[Pillars for excellence in nutrition support units. Regulation]. / Pilares para la excelencia en las unidades de nutrición. Regulación.

INTRODUCTION: Nutritional assessment and treatment, necessary for the prevention and treatment of disease-related malnutrition, should be carried out by a multidisciplinary team where each member has well-defined skills and functions, and mechanisms are established to allow adequate coordination, both in the inpatient and outpatient settings. In Spain, the development and implementation of these teams or units dedicated to clinical nutrition has been very important: today they are present in most hospitals. This paper reviews the characteristics of clinical nutrition units, the functions of their team members, and the regulatory framework in our country.

INTRODUCCIÓN: La valoración y el tratamiento nutricionales, necesarios para poder realizar la prevención y tratamiento de la desnutrición relacionada con la enfermedad, se deben llevar a cabo por un equipo multidisciplinar en el que cada miembro tenga bien definidas sus competencias y funciones, y donde se establezcan mecanismos que permitan una adecuada coordinación en el entorno hospitalario y ambulatorio. En España, el desarrollo y la implantación de estos equipos o unidades dedicados a la nutrición clínica han sido muy importantes: hoy en día están presentes en la mayor parte de los hospitales. En este artículo se revisan las características de las unidades de nutrición clínica, las funciones de los miembros del equipo y la normativa que regula su funcionamiento en nuestro país.

Should plant-based hospital meals be the law? An American experience.

Hospitalization is an unparalleled opportunity for physicians to educate patients about the interconnection between poor dietary choices and the occurrence of many chronic diseases. For those patients who are ready to embrace nutrition as an essential part of the healing process, however, it is oftentimes difficult to find healthy menus at hospitals. Meat-based entrées, sugar-sweetened beverages and candy appear to be omnipresent in cafeterias and restaurants at U.S. hospitals. On the other hand, healthy plant-based menus are still the exception rather than the rule. Some states undertook considerable efforts to change this and made plant-based meals the law. Upon request by a patient, hospitals in New York are now required by law to provide plant-based options at every meal. This recent development triggered a controversial discussion within the medical community whether other states should follow this example and make plant-based hospital menus the law as well. This editorial illuminates why mandatory plant-based hospital menus could be a win-win situation for many involved stakeholders, including patients, hospitals and food services. This step is not a loss-marking venture for hospitals but rather a chance to save money and to improve corporate brand marketing at the same time. The introduction of mandatory plant-based menus in hospitals at a large scale represents a unique opportunity at the nexus of health, innovative corporate strategies and economics. Adequate framework conditions are necessary to ensure that all individuals can make healthy and affordable dietary choices while being hospitalized.

ASSESSMENT OF GOOD PRACTICES IN HOSPITAL FOOD SERVICE BY COMPARING EVALUATION TOOLS.

INTRODUCTION: since food service in hospitals complements medical treatment, it should be produced in proper hygienic and sanitary conditions. It is a well-known fact that food-transmitted illnesses affect with greater severity hospitalized and immunosuppressed patients. AIMS: good practices in hospital food service are evaluated by comparing assessment instruments. METHODS: good practices were evaluated by a verification list following Resolution of Collegiate Directory n. 216 of the Brazilian Agency for Sanitary Vigilance. Interpretation of listed items followed parameters of RCD 216 and the Brazilian Association of Collective Meals Enterprises (BACME). Fisher's exact test was applied to detect whether there were statistically significant differences. Analysis of data grouping was undertaken with Unweighted Pair-group using Arithmetic Averages, coupled to a correlation study between dissimilarity matrixes to verify disagreement between the two methods. RESULTS AND DISCUSSION: Good Practice was classified with mean total rates above 75% by the two methods. There were statistically significant differences between services and food evaluated by BACME instrument. Hospital Food Services have proved to show conditions of acceptable good practices. CONCLUSION: the comparison of interpretation tools based on RCD n. 216 and BACME provided similar results for the two classifications.

Introducción: por ser un adyuvante al tratamiento médico, la alimentación hospitalaria debe ser producida en adecuadas condiciones higiénicas y sanitarias, considerando qué enfermedades transmitidas por los alimentos afectan con mayor severidad a pacientes hospitalizados e inmunodeprimidos. Objetivos: evaluar la adopción de buenas prácticas en los servicios de alimentación hospitalarios, comparando instrumentos de evaluación. Métodos: la evaluación de las buenas prácticas fue realizada utilizando una lista de verificación conforme la Resolución de Directora Colegiada ­ RDC n.º 216 de la Agencia Nacional de Vigilancia Sanitaria. Para la interpretación de los ítems listados fueron utilizados los parámetros de la RDC n.º 216 y de la Asociación Brasileña de Empresas de Comidas Colectivas (ABERC). Se aplicó el test exacto de Ficher para analizar si existían diferencias estadísticamente significativas y también fue realizado un análisis de agrupamiento de los datos per el método Unweighted Pair-group using Arithmetic Averages y un estudio de la correlación entre las matrices de disimilitud, objetivando verificar la concordancia entre los dos métodos de diagnóstico. Resultados y discusión: las buenas prácticas fueron clasificadas con valores medios totales superiores al 75% de adecuación, en los dos instrumentos utilizados. Se observaron diferencias estadísticamente significativas entre los servicios y la alimentación evaluados por el instrumento de la ABERC. Los servicios de alimentación hospitalarios, de modo general, presentaron condiciones de buenas prácticas aceptables. Conclusión: la comparación de los instrumentos de interpretación basados en la RDC n.º 216 y ABERC mostró resultados semejantes en ambas clasificaciones.

Detection of a nosocomial outbreak of salmonellosis may be delayed by application of a protocol for rejection of stool cultures.

In October 2001 an outbreak of Salmonella enterica serovar enteritidis phage-type 6 occurred in a hospital and a nursing home, both served by the same hospital kitchen. Five nursing home residents died during the outbreak. S. enteritidis was isolated from three of them. Of 231 stool samples from nursing home residents, hospital patients and employees, 82 were culture-positive. All symptomatic patients were treated with oral ciprofloxacin. Inspection of the kitchen showed that during preparation of the desserts implicated in causing the outbreak, temperatures were not measured and storage temperatures were too high. No left-over food samples were available for analysis. According to the 'four-day rule' in use in this hospital, the stool samples related to the first outbreak were not cultured for Salmonella spp., whereas culturing afterwards from both stored specimens and repeats, showed that some of these samples would have been positive for S. enteritidis. Thus without the application of stool culture rejection criteria the outbreak would have been detected one day earlier. With the four-day rule in effect, the outbreak might have been detected much later, if an unusually high number of nursing home residents with gastroenteritis had not been noticed by nursing home physicians. The rule was revised to prevent a possible delay in the future. As a result of this outbreak, the government has announced legislation forbidding the sale of Salmonella-contaminated eggs. An official ban on the use of raw eggs will be included in several hygiene codes.