Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review.

CONTEXT: The safety of enteral formulas is important to restore and maintain the health of patients. OBJECTIVE: A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home. DATA SOURCES: A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature. DATA EXTRACTION: Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used. DATA ANALYSIS: Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent. CONCLUSIONS: A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022367573.

Irregularidades registradas durante inspeções sanitárias em restaurantes e similares / Irregularities recorded during sanitary inspections in restaurants and similar

Identificar irregularidades em restaurantes pode auxiliar a minimizar riscos de contaminação. O objetivo desse estudo foi analisar as irregularidades registradas em inspeções sanitárias de restaurantes e similares em Curitiba, Brasil, entre 2005 a 2017. A descrição das irregularidades foi organizada seguindo as categorias e os itens da legislação de Boas Práticas (BP) para serviços de alimentação do Brasil e as cinco chaves para uma alimentação mais segura, definidas pela Organização Mundial da Saúde. Do total de 4.098 registros, houve a descrição de 8.327 irregularidades. Em relação às BP, houve a prevalência da descrição de irregularidades nos anos de 2005, 2006 e 2013, e das categorias: edificações, instalações, equipamentos, móveis e utensílios (42,80%); preparação do alimento (11,54%); documentação e registro (9,92%) e matéria-prima, ingredientes e embalagens (9,06%). Em relação às cinco chaves para uma alimentação mais segura, apenas 3.209 (38,53%) descrições correspondiam a esse tema, com destaque a: manter a limpeza (40,70%) e usar água e matérias-primas seguras (34,71%). Houve uma tendência decrescente na descrição das irregularidades no período estudado, porém ainda é um desafio implementar as BP em restaurantes e similares no Brasil, o que pode favorecer a ocorrência de doenças e aumentar o risco à saúde da população.

Identifying irregularities in restaurants can help minimize contamination risks. The objective of this study was to analyze the irregularities recorded in sanitary inspections of restaurants and similar establishments in Curitiba, Brazil, between 2005 and 2017. The description of the irregularities was categorized following the items and criteria outlined in the Good Practices (GP) legislation for food services of Brazil and the Five Keys to Safer Food, defined by the World Health Organization. Out of the total of 4,098 records, 8,327 irregularities were documented. Concerning GP, there was a prevalence of irregularities described in the years 2005, 2006 and 2013, mainly in the following categories: buildings, installations, equipment, furniture and utensils (42.80%); food preparation (11.54%); documentation and registration (9.92%) and raw materials, ingredients and packaging (9.06%). Regarding the Five Keys to Safer Food, only 3,209 (38.53%) corresponded to this theme, with particular emphasis on maintaining cleanliness (40.70%) and using safe water and raw materials (34.71 %). The study observed a declining trend in the description of irregularities over the study period. However, the successful implementation of GP in restaurants and similar establishments in Brazil remains a challenge, potentially favoring the occurrence of foodborne diseases and increasing the risk to public health.

Checklist to assess food safety when handling home enteral nutrition.

BACKGROUND: Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN). METHODS: This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases. RESULTS: The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended. CONCLUSION: The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.

Microbiological quality of enteral formulations handled at home: A systematic review.

BACKGROUND: Studies have shown an increase in the number of patients who use enteral nutrition at home and the benefits of this type of nutrition care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS: This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies that microbiologically analyzed homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS: Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n = 73) of the HEPs, 81.96% (n = 50) of the BEPs, and 44.87% (n = 35) of the CEFs. The presence of 10 different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION: The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling.

Does the nutritional composition and category of administered enteral nutrition affect the nutritional status of patients receiving home nutritional therapy?

