Dirty UK hospitals serving out-of-date poorly stored food

I wrote a letter to the hospital in Brisbane where my friend has been holed up, complaining about serving sandwiches with raw sprouts to sick people – or anyone.

brisbane-hospital-foodThere was some totally unscientific answer about how these sprouts were special because they came from a different place and they disappeared from the sick persons menu for a few weeks.

The sprouts are now back.

Nothing new, food hygiene reports obtained by the Press Association under the UK Freedom of Information Act and data from the UK Food Standards Agency (FSA) concluded that dirty hospitals are serving out-of-date food to patients.

Meals are being prepared in mouldy kitchens, putting vulnerable patients at “high risk” of food poisoning, while others have unclean worktops, food trolleys and sinks.

FSA data also revealed poor rankings for hundreds of care homes and children’s nurseries.

Some 400 hospitals, hospices, care homes, nurseries and school clubs are currently listed as needing “major”, “urgent” or “necessary” improvement.

One care home was infested with cockroaches while another had evidence of rats.

The Patients Association has called the findings “shameful” and “immensely worrying”.

The Food Hygiene Rating Scheme – which rates organisations and businesses from zero to five – is run by the FSA and councils in England, Wales and Northern Ireland.

The investigation found:

Eight health and care premises currently have a zero rating – which means urgent improvement is necessary. None are hospitals.

Some 187 have a rating of one – which means major improvement is necessary. Three of these are hospital premises, including the private Priory Hospital in Altrincham, Cheshire (because in the UK, like its bastard child, Australia, private is considered better, except when it comes to the basics)..

hospital-foodAnd 205 are ranked as two – improvement necessary. They include six hospitals and about 100 care homes. Among those given the ranking of two was Glenfield Hospital in Leicester.

At Glenfield Hospital in Leicester, an inspection of its kitchens serving patients found:

Sliced chicken two days past its use-by date (hello, Listeria?).

Staff had created their own date labels for when they thought food should be used, creating a “high risk” for patients who might develop food poisoning (food fraud)).

The experts also found leaking sinks, “inadequate” knowledge among staff about how to handle food safely, and mouldy areas, including the salad preparation room.

Food was being kept in fridges with temperatures up to 13C despite rules saying they should be 5C or below to prevent bacteria developing.

Darryn Kerr, director of facilities at Leicester’s Hospitals, said the organisation was “disappointed” by the ratings.

He said catering services were brought back in-house in May after being run by an external provider.

Parkview Residential Care Home in Bexleyheath, south-east London, was found to have an “infestation of Oriental cockroaches” during an August inspection.

The kitchen was closed voluntarily for the second time following a previous warning and inspectors gave it a zero rating.

Ivy House care home in Derby, which specialises in dementia care, scored zero after inspectors found evidence of rat activity.

Not the best idea: serving smoked salmon to hospital patients

I’m not a huge smoked salmon fan, but when there’s not much to choose on a breakfast buffet, I’ll grab some with a bagel and cream cheese.

With its history of Listeria monocytogenes risks, I wouldn’t serve smoked salmon to someone who was immunocompromised.shutterstock_187930064

Or a hospital patient.

According to EJ Insight, a 79-year-old hospital patient in Hong Kong has listeriosis following a smoked salmon sandwich.

The Centre for Health Protection (CHP) epidemiological investigations revealed that the patient had consumed high-risk foods including sandwiches with smoked salmon provided by the kitchen of the private hospital in late December, Ming Pao Daily reported.

The patient has been confined at the hospital since Sept. 12 last year for several chronic diseases. She developed fever and her body conditions deteriorated since Jan. 1.

While a sample of smoked salmon collected from the hospital kitchen tested negative for Listeria monocytogenes, the patient’s blood culture yielded the bacteria.

The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department subsequently collected five smoked salmon samples and 19 environmental samples from the factory of Elegant Fine Food Limited, the food supplier, on Shipyard Lane in Quarry Bay.

Four of the samples tested positive for Listeria monocytogene, while all environmental samples were negative.

The CFS has ordered the food supplier to immediately recall all of its smoked salmon products while all of its existing stocks were confiscated. Its production lines have been suspended for sterilization.

A CFS spokesperson said investigations are ongoing.

Why is this on a hospital menu?

