Quality evaluation of nutrition policies in early childhood education and care services in Nerang, QLD

ISSUE ADDRESSED

Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland.

METHODS

Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool.

RESULTS

Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100).

CONCLUSIONS

All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

Developing, translating, and validating a survey instrument for assessing hospital food service staff's food safety knowledge, perceptions, and practices during the COVID-19 pandemic

OBJECTIVES

To develop and validate a questionnaire to assess the food safety knowledge, perceptions, and practices (KPPs) of hospital food service staff (FSS) amidst the challenges of the coronavirus disease-2019 (COVID-19) pandemic.

METHODS

The questionnaire was subjected to a rigorous evaluation process, which included a literature review and focus groups comprising the general public, FSS, and key experts in food service. The pilot testing highlighted its utility and determined its content validity ratio (CVR).

RESULTS

Most items received high CVR scores of 0.96, indicating excellent content validity. A subsequent pilot study involved 40 FSS. Reliability testing, using Cronbach's alpha value of 0.914, demonstrated good internal consistency across the questionnaire scales. The final version consisted of 115 items.

CONCLUSION

The developed questionnaire, available in both English and Arabic, exhibits both validity and reliability. It acts as a crucial tool for healthcare facilities to assess food safety KPPs among FSS, both under regular operations and during crises like the COVID-19 pandemic. This tool is adaptable to various hospital settings, aiding in the reduction of foodborne diseases risks.

Barriers and enablers to a healthy food environment in Australian childcare services: Exploring directors' perspectives

ISSUE ADDRESSED

Early childhood education and care (ECEC) settings are ideal environments to optimise nutrition and positively influence children's food behaviours. However, recent research has identified the need to improve nutrition policies, food provision, and mealtime environments in Australian ECEC settings. This study explored the perceptions of ECEC directors regarding barriers and enablers to a health-promoting food environment within ECEC services.

METHODS

Eleven directors from ECEC services in Nerang, Queensland, and surrounding areas, participated in qualitative interviews between March and May 2021. Transcripts were analysed using qualitative content analysis that followed a deductive-inductive approach employing nutrition-related domains from the Wellness Child Care Assessment Tool, these being: (i) nutrition policy; (ii) nutrition education; (iii) food provision; and (iv) mealtimes. Transcripts were coded independently by two researchers in NVivo and consensus for barriers and enablers was achieved through discussion.

RESULTS

Barriers and enablers were reported across four domains (nutrition policy, nutrition education, food provision, and mealtimes). Comprehensive nutrition-related policies were an enabler to a healthy nutrition environment but were sometimes described as lacking detail or customisation to the service. Nutrition education for children was described as competing with other activities for time and resources in an already-crowded curriculum. Financial and time pressures faced by families were a barrier to healthy food provision in services where families provided food for children. The ability of staff to sit with children and engage in conversation during mealtimes was an enabler; however, competing demands on time and the unavailability of food for staff were cited as barriers to health-promoting mealtimes.

CONCLUSIONS

Directors in ECEC services report both barriers and enablers to a healthy food environment. Nutrition policies were an enabler when comprehensive and relevant but a barrier when vague and not tailored to the service environment. ECEC services should be supported to develop and implement service-specific nutrition policies and practices by engaging with parents and staff. SO WHAT?: The barriers and enablers reported in this study should be considered when designing and implementing future evidence-based interventions to improve the nutrition environment in ECEC services.

Factors Associated with Adherence to the Brazilian Food Guide in Food Service Workers

The present study aimed to evaluate factors associated with adherence to the Food Guide for the Brazilian Population (GAPB) among food service workers. A cross-sectional study was conducted with 421 employees from 43 food service establishments located in a capital of Brazil. Health and lifestyle data were collected, including the continuous use of medication, smoking, physical activity, and alcohol consumption. An instrument based on the GAPB was utilized, covering the domains of planning, household organization, eating habits, and food choices, according to GAPB recommendations. The findings revealed a direct association between the quality of life scores and the total GAPB adherence score (β = 1.17; p < 0.001), as well as the domains of planning (β = 0.53; p < 0.001), household organization (β = 0.22; p = 0.001), and eating habits (β = 0.38; p < 0.001). Adherence to the GAPB among food service workers was strongly linked to their perception of quality of life, in addition to other factors such as gender, age, education, type of work activity, and variables of lifestyle. Therefore, the eating practices of these employees need to be assessed comprehensively, and enhancing their quality of life can encourage proper and healthy eating.