BACKGROUND & AIMS: Home enteral nutrition is a nutritional intervention that can help in the recovery of health after hospital discharge. The objectives of this study were to evaluate the nutritional composition of different categories of enteral nutrition administered to patients at home, the relationship with their nutritional status, and to compare the nutritional recommendations to the nutritional content provided by the different categories of enteral nutrition. METHODS: 111 samples of homemade enteral preparations (HEP), blended enteral preparations (BEP) and commercial enteral formulas (CEF) were collected from patients' homes. Physicochemical analyses were performed on the enteral formulations, and anthropometric and body composition evaluations were performed on the patients. Comparisons between the infused and prescribed nutritional content were performed. Shapiro-Wilk, Wilcoxon, and Kruskal-Wallis tests with post hoc DMS were conducted. RESULTS: The enteral nutrition categories demonstrated adequacy in relation to the physical analyses. The energy content was similar among the evaluated categories. The BEP and CEF presented higher levels of total solids, proteins, lipids, caloric density and non-protein calories; they also had a lower volume of infused/day content, and both were classified as normocaloric. The HEP were classified as hypocaloric. Regarding the infused content in relation to the recommended content, the HEP presented lower levels of protein and lipids; the CEF showed lower lipid and carbohydrate content, and the BEP presented adequacy in all nutrients. Most of the evaluated anthropometric parameters did not differ between the enteral nutrition categories. The anthropometric indicator of arm circumference (cm and %) was higher in patients receiving CEF and BEP, and the triceps skin fold (mm) was higher in patients receiving CEF and HEP. CONCLUSIONS: It is recommended to review the macronutrient content in nutritional prescriptions, regardless of the enteral nutrition category used. Most anthropometric parameters did not differ between the categories of enteral nutrition administered, especially those that were indicative of lean body mass.

Macronutrients and energy in home-prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis.

BACKGROUND: The effectiveness of home enteral nutrition depends on the supply and delivery of the prescribed nutrients. This study compared the macronutrient and energy values of home-prepared enteral tube feeding analyzed in the laboratory with the same information calculated from labels and food composition tables. METHODS: A total of 107 enteral formulations were analyzed: 66 commercial enteral formulas (CEFs), 19 homemade enteral preparations, and 22 blended enteral preparations (BEPs). The values of macronutrients and energy and the ratio between the values found in the laboratory and the calculated values were all evaluated. The tolerance limit of acceptable variation was 20%. The results were subjected to chemometric methods using principal component analysis (PCA) and hierarchical cluster analysis (HCA). RESULTS: In the three categories of the enteral formulations, the calculated values for protein and fat were higher than those obtained in the laboratory. The calculated values for energy were higher than those obtained in the laboratory for the BEPs and CEFs. The CEFs had the highest percentage within the limit of acceptable variation for carbohydrate and protein, whereas the BEPs presented the lowest values for fat and energy. In the exploratory analysis of data using PCA and HCA, it was possible to verify similarities and discrepancies between the enteral formulations analyzed in the laboratory with those calculated from the labels and food composition tables. CONCLUSION: The enteral formulations showed differences between the values of macronutrients and energy analyzed in the laboratory and those calculated from labels and/or food composition tables.

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler.

BACKGROUND: Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics. METHODS: We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire. RESULTS: 82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training." CONCLUSION: Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Conhecimento e uso de rótulos nutricionais por consumidores / Consumers' knowledge and use of nutritional information on food labels

A rotulagem de alimentos é importante para a comunicação entre produtores e consumidores. No entanto, para ajudar os consumidores a ter maior autonomia em suas escolhas alimentares, é importante interpretar corretamente a rotulagem dos alimentos. Assim, esta pesquisa avaliou o conhecimento e o uso das informações nutricionais apresentadas nos rótulos dos alimentos. Pesquisa quantitativa, exploratória e transversal, realizada em 2018 em uma universidade pública no Brasil, com 415 consumidores com 18 anos ou mais. Para avaliar o conhecimento, aplicouse questionário estruturado com pontuação de 0 a 24. Os dados foram analisados por meio de análise descritiva, correlação de Spearman e teste de Kruskal-Wallis e Mann Whitney. Participaram indivíduos com idade de 21,02 ± 2,89 anos, dos quais 58,31% eram do sexo feminino. Muitos consumidores liam frequentemente os rótulos dos alimentos (56,39%). A pontuação média de conhecimento foi de 14,99 ± 4,12. A média do escore de conhecimento foi afetada pela idade (p = 0,039) e renda (p = 0,020). Os participantes que utilizaram alegações nutricionais como critério de compra (p = 0,004) obtiveram maiores pontuações. Os maiores problemas na interpretação dos rótulos nutricionais estavam relacionados às reivindicações obrigatórias de nutrientes e aos termos "zero gordura trans (0%)", "alimento funcional", "diet" e "light". Considerando que a regulamentação dos rótulos de alimentos está em processo de revisão no Brasil, torna-se importante pesquisar seu uso e conhecimento por consumidores adultos jovens. Isso contribuirá para a discussão da revisão da legislação, além de ajudar os profissionais a orientarem os consumidores na interpretação dos rótulos. (AU)

