Microbiological assessment of a hospital kitchen before and after Good Manufacturing Practices’ intervention
DOI:
https://doi.org/10.5327/fst.00379%20Palavras-chave:
Pacientes, doenças transmitidas por alimentos, superfícies, APPCCResumo
The aim of this study was to investigate the impact of Good Manufacturing Practices (GMP) on the identification and prevention of bacteria that could pose a risk to patient meals. The study used two GMP checklists and microbiological sampling of bacteria, performed six months apart, to assess the facility’s ability to reduce bacterial counts. The results showed hygiene deficiencies in all areas of the hospital. However, there was a significant improvement in GMP compliance following the implementation of an action plan (p = 0.0234). Before the intervention, 55.55% of the criteria were compliant and after the intervention, 69.63% were compliant. Surfaces involved in raw material handling were identified as the most critical in terms of contamination, with high levels of aerobic mesophilic count, Enterobacteriaceae, and Listeria monocytogenes. The intervention significantly reduced the number of bacteria on these surfaces (p < 0.05). Before, the aerobic mesophilic ranged from 0.00 to 6.34 log CFU/cm², and after, from 0.00 to 4.31 log CFU/cm². Additional testing of incoming materials, food, and hands showed no significant risk. The study highlighted the importance of good hand hygiene, which improved after extensive staff training. The GMP guideline and microbiological characterization of the production areas in the hospital kitchens were essential for understanding and acting on bacterial contamination.
Downloads
Referências
Al-Abri, S. S., Al-Jardani, A. K., Al-Hosni, M. S., Kurup, P. J., Al-Busaidi, S., & Beeching, N. J. (2011). A hospital acquired outbreak of Bacillus cereus gastroenteritis, Oman. Journal of Infection and Public Health, 4(4), 180-186. https://doi.org/10.1016/J.JIPH.2011.05.003
Altekruse, S. F., & Swerdlow, D. L. (1996). The changing epidemiology of foodborne diseases. American Journal of the Medical Sciences, 311(1), 23-29. https://doi.org/10.1097/00000441-199601000-00005
Argaw, S., & Addis, M. (2015). A review on staphylococcal food poisoning. Food Science and Quality Management, 40(2015), 59-72.
Assanasen, S., & Bearman, G. M. L. (2018). Guide to infection control in the hospital setting. Food: considerations for hospital infection control.
Ayçiçek, H., Aydoǧan, H., Küçükkaraaslan, A., Baysallar, M., & Başustaoǧlu, A. C. (2004). Assessment of the bacterial contamination on hands of hospital food handlers. Food Control, 15(4), 253-259. https://doi.org/10.1016/S0956-7135(03)00064-1
Banna, M. H. Al, Khan, M. S. I., Rezyona, H., Seidu, A. A., Abid, M. T., Ara, T., Kundu, S., Ahinkorah, B. O., Hagan, J. E., Tareq, M. A., Begum, M. R., Chowdhury, M. F. T., & Schack, T. (2022). Assessment of food safety knowledge, attitudes and practices of food service staff in Bangladeshi hospitals: a cross-sectional study. Nutrients, 14(12), 2540. https://doi.org/10.3390/NU14122540
Boone, I., Rosner, B., Lachmann, R., D’Errico, M. L., Iannetti, L., Van der Stede, Y., Boelaert, F., Ethelberg, S., Eckmanns, T., Stark, K., Haller, S., & Wilking, H. (2021). Healthcare-associated foodborne outbreaks in high-income countries: a literature review and surveillance study, 16 OECD countries, 2001 to 2019. Eurosurveillance, 26(41). https://doi.org/10.2807/1560-7917.ES.2021.26.41.2001278
Brasil (1976). Presidência da República. Casa Civil. Decreto no 77.052, de 19 de janeiro de 1976. Dispõe sobre a fiscalização sanitária das condições de exercício de profissões e ocupações técnicas e auxiliares, relacionadas diretamente com a saúde.
Brasil (1990). Presidência da República. Casa Civil. Lei no 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências.
