92% vs 76% in the HIG reached >75% of energy requirements ( P = .04); 90% in the IG vs 66% in the HIG reached >75% of protein requirements ( p = <0.01). The IG had a significantly higher mean intake of energy and protein compared with the HIG: ABW, 31 kcal kg-1 vs 25 kcal kg-1 ( P < .01) and 1.2 g protein kg-1 vs 0.9 g protein kg-1 ( P < .001). More than 85% of the patients with a baseline <50% of the EP requirement achieved ≥75% of the energy and protein requirement. No difference between readmission rates was found. CONCLUSION: Providing a protein-enriched menu in conjunction with individualized dietary counseling significantly increased protein and energy intake in hospitalized patients at nutrition risk.

At Your Request(®) room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake.

BACKGROUND: Malnutrition in hospitals may be combatted by improving the meal service. AIM: To evaluate whether At Your Request(®), a meal service concept by Sodexo with a restaurant style menu card and room service, improved patient satisfaction, nutritional status, and food intake compared to the traditional 3-meals per day service. METHODS: We prospectively collected data in Hospital Gelderse Vallei (Ede, the Netherlands) before (2011/2012; n = 168, age 63 ± 15 y) and after (2013/2014; n = 169, 66 ± 15 y) implementing At Your Request(®). RESULTS: Patient satisfaction increased after implementing At Your Request(®) from 7.5 to 8.1 (scale 1-10) and from 124.5 to 132.9 points on a nutrition-related quality of life questionnaire (p < 0.05). Body weight and handgrip strength did not significantly change in both periods. At admission, more patients in the At Your Request(®) period had risk of malnutrition (MUST ≥ 1; 47 vs 37). MUST scores improved in 18 patients in both periods. With At Your Request(®) 0.92 g protein per kg (g/kg) bodyweight was ordered. Protein intake based on food records from patients on an energy and protein enriched diet was 0.84 g/kg during At Your Request(®) (n = 38) versus 0.91 g/kg during the traditional meal service (n = 34). CONCLUSION: At Your Request(®) is a highly rated hospital menu concept that helps patients to maintain nutritional status. The concept offers options for improving the intake of specific nutrients and foods, which should be evaluated in further studies.

Avaliação Qualitativa de Cardápios Hospitalares / Qualitative Evaluation of Hospital Menus

Modelo: Estudo caracteriza-se como transversal, qualitativo. Objetivo: Avaliar qualitativamente as preparações de cardápios oferecidos em hospitais no município de Uberaba - MG. Metodologia: A análise foi realizada pelo método "Avaliação Qualitativa de Preparações do Cardápio" dos almoços oferecidos em cinco Unidades de Alimentação e Nutrição hospitalares públicas ou particulares durante três semanas alternadas entre os meses de fevereiro a junho de 2018. Avaliou-se as ofertas de frutas, folhosos, repetições de cores, presença de alimentos sulfurados, doces, frituras, carnes gordurosas e frituras + doces na mesma refeição. Resultados: Os itens foram classificados como "ótimo" a baixa oferta de frituras (6,7%), carnes gordurosas (8,0%) e nenhuma oferta de doce + frituras no mesmo dia (0%), "bom" para oferta de folhosos (75%) e doces (22,7%), "regular" para repetição de cores (42.7%), "ruim" quanto aos alimentos sulfurados (56%) e "péssimos" quanto a oferta de frutas (9,3%). Conclusão: Os cardápios possuíam aspectos positivos como ausência de doce + fritura, baixa utilização de frituras e carnes gordurosas, boa oferta de folhosos e doces; os aspectos preocupantes relacionaram-se com a repetição de cores e negativos com a presença de alimentos sulfurados e ausência de frutas. (AU)

Study design: Cross-sectional, qualitative study. Objectives: To qualitatively evaluate the menu preparations offered at hospitals from the city of Uberaba - MG Methods: The analysis was conducted using the method "Qualitative evaluation of menu preparations" to evaluate lunch menus offered at 5 Food and Nutrition Units from public or private Hospitals for 3 weeks alternated between February and June 2018. The offer of fruits, leafy vegetables, sweets, fried food, fatty meats and fried food + sweets in the same meal were evaluated, as well as the color repetitions and the presence of sulphurated food. Results: Items rated as "Excellent" showed low offer of fried food (6.7%), fatty meats (8.0%) and no offer of sweet + fried food on the same day (0%); "Good" showed the offer of leafy vegetables (75%) and sweets (22.7%); "Regular" indicated color repetition (42.7%); "Bad" indicated sulphurated food (56%) and "Very bad" stood for fruit offer (9.3%). Conclusion: The menus had positive aspects such as the absence of sweet + fried food, low presence of fried food and fatty meats, good offer of leafy vegetables and sweets. The worrying aspects were associated with color repetition and the negative aspects were related to the presence of sulphurated food and absence of fruits. (AU)