The impact of providing flexible meals on patients' nutritional intake, fasting times and cost when admitted to a trauma unit

BACKGROUND

Malnutrition is associated with increased morbidity, mortality, decreased quality of life, increased length of hospital stay and higher treatment costs. Prevalence rates in Australian hospitals is reported between 30% and 50%. Trauma patients experience significant periods of restricted oral intake resulting from pre-operative fasting for complex and frequent surgical procedures. In addition, they have elevated nutritional requirements for recovery resulting in significant accrued nutritional deficits. The present study hypothesised that not having hot meals available outside of the hospital food service system was contributing to increased nutritional deficits. The study aimed to investigate the impact of providing flexible frozen meals and snacks in a trauma ward, on nutritional intake, cost and duration of perioperative fasting.

METHODS

This was a pre- and post-interventional study examining 40 fasting experiences of hospitalised patients in a trauma ward. Frozen meals and snack bags were readily accessible to nursing staff to provide to patients out of kitchen service hours. Nutritional intake and fasting times were measured from patient records and interviews.

RESULTS

Implementing flexible food items increased patient nutritional intake by 28% (15%-43%) on the day of fasting. Fasting duration was not significantly reduced (1.73 h); however, when patient fasting was ceased, food was provided more responsively. Nursing staff showed improved satisfaction with project implementation.

CONCLUSIONS

The present study has demonstrated that provision of food items outside of regular meal service hours is a low cost intervention that improves nutritional intake, provides nutrition more responsively and is well received by nursing staff.

Importance-performance analysis of sodium reduction practices by school nutrition teachers and dietitians in the Republic of Korea

BACKGROUND/OBJECTIVES

This study investigated the importance and performance level of sodium reduction practices in school meal service by school nutrition teachers and dietitians, and compared them according to school level and placement of the school nutrition teacher.

SUBJECTS/METHODS

An online survey was conducted with 608 nutrition teachers and dietitians in schools in the Republic of Korea from September 28 to November 12, 2021 (response rate: 57%). The questionnaire comprised 11 items related to sodium reduction practices (purchasing, food preparation and serving, and education). The importance and performance level of each item was rated on a 5-point scale. The mean differences were analyzed using t-tests or one-way analyses of variance and Duncan's post-hoc tests. An importance-performance analysis was performed on sodium reduction practices.

RESULTS

Participating in sodium reduction education, sodium reduction education for cooks, and sodium reduction education for students were assessed to have high importance but low performance. Overall, the higher the school level, the lower was the importance level of sodium reduction practices. The performance in kindergartens and elementary schools was higher than that in middle and high schools. The importance in the purchasing category perceived by dietitians was lower as compared to nutrition teachers. In addition, the performance in the purchasing, food preparation and serving, and education categories perceived by dietitians was lower than those of nutrition teachers.

CONCLUSION

Sodium reduction education for nutrition teachers and dietitians, cooks, and students should prioritize practicing sodium reduction in school meal service. Specific guidelines for managing sodium reduction at all stages-purchasing, food preparation, and serving-should also be developed. The results could be used as basic data to reduce the sodium content in school meals.

Leveraging an Experience-Based Codesign Approach to Improve the Inpatient Food Service Experience

Introduction

Hospital food service is a key patient experience domain in an inpatient setting, which also plays an important role in responding to clinical and nutritional needs by providing food that is acceptable to patients. To achieve the strategic objective of a "distinguished patient experience," a Food Service Patient Experience Improvement Project was implemented at Al Hada Armed Forces Hospital during the second quarter of 2021 (Q2-2021) to improve the patient experience of meals at inpatient units.

Methods

A quasi-experimental study design was used to assess the improvements in the inpatient meal experience by implementing an experience-based codesign approach. Improvements in the inpatient setting patient experience survey (Press Ganey) meals domain were measured. SQUIRE 2.0 guidelines were used to report this quality improvement project.