Brasil (1997). Presidência da República. Casa Civil. Lei no 9.431, de 6 de janeiro de 1997. Dispõe sobre a obrigatoriedade da manutenção de programa de controle de infecções hospitalares pelos hospitais do País. Retrieved from https://www.planalto.gov.br/ccivil_03/leis/l9431.htm#:~:text = LEI
Brasil (2004). Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução n° 216, de 15 de setembro de 2004. Dispõe sobre Regulamento Técnico de Boas Práticas para Serviços de Alimentação.
Brasil (2020). Agência Nacional de Vigilância Sanitária. Nota técnica NT 18.2020 - COVID-19 e as Boas Práticas de Fabricação e Manipulação de Alimentos. Agência Nacional de Vigilância Sanitária.
Brasil (2020). Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Instrução normativa - IN no 82, de 17 de dezembro de 2020. Dispõe sobre Boas Práticas de Fabricação de fórmulas dietoterápicas para erros inatos do metabolismo.
Brasil (2020). Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução da Diretoria Colegiada - RDC no 460, de 21 de dezembro de 2020. Dispõe sobre os requisitos sanitários das fórmulas dietoterápicas para erros inatos do metabolismo.
Brasil (2021). Ministério da Saúde. Portaria GM/MS no 888, de 4 de maio de 2021. Altera o Anexo XX da Portaria de Consolidação GM/MS no 5, de 28 de setembro de 2017, para dispor sobre os procedimentos de controle e de vigilância da qualidade da água para consumo humano e seu padrão de potabilidade.
Brasil (2022). Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Instrução normativa - IN no 161, de 1o de julho de 2022. Estabelece os padrões microbiológicos dos alimentos.
Cokes, C., France, A. M., Reddy, V., Hanson, H., Lee, L., Kornstein, L., Stavinsky, F., & Balter, S. (2011). Serving high-risk foods in a high-risk setting: survey of hospital food service practices after an outbreak of listeriosis in a hospital. Infection Control & Hospital Epidemiology, 32(4), 380-386. https://doi.org/10.1086/658943
Cordero, N., Maza, F., Navea-Perez, H., Aravena, A., Marquez-Fontt, B., Navarrete, P., Figueroa, G., González, M., Latorre, M., & Reyes-Jara, A. (2016). Different transcriptional responses from slow and fast growth rate strains of listeria monocytogenes adapted to low temperature. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.00229
Evans, M. R., Hutchings, P. G., Ribeiro, C. D., & Westmoreland, D. (1996). A hospital outbreak of salmonella food poisoning due to inadequate deep-fat frying. Epidemiology and Infection, 116(2), 155. https://doi.org/10.1017/S0950268800052389
FAO (2022). Food safety and quality - Background: FAO’s work on food safety and quality. FAO. Retrieved from http://www.fao.org/food-safety/background/en
Food Standards Australia New Zealand (2002). Food Safety: Temperature control of potentially hazardous foods. Guidance on the temperature control requirements of Standard 3.2.2 Food Safety Practices and General Requirements. Food Standards Australia New Zealand.
Gaul, L. K., Farag, N. H., Shim, T., Kingsley, M. A., Silk, B. J., & Hyytia-Trees, E. (2013). Hospital-acquired listeriosis outbreak caused by contaminated diced celery-texas, 2010. Clinical Infectious Diseases, 56(1), 20-26. https://doi.org/10.1093/cid/cis817
Governo do Estado de São Paulo (2013). Secretaria de Estado da Saúde. Coordenadoria de Controle de Doenças. Centro de Vigilância Sanitária. Portaria CVS 5, de 09 de abril de 2013. Aprova o regulamento técnico sobre boas práticas para estabelecimentos comerciais de alimentos e para serviços de alimentação, e o roteiro de inspeção, anexo. Governo do Estado de São Paulo.