A saúde em troca da excelência: o sofrimento de atendentes de nutrição de um hospital público acometidos por LER/Dort / Health rather than excellence: the suffering of nutrition attendants of a Public Hospital affected by RSI/WRMSD

Resumo Este artigo apresenta resultados de pesquisa cujo objetivo foi compreender as relações entre os aspectos da organização do trabalho e a saúde de atendentes de nutrição acometidos por LER/Dort. Durante o processo houve levantamento de estatísticas de absenteísmo relacionado a LER/Dort em um hospital público em Porto Alegre/RS, no período de 1 de junho de 2015 a 30 de junho de 2016, e seleção da Seção de Distribuição de Alimentos e de seus atendentes de nutrição para aprofundamentos. Foram utilizados um questionário estruturado com dados sociodemográficos e de trabalho e o instrumento Self-Reporting Questionnaire (SRQ-20), para pesquisar a prevalência de transtornos mentais comuns (TMC), e realizadas entrevistas coletivas com os atendentes acometidos por LER/Dort, utilizando o referencial teórico da psicodinâmica do trabalho. Os resultados obtidos apontaram para modos de organização do trabalho e gestão com cobranças excessivas, assédio moral e falta de reconhecimento no trabalho, que geram sofrimento e influenciam nos processos de adoecimento. Sugere-se um espaço de escuta e discussões com reuniões que envolvam os trabalhadores, técnicos de nutrição e a coordenação que possam caracterizar uma ação permanente.

Abstract This article presents the results of a research that aimed to understand the relationship between aspects of the work organization and the health of nutrition workers affected by RSI/WRMSD. Throughout the process, absenteeism statistics related to RSI/WRMSD were obtained from a Public Hospital in Porto Alegre/ RS, from 06/01/2015 to 06/30/2016, and a section of such hospital was selected for further study. We selected the Food Distribution Section and its nutrition attendants for the research. A structured questionnaire with sociodemographic and professional data and the Self-Reporting Questionnaire (SRQ-20) were used to investigate the prevalence of common mental disorders (CMD), and collective interviews were conducted with attendants affected by RSI/WRMSD, using the theoretical reference of the Work Psychodynamics. Results obtained pointed to ways of organizing and managing work which included excessive pressure, moral harassment, and lack of recognition, generating suffering and influencing the processes of illness. A space for listening and discussing work issues is suggested, with meetings involving all workers, nutrition technicians, and the coordination, which may characterize a permanent action.

Alimentação hospitalar: proposições para a qualificação do Serviço de Alimentação e Nutrição, avaliadas pela comunidade científica / Hospital food: proposals for qualification of the Food and Nutrition Service, evaluated by the scientific community

OBJETIVO: validar proposições para qualificar a alimentação hospitalar pela comunidade científica brasileira. MATERIAIS E MÉTODOS: aplicou-se um questionário eletrônico a profissionais da área de nutrição clínica, cadastrados na Plataforma Lattes, base de dados brasileira de currículos de pesquisadores e instituições, das áreas de Ciência e Tecnologia. O questionário era acompanhado por uma escala Likert, com espaços para argumentações. Os temas abrangiam a participação do paciente, a qualidade nutricional e sensorial das dietas hospitalares e o planejamento e metas do Serviço de Alimentação e Nutrição Hospitalar (SANH). Também foram solicitadas as cinco prioridades para um SANH. Foi considerada aprovada a proposição com concordância total ou parcial maior ou igual a 70 por cento. RESULTADOS: todas as proposições obtiveram concordância total igual ou maior que 70 por cento. Houve adesão mínima de 70 por cento na proposição que considera que a intervenção nutricional deve ser realizada em comum acordo com o paciente, e máxima de 93 por cento sobre a necessidade de controles estatísticos de dietas prescritas pelo SANH. As prioridades mais citadas referem-se à infraestrutura e à capacitação de recursos humanos (40 por cento), a qualidade da alimentação hospitalar (27 por cento) e ao estado nutricional do paciente.