Results

A significant improvement was observed in the inpatient meals patient experience mean score before (Q1-2021, 68.75) versus after (Q3-2021, 81.93) the implementation of the Food Service Patient Experience Improvement Project.

Conclusion

Food services are an important element in the patient recovery process and experience. The experience-based codesign is an effective coproduction approach to improve the patient experience and promote patient-centered care.

Patient Mealtime Experience: Capturing Patient Perceptions Using a Novel Patient Mealtime Experience Tool

INTRODUCTION

The aim of this study is to describe the mealtime experience using the qualitative components of the Austin Health Patient Mealtime Experience Tool (AHPMET) to complement the quantitative findings of this tool.

METHODS

A multiphase, cross-sectional study was undertaken across all sites of Austin Health (Victoria, Australia) between March 2020 and November 2021. Patient mealtime experience was measured using the AHPMET. Descriptive statistics and a deductive thematic analysis approach described the patients' mealtime experiences.

RESULTS

Questionnaire data were collected from 149 participants. Patients were most satisfied with staff interactions, and least satisfied with dimensions of food quality, specifically, flavour, presentation, and menu variety. Clinical symptoms, nutrition impact symptoms and the patient's position were barriers to consumption.

DISCUSSION

Food quality was perceived as the poorest aspect of patient satisfaction with the hospital foodservice, particularly flavour, presentation, and menu variety. Future foodservice quality improvements must prioritise improving food quality to have the greatest impact on patient satisfaction. While clinical and organisational systems have a role in improving mealtime experience and oral intake, communicating patient perceptions of the mealtime experience is critical for responding to current perceptions of hospital food quality.

CONCLUSION

Mealtime experience in the hospital has a significant impact on oral intake and patients' wider perception of hospital services. Questionnaires have been used to capture patient satisfaction with foodservice in the hospital; however, no comprehensive questionnaires including qualitative questions that capture the broader mealtime experience have been validated across different hospital settings. The tool developed through this study can be implemented in any acute and subacute health service to provide feedback and improve the mealtime experience of patients. This has the capacity to improve mealtime intake, mitigate malnutrition, and improve quality of life and patient outcomes.

Transformative systemic changes to embed environmental sustainability in foodservices: A grounded theory exploration

AIMS

Foodservices are a strong contributor to global environmental impact. Systemic change is required to lead the transformation towards environmentally sustainable foodservices. However, guidance to support foodservices to be more environmentally sustainable is lacking. The aim was to explore food-related environmentally sustainable strategies and their transferability to foodservices in a range of settings, to inform a framework for future application and research.

METHODS

A constructivist grounded theory study design was used. Semi-structured interviews with foodservice sustainability consultants, who support foodservice organisations to improve environmental sustainability, were conducted. Interviews were recorded, transcribed, and coded line-by-line. Ten consultants were purposively sampled for diversity in location, organisation type, funding model, and services provided. Codes were collapsed into categories, to inform the development of themes and a framework for the implementation of strategies.

RESULTS

Four sub-themes were created under an overarching theme of 'Transforming the Foodservice System': embedding leadership, shifting perspective, constructing collaborative networks, and fostering momentum. A range of implementation strategies were captured within the sub-themes.

CONCLUSION

These themes informed the development of a practical application framework for implementing sustainable strategies in foodservices that is useful for practice and future research in the area.

The origins of hospital food: Where does it come from and what do staff, patients and suppliers think about local food?

AIMS

To identify the origin of fresh and minimally processed foods served to hospital patients, and explore the challenges and enablers to local food procurement in hospitals.

METHODS

A mixed methods study was conducted in a healthcare network in Victoria, Australia. Packaging labels and product information were used to audit fresh and minimally processed foods purchased in 1 week. Processed food items and meals made offsite were not audited. Interviews were conducted with patients, staff and suppliers to explore their perspectives towards local food in hospitals. Framework analysis was used to identify themes.

RESULTS

Of 105 food products audited, 32% were imported, 25% were 'local' from Victoria and the remaining 43% were from within Australia (excluding Victoria). Qualitative interviews revealed several challenges including: increased cost of local food items, inconsistent supply and variable quality of local produce, difficulty accessing origin information, and lack of autonomy for hospitals to make food procurement choices. Enablers included: conducting a food origin audit to increase awareness, group purchasing organisation prioritising local food suppliers, and suppliers valuing local produce.