Food labelling is important to communication between food producers and consumers. For consumers to have greater autonomy in terms of their food choices, it is important to facilitate a correct interpretation about what is on a food label. This paper assessed consumers' knowledge and use of nutritional information on food labels. Cross-sectional exploratory quantitative, "blind" research carried out in 2018 in a public university in Brazil, with 415 consumers aged 18 years or older. A structured questionnaire with a score ranging from 0 to 24 was applied. Descriptive analysis, Spearman correlation coefficient, the Kruskal-Wallis test and the Mann Whitney test were employed. Participants were individuals aged 21.02 ± 2.89 years, of which 58.31% were female. Many consumers reported they read food labels frequently (56.39%). The mean score was 14.99 ± 4.12. The knowledge score mean was affected by age (p =0.039) and income (p = 0.020). Participants who used nutritional claims as a criterion for purchase (p = 0.004) had higher scores. The biggest issues in interpreting nutritional labels were related to mandatory nutrient claims and the terms "trans-fat free (0%)", "functional food", "diet" and "light". Food label regulation is a process currently under review in Brazil, so research on the use and knowledge of nutritional information on food labels by young adult consumers becomes important. It will contribute to the discussion of the revision of legislation, as well as helping professionals guide consumers in the interpretation of labels. (AU)

Use of nutritional food labels and consumers confidence in label information / Uso da rotulagem nutricional e percepção sobre a confiabilidade das informações por consumidores

ABSTRACT Objective This investigation evaluated the use of food labels and consumers' perception of the reliability of food labels nutritional information. Methods This is a transversal exploratory quantitative investigation, carried out in Curitiba, Brazil. A total of 536 students from a public institution participated in the survey answering a structured questionnaire. Descriptive analyses, Chi-Square test and Fisher's exact test were performed considering a significance level of 5%. Results The participants' mean age was 21.11±2.83 years, and 59.3% were female. It was noticed that 41.6% of consumers used the nutritional information sometimes and 14.7% always, mainly because they liked to know what they were buying and consuming (35.8%). Lack of patience (29.5%) and concern about the composition of the food purchased (34.2%) were the main reasons for not using the information provided. The most commonly used nutrition claim was "trans fat-free" (42.5%) and the type of food in which nutrition labeling was used most was milk and dairy products (42.0%). Frequent use of nutritional information was higher among women (p<0.01) and among those who practice physical activity (p=0.04). Many individuals relied on food labels nutritional information (61.9%), but out of these, 43.6% did not use that information at the time of purchase. There was no difference between respondents' confidence in the information, sociodemographic and health data. Conclusion Many people still do not use the label nutrition information. Efforts should be made to change this scenario. Changes in nutrition labeling can help modify this situation, with the use of clearer label information, more easily understood, that does not raise any doubts in the consumers' mind.

RESUMO Objetivo Este estudo avaliou o uso da rotulagem nutricional e a percepção sobre a confiabilidade das informações por consumidores. Métodos Pesquisa transversal, exploratória e de abordagem quantitativa, realizada no município de Curitiba, Brasil. Participaram 536 estudantes, de uma instituição pública, respondendo um questionário estruturado. Foram realizadas análises descritivas, teste Qui-Quadrado e teste exato de Fisher, considerando nível de significância de 5%. Resultados A idade média dos participantes foi 21,11±2,83 anos, sendo 59,3% do sexo feminino. Quanto ao uso das informações nutricionais, 41,6% utilizavam às vezes e 14,7% sempre, principalmente porque gostavam de saber o que estavam comprando e consumindo (35,8%). A falta de paciência (29,5%) e de preocupação com a composição do alimento comprado (34,2%) foram os principais motivos pelos quais não utilizarem as informações. A alegação nutricional mais utilizada foi "sem gordura trans" (42,5%) e o tipo de alimento em que mais se utilizou a rotulagem nutricional foi leite e derivados (42,0%). O uso frequente das informações nutricionais foi maior entre as mulheres (p<0,01) e os praticantes de atividade física (p=0,04). Muitos indivíduos confiavam nas informações presentes nos rótulos dos alimentos (61,9%), porém, destes, 43,6% não as utilizavam no momento da compra. Não foram observadas diferenças entre a confiança das informações, os dados sociodemográficos ou de saúde dos entrevistados. Conclusão Muitas pessoas ainda não usam as informações nutricionais, sendo necessário esforços para mudar este panorama. Alterações na rotulagem nutricional podem mudar este processo, com o uso de informações mais claras, de fácil entendimento, que não gerem dúvida ao consumidor.