The scope of this paper is to validate proposals used to qualify hospital food by the Brazilian scientific community. An electronic questionnaire was applied to clinical nutrition professionals registered on the Lattes Platform (Brazilian database of institutions and researchers' curricula in the areas of Science and Technology). The questionnaire incorporated a Likert scale and had spaces for comments. The themes dealt with patient participation, the nutritional and sensory quality of hospital diets, and planning and goals of the Hospital Food and Nutrition Service (HFNS). The questionnaire also asked for the top five priorities for a HFNS. Proposals with total or partial adherence equal to or greater than 70 percent were considered to be approved. All proposals had total adherence equal to or greater than 70 percent. The proposal that had minimal adherence (70 percent) was the one that proposed that nutritional intervention must be arranged by mutual agreement with the patient. The proposal that had maximal adherence (93 percent) was the one advocating that there must be statistical control on diets prescribed by the HFNS. The most cited priorities referred to infrastructure and training of human resources (40 percent), the quality of hospital food (27 percent) and the nutritional status of the patient.

Caracterización de la Gerencia y organización de los servicios de alimentación de Hospitales y Centros de Salud de Itapúa dependientes del Ministerios de Salud de Itapúa dependientes del Ministerio de Salud Pública y Bienestar Social / "EVALUATION OF THE QUALITY OF LIFE IN ELDERLY ADULTS WITH RISK OF DISFAGIA OF THE HOME OF ELDERLY SANTA MARIA OF THE CITY OF ENCARNACION"

Introducción: El Departamento de alimentación o Servicio de Alimentación es un organismo técnico-administrativo del hospital, responsable de la administración de la alimentación de toda la población hospitalaria, tanto de enfermos como de sanos. Actualmente, la situación de la nutrición hospitalaria en nuestro país, se está iniciando en el campo de la terapéutica nutricional, el cual representa un desafío para los profesionales de nuestro medio respecto a los Servicios de Alimentación Hospitalaria, comparando con otros países que cuentan con sus propias normativas. Objetivo: Caracterizar la gerencia y organización de los Servicios de Alimentación de Hospitales y Centros de Salud de Itapúa dependientes del Ministerio de Salud Pública y Bienestar Social. Metodología: estudio observacional descriptivo, de corte transversal. No probabilístico de casos consecutivos. Se evaluó a 10 Servicios de Alimentación Hospitalaria, 1 Hospital Regional, 2 Hospital Distrital y 7 Centros de Salud de Itapúa, pertenecientes al M.S.P.B.S. Año 2014. Aplicando la encuesta elaborada por la FELANPE; con modificaciones de las Normativas de Chile y Bolivia. Resultados: El 50% (n=5) de los jefes del S.A no son profesionales; en cuanto a la Formación del Jefe en Administración de Hospitales o S.A., el 70% (n=7) solo posen cursos de capacitación; el 90%(n=9) de los que trabajan del área no son profesionales de la nutrición. Deficiencia en la Dependencia Orgánica, Gestión e inocuidad del S.A. y Nutrición enteral. Conclusión: La mayoría de los trabajadores del S.A. no son profesionales solo han realizado cursos de capacitación en esta área. Se denota un déficit en la dependencia orgánica y en materiales técnicos-administrativos por el cual se debe mejorar la presencia de profesionales especializados, el sistema de gestión y organización en el S.A, para garantizar la eficacia y la calidad del servicio prestado a los pacientes y al resto de la comunidad sanitaria. Palabras clave: servicio de alimentación, servicio de alimentación hospitalaria, gerencia.

Introduction: The Department of Food supply or service is a technical-administrative body of the hospital, responsible for power management of the entire hospital population, both sick and healthy. Currently, the situation of hospital nutrition in our country is starting in the field of nutritional therapy, which represents a challenge for professionals in our country regarding the Services Hospital Food, compared to other countries with their own regulations. Objective: To characterize the management and organization of Foodservice Hospitals and Health Centers Itapúa under the Ministry of Public Health and Social Welfare. Methods: Descriptive observational study of cross section. No probability of consecutive cases. We evaluated 10 Hospital Services Food, 1 Regional Hospital, 2 and 7 District Hospital Health Centers Itapúa belonging to MSPBS 2014. Applying the survey by FELANPE; with amendments to the regulations of Chile and Bolivia. Results: 50% (n = 5) of the heads of the SA are not professionals; regarding the formation of the Chief Administration Hospital or SA, 70% (n = 7) only pose training courses; 90% (n = 9) of those working in the area are not nutrition professionals. Deficiency in Organic Unit in the management and safety of SA and Enteral Nutrition. Conclusion: The majority of workers in S.A. are not professionals only have conducted training courses in this area. There is a deficit in the organizational unit and in the technical-administrative materials by which the presence of specialized professionals, the management and organization system in the SA, should be improved to ensure the efficiency and quality of the service provided to the patients and the rest of the health community. Keywords: food service, hospital food service, management

