Food served to the patients and public is often a major source of dissatisfaction in the hospitals.
The exact cause could be anything. It could be unpalatable food because of poor quality raw materials or over/under cooking; unhygienic presentation in unclean utensils by unkempt staff or it could be adulterated spoilt, foul smelling food leading to food poisoning.
It could be because of wrong diet given to the wrong patient or may be non-vegetarian food served to a strict vegetarian. It could also be unhygienic preparation with insects, stones, body hair present in the dishes.
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As such, it is difficult to please every patient because of their different tastes vis-a-vis the bland kind of diet served to patients in the hospital.
On top of it, if the quality of food is compromised it can have serious repercussions. Wrong diet can further deteriorate the patient’s condition. Rotten, infected or poisonous food can lead to food poisoning and deaths.
It is the responsibility of hospital management to ensure that the foods, snacks, beverages served are safe and devoid of any hazards to the consumers. It is also a criterion for registration of hospitals and nursing homes (Section 2.9 of the application form) by Govt, of NCT of Delhi.
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Hospital management is legally liable for any ill effect of food on the patients, public or staff under the Prevention of Food Adulteration Act, 1954 or IPC Sections 272 (adulteration of food or drink intended for sale) or section 273 (sale of food or drink noxious to health) as the case may be.
Even if the dietary service is outsourced or run by a contractor, to the patients, it is the hospital management which is answerable and will be, therefore, liable along with the contractor.
A. Penalties under Prevention of Food Adulteration Act, 1954:
1. Under Section 16, subject to the provision of sub-section (1A):
i. Import into India or manufacture, storage, sale or distribution of any article of food which is adulterated or misbranded or the sale of which is prohibited under any Act or the import/manufacture, storage, sale or distribution of any adulterant (which is not injurious to health)—is punishable with imprisonment for six months to three years, and fine of at least one thousands rupees.
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ii. If the adulterant is such as would be injurious to health, it would be punishable with imprisonment for one year to six years and with fine not less than two thousand rupees.
iii. If consumption of such food article leads to death or grievous hurt within the meaning of Section 320 of the Indian Penal code, he shall be punishable with imprisonment for three years to life term and with fine not less than five thousand rupees.
2. Under sub-section (ID) commission of second similar offence will be punishable with cancellation of license, and publication in the newspapers the offenders name and place of residence, the offence and the penalty imposed, at the offender’s expense.
3. Under Section 17 if the offence has been committed by a company, the company and the person in charge of and responsible for conduct of business of the company shall be deemed to be guilty of the offence and shall be liable to be punished accordingly.
Cases of (adulterated) food poisoning reporting to the hospital may have to be reported to public health authorities (under Section 15 if required) and even to police authorities in cases of deaths occurring due to food poisoning.
B. Safety Measures:
1. There should be a documented quality manual including the policy, the scope of services and the procedure for every important activity of dietary service.
The scope may clarify whether the department would cater only for the patients or for staff and public also. The manual should include details of the quality control system to be implemented in the department and should be reviewed at least once a year.
2. Staffing: Officer in charge dietary service should be qualified/experienced / trained people who provide high quality diet free of infections.
Kitchen staff and supervisors for the patient’s kitchen should be separate from the staff/visitors kitchen and should be supervised by a qualified/experienced dietician.
3. The dietary department is so constructed as to promote high standards of hygiene and sanitation.
4. In the patients’ kitchen, there should be a separate arrangement for preparation of therapeutic diets such as, diabetic, low cholesterol, gluten free, liquid and semisolid diets as advised by the physicians.
5. Dietician should visit the wards every day and participate in assessment and reassessment of nutritional status and requirements of the patients and provide dietary advice and counseling to the inpatients.
6. Dietician should ascertain patients’ food allergies, if any, from the patients and their case records and plan their diets accordingly.
7. There is a procedure for medical inspection of all food handlers prior to the appointment and subsequent periodic (3-6 monthly) check-up and treatment/disinfection and maintenance of all the records.
Any staff with any communicable infections/skin diseases should not be allowed to join duty until fully treated and cured.
8. Adequate attention to ensure a very high standard of hygiene and sanitation in the kitchen. It should be ensured that the food is prepared, cooked and preserved under the most hygienic conditions.
9. Cooked food is always kept covered with the lids or in wraps to protect it from insects and dust.
10. There should be arrangement for separate hygienic storage of non-vegetarian items/ foods.
11. Distribution of meals in the wards should be supervised by both the nurses as well as the dietician.
12. Food, at the service point must be tasted randomly, daily, by the duty administrator or one of the senior physicians and their comments recorded in a book for the perusal of the MS, every day.
13. All dietary and catering staff, including trainees, receives initial and continuous training in food handling and hygiene practices such as hand washing, use of protective equipment and clothing, etc. and a record is maintained.
14. Ensuring that the dietary department is completely free of pests, rodents as well as insect nuisance with the help of pest control agencies.
15. There should be a procedure for ensuring that the maintenance and calibration of equipment are being done by the suppliers/qualified engineers as per a fixed schedule and the records are maintained.
16. Temperature in the refrigerators/freezers is regularly monitored and the records kept.
17. There should be a procedure for investigating any instances of food poisoning.
18. A documented policy strictly forbidding the usage and clarifying the disposal of leftover food items.
19. There is a program of regular periodic inspections of the kitchen, including night inspections to check for pests and vermin. And a record of the observations/actions taken is maintained.
20. There is a procedure for regular/periodic emptying and cleaning of all storage bins, racks, cupboards, refrigerators, coolers as per a schedule.
21. There are regular and rigidly followed schedules of cleaning the kitchen and all the fixed equipments in the kitchen and records of the same are maintained.
22. There should be a proper arrangement for collection (during preparation) and disposal of waste.
Quality of food served has a salutary effect on the treatment and speedy recovery of patients and is a significant factor for satisfaction of patients.
Good quality nourishing food, of the right type, at the right time and in the right condition, can make a stellar contribution to the recovery of the patients. Food, however, can also be a source of infections and poisoning among patients.
Both the management as well as clinicians should pay due attention to ensure that the food served to patients is free from infections or contaminants and is safe and hazard free.