On and shortly after the 6th May 1990, 16 people were affected by food poisoning in an old peoples' residential home, of whom two died. The vehicle of infection was identified as a baked Alaska contaminated by Salmonella enteritidis phage type (PT) 8 and, at an early stage of the investigation, the source was attributed to a single infected egg. A separate investigation by the author, however, revealed that the baked Alaska meringue had been dispensed from an inadequately cleaned piping bag which had been recovered from the kitchen a month after the outbreak. A pure, profuse culture of S. enteritidis PT8 was isolated from it. At least one secondary case may have been attributable to food made with this bag. Ministry of Agriculture Investigations of the flocks suspected of producing the eggs used for the baked Alaska demonstrated an absence of S. enteritidis. On this basis, the author considered a more likely cause of the outbreak to be the piping bag, contaminated from source or sources unknown within the kitchen. Furthermore, the possibility of human carrier transmission cannot be wholly ruled out. The incident underlines the dangers of jumping to conclusions at the outset of food poisoning investigations and emphasises that hypotheses formulated on sources of contamination must be properly tested, the absence of which, in this instance, led the investigators to unwarranted conclusions as to the cause of the outbreak.
Mass catering systems can be used to provide food for the elderly in their own homes, in luncheon clubs, in residential homes and similar establishments and in hospitals. Food and service should be not only nutritionally correct, but also pleasing and acceptable. Eating contributes to psychological and social as well as physical health. Because of limited budgets, strict control of suppliers must be maintained with clear specifications of all items. Staff responsible for menu planning and food service must be adequately trained. Meals should be enjoyable as well as healthy.
Commercial, public foodservices are experiencing an increasing demand for menu selections consumers see as healthful. Demographic, economic and lifestyle forces are resulting in a growing proportion of individuals and families who eat away from home more frequently. Many are seeking prudent food choices not only at home, but also in foodservice operations. To them, nutrition represents one controllable lifestyle element which can influence their personal health. Weight control and preventive nutrition are the nutrition-related objectives of most consumers interested in foodservice nutrition. They look to dietary guidelines, both those which are specific to their particular health concerns, (e.g. weight control), and those intended as eating-style changes to reduce the risk of such diet-related conditions and diseases as obesity, atherosclerosis, high blood pressure, diabetes and certain forms of cancer. Focusing on these health objectives, interested foodservice operators should offer items which allow consumers to avoid certain foods and food preparation methods which add up to too much of the following: total calories; fat; refined carbohydrates; cholesterol; sodium; and certain controversial substances, (e.g., caffeine). They seek to replace some of the 'avoid' items with a variety of choices of minimally-processed plant foods, and with less-fatty animal foods. Employee education to support menuing nutrition should begin with the development of an awareness of specific target market health concerns. Employees can then be made familiar with methods to translate these dietary wants and needs into appealing, well-tuned products and service elements. The success of nutrition program elements relies heavily on this understanding by employees in their roles from recipe development to table service.
Sporadic cases of salmonellosis always by the same serotypes occurred in two different care institutions. In the first institution the cases had been caused by S. binza and S. eimsbuettel, in the second by S. mons and S. braenderup. The cases of salmonellosis prompted studies into the occurrence of these Salmonella serotypes in the kitchens of the relevant institutions, as well as into the occurrence of salmonellas in kitchens of care institutions in general. Using Moore's swabs the relevant Salmonella serotypes could be demonstrated in the kitchens of the institutions with sporadic cases of salmonellosis, while in kitchens of 15 other arbitrary chosen institutions Salmonella could not be detected at all. This demonstrated that the occurrence of sporadic cases of salmonellosis was related to the occurrence of salmonellas in the kitchens. Then investigations were started to establish the origin of the salmonellas. There was a mice plague in one institution. Mouse-dung was found positive for the relevant Salmonella serotype(s). Cases of salmonellas did not occur any more when the mice had been eradicated. It was concluded that the sporadic cases of salmonellosis in that institution were strongly associated with the presence of mice. In the other institution it appeared that disinfection was inadequate and that salmonellae were spread all over the kitchen environment during cleaning, leading to recontamination. After thorough disinfection and adaptation of cleaning and disinfection procedures sporadic cases of salmonellosis did not occur anymore. Results of these investigations demonstrated the important role of vermin and proper cleaning and disinfection in food hygiene. Moreover, the sporadic cases of salmonellosis came to light because gastro-enteritis was a reason for examination of faecal specimens of patients. This is not usual in many care institutions. However, in this way problems in hygiene can be traced, especially in the kitchen. For this reason it is recommended strongly to examine faecal specimens in cases of gastro-enteritis, even in sporadic cases.
Both nutritional and hygienic factors contribute to the economic success of a catering operation. Customers are increasingly nutritionally health conscious and also look for cleanliness when choosing somewhere to eat. Outbreaks of food poisoning are very bad publicity. Good quality of food is important but this is not necessarily synonymous with microbiological safety. Raw materials need to be checked on receipt and there should be good communication between the purchasing and the reception staff. Correct storage prolongs quality and safety and prevents waste, which frequently becomes most apparent when the food reaches the preparation area. The cold kitchen is very vulnerable and poor quality or badly stored raw materials compound bad handling to cause a risk to the consumer and a reduced shelf life leading to wastage. Warm holding of food needs to be balanced between the requirements of microbiological safety and loss of quality from holding too long at a high temperature. The official food inspector plays an important role, not just as the enforcer of food hygiene law, but also as an impartial adviser on hygiene. Caterers and their staff need to be encouraged to see hygiene as a positive way to economic success by reducing waste and thus achieving greater productivity: it is easier for most people to become enthusiastic about profits than about microbiology. The Swedish Catering Institute has published a training package with this as its main objective.
Serious consequences can arise from lack of hygiene in mass catering. The uncritical use of routine microbiological tests purporting to measure hygiene merely creates a false sense of security. The microbiological safety of food is achieved by as far as possible ensuring the absence of pathogenic microorganisms and by all means preventing their multiplication. The Hazard Analysis Critical Control Point concept is used to identify microbiologically vulnerable points in the food production process and to determine the most appropriate methods of control to be applied, usually such methods as improved handling techniques, monitoring of temperature and more intensive supervision. Microbiological testing is of value in the initial analysis, at appropriate intervals for verifying the effectiveness of control measures, and in demonstrating to food handlers the reality of the microbial risk if good hygienic standards are not maintained.
This paper describes the first steps taken in Grampian Health Board to change hospital staff menus in order to provide meals higher in starchy carbohydrate and dietary fibre but lower in fat and sugar, as recommended in several recent reports. These changes are discussed with reference to the alterations made by the catering department. A nutrition education programme was used to promote these changes and the methods used for this are also described. An overall evaluation was carried out by means of a dietary intake questionnaire administered before and after the programme and the results of this show a significant decrease in fat intake and increases in carbohydrate and dietary fibre intakes.