Variation in the energy and macronutrient contents of texture modified hospital diets / Variación en la energía y contenido de macronutrientes de dietas hospitalarias con textura modfiicada

Objective: To compare the nutritional content of the main meals of a normal hospital diet with those of texture modified diets (soft, puréed and liquid). Methodoloogy: The ash, moisture, macronutrient and energy contents of the foods comprising the main meal of the hospital diets were determined. The values were calculated per capita for each food item comprising the diets and then added up in order to estimate the total amount of energy and macronutrients supplied by main meal. Results: Compared with the normal diet, the puréed and liquid diets presented higher moisture content as well as reduced content of energy (31.4% and 39.9%, respectively), protein (45.4% and 79.8% ,respectively) and lipid (41% and 76%, respectively). Conclusion: Texture modified diets exhibit lower energy and macronutrient content, the main changes being detected for the liquid diet, which might imply an insufficient micronutrient supply.

Objetivo: Comparar la composición nutricional de las comidas principales en la dieta hospitalaria en general con los de las dietas modificadas para la consistencia (blanda, puré y líquida). Metodología: Se determinó el contenido de cenizas, humedad, nutrientes y energía de los alimentos de la comida principal de las dietas hospitalarias recogidas. Los valores fueron convertidos a cantidades per cápita establecidas para cada alimento de cada dieta y sumados con el fin de estimar el total ofrecido por la comida principal. Resultados: Las dietas líquida y puré tuvieron más humedad, reducción de 41 a 76.0% del contenido de grasas, reducción de 45.4 a 79.8% del contenido proteico y de 31.9 a 39.9% de la energía total. Conclusión: Las dietas de consistencia modificada presentaron una reducción en el contenido de energía y macronutrientes, encontrándose los principales cambios en la dieta líquida, lo que culminó en una probable disminución de la ingesta de micronutrientes.

Prevalência de sintomas osteomusculares entre trabalhadores de um Serviço de Nutrição Hospitalar em São Paulo, SP / Prevalence of musculoskeletal symptoms among hospital food service workers in São Paulo, Brazil

Objetivo: identificar a prevalência de sintomas osteomusculares entre trabalhadores de um serviço de nutrição de um hospital público. Método: estudo epidemiológico transversal com aplicação de questionários para 115 trabalhadores (representando 89% do quadro de pessoal) do serviço de nutrição de um hospital de cardiologia, em São Paulo, em 2007. O instrumento utilizado foi baseado no Questionário Nórdico de Sintomas Osteomusculares de Kuorinka et al. (1987) para identificação de dor ou desconforto relacionados ao trabalho, localização e tipo de queixa, além de caracterizar a frequência, a intensidade e a duração dos sintomas. Resultados: a média da idade dos trabalhadores foi de 37 ± 9,8 anos,81% eram do sexo feminino, 58% possuíam Ensino Médio e o tempo médio de trabalho foi de 9,3 ± 7,5 anos em jornada de trabalho de 40 horas semanais. Do total de participantes, 89% referiram dor ou desconforto relacionados ao trabalho no último ano em membros inferiores (65%), ombros (55%), região lombar (39%), região cervical (37%), mãos/punhos/dedos (29%), coluna (28%), antebraço (28%) e cotovelos (10%). O movimento de andar e transportar carga foi a causa mais citada para os sintomas (31%). Conclusão: entre os trabalhadores do serviço, aprevalência de sintomas osteomusculares foi alta, principalmente nos membros inferiores e nos ombros. Recomendam-se novas pesquisas que incluam a avaliação do ambiente e das atividades desenvolvidas pelos trabalhadores.

Objective: To identify musculoskeletal symptoms among workers from a food service of a public cardiologic hospital located in São Paulo, Brazil. Method:A cross sectional study was carried out in 2007, by applying questionnaires to 115 workers (89% of total staff). The instrument was based on the Nordic Questionnaire on Musculoskeletal Symptoms by Kuorinka et al. (1987), for identification of any kind of pain or discomfort related to work, its location, type of complaint, and frequency, intensity, and duration of symptoms. Results: The workers? average age was 37 ± 9.8 years, 81% were women, and 58% had highschool level. They had been working in the hospital for 9.3 ± 7.5 years, on a 40-hour week schedule. Most (89%) of the subjects reported pain or discomfortrelated to work during the last 12 months, mainly in lower limbs (65%). Other parts of the body mentioned by the workers were: shoulders (55%), lumbar region (39%), cervical region (37%), wrist/hands/fingers (29%), spine (28%), forearm (28%), and elbows (10%). The movements made while walking or carrying loads were the most reported cause of symptoms (31%). Conclusion: The study found a high prevalence of musculoskeletal symptoms among workers from the hospital food service, mainly in lower limbs and shoulders. It is recommended that futurestudies include assessment of environment and worker?s activities.