Heir, E., Møretrø, T., Simensen, A., & Langsrud, S. (2018). Listeria monocytogenes strains show large variations in competitive growth in mixed culture biofilms and suspensions with bacteria from food processing environments. International Journal of Food Microbiology, 275, 46-55. https://doi.org/10.1016/j.ijfoodmicro.2018.03.026
Hobbs, J. L., Lee, C., Thompson, B., Andrew, A., Navarro, C., Dubey, V., Maki, A., Kong, A., Griffin, M., Chau, K., Murphy, A. M., Lombos, M., Majury, A. L., Gerrie, M., Szidonya, E., Chung, J., Ozaldin, O., Patel, T., Brandon, N., & Warshawsky, B. (2023). Two Listeria monocytogenes outbreaks in a cancer centre: onsite food premises and their potential health risk to patients. BMC Public Health, 23(1), 1443. https://doi.org/10.1186/s12889-023-16371-7
Khuri-Bulos, N. A., Khalaf, M. A., Shehabi, A., & Shami, K. (1994). Foodhandler-associated salmonella outbreak in a university hospital despite routine surveillance cultures of kitchen employees. Infection Control and Hospital Epidemiology, 15(5), 311-314. https://doi.org/10.1086/646918
Lacey, S. (1993). Isolation of Salmonella enteritidis from cook-chill food distributed to hospital patients. Journal of Hospital Infection, 25(2), 133-136. https://doi.org/10.1016/0195-6701(93)90104-8
Lahou, E., Jacxsens, L., Verbunt, E., & Uyttendaele, M. (2015). Evaluation of the food safety management system in a hospital food service operation toward Listeria monocytogenes. Food Control, 49, 75-84. https://doi.org/10.1016/j.foodcont.2013.10.020
Lund, B. M., & O’Brien, S. J. (2011). The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathogens and Disease, 8(9), 961-973. https://doi.org/10.1089/fpd.2011.0860
McKillop, E. J. (1959). Bacterial contamination of hospital food with special reference to clostridium welchii food poisoning. Journal of Hygiene, 57(1), 31-46. https://doi.org/10.1017/S0022172400019872
Najjar, Z., Gupta, L., Sintchenko, V., Shadbolt, C., Wang, Q., & Bansal, N. (2015). Listeriosis cluster in sydney linked to hospital food. Medical Journal of Australia, 202(8), 448-449. https://doi.org/10.5694/mja14.00913
Naranjo, M., Denayer, S., Botteldoorn, N., Delbrassinne, L., Veys, J., Waegenaere, J., Sirtaine, N., Driesen, R. B., Sipido, K. R., Mahillon, J., & Dierick, K. (2011). Sudden death of a young adult associated with Bacillus cereus food poisoning. Journal of Clinical Microbiology, 49(12), 4379-4381. https://doi.org/10.1128/JCM.05129-11
Pan, Y., Breidt, F., & Kathariou, S. (2009). Competition of Listeria monocytogenes Serotype 1/2a and 4b Strains in Mixed-Culture Biofilms. Applied and Environmental Microbiology, 75(18), 5846. https://doi.org/10.1128/AEM.00816-09
Pieniz, S., Rodrigues, D. F., Arndt, R. M., Mello, J. F., Rodrigues, K. L., Andreazza, R., Camargo, F. A. O., & Brandelli, A. (2019). Molecular identification and microbiological evaluation of isolates from equipments and food contact surfaces in a hospital food and nutrition unit. Brazilian Journal of Biology, 79(2), 191-200. https://doi.org/10.1590/1519-6984.175350
Pinto, U. M., Cardoso, R. R., & Vanetti, M. C. D. (2004). Detecção de Listeria, Salmonella e Klebsiella em serviço de alimentação hospitalar. Revista de Nutrição, 17(3), 319-326. https://doi.org/10.1590/S1415-52732004000300005
Public Health England (2020). Investigation into an outbreak of Listeria monocytogenes infections associated with hospital-provided pre-prepared sandwiches, UK May to July 2019. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/937907/2019-05-Listeria-CC8-Outbreak-Report.pdf
Puga, C. H., Dahdouh, E., SanJose, C., & Orgaz, B. (2018). Listeria monocytogenes colonizes pseudomonas fluorescens biofilms and induces matrix over-production. Frontiers in Microbiology, 9. https://doi.org/10.3389/fmicb.2018.01706
Raadabadi, M., Sadeghifar, J., Dargahi, H., Bahadori, M., & Nejati, M. (2012). Investigating the level of meeting HACCP standard requirements in the nutrition department of the selected hospitals affiliated to Tehran University of Medical Sciences. Archives of Pharmacy Practice, 3(2), 159-165.
Regan, C. M., Syedt, Q., & Tunstall$, P. J. (1995). A hospital outbreak of Clostridium perfringens food poisoning-implications for food hygiene review in hospitals. Journal of Hospital Infection, 29(1), 69-73. https://doi.org/10.1016/0195-6701(95)90295-3
Réglier-Poupet, H., Parain, C., Beauvais, R., Descamps, P., Gillet, H., Le Peron, J. Y., Berche, P., & Ferroni, A. (2005). Evaluation of the quality of hospital food from the kitchen to the patient. Journal of Hospital Infection, 59(2), 131-137. https://doi.org/10.1016/j.jhin.2004.07.023
Roy, S., Rigal, M., Doit, C., Fontan, J. E., Machinot, S., Bingen, E., Cezard, J. P., Brion, F., & Hankard, R. (2005). Bacterial contamination of enteral nutrition in a paediatric hospital. Journal of Hospital Infection, 59(4), 311-316. https://doi.org/10.1016/j.jhin.2004.09.026
Russini, V., Spaziante, M., Zottola, T., Fermani, A. G., Di Giampietro, G., Blanco, G., Fabietti, P., Marrone, R., Parisella, R., Parrocchia, S., Bossù, T., Bilei, S., & De Marchis, M. L. (2021). A nosocomial outbreak of invasive listeriosis in an Italian hospital: Epidemiological and genomic features. Pathogens, 10(5), 591. https://doi.org/10.3390/pathogens10050591
Sharp, J. C. M., Collier, P. W., & Gilbert, R. J. (1979). Food poisoning in hospitals in Scotland. Journal of Hygiene, 83(2), 231-236. https://doi.org/10.1017/S0022172400026012
Shetty, A., McLauchlin, J., Grant, K., O’Brien, D., Howard, T., & Davies, E. M. (2009). Outbreak of Listeria monocytogenes in an oncology unit associated with sandwiches consumed in hospital. Journal of Hospital Infection, 72(4), 332-336. https://doi.org/10.1016/j.jhin.2009.01.012
Steere, A. C., Hall, W. J., Wells, J. G., Craven, P. J., Leotsakis, N., Farmer, J. J., & Gangarosa, E. J. (1975). Person-to-person spread of salmonella typhimurium after a hospital common-source outbreak. Lancet, 305(7902), 319-322. https://doi.org/10.1016/S0140-6736(75)91221-0
Teffo, L. A., & Tabit, F. T. (2020). An assessment of the food safety knowledge and attitudes of food handlers in hospitals. BMC Public Health, 20(1). https://doi.org/10.1186/S12889-020-8430-5
Townsend, A., Strawn, L. K., Chapman, B. J., Yavelak, M., Mishra, A., & Dunn, L. L. (2022). Factors that predict Listeria prevalence in distribution centers handling fresh produce. Food Microbiology, 107, 104065. https://doi.org/10.1016/j.fm.2022.104065
Wiktorczyk-Kapischke, N., Skowron, K., Grudlewska-Buda, K., Wałecka-Zacharska, E., Korkus, J., & Gospodarek-Komkowska, E. (2021). Adaptive response of listeria monocytogenes to the stress factors in the food processing environment. Frontiers in Microbiology, 12. https://doi.org/10.3389/fmicb.2021.710085
World Health Organization (WHO) (2002). Prevention of hospital-acquired infections: a practical guide. WHO. Retrieved from http://www.who.int/emc
World Health Organization (WHO) (2009). Patient Safety. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. WHO.
Wu, Y., Liu, X., Chen, Q., Liu, H., Dai, Y., Zhou, Y., Wen, J., Tang, Z., & Chen, Y. (2018). Surveillance for foodborne disease outbreaks in China, 2003 to 2008. Food Control, 84, 382-388. https://doi.org/10.1016/j.foodcont.2017.08.010