Quality Indicators of Catering Services in a Hospital

1. Group Members of EPGDHA Batch 2013-2014
1. Dr. Susan Fernandes
2. Dr. Allan Pereira
3. Dr. Sreya Joseph
4. Mrs. Elizabeth David
5. Ms. Diana Vincent
6. Mr. Tapan Doshi
7. Mr. Sameer Shinde

2. Quality
Control
Equipments
Food
Cooked
Kitchen
Sanitation
Raw
Materials

3.  Quality Control of Food:
1. Its is very important to
maintain quality of food
2. Standardization of cooking
methods.
3. Regular Health Check up
of Kitchen Staff.
4. Regular Training in Food
Handling
5. Surprise testing of cooked
food by senior officials
 Quality Control of Area:
1. Schedule of Kitchen
Cleaning
2. Maintenance & calibration
of equipments.
3. Monitoring of Cold room,
Deep freezers &
Refrigerator
4. Method of Disposal of
waste
5. Proper ventilation &
smoke exhaust

4.  Hospital malnutrition & increased prevalence of hospitalized patients with
chronic diseases require hospital improvements in nutritional care quality.
 This presentation describes the construction of indicators to assess the quality
of hospital food & nutritional care.
 Design Nutritional Groups: each group has 4 indicators.
1. Nutritional Care Quality (NCQ) : It includes
a. Inpatient dietary coverage
b. Evaluation & monitoring of nutritional status
c. Integration of nutritional assistance activities within the team
d. Diet therapy.
1. Food Service Quality (FSQ): It includes
a. Mediation with users & other hospital sectors,
b. Autonomy & management control
c. Meal production
d. Staff qualification

5. There are nine meals in a day
 Bed tea
 Breakfast
 Mid morning
 Lunch soup
 Lunch
 Evening tea
 Dinner soup
 Dinner
 Health beverage

6.  NO DIET– “N” DIET [NIL ORALLY /NBM}.
 FLUID DIET– “F” DIET.
 SUBSISTENCE DIET –”S”DIET.
 CONVALESCENT DIET—”C”DIET.
 ORDINARY DIET – “O” DIET.
 HIGH PROTEIN DIET –”TB” DIET.
 DIABETIC DIET.
 SALT RESTRICTED DIET.
 BLAND DIET.
 EXTRAS ON DEMAND.

7. Sr. No Date : Time: Ward Comments
1 No. of beds
2 No. of Patients
3 No. of patients fasting
4 No. of patients requiring a meal
5 Time trolley left the kitchen
6 Time trolley arrived in ward
7 Time service commenced
8 Time service completed
9 No. of patients eating in this environment (Yes / No)
a In bed
b At bedside
c At table in bay
d Communal dinning room
10 Preparation All Most Some None
a
Was the patient provided help with using the
toilet and washing hands?
b
Were the bed tables & eating areas cleaned

8. Sr. No Meal Checking All Most Some None
11
Was the meal trolley large enough to carry
hot food?
12
Were the temperatures of the food recorded
on any of the services at the ward level
13
Were the meals checked against what the
meal had been ordered?
14
Did the patient/ clients receive his/ her
menu card along with the meal
Sr. No Meal Service & Beverage All Most Some None
15 Meal service carried out in pleasant manner
16 Appropriate crockery provided?
17 Patients/ clients proper identified?
18 Patients well seated for meal?
19 Lids / cling film removed?
20 Assistance given to cut food?
21 Nutritional intake noted?
22 Was water made available?
23
Was the meal accompanied by choice of
beverage ordered
Sr. No Interruptions All Most Some None
24 Did routine rounds disrupt patients meal?
25
Did the medicine trolley disrupt patients
meal?
26
Did blood test or others clinical
investigation disrupt patients meal
Had patient finished eating before the meal

9. Sr.
No
Details Accountable
Who carries out
the task?
1
Meal ordering fro e.g.: diet order form or
bulk order form, if applicable
2
Menu completion on behalf of individual
patients
3 Preparation of ward environment for meals
4 Preparation of patients for meals
5
Ensuring the patients receives the correct
meal
6 Distribution of meals
7 Assisting patients with feeding
8
Monitoring food consumption of
individual patients
9 Collection of plates
10
Dealing with complaints/ feedback on
catering services

10.  A strict check on the quality of the food prepared & served to
patients.
 Quality of food grains, raw vegetables, fruits, sweets beverages are
to be checked routinely
 Non veg items should be absolutely fresh if served.
 Quality of cooking medium & spices OF
 Supervisory visits /Quarterly quotations /Regular checks on the
dietary department.
 Good Physical layout ensuring easy workflow.
 Correct use of standardized recipes.
 Scientific technique& procedure for preparing each category of food
so that their natural flavor & nutritional value is not compromised.
 Progressive cooking & preparation of food in the shortest period of
time .
 Availability of Quality trained staff.
 Good management & supervision.

