So-called risky foods have been found on menus of healthcare facilities in Germany and Italy, according to a study published this spring.

Products that may present a risk to vulnerable people – including deli salads, raw/fermented sausage products, soft cheese, smoked fish or frozen berries – were offered on the menu of all facilities in Germany, and one-third of Italian sites. 

Researchers looked at the use of electronic food menu data to support investigations of healthcare-associated foodborne outbreaks through a survey of 35 healthcare facilities in Germany and Italy. They found the use of food menu data in outbreak investigations was challenging because of incomplete documentation. 

Large variability was reported in the storage time of menu data – from none up to 10 years. Formats included paper, electronic PDFs, Word or Excel documents, and searchable databases.

Need to raise awareness
The survey, between June 2019 and February 2021, was completed by hospital hygienists, kitchen managers, caterers, or dieticians in charge of managing food menus for patients. It included 22 sites in Italy and 13 in Germany. Findings were published in the journal Epidemiology and Infection.

The questionnaire covered information on catering service management, format and storage duration of food menu data, availability of menu data for each patient, history of menu data by the facility in relation to a suspected foodborne outbreak, and information on whether it provided known high-risk foods.

The study involved 26 hospitals and nine nursing homes of various sizes. One nursing home in Germany didn’t participate, saying “food poisoning was not an issue” in their facility. This highlights the need to raise awareness about the risk of outbreaks and to strengthen food hygiene recommendations among staff and food businesses, said researchers.

Catering systems included in-house, external, and mixed. Catering activities were mainly outsourced by Italian hospitals, wheras in Germany, in-house catering was more often reported in hospitals and nursing homes.

One hospital in Germany, in which a Salmonella Derby outbreak occurred because of spreadable raw fermented sausage (German Teewurst) did not offer this item anymore but other potentially high-risk foods were available to patients, such as soft cheese and smoked fish.

Use of menu data during outbreaks
The majority of hospitals in Italy reported that a direct link between the food menu data and individual patients could be established, in contrast to only half of the hospitals in Germany. In nursing homes, the direct link of menu data to individual nursing home residents was uncommon in Italy and Germany.

Electronic databases were available for most Italian hospitals but only a few German ones. No such databases were used by nursing homes.

Scientists said food menu data should be documented for all offered meals and be linked to individual patients or nursing home residents. A minimum duration of data storage of at least a year would help with the investigation of lengthy events such as listeriosis outbreaks or for items with a long shelf-life, such as frozen food.

Digitization and collection of additional data will result in more costs, including human resources. The cost–benefit of collecting and digitizing food menu data should be evaluated, since usage and analysis of these data may have shared benefits for different healthcare professionals, found the study.

Further research is needed to identify whether the presence of high-risk foods on the menu is related to a lack of knowledge of food safety recommendations or reflects demand by patients and nursing home residents, said scientists.