CONCLUSION

A food origin audit and interviews with stakeholders provided a rich understanding of current practices and how to increase local food procurement.

The Hospital Food Experience Questionnaire Predicts Adult Patient Food Intake

Purpose: Describe food/beverage intake among all patients and those with low meal intake and determine if the Hospital Food Experience Questionnaire (HFEQ), or its shorter version (HFEQ-sv), predicts food intake while considering patient (e.g., gender) and hospital characteristics (e.g., foodservice model).Methods: Cross-sectional study of 1087 adult patients from 16 hospitals in Ontario, Canada. The valid and reliable HFEQ assessed patients' meal quality perceptions. Visual estimation determined overall meal and food/beverage intake using the Comstock method. Binary logistic regressions tested the association between patient and hospital characteristics and whether HFEQ or HFEQ-sv scores added utility in predicting overall meal intake (≤50% vs. ≥75%).Results: Approximately 29% of patients consumed ≤50% of their meal. Models assessing patient and hospital characteristics and either the HFEQ or the HFEQ-sv were significant (LRT(43) = 72.25, P = 0.003; LRT(43) = 93.46, P < 0.001). Men and higher HFEQ or HFEQ-sv scores demonstrated significantly higher odds of ≥75% meal consumption. Considering HFEQ or HFEQ-sv scores explained greater variance in meal intake and resulted in better model fits.Conclusions: The HFEQ and HFEQ-sv predict patient meal intake when adjusting for covariates and add utility in understanding meal intake. Either version can be confidently used to support menu planning and food delivery to promote food intake.

Application of draft nutritional standards for school lunches in the Republic of Korea: a feasibility study from the supplier perspective

BACKGROUND/OBJECTIVES

The purpose of this study was to evaluate the feasibility of application of the draft nutritional standards for school lunches in the Republic of Korea (South Korea) from the supplier perspective.

SUBJECTS/METHODS

In November 2018, a pilot operation was conducted at 104 participating schools for 2 weeks each by applying the draft standards A and B. To evaluate the ease and appropriateness of application of the standards, we analyzed the nutritional values and food cost of the school lunches for 2 weeks before and for 4 weeks under the pilot operation. We conducted an online survey of school dietitians or nutrition teachers of the participating schools to evaluate the feasibility of application of the standards in school lunch sites.

RESULTS

The proportions of schools of which lunches met the reference values of the school's own nutritional standards were 19.2% for the standards A and 21.2% for the standards B. The food cost of school lunches applying the standards A (KRW 2,880) was significantly lower than that of school lunches applying the standards B (KRW 3,030) or the existing standards (KRW 2,980). As a result of the survey, the mean score for the ease of application was significantly higher for the standards B (2.75) than for the standards A (2.24). The proportions of school dietitians or nutrition teachers reporting no problem in meeting an existing food cost standard were 72.5% for the standards A and 61.8% for the standards B, respectively. The overall appropriateness of application was higher for the standards B, because almost two-thirds (58.8%) of the respondents answered that the standards B were more appropriate than the standards A.

CONCLUSION

The standards B were more feasible to apply as nutritional standards for school lunches than the standards A from the supplier perspective.

Development of nutrient-based nutritional standards for foodservice at shelters during disasters in the Republic of Korea

BACKGROUND/OBJECTIVES

In times of disaster, simplified and minimized nutritional standards are necessary for a quick response to provide nutritious relief food. This study aimed to develop nutrient-based nutritional standards for foodservice at shelters during disasters in the Republic of Korea (South Korea).

SUBJECTS/METHODS

The standards were developed in 2 phases. First, nutrients to be included in the standards were selected. Initial candidates were selected considering 3 aspects: preceding standards, insufficient intake during disasters, and inadequate intake among South Koreans. Final selection was made by excluding nutrients for 3 reasons: nutrients for which there is no deficiency concern in South Korea, nutrients whose intake data were not available, or nutrients whose values presented by Dietary Reference Intakes for Koreans are difficult to achieve based on the current diet among South Koreans. Second, the reference values of energy and the selected nutrients were calculated. The reference values for the entire population who were 1-year-old and over were calculated by multiplying the estimated energy requirements or the recommended nutrient intake and the proportion of each age and sex group. Respective reference values were also calculated for 4 different age groups (1-5, 6-11, 12-64, and ≥ 65-year-old).