11.  A food borne hazard is a physical, chemical, or biological object in
food or drink that can cause injury or illness.
 Physical: Hard or soft objects in food that can cause injury. Eg:
broken glass, jewellery, adhesive bandages, staples, & fingernails.
 Chemical: Poisonous substances that occur naturally or are added
during food handling. Eg: include cleaning agents, pesticides, &
certain metals. Due to a broken valve in a soda machine.
 Biological: Germs that cannot be seen without a microscope. Eg:
parasites, bacteria & viruses. Several customers became infected
with hepatitis A after eating sandwiches prepared by an ill food
worker.

12.  Potentially Hazardous Foods
include:
 Animal Products
1. Meat, fish, poultry, seafood,
eggs
2. Dairy products
 Cooked Starches
a. Cooked rice, beans, pasta,
potatoes
 Fruits & Vegetables
a. Cooked vegetables
b. Tofu
c. Sprouts (such as alfalfa or
bean sprouts)
d. Cut melons
e. Garlic or herbs bottled in oil

13.  Food workers with good personal hygiene
 Food cooked to or held at correct
temperatures
 Prevention of cross contamination
Top three Food Safety Defences

14. Food workers, even if they look & feel healthy, may accidentally spread harmful
germs to food if they do not have good hygiene.
Food workers should work with food if they have:
 Diarrhoea, vomiting, or jaundice
 Diagnosed infections that can be spread through food such as Salmonella,
Shigella, E. coli, or hepatitis A
 Infected, uncovered wounds
 Continual sneezing, coughing, or runny nose

15. Proper food worker hygiene includes:
 Not working with food when you are sick
Washing your hands the right way & at the right time
 Using clean gloves & utensils when handling food
 Keeping fingernails trimmed so hands can be easily cleaned
8 Steps of HAND WASHING

16. Proper temperatures are required for
the safety of potentially hazardous
foods.
A thermometer must be used to make
sure the cooked, cooled, & stored at
food is delivered at correct
temperature.
Most bacteria do not grow in hot or
cold temperatures. To keep food safe,
cold foods must be kept 41°F or colder.
Hot foods mu 140°F or hotter.
The range of temp between 41°F -
140°F is called the Danger Zone When
potentially hazardous foods are left in
the Danger Zone, bacteria can grow
fast or poisons that can make people
sick.

17. The metal stem “dial” thermometer
is the most common thermometer
used in food service.
Dial thermometers work well for
taking temperatures of thick foods.
The stem must be pushed several
inches into the food & left in for at
least 20 seconds
Digital thermometers are also used
to measure food temperatures.
They have a metal stem too, but
have digital numbers instead of a
dial.
Digital thermometers are easy to
read & are better for measuring
temperatures in thin foods

18.  Thermometers should be checked often to make sure they
read the correct temperature.
 To check for accuracy the thermometer’s sensor is put in a
cup of crushed ice & water. The mixture should be 32°F. If the
thermometer doesn’t read 32°F, the thermometer needs to
be calibrated from a recognised lab.
 Using a thermometer:
1. Make sure it is clean, sanitized & accurate
2. Insert into the thickest part of the food – usually the center
of the food
3. Take the temperature for several seconds until the numbers
stop changing.

19.  Cooking food to the right
temperature is the best way to kill
germs that might be in the food.
 All raw animal products cooked in a
microwave oven must be heated to
at least 165°F.
 Cooked potentially hazardous food
must be kept until it is served.
 Hot food must be kept at 140°F or
hotter.
 Cold food that will be hot held must
be reheated to at least 165°F quickly
(within two hours).
 Tips for keeping food hot:
1. cover pans
2. stir food often to distribute heat
3. never mix cold foods with cooked
foods
 COLD food must be kept 41°F or colder .
 Potentially hazardous salads made from food
at room temperature (such as canned tuna)
must be cooled to 41°F within 4 hours of
preparation
 There are three safe methods for thawing
food:
1. In the refrigerator Put frozen food in the
refrigerator until it is thawed.
2. Submerged under cold running water. Keep
the food covered in cold (70°F or colder),
running water until it is thawed
3. As part of the cooking process or in the
microwave: Small items, such as frozen
burritos, may be thawed while they cook
 Three approved cooling methods
1. shallow pan method (food no more than 2
inches deep)
2. size reduction (cutting solid food into
smaller pieces)
3. time & temperature monitored (forcing
food to cool in a short amount of time)
Keep “Hot Foods Hot” & “Cold Foods Cold”

21.  Cross contamination happens when bacteria
from raw foods get onto other foods. Raw meat
is the main source of cross contamination.
 Tips to avoid cross contamination:
1. Wash hands after handling raw meat
2. Wash & sanitize all food-contact surfaces that
touch raw meat
3. Prepare raw meat in an area away from other
foods
4. Use a separate cutting board for raw meat
5. Store raw meat below other foods in the
refrigerator & freezer
6. Store meat with a higher cooking temperature
(like chicken) below meat with a lower cooking
temperature (like fish)
7. Food-contact surfaces should be washed,
rinsed, & sanitized after each use to remove
germs that can cause illness.
8. The sanitizer should be changed often because
grease, dirt & food piece make the sanitizer
less effective
Prevention of Cross Contamination