Cockroach infestation shuts down cafeteria at California hospital

The cafeteria at St. John’s Health Center – the fabled Santa Monica hospital – was shut down this week after a health inspector found a cockroach infestation in the kitchen, county health officials said.

cockroachAt least 10 live cockroaches were found in the kitchen for the cafeteria, which is located on the second floor of the hospital in the 2100 block of Santa Monica Boulevard, according to the Los Angeles County Department of Public Health.

Officials at the Westside hospital expect to reopen the cafeteria Saturday, and in the meantime, patients’ visitors are being provided with a list of local restaurants, said Patricia Aidem, a hospital spokeswoman.

“Providence Saint John’s apologizes for the inconvenience to our visitors, physicians and staff and, while it’s difficult to control these natural occurrences, pledges continued diligence in ensuring cleanliness and safety,” the hospital chain said in a statement.

Founded by Roman Catholic nuns in 1942, St. John’s hospital has cared for celebrity patients such as Elizabeth Taylor, Michael Jackson and President Ronald Reagan.

Cost of Salmonella

Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients.

salm.hospital.nov.15The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes.

A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000–2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity.

In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: $9,777 (2000) to $29,690 (2011).

Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms the need for continual healthcare and public health investments to prevent and control this disease in vulnerable groups.

 Salmonellosis Hospitalizations in the United States: Associated Chronic Conditions, Costs, and Hospital Outcomes, 2011, Trends 2000–2011

Foodborne Pathogens and Disease [ahead of print]

Cummings Patricia L., Kuo Tony, Javanbakht Marjan, Shafir Shira, Wang May, and Sorvillo Frank.

http://online.liebertpub.com/doi/abs/10.1089/fpd.2015.1969

Duh alert: Salmonella outbreak investigation at Australian hospital rules out imported fish (check the egg dishes)

Testing has ruled out imported fish as the source of a Salmonella outbreak at Burnside Hospital in Adelaide, SA Health says.

fish.headsEleven patients have developed gastroenteritis caused by Salmonella since July, one needing re-admission for more treatment.

A statement from the hospital last week said the presence of the bacteria was confirmed at the hospital on September 8 and all recent and current patients had been informed about the issue.

Imported fish was identified as a possible source of the outbreak, but SA Health said testing had now ruled that out.

Cross-contamination from eggs is under investigation as a possible cause of the outbreak, for which the hospital apologized last week.

sprout.salad.aust.aug.15“The hospital has meticulously followed all advice provided by SA Health and the Eastern Health Authority in our efforts to reduce the possibility of others contracting the illness,” it said.

And that advice is not to use pasteurized eggs in dishes for those in a hospital – those immunocompromised – and serve raw alfalfa sprouts (pic from a Brisbane hospital, left).

Some advice: don’t serve raw sprouts and only use pasteurized eggs.

Why are hospital patients the critical control point for doctor handwashing?

People in the hospital are invariably immunocompromised. They shouldn’t be fed things like deli meats that may harbor Listeria.

jon.stewart.handwashing.2002And it shouldn’t be the patient’s responsibility to ask if their doctor or nurse washed their hands.

A February audit shows more than 40 per cent of health-care workers and support staff at hospitals in the Regina area (that’s in Canada) failed to wash their hands properly. 

A follow-up report in June also reveals that 67 per cent of 204 doctors observed didn’t follow regional handwashing rules before patient contact. 

Regina Qu’Appelle Health Region (RQHR) requires all staff to wash their hands with soapy water or alcohol-based gels for a minimum of 20 seconds before and after contact with patients. They’re not allowed to wear excessive jewellery on their hands or wrists and can’t have gel nails. 

Kateri Singer, the woman in charge of infection prevention for RQHR said the region’s goal is 100 per cent compliance with handwashing rules “because it is the single most important thing we can do as health-care workers.” 