Qualidade da água utilizada por food trucks em eventos de rua / Quality of water used by food trucks in street events

Objetivou-se a qualidade água utilizada por food trucks em eventos de rua em Curitiba, Paraná. Em 38 food trucks, foi aplicado um instrumento para avaliar a higiene da água, um teste colorimétrico foi utilizado para avaliar cloro e pH e verificou-se a presença de Escherichia coli, coliformes totais, Pseudomonas aeruginosa e bactérias heterotróficas nas amostras de água. Constatou-se baixo nível de cloro na água e a higienização do reservatório foi deficiente, sendo que estes foram os que apresentaram maior contaminação por bactérias heterotróficas. Conclui-se a necessidade dos food trucks reavaliar os critérios de higienização do reservatório de água, bem como o controle e manutenção do cloro para minimizar os riscos de contaminação existentes na água utilizada nos eventos de rua.

Riscos microbiológicos e higiene das mãos de manipuladores e superfícies utilizadas por food trucks em eventos de rua / Microbiological risks and hygiene of handlers 'hands and surfaces used by food truck in street events

Avaliou-se os riscos microbiológicos e a higiene das mãos e superfícies de manipulação utilizadas por food truck em eventos de rua. O estudo foi realizado com 38 manipuladores e 38 superfícies de food trucks de Curitiba, Paraná. Os critérios de higiene foram avaliados através de uma lista de verificação. Verificou-se ainda a presença de Staphylococcus aureus, Escherichia coli e aeróbios mesófilos nas mãos e superfícies de manipulação. Constatou-se baixo percentual de adequação nos critérios de higiene da superfície e das mãos. Na análise microbiológica, 7,89% mãos apresentaram contaminação, enquanto que esse resultado foi encontrado em 39,47% das superfícies. Conclui-se que os riscos microbiológicos são evidentes e que as práticas de higiene das superfícies e das mãos dos manipuladores de food trucks precisam ser reavaliadas durante os eventos.

Satisfaction of nutritionists who work in food service / Satisfação dos nutricionistas que atuam na alimentação coletiva

ABSTRACT Objective To evaluate the job satisfaction of nutritionists who work in food service in the state of Paraná (Brazil). Methods A survey was carried out with 249 nutritionists through a semi-structured online questionnaire, which assessed their profile, professional activities, and job satisfaction. The Mann-Whitney and Kruskal-Wallis tests and the ordinal logistic regression at a 5% significance level were applied to evaluate the differences and relationship between job satisfaction and the independent variables. Results The average age of the survey participants was 31.9±6.4 years, the majority was female (95.58%), and graduated between 2000 and 2016 (90.36%). The survey revealed that 55.41% of the nutritionists were satisfied at work, 33.68% were indifferent, 6.86% were highly satisfied, and 4.04% were dissatisfied. The variables that influenced job satisfaction the most were age, years of training, income, and workdays in the week. Income explained satisfaction positively. There was statistical difference in relation to the satisfaction of participants regarding their knowledge on food service (p=0.0350), completion of postgraduate courses (p=0.0082), and interest in working in an area of nutrition other than food service (p<0.0001). Conclusion Although most professionals are satisfied, many were indifferent to job satisfaction, which may reflect a low perspective on their current job or poor experience in the food service. These results suggest the need for further actions aiming at raising nutritionists' perceived professional importance.

RESUMO Objetivo Avaliar a satisfação no trabalho dos nutricionistas que atuam na área de alimentação coletiva no estado do Paraná. Métodos Pesquisa realizada com 249 nutricionistas, por meio de um questionário semiestruturado online, que avaliou o perfil, o exercício profissional e a satisfação do nutricionista. O teste Mann-Whitney, Kruskal-Wallis e a regressão logística ordinal com nível de significância de 5% foram utilizados para avaliar a diferença e relação entre a satisfação e as variáveis. Resultados A idade média dos respondentes foi de 31,9±6,4 anos, sendo a maioria do sexo feminino (95,58%) e graduado entre 2000 e 2016 (90,36%). Constatou-se que 55,41% dos nutricionistas estavam satisfeitos no trabalho, 33,68% indiferentes, 6,86% altamente satisfeitos e 4,04% insatisfeitos. As variáveis que mais influenciaram a satisfação foram a idade, os anos de formação, o salário e os dias da semana de trabalho, sendo que a renda explicou positivamente a satisfação. Houve diferença estatística com relação à satisfação dos participantes com a avaliação do conhecimento sobre alimentação coletiva (p=0,0350), a realização de pós-graduação (p=0,0082) e o interesse em atuar em outra área da nutrição que não a alimentação coletiva (p<0,0001). Conclusão Apesar de a maioria dos profissionais estarem satisfeitos, muitos foram indiferentes à satisfação no trabalho, podendo refletir ausência de perspectiva sobre seu trabalho atual ou indicar a falta de familiaridade com a alimentação coletiva. Os dados indicam a necessidade de mais ações de valorização junto a esses profissionais.

Condições higienicossanitárias em serviços de nutrição hospitalar durante período de intervenção / Hygienic-sanitary conditions in hospital nutrition services during intervention period

O objetivo do estudo foi avaliar as condições higienicossanitárias de serviços de nutrição hospitalar,durante período de intervenção sistemática, baseado nos requisitos de higiene pessoal e ambiental. Foram avaliadas 15 unidades, por meio de lista de verificação e realizou-se análise microbiológica das mãos dos manipuladores e superfícies de apoio, antes e após intervenção. A intervenção foi elaborada e implementada nos serviços de nutrição hospitalar, durante um ano, por profissionalterceirizado, sendo composto por três etapas: 1) aplicação da lista de verificação e plano de ação; 2) capacitações; 3) visitas mensais para motivação dos manipuladores e responsáveis técnicos, auxílio e acompanhamento na implementação dos requisitos de higiene pessoal e ambiental. Foram avaliados os microrganismos aeróbios mesófilos, Staphylococcus aureus, coliformes totaise termotolerantes. Constatou-se que os serviços de nutrição hospitalar melhoraram as condições de higiene pessoal e ambiental e diminuíram a contaminação nas mãos e superfícies,após intervenção. Conclui-se que a intervenção sistemática por profissional externo auxiliou na adequação das condições higienicos sanitárias nos serviços de nutrição hospitalar e proporcionou mudanças positivas no comportamento dos manipuladores.

The objective of the study was to evaluate the hygienic-sanitary conditions in hospital nutrition services during of systematic intervention period based on requirements for personal andenvironmental hygiene. Fifteen hospital nutrition services were evaluated using a checklist and a microbiological analysis of the hands of food handlers and surfaces in contact with foods, before and after the intervention. The intervention was developed and conducted at the locations for one year by a third-party professional and included three stages: 1) application of checklist and action plan; 2) trainings; 3) monthly visits for motivation of handlers, supervisory technicians,and assistance and supervision in the implementation of the requirements regarding personal and environmental hygiene. The aerobic mesophilic microorganisms were studied as wellas Staphylococcus aureus, total coliforms and thermotolerant coliforms. It was found that the personal hygiene and environmental conditions at the hospital nutrition services improved andthere was decreased contamination of hands and surfaces after intervention. It was concluded that the systematic intervention by outside professional helped hygienic-sanitary conditions in hospital nutrition services meet the requirements and provide positive changes in the conduct of foodhandlers.

Condições higienicossanitárias em serviços de nutrição hospitalar durante período de intervenção / Hygienic-sanitary conditions in hospital nutrition services during intervention period

O objetivo do estudo foi avaliar as condições higienicossanitárias de serviços de nutrição hospitalar, durante período de intervenção sistemática, baseado nos requisitos de higiene pessoal e ambiental. Foram avaliadas 15 unidades, por meio de lista de verificação e realizou-se análise microbiológica das mãos dos manipuladores e superfícies de apoio, antes e após intervenção. A intervenção foi elaborada e implementada nos serviços de nutrição hospitalar, durante um ano, por profissional terceirizado, sendo composto por três etapas: 1) aplicação da lista de verificação e plano de ação; 2) capacitações; 3) visitas mensais para motivação dos manipuladores e responsáveis técnicos, auxílio e acompanhamento na implementação dos requisitos de higiene pessoal e ambiental. Foram avaliados os microrganismos aeróbios mesófilos, Staphylococcus aureus, coliformes totais e termotolerantes. Constatou-se que os serviços de nutrição hospitalar melhoraram as condições de higiene pessoal e ambiental e diminuíram a contaminação nas mãos e superfícies, após intervenção. Conclui-se que a intervenção sistemática por profissional externo auxiliou na adequação das condições higienicossanitárias nos serviços de nutrição hospitalar e proporcionou mudanças positivas no comportamento dos manipuladores.

The objective of the study was to evaluate the hygienic-sanitary conditions in hospital nutrition services during of systematic intervention period based on requirements for personal and environmental hygiene. Fifteen hospital nutrition services were evaluated using a checklist and a microbiological analysis of the hands of food handlers and surfaces in contact with foods, before and after the intervention. The intervention was developed and conducted at the locations for one year by a third-party professional and included three stages: 1) application of checklist and action plan; 2) trainings; 3) monthly visits for motivation of handlers, supervisory technicians, and assistance and supervision in the implementation of the requirements regarding personal and environmental hygiene. The aerobic mesophilic microorganisms were studied as well as Staphylococcus aureus, total coliforms and thermotolerant coliforms. It was found that the personal hygiene and environmental conditions at the hospital nutrition services improved and there was decreased contamination of hands and surfaces after intervention. It was concluded that the systematic intervention by outside professional helped hygienic-sanitary conditions in hospital nutrition services meet the requirements and provide positive changes in the conduct offood handlers.

Good hygiene practices in hospital nutrition services: the view of internal and external auditors

The objective of this study was to evaluate the hygienic-sanitary conditions of hospital nutrition services according to internal and external auditors, before and after intervention, based on the requirements of Good Hygiene Practices. Fifteen hospital nutrition services were evaluated based on a checklist applied by internal auditors and by an external auditor. The intervention program was prepared and implemented in all the locations over one year, and was composed of four points: 1) training; 2) preparation of the action plan; 3) preparation of the documentation; 4) monthly visits to motivate the food handlers and responsible technicians, accompaniment and assistance in the implementation of Good Hygiene Practices. An improvment in the application of Good Hygiene Practices was observed in the hospital nutrition services after the systematic intervention, in the view of both the internal and external auditors, except the requirement related to operational aspects, which had a low percentage of adequacy, both before and after the intervention Before the intervention, there was a significant difference between the evaluation of the internal auditors and the external auditor, which was not found later. These results suggest that the systematic intervention assisted in the adoption of Good Hygiene Practices by hospital nutrition services, according to both the internal and external auditors, and contributed to increasing the knowledge of the internal auditors.(AU)

Diagnóstico e adequação das boas práticas em área de alimentos e bebidas de hotéis: aspectos relacionados à higiene pessoal e ambiental / Diagnostic and adequacy of the best practices in the area of hotel foods and beverages: factors related to the personal and environmental hygiene

Neste estudo foram avaliadas as condições higiênico-sanitárias das mãos dos manipuladores e das superfícies de apoio na área de manipulação de alimentos e bebidas de hotéis, antes e após a aplicação de estratégia de intervenção. Foram avaliadas duas áreas de alimentos e bebidas de hotéis de Curitiba/PR, por meio de uma lista de verificação contendo critérios de higiene pessoal e ambiental, bem como pela análise microbiológica das amostras coletadas das mãos dos manipuladores e das superfícies de apoio, em dois momentos, antes e após a aplicação de estratégia de intervenção. A estratégia de intervenção foi implementada durante dois meses, com acompanhamento semanal por um profissional terceirizado, que auxiliou na elaboração do plano de ação e nas melhorias necessárias em relação à higiene pessoal e ambiental. Pesquisaram-se os micro-organismos aeróbios mesófilos e coliformes termo tolerantes nas amostras. Constatou-se que, após a estratégia de intervenção, os hotéis apresentaram melhorias em relação à higiene pessoal e ambiental; e na segunda avaliação, houve diminuição na contagem de micro-organismos aeróbios mesófilos nas mãos e nas superfícies em contato. A estratégia de intervenção foi eficiente na melhoria das condições higiênico-sanitárias, e a visão do profissional externo contribuiu na adequação das atividades de rotina.

The aim of this study was to evaluate the hygienic-sanitary conditions of the hands of food handlersand of the surfaces in contact with foods in the hotel food and beverage area, before and after applyingthe intervention strategy. Two hotel food and beverage areas in Curitiba/PR, were evaluated usinga checklist including personal and environmental hygienic criteria. Also, microbiological analyseswere performed in samples collected from the handlers hands and from the surfaces in contact withfoods, at two moments, before and after applying the intervention strategy. The intervention strategywas carried out for two months, with weekly monitoring by an outsourced professional, who assistedin the elaboration of the action plan and in the necessary improvements related to personal and environmentalhygiene. The aerobic mesophilic microorganisms and thermotolerant coliforms were analyzed in thecollected samples. The investigated hotels showed improvements in the personal and environmentalhygiene and there was a decrease in the aerobic mesophilic microorganisms counting in handsand in contact surfaces. The intervention strategy was efficient for improving the hygienic-sanitaryconditions, and the vision of outsourced professional contributed to the adequacy of the routine activities.

Diagnóstico e adequação das Boas Práticas em área de alimentos e bebidas de hotéis: aspectos relacionados à higiene pessoal e ambiental / Diagnostic and adequacy of the Best Practices in the area of hotel foods and beverages: factors related to the personal and environmental hygiene

Neste estudo foram avaliadas as condições higiênico-sanitárias das mãos dos manipuladores e das superfícies de apoio na área de manipulação de alimentos e bebidas de hotéis, antes e após a aplicação de estratégia de intervenção. Foram avaliadas duas áreas de alimentos e bebidas de hotéis de Curitiba/PR, por meio de uma lista de verificação contendo critérios de higiene pessoal e ambiental, bem como pela análise microbiológica das amostras coletadas das mãos dos manipuladores e das superfícies de apoio, em dois momentos, antes e após a aplicação de estratégia de intervenção. A estratégia de intervenção foi implementada durante dois meses, com acompanhamento semanal por um profissional terceirizado, que auxiliou na elaboração do plano de ação e nas melhorias necessárias em relação à higiene pessoal e ambiental. Pesquisaram-se os micro-organismos aeróbios mesófilos e coliformes termotolerantes nas amostras. Constatou-se que, após a estratégia de intervenção, os hotéis apresentaram melhorias em relação à higiene pessoal e ambiental; e na segunda avaliação, houve diminuição na contagem de micro-organismos aeróbios mesófilos nas mãos e nas superfícies em contato. A estratégia de intervenção foi eficiente na melhoria das condições higiênico-sanitárias, e a visão do profissional externo contribuiu na adequação das atividades de rotina.

The aim of this study was to evaluate the hygienic-sanitary conditions of the hands of food handlers and of the surfaces in contact with foods in the hotel food and beverage area, before and after applying the intervention strategy. Two hotel food and beverage areas in Curitiba/PR, were evaluated using a checklist including personal and environmental hygienic criteria. Also, microbiological analyses were performed in samples collected from the handlers hands and from the surfaces in contact with foods, at two moments, before and after applying the intervention strategy. The intervention strategy was carried out for two months, with weekly monitoring by an outsourced professional, who assisted in the elaboration of the action plan and in the necessary improvements related to personal and environmental hygiene. The aerobic mesophilic microorganisms and thermotolerant coliforms were analyzed in the collected samples. The investigated hotels showed improvements in the personal and environmental hygiene and there was a decrease in the aerobic mesophilic microorganisms counting in hands and in contact surfaces. The intervention strategy was efficient for improving the hygienic-sanitary conditions, and the vision of outsourced professional contributed to the adequacy of the routine activities.