23. Personal hygiene
 Clean hands & clothing.
 Minimise jewellery on hands & wrists.
 Tie-back or cover hair.
 Clean & short fingernails.
 Avoid unnecessary contact with food.
 Cover all cuts & sores with a brightly coloured waterproof dressing.
 Do not eat over food or food surfaces.
 Do not prepare food when you are ill.
 Avoid touching your face & hair.
 Do not cough or sneeze over food.
 Do not taste food with your fingers or “double dip” with a spoon.
 If wearing gloves, change frequently.
Cleaning
 Essential for the safe operation of any food business.
 Must be continuous and ongoing.
 Thoroughly clean and sanitise all food surfaces, equipment and utensils with hot water and detergent
and chemicals (sanitisers). Remember that most detergents do not kill bacteria, but hot water and
sanitisers do!
 Implement a cleaning schedule to ensure that cleaning is conducted on a regular basis (including hard
to reach places).

25. Measures to Control Pest
Pest Control
 Keep them out – seal the food
premises.
 Starve them out – keep food
premises clean.
 Throw them out – conduct
regular pest inspections or
services.
 Don’t give them a home -
remove all unnecessary
equipment & items.
 Report all pest sightings or
evidence of pest activity to your
supervisor.

26. Waste Management & Log sheets
 Place waste in plastic lined
bins.
 Remove all waste from the
premises as required.
 Empty & clean waste bins
regularly.
 Ensure all external bins are
covered.
 Protect external waste bin
area from pests & birds.
 Label food and keep separate.
 Recycle the waste generated.

27. Ward: Sheet Number:
Period from: To:
Date
Meal Time ( B,
L D)
No. of meal
ordered
No. of
additional
meals
supplied
Total No. of
Meals
supplied
Total no. of
unserved
meals
% unserved
meals
Avg % of
plate waste
Total
Total % of ward wastage

28. Date: Ward:
Menu cycle: Meal time:
Main course Items
No. of portions
ordered
Additional
portions supplied
Total no. of
portions supplied
Total no. of un
served portions
supplied
% of unserved
portions
Avg% of unserved Meals
Avg % of plate waste
Total % of ward waste

29. Hospital Name Unit:
Date: Sheet No:
Period from: To:
Ward
% of unserved
meals
Avg % plate
waste
Total % of ward
waste
Total % of food waste:

30. Date : Ward : Completed by:
Menu cycle: Meal time: Sheet Number:
Bed
Patients/ clients name or
tray / bed number
Meal portion Size
( S, M, L)
% of plate waste
Reason of waste
(see the codes)
Corrective action
Avg % of plate waste
Reasons for not eating Codes
Clinical Reasons: effect of drugs, dental problems, swallowing, nausea, vomiting, diarrhoea, poor
appetite
C
Patients/ clients requiring food assistance with food & packets, unable to reach food, unable to
consume food without assistance
A
The environment: interruptions, uncomfortable or unpleasant environment E
The Meal Service: unacceptable food choices, insufficient time given to eat, patient not available at
the ward meal time, too much food on the plate
M
Food Issues: unfamiliar dishes, lack of sauces, condiments, food cold or of poor quality ,incorrect or
unfamiliar textures
F

32. Research Articles:
 Food safety is everybody's business,
Washington State & Food Beverage Workers
Manual.
 Managing Food waste in NHS: 2005 New south
Wales
Websites:
www.google.com
www.slideshare.net

33.  Only work when you are healthy.
 Wash your hands often & well.
 Don’t touch ready-to-eat food with bare hands.
 Keep food hot or cold.
 Cook food to proper temperatures.
 Cool hot food as quickly as possible.
 Keep raw meat away from other food.
 Wash, rinse, sanitize, air dry – always follow the 4 steps in order.
 Keep food preparation areas & utensils clean & sanitized.
 Report or prevent all suspected breaches of food safety.
 Report all evidence of pest activity.
 Conduct regular temperature checks of food with your probe thermometer.
 Implement a cleaning schedule.
 Obtain & read a copy of the Food Safety Standards.
 Encourage other food handlers to attend food safety training programs like
this one.
 Be aware food hazards are everywhere! Don’t give them any opportunity to
contaminate food.
 Always remember - prevention is better than cure.
 Ask questions if you have them.

34. It is essential that catering
services in hospital requires skills
& knowledge of food safety &
food handling controls to
minimise the risk of food
poisoning in hospital hence it is
our responsibility to ensure that
food for your patients is safe &
suitable to eat.

35. Thank You