The Improvement of Hospital Food Service in Quality and Customer Satisfaction by Using 6-sigma Strategy

This study was performed to improve the hospital food service in quality and customer satisfaction by using 6-sigma strategy which was processed by DMAIC methods. The research procedure was as follows; analyzing the main causes of customer dissatisfaction of food service by using numerical method, and then finding out the standardized problem solving methods, and finally reforming food service process. The effectiveness of 6-sigma activity was measured by 'food service quality index', 'customer satisfaction index' and 'total food service satisfaction index'. Food service quality index was calculated by adding grade of soup temperature, food service, delivery time, and setting accuracy. Statistical data analyses were completed by using the Minitab Ver. 14. By performing 6 sigma activity, food service quality index was increased from 67 to 79 points (p<0.05) and customer satisfaction index also rise from 73 to 79points (p<0.05). Satisfaction of meals' taste, diverse menu, food setting accuracy, remove of food service, overall food service were significantly improved(p<0.05). The results of capability analysis in food service quality index, customer satisfaction index, and total food service satisfaction index were improved 2.11sigma to 2.49sigma , 1.88sigma to 2.43sigma, and 2.04sigma to 2.47sigma respectively (p<0.05). Therefore this study showed that subjective food service improving process could be measured by objective numerical value which might be used for financial value in hospital management.

Avaliação da qualidade de unidades de alimentação e nutrição (UAN) hospitalares: construção de um instrumento / Quality evaluation unit of food and nutrition (UAN) hospital: construction of an instrument

Com a finalidade de assegurar a qualidade da alimentação servida em uma Unidade de Alimentação e Nutrição (UAN) hospitalar, vários cuidados precisam ser adotados em razão do seu complexo funcionamento. Uma forma de monitorar essa qualidade seria a avaliação feita pelos serviços de Vigilância Sanitária; entretanto, não se dispõe de legislação específica nem de instrumento capaz de proporcionar a máxima precisão. O objetivo deste trabalho foi construir e validar o conteúdo de um instrumento, denominado Instrumento de Avaliação de Unidades de Alimentação e Nutrição (IAUAN) para avaliar a qualidade dessas unidades hospitalares no aspecto das condições higiênico-sanitárias. Este foi construído mediante estudo metodológico e com base nas dimensões de estrutura, dos processos e dos resultados, fundamentados na legislação geral sobre alimentos, na literatura científica, em instrumentos já utilizados por alguns serviços de Vigilância Sanitária e na experiência prática do autor. Para a validação do conteúdo do instrumento empregou-se o método Delphi, de consenso, adaptado. Participaram desse processo dez especialistas das áreas de Segurança Alimentar, Vigilância Sanitária ou Nutrição em Unidade de Alimentação e Nutrição Hospitalar...

To assure the quality of the food or meals served by a hospital food service some cares need to be taken especially considering its complexity. It is a unit production that involves not only different sorts of materials and human resources as well as equipment and routines. Therefore, such unit ought to have mechanisms to guarantee the quality of the food supplied. A way to monitor such quality would be the assessment conducted by services of sanitary monitoring. Nevertheless , there is neither a specific legislation nor a specific instrument able to evaluate the quality of this service with maximumprecision. The purpose of this study was to construct and to validate an instrument to evaluate the quality of the hospital food service concerning the hygienical sanitary conditions. The instrument was constructed based on the dimensions of structure, processes and results, on the general legislation on foods, on scientific literature, on instruments which have already been used by some services of Sanitary Monitoring and on the experience of the author. For the validation of the content of the instrument an adapted version of the Delphi method, of consensus, was used. Ten experts from the areas of Alimentary Security, Sanitary Monitoring or Nutrition in food service and Hospital Nutrition agreed to participate. They were requested to give their opinion regarding the instrument as a whole, so as to the way the questions were presented and their comprehension. Moreover, they could suggest the modification or the exclusion as well as the inclusion of new questions. The specialists had to analyze the described parameters mentioned above and also they were supposed to classify each question in Recommendable (R), Necessary (N) Essential (I) and Informative(INF)...

A Study on the Status of contract managed hospital food services

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.

A Study on the Status of contract managed hospital food services

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.