RESULTS

The standards for the entire population were 2,000 kcal for energy, 55 g for protein, 650 µg retinol activity equivalents for vitamin A, 95 mg for vitamin C, 1.1 mg for thiamin, 1.3 mg for riboflavin, 14 mg niacin equivalents for niacin, 350 µg dietary folate equivalents for folic acid, 750 mg for calcium, and 11 mg for iron. Four additional standards corresponding to each age group were developed.

CONCLUSIONS

The nutritional standards during disasters were developed for South Korea, including energy and 9 nutrients with reference values for the entire population and 4 different age groups. The standards will contribute to maintaining the health of disaster evacuees in South Korea.

Quantifying waste and its costs in hospital foodservices

AIM

To measure the amount of different types of food and food packaging waste produced in hospital foodservice and estimate the cost associated with its disposal to landfill.

METHOD

A foodservice waste audit was conducted over 14 days in the kitchens of three hospitals (15 wards, 10 wards, 1 ward) operating a cook-chill or cook-freeze model with food made offsite. The amount (kg) of plate waste, trayline waste and packaging waste (rubbish and recycling) was weighed using scales and the number of spare trays and the food items on them were counted. Waste haulage fees ($AU0.18/kg) and price per spare tray item were used to calculate costs associated with waste.

RESULTS

On average there was 502.1 kg/day of foodservice waste, consisting of 227.7 kg (45%) plate waste, 99.6 kg (20%) trayline waste and 174.8 kg (35%) packaging waste. The median number of spare trays was 171/day, with 224 items/day on them worth $214.10/day. Only 12% (20.4 kg/day) of packaging waste was recycled and the remaining 88% (154.4 kg/day) was sent to landfill along with food waste at two hospitals. Overall 347.3 kg/day was sent to landfill costing $62.51/day on waste haulage fees, amounting to 126.8 tonnes and $22 816.15 annually.

CONCLUSION

A substantial amount of waste is generated in hospital foodservices, and sending waste to landfill is usual practice. Australia has a target to halve food waste by 2030 and to achieve this hospital foodservices must invest in systems proven to reduce waste, solutions recommended by policy advisors (e.g., waste auditing) and waste diversion strategies.

Carbon Footprint of Away-From-Home Food Consumption in Brazilian Diet

Environmentally unsustainable diets are often characterized by being high in calories, processed foods, and red meats, characteristics related to away-from-home food (AFHF). The aim of this study is to evaluate if AFHF consumption is related to environmental sustainability. Data of 20,780 adults from 24 h recalls collected in the 2017-2018 Brazilian National Dietary Survey (NDS) were used to estimate carbon footprint coefficients. The mean carbon footprint was estimated among individuals who consumed AFHF and non-consumers. Linear regression models were used to evaluate differences between away-from-home eating and the carbon footprint of the diet, adjusting for age and income. A total of 41% of Brazilians consumed AFHF during the previous day. The mean carbon footprint from foods consumed away from home represented 18% of the total carbon footprint. AFHF was positively associated with increased total carbon footprint (β: 204.1; p-value: 0.0145). In conclusion, the consumption of foods away from home in urban areas of Brazil was associated with atmospheric greenhouse gas emissions independently of age and income. Away-from-home food consumption should be considered to reinforce the influence of diet on individual and planet health.

Food and food-related waste management strategies in hospital food services: A systematic review

AIM

This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation.

METHODS

Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively.

RESULTS

Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes.

CONCLUSION

This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.

'It's a constant changing environment, and we're just playing catch up': Hospital food services, food waste, and COVID-19

AIMS

Hospital food service operations have been affected by the COVID-19 pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID-19 pandemic on hospital food services, particularly on food waste and the completion of food waste audits.

METHODS

A qualitative interview research design was used. Semi-structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty-one participants were interviewed from 12 hospitals. No questions were related to the COVID-19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis.

