Electronic data on food served in healthcare facilities in Italy and Germany. Feasibility evaluation to support investigations of healthcare associated foodborne outbreaks

Healthcare associated foodborne outbreaks (HAI-FBO) result from exposure to contaminated food served in healthcare facilities. Because of the fragile population, HAI-FBO may cause considerable morbidity and mortality, and it is important to find, solve and contain such outbreaks quickly. For the timely investigation of HAI-FBO, electronic data records of food served in healthcare facilities may prove highly useful. To further investigate this possibility, we carried out a survey within NOVA (One Health European Joint Programme) among Italian and German healthcare facilities, to explore data availability, accessibility and usefulness of patient food data in hospitals and nursing home residents. We included 33 healthcare facilities in Italy (20) and in Germany (13) in the survey: 12 general hospitals, 11 paediatric hospitals, eight nursing homes and two mixed structures. A semi-structured questionnaire covered questions on hospital catering types, food menu data availability, traceability, accessibility, and risky foods. The organisation of the catering service varied between health care facilities and between Italy and Germany. Mixed catering predominated in Italian hospitals (12/18), whereas in German hospitals in-house catering was more frequent (3/5). Food served in the healthcare facilities could be linked to individual patients in 16/18 hospitals in Italy and 2/5 hospitals in Germany, whereas in nursing homes or mixed structures, this link was possible in 1/8, and 1/2 nursing homes or mixed structures in Germany and Italy, respectively. A large variability was observed in the storage time of food menu data and their formats, ranging from paper to electronic searchable databases. In Italy, the outsourcing of catering was frequently associated with a non-optimal awareness of the availability of food traceability data. In both countries, several foods considered as high risk of causing HAI-FBO were served to patients. Availability and accessibility of electronic food menu data in health care facilities was very variable. Some facilities have systems that could be readily used for outbreak investigations. Thus, traceability studies for the identification of implicated food and exposed patients should be promoted. Awareness should be raised to avoid serving risk foods to vulnerable populations in hospitals and nursing homes. Standards for fast identification of food and direct food-to-patient association should be developed and comply with multiple systems.