Boas práticas em serviços de alimentação do mercado municipal de Curitiba-PR / Good practices in food services at the municipal market of Curitiba – PR

Os mercados municipais localizados nas grandes cidades brasileiras são considerados pontos turísticos importantes e devem dispor de alimentos e serviços de qualidade. O objetivo do estudo foi de avaliar as Boas Práticas em Serviços de Alimentação do mercado municipal de Curitiba, Paraná. Foram avaliados seis estabelecimentos, por meio de lista de verificação, observando-se os requisitos de Boas Práticas, que foi aplicada por profissional capacitado na área de segurança dos alimentos. Calculou-se o percentual de adequação geral e por requisitos, e os Serviços de Alimentação foram classificados em Grupo 1- de 76 a 100 % de atendimento dos itens; Grupo 2-de 51 a 75 % e Grupo 3- de 0 a 50 %.Todos os estabelecimentos foram classificados no Grupo 2 e o maior percentual de adequação foi o controle integrado de vetores e pragas urbanos e o abastecimento de água, com 100 % de conformidade. Os requisitos de documentação, registros e responsabilidades não apresentaram itens adequados. Conclui-se que há necessidade de melhoraria nos requisitos exigidos quanto às Boas Práticas para Serviços de Alimentação, principalmente nos itens documentação, registros e responsabilidade, que são essenciais para a organização, padronização das atividades de rotina e contribuição para oferta de alimentos seguros.

The municipal markets located in the large Brazilian cities are considered as important touristic spots, and they ought to provide high quality food and service. This study evaluated the Good Practices in Food Services at the Municipal Market of Curitiba, Paraná. Six establishments were evaluated by means of a checklist covering the Good Practice requirements, which was applied by a food-safety trained professional. The percentages of overall adequacy and of every requisite were calculated, and the Food Services were classified into Group 1- reaching 76-100 % of items; Group 2- 51-75 %; Group 3- 0-50 %. All of the evaluated markets were classified into Group 2, and the highest adequacy percentages were in the integrated urban vector and pest control and in the water supply, showing 100 % of compliance. The requirements on documentation, records and responsibilities did not reach any adequacy. The evaluated Food Services should be improved in the requirements for Good Practices, especially regarding to the documentation, records and responsibility items, as they are essential for the organization, standardization of the routine activities and for subsiding the safe food tender.

Avaliação da implementação das boas práticas de manipulação em unidade de acolhimento institucional por meio de um Programa de Incentivo fiscal e capacitação / Evaluation of the implementation of good handling practices in an institutional inclusion unit through a tax incentive Program and training

O objetivo deste estudo foi de avaliar a implementação das Boas Práticas de Manipulação em Unidade de Acolhimento Institucional de Santa Maria/RS, por meio de um programa de incentivo fiscal e capacitação, e o efeito do investimento realizado. No primeiro mês, aplicou-se uma lista de verificação para avaliar as Boas Práticas de Manipulação. Posteriormente elaborou-se um plano de ação para ajustar as não conformidades, levantar os custos e encaminhar o projeto para aprovação. Após aprovação, realizou-se a capacitação e estipulou-se o prazo de oito meses para efetuar adequação dos itens. No último mês aplicou-se novamente a lista de verificação. Na primeira aplicação, a Unidade apresentou 38 % de adequação; e após os investimentos a conformidade foi de 93 %. Nesta primeira aplicação, os itens controle integrado de pragas, documentação e registro, e responsabilidade não apresentaram adequação. Após os investimentos, estes itens e o abastecimento de água, manejo de resíduos, matéria-prima, ingredientes, embalagem, armazenamento e transporte do alimento preparado obtiveram 100 % de adequação; e o item com maior investimento foi de edificações, instalações, móveis e utensílios. Após a execução de investimento e capacitação houve aumento no percentual de adequação, em relação às Boas Práticas de Manipulação...