RESULTS

Five themes were generated from the interviews related to COVID-19 and hospital food services; impacts on practice, labour, change, technology and post-pandemic expectations. Participants reported COVID-19 negatively affected food service operations. Changes included increased food waste, contact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID-19 restrictions.

CONCLUSIONS

Despite the impact COVID-19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post-pandemic, and may be facilitated through the operational changes forced by COVID-19.

Major concerns regarding food services based on news media reports during the COVID-19 outbreak using the topic modeling approach

BACKGROUND/OBJECTIVES

Coronavirus disease 2019 (COVID-19) cases were first reported in December 2019, in China, and an increasing number of cases have since been detected all over the world. The purpose of this study was to collect significant news media reports on food services during the COVID-19 crisis and identify public communication and significant concerns regarding COVID-19 for suggesting future directions for the food industry and services.

SUBJECTS/METHODS

News articles pertaining to food services were extracted from the home pages of major news media websites such as BBC, CNN, and Fox News between March 2020 and February 2021. The retrieved data was sorted and analyzed using Python software.

RESULTS

The results of text analytics were presented in the format of the topic label and category for individual topics. The food and health category presented the effects of the COVID-19 pandemic on food and health, such as an increase in delivery services. The policy category was indicative of a change in government policy. The lifestyle change category addressed topics such as an increase in social media usage.

CONCLUSIONS

This study is the first to analyze major news media (i.e., BBC, CNN, and Fox News) data related to food services in the context of the COVID-19 pandemic. Text analytics research on the food services domain revealed different categories such as food and health, policy, and lifestyle change. Therefore, this study contributes to the body of knowledge on food services research, through the use of text analytics to elicit findings from media sources.

Meal choice for residential aged care is not yet defined: A scoping review of policies, standards, reports and guidelines

AIM

For residents in residential aged care, making choices in relation to food and mealtimes are opportunities to maintain a sense of self and autonomy. It is unknown, however, whether the concept of choice is adequately addressed in texts relating to residential aged care. The purpose of this review is to examine whether residents' right to make choices regarding the meals they eat, is discussed in grey literature including, policies, standards, reports and guidelines, which all impact practice in residential aged care.

METHODS

Grey literature was located utilising; Google, Google Scholar and hand searching. Texts had to be in reference to residential aged care and were assessed using the Appraisal of Guidelines for Research and Evaluation II and Joanna Briggs Institute tools.

RESULTS

Twenty-nine texts were included in the final review, consisting of, 12 policies and standards, 12 guidelines and 5 reports. Choice was discussed broadly in the majority of texts, with no definition included for the level of choice that should be provided by residential aged care. The use of alternative meals to provide choice was discussed; however, texts varied in their requirements and recommendations as to what constituted an adequate alternative.

CONCLUSIONS

The ambiguity surrounding choice affects the practices within residential aged care and ultimately the service provided to residents. With most recommendations being only general in nature, residential aged care homes are not provided with sufficient guidance for meal planning. To ensure residents' right to make choices in their meals is guaranteed, more definitive requirements and recommendations are needed.

Development of a new tool to monitor and identify inadequate oral intake in hospital

BACKGROUND

There is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients.

METHODS

Ninety trays were sampled and assessed independently using the new tool 'Meal Intake Points' and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake.

RESULTS

This new tool achieved very strong association for energy estimates (r = .91) and strong association for protein estimates (r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100%; specificity 76%-80%). Minor revision of the original tool was needed to optimise performance.

CONCLUSIONS

Meal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital-acquired malnutrition.

Exploring patient satisfaction with hospital foodservice: A Swedish study using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire

AIM

The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research.

METHODS

The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05.

RESULTS

Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals.

CONCLUSIONS

Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.

The views, experiences and expectations of Australian Meals on Wheels customers: A national survey

OBJECTIVE

To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services.

METHODS

A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned  337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data.

RESULTS

Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P = .001). Delivery of pantry items was the most popular additional option for future services.

CONCLUSION

Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.

Development of the Australian National Meal Guidelines for home-delivered and centre-based meal programs for older adults

ISSUE ADDRESSED

This research aimed to develop and disseminate National Meal Guidelines for Australian home-delivered and centre-based meal programs.

METHODS

Development was led by a project group of dietitians and a steering group of representatives from the Australian Meals on Wheels Association. The process framework included three phases: (1) Review of existing standards and guidelines and systematic literature review (SLR), (2) stakeholder consultation conducted via six workshops, across six states (N = 212) and surveys with service providers, health professionals (N = 289) and customers (N = 337) and (3) review of the draft guidelines by stakeholders.

RESULTS

The final guidelines address: nutritional needs of older adults; meal and menu planning including nutrient requirements for meal components; presentation and meal enjoyment; special diets; and enhancing the meal service.

CONCLUSION

These guidelines provide consistent guidance to services providing home-delivered and centre-based meal programs. Further evaluation of their uptake and impact on service practices and customer nutrition and satisfaction is required. SO WHAT?: The National Meal Guidelines provide nationally consistent, evidence-based guidance on menu planning and nutritional quality of meals to services providing home-delivered and centre-based meal programs. The guideline development framework outlined here also provides a process for future food service guideline development.

Lessons for Employing Participatory Design When Developing Care for Young People with Cancer: A Qualitative Multiple-Case Study

Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer.

Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer.

Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to “dream” together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study.

Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.

School Nutrition Policies and Practices on an American Indian Reservation: Research and Policy Considerations

Navajo (Diné) and other American Indian children are more affected by overweight and obesity than their U.S. counterparts. In this descriptive study, the authors combined a socioecological and Navajo cultural framework to analyze the various factors that influence food choices available to children in schools. The Healthy Hunger-Free Kids Act of 2010 updated nutrition standards for school meals and all other foods and beverages sold in schools. Some studies have shown that improved nutrition standards were not favorably received by students and school food programs. To better understand these broader trends in a Navajo context, the researcher administered in-person surveys to 6 principals and 14 food service workers from a sample of 6 schools and performed on-site observations of two schools. Data were analyzed using a combination of descriptive statistics, matrix analysis, and thematic analysis techniques. Results showed that schools were offering more healthy food options in school lunches and that some schools were still serving unhealthy foods, such as pizza, tater tots, and French fries. Classroom and fundraising events provided other sources for low-nutrient foods and beverages. Participants had mixed responses about the updated nutrition standards, and food waste of healthy foods was a major concern. This study proposes opportunities for nurses to engage in research and advance stronger policies that increase healthy food options and limit access to less healthy foods.

Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study

AIMS AND OBJECTIVES

To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff.

BACKGROUND

Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life.

DESIGN

This study used an exploratory descriptive qualitative approach guided by self-determination theory.

METHOD

A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study.

RESULTS

Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being.

CONCLUSIONS

This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Students' dietary habits, food service satisfaction, and attitude toward school meals enhance meal consumption in school food service

BACKGROUND/OBJECTIVES

This study aimed to compare student consumption of school meals by school level, to identify the influencing factors of school meal consumption, and to assess improvement needs of school food service among students.

SUBJECTS/METHODS

A total of 1,441 elementary, middle, and high school students attending 58 schools in Gyeonggi-do, South Korea participated in the survey in 2015. A questionnaire and informed consent forms for students and legal guardians were sent home and completed responses were returned to the researcher.

RESULTS

Approximately 58% of the students perceived the portion sizes of school meals as appropriate and 76.1% consumed almost all or all of the meals served. More elementary and middle school students than high school students consumed almost all or all of the meals (P < 0.001). A regression analysis revealed that the students with a higher dietary behavior score (P < 0.001), higher satisfaction with food service (P < 0.001), a higher environmental protection practice score (P < 0.05), and more positive attitudes toward school meals (P < 0.01) consumed significantly more meals. The provision of foods that taste good and reflecting student opinions on menus were the most important factors for increasing school meal consumption.

CONCLUSIONS

To increase consumption of school meals, food service staff should provide students with quality meals and engage students in school food service. Nutrition education that emphasizes healthy eating behaviors and cafeteria environment modification that applies strategies based on behavioral economics can encourage students to consume more school meals.

How Widely are Supportive and Flexible Food Service Systems and Mealtime Interventions Used for People in Residential Care Facilