The health benefits and cost-effectiveness of complete healthy vending.

Vending machines contribute to growing levels of obesity. They typically contain energy dense, high fat snacks and attempts at persuading consumers to switch to healthier snacks sold within the same machine have had limited success. This study explored the health benefits and cost effectiveness of the complete replacement of regular snacks with healthy items. Two vending machines were manipulated in a 6-month trial, with a healthy and regular range of products alternated between the two machines every fortnight. Healthy vending resulted in a 61% drop in calories sold relative to regular vending, significant with time and product range as random factors. There was no evidence of compensatory behaviour from nearby shop sales nor in multi-item purchases from vending machines. The impact on profit was less clear. Sales dropped by 30% during healthy vending but variability across product range meant that the change was not significant. Overall our results demonstrate that complete healthy vending can be introduced in hospitals without a catastrophic loss in sales nor compensatory behaviours that offset the public health gains of consuming healthier products.

Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial.

BACKGROUND: Hospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options. METHODS: Hospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models. RESULTS: Data from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold. CONCLUSIONS: Simple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops. TRIAL REGISTRATION: Retrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).

Making hospital shops healthier: evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets.

BACKGROUND: The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. METHODS: The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n = 17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines), and (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n = 32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. RESULTS: All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS's impact, managers identified some opportunities in the scheme and positive changes in the supply chain. CONCLUSIONS: Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings.

Getting the balance right-tackling the obesogenic environment by reducing unhealthy options in a hospital shop without affecting profit.

Background: UK hospitals have been criticized for fuelling obesity by allowing contracts with food retailers selling high fat and high-sugar products on hospital premises. Methods: We assessed the impact for a major retailer of increasing healthy food choices at their Royal Free London NHS Foundation Trust outlet. To assess the impact on sales, profit and acceptability to customers, a multi-component intervention based on behavioural insights theory was enacted over 2 months (November-December 2014) at the Royal Free site WHSmith. Sales data on all food and drink were assessed over three time periods: (i) 2 months immediately prior to, and (ii) immediately after the intervention, and (iii) the equivalent period 10 months later. Acceptability to customers was assessed via questionnaires, and profit assessed as a proxy for retailer satisfaction. Results: Compared to the pre-intervention period, total sales increased immediately after the intervention, and again 10 months after the intervention. Sales of healthier options increased as a proportion of total sales following the intervention, sales of sweets and chocolates decreased, while the relative sales of other items remained similar. Conclusions: We demonstrated that healthier alternatives could be provided in a hospital retail premises without negatively affecting total sales, retailer or customer satisfaction.

Healthcare policy and healthcare utilization behavior to improve hospital infection control after the Middle East respiratory syndrome outbreak

The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule.

A national, cross-sectional survey of children's hospital-based safety resource centres.

OBJECTIVE: To describe the location, staffing, clientele, safety product disbursement patterns, education provided and sustainability of safety resource centres (SRCs) in US children's hospitals. METHODS: A cross-sectional survey was distributed to children's hospital-based SRC directors. Survey categories included: funding sources, customer base, items sold, items given free of charge, education provided and directors' needs. RESULTS: 32/38 (84.2%) SRC sites (affiliated with 30 hospitals) completed the survey. SRCs were in many hospital locations including lobby (28.1%), family resource centres (12.5%), gift shop/retail space (18.8%), mobile units (18.8%) and patient clinics (12.5%). 19% of respondents reported that their SRC was financially self-sustainable. Sales to patients predominated (mean of 44%); however, hospital employees made up a mean of 20% (range 0-60%) of sales. 78.1% of SRCs had products for children with special healthcare needs. Documentation kept at SRC sites included items purchased (96.9%), items given free of charge (65.6%) and customer demographics (50%). 56.3% of SRCs provided formal injury prevention education classes. The SRCs' directors' most important needs were finances (46.9%), staffing (50%) and space (46.9%). All of the directors were 'somewhat interested' or 'very interested' in each of the following: creation of a common SRC listserv, national SRC data bank and multisite SRC research platform. CONCLUSIONS: SRCs are located in many US children's hospitals, and can be characterised as heterogeneous in location, products sold, data kept and ability to be financially sustained. Further research is needed to determine best practices for SRCs to maximise their impact on injury prevention.

Consumer nutrition environments of hospitals: an exploratory analysis using the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops, 2012.

INTRODUCTION: Hospitals are the primary worksite of over 5 million adults in the United States, and millions of meals are procured and consumed in this setting. Because many worksite nutrition initiatives use an ecological framework to improve the dietary habits of employees, the nutrition values of foods served in hospitals is receiving attention. METHODS: This study used the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops to quantitatively describe the consumer nutrition environments of 39 hospitals in Southern California. Data were collected by visiting each facility once from February 2012 through May 2012. RESULTS: On average, hospitals achieved only 29%, 33%, and less than 1% of the total possible points for their cafeteria, vending machines, and gift shops sections, respectively; overall, hospitals scored 25% of the total possible points. Large facility size and contracted food service operations were associated with some healthy practices in hospital cafeterias, but we found no association between these variables and the sectional or overall nutrition composite scores. CONCLUSION: The average consumer nutrition environment of hospitals in this sample was minimally conducive to healthful eating. Nutrition-related interventions are warranted in hospital settings.

Retail renaissance.

FINANCE: Hospital gift shops are reinventing themselves as booming retail operations. FINANCE: The AHA's report on the capital crisis' impact on hospitals.

Listeria outbreak associated with sandwich consumption from a hospital retail shop, United Kingdom.

An outbreak of listeriosis occurred in the Swindon area of the UK in autumn 2003. Five cases were detected in pregnant women. Four of these women were thought to have eaten prepacked sandwiches from a retail outlet in one particular hospital. Sampling at the supplier detected Listeria monocytogenes, which was indistinguishable on molecular testing from the patients isolates. Recent changes in UK food legislation should help diminish the risk of further outbreaks/cases such as ours occurring.

Hospital hairdresser as a potential source of cross-infection with MRSA.

Following medical staff concerns about patients screening positive for methicillin-resistant Staphylococcus aureus (MRSA) from the hairline site only, it was suggested that the hospital hairdresser could be a possible source for cross-contamination. Analysis of her procedures and decontamination practices confirmed her to be a potential source. Swabbing of her equipment after a day's session with her normal cleansing practice revealed the presence of MRSA, confirmed by phage typing as an epidemic strain within the hospital. This provided putative evidence for a vehicle of transmission. A review of advice for hairdressers in hospitals was obtained from the literature and via a telephone survey of infection control nurses in London. A composite policy was produced for hairdressers attending MRSA-positive patients in hospital to minimize this potential risk.