CBC’s iTeam has combed through RQHR’s February and June reports and has highlighted some of the least compliant facilities. The following percentages indicate non-compliance rates:

Broadview Union Hospital (February) – 94.8%​

Grenfell Health Centre (June) – 77.4%

Regina Lutheran Home (June) – 77.8%​

Wolseley Memorial Hospital (June) – 66.7%

Regina General Hospital – Day Surgery (February) – 86.7%

Regina General Hospital – Labour and Birth (June) – 94%

Pasqua Hospital – Day Surgery (February) – 100%

Pasqual Hospital – Short Stay (February) – 95.2%

Pasqua Hospital – Operating Room (February) – 68%

Pasqual Hospital – 3A (June) – 97%

Transparency is a key to change

handwashing.junk.apr.13Singer said though these numbers look bad, she’s committed to disclosure because “the public has the right to know” whether or not their doctor or nurse is keeping their hands clean. And she said patients have the right to hold them to account.

RQHR seems to have taken the lead in Saskatchewan when it comes to transparency regarding handwashing practices. Its public reports are far more comprehensive than any other region in the province.

Singer said transparency can be a catalyst to change behavior.

Michael Gardam, director of infection, prevention and control at Toronto’s University Health Network, told CBC Saskatchewan’s Morning Edition host Sheila Coles patients often do not feel they can stand up for themselves.

“I have seen patients get screamed at by health care providers,” Gardam said. “I’ve seen patients be told, ‘Don’t come back to my clinic. How dare you challenge me.'”

Cafeterias in Boston hospitals get failing grades

Boston is home to many of the nation’s best hospitals, but the I-Team discovered some of these institutions may not always be as careful with the food they serve as they are with patient care.

UnknownThe I-Team obtained inspection reports for 12 Boston hospitals and we found several facilities failing on many levels. Dana Farber Cancer Institute and Carney Hospital both failed inspections for not keeping food cold enough. At Dana Farber, inspectors found boiled eggs at 54 degrees, tuna at 53 degrees and chicken at 51 degrees. Carney Hospital also had food items above 50 degrees. According to Boston University nutritionist Joan Salge-Blake, anything higher than 41 degrees is asking for trouble.

Culture change isn’t about training, education and environment

Over the past decade lots of folks have been throwing around the term food safety culture to describe how a business operates. Education, training, equipment, tools, the environment, investment and support from higher-ups all influence how well an organization addresses risk, there’s something else that binds it together.

The culture, or value system, can be difference between having an outbreak or not. The values dictate decisions from the front-line staff to the CEO.

Maybe it’s the hippie in me but it’s sort of like the vibe of the organization that can be gauged by asking does anyone really care?

images-1

And if they do, do they know what they should be caring about?

The health care world struggles with the same issues, with similar consequences. According to Yahoo News the Vanderbilt University Hospital dealt with a culture change around infection control. And it’s taken six years to turn things around.

Dr. Gerald Hickson had two primary concerns after his wife’s double-knee replacement operation at Vanderbilt University Hospital in July 2008: making sure she received appropriate pain control and getting her moving as quickly as possible to avoid blood clots. But as he sat with her during her recovery, Hickson made a disturbing discovery. Most of the nurses, doctors and other hospital workers filing in and out of the room to care for his wife, who was at risk of contracting an infection after surgery, were not washing their hands.

A compulsive person by nature, Hickson started counting. He found 92 instances when staff members should have soaped up or used antiseptic foam. The total number of times they actually did? 32. Hickson did not want to humiliate anyone, but he was also fiercely committed to protecting his wife. With polite Southern collegiality, he calmly pointed out the 60 opportunities when staffers could have provided safer care but didn’t. Some staffers were immediately embarrassed. Several wondered if he was kidding, got defensive and offered explanations for their lapses. 

Hickson reported his findings to Dr. Tom Talbot, VUMC’s chief epidemiologist, and Talbot ran with it, spearheading an ambitious clean hands initiative that was launched in July 2009. Since then, hand-washing rates at Vanderbilt have jumped from 58 percent to 97 percent; at the same time, the number of several stubborn infections has dropped, one of them by as much as 80 percent. “We get into bad habits, all of us do, and sometimes we need somebody to remind us to get back on the right pathway,” says Hickson. “That’s the key to transforming health care.”

Talbot orchestrated a number of practical changes right away, including installing additional hand sanitizer dispensers at the entrance and exit of every patient’s room or bay and within easy reach inside. Staffers were instructed to clean their hands before and after every encounter with patients, even if all they planned to do was have a conversation. Even the smallest details were addressed. Clinicians who complained that their skin had become irritated by excess antiseptic gel were told to cut back to a dime-size portion, and moisturizing lotion dispensers were added throughout the hospital.

That was the easy part. Talbot knew that it would take an all-out culture shift to see dramatic improvement. A prior hand-washing program, which focused largely on education and random surveillance, had done little to boost rates. This time, Talbot drilled down on what he believed would be the keys to success: training, communication and shared accountability up and down the staff hierarchy.

Because the hospital’s top leadership would be the ultimate enforcers, Hickson and Talbot knew they needed buy-in before the program was officially launched. The old days of giving high-performing doctors a pass on unprofessional conduct — “Oh, that’s just Dr. So and So, that’s how he is” — would be over. Every hospital worker, no matter his or her rank, would be held to the same high standards. “We had to have support from leadership, so if we had pushback, we would elevate that up and they wouldn’t blink,” says Talbot. “Instead, they would say, ‘That’s not the kind of behavior we expect here.’”

Competition is a big motivator at Vanderbilt, too. Hand-washing scores for individual units and departments are tallied up from highest to lowest, and results are posted every month in break rooms and other staff areas so that everyone can see how his or her team compares with the one down the hall. “You want to look better than other services when that scorecard comes out,” says Johnson. “You don’t want to be at the bottom. That’s just human nature.”

Today, after more than 200,000 hand-washing observations, Vanderbilt’s overall hand-washing compliance rate has almost doubled. At the same time, three major types of infections linked to the insertion of tubes and catheters have been reduced considerably, according to Talbot. Urinary tract infections related to catheters in intensive care units have dropped by 33 percent; pneumonia linked to ventilators by 61 percent; and bloodstream infections associated with central lines — the tubing that delivers fluids and medications to patients — by 80 percent in ICUs.

Culture change is not about mission statements and core values written on a poster. It’s about fostering feelings within the organization from top-to-bottom that this stuff matters.

UK women bruises elbow, goes to hospital, dies from Norovirus

The inquest opens on Thursday (19 June) into the death of a Silverton woman who was in the care of a hospital and placed on the controversial Liverpool Care Pathway (LCP).

norovirus.elderly womanMrs Christine Walker, 86, was admitted to Cheltenham General Hospital on 17 March last year, following a fall.

She had hurt her elbow but, when examined, it was found she only suffered some bruising. However, she was kept in for monitoring.

The next day she was transferred to Kemerton ward, but was not seen by a doctor for three days. When a consultant finally attended her, she was found to be vomiting and suffering from diarrhoea.

She was confirmed as having contracted norovirus in the three days she was left unattended whilst on the ward.

Mrs Walker’s condition continued to deteriorate and her son Nick claims that, on 10 April, he discovered she had been placed on the Liverpool Care Pathway two days previously.

The LCP is a controversial strategy for managing end-of-life care, in which food, water and medicines are gradually withdrawn.

But this approach is only supposed to be used with full consent of the family. The hospital claims they had consulted the family, but Mrs Walker’s son denies the subject had ever arisen.

The family are represented by Oliver Thorne, a medical negligence specialist with Exeter-based lawyers Michelmores.

125 ill with norovirus at Oregon V.A. hospital

Retirement homes and hospitals have a lot of trouble with norovirus. If an ill resident, patient or staff member sheds the virus through vomit or poop in a public area a lot of folks can get sick.

According to KDRV ABC Channel 12, The V.A. hospital in White City Oregon is dealing with its own norovirus outbreak with over 125 veterans and 25 staff ill.vomit

“This is very contact oriented, it’s not airborne, it’s by touch,” said V.A. Infection Preventionist Sue Thurston.

Thurston said about 470 vets live at the V.A, and more than a quarter of them are sick.
Veterans are being asked to not leave their rooms until they feel better and bag meals are dropped off at their rooms.

“We’re wiping down everything you can touch –  all the side rails, all the doorknobs, all the vending  machines, all the rooms, all the surfaces, every single flat surface is being wiped down and disinfected,” said Thurston (I wonder what sanitizer they are using and wiping may just be spreading virus particles around -ben).

Although the virus isn’t respiratory, epidemiological investigations of past outbreaks suggest that virus particles can be aerosolized through vomit events. At IAFP 2013, North Carolina State University graduate student Grace Tung showed a simulated vomit event would yield a spread of droplets 8-12 ft.; the greatest distance traveled in any one experiment was 14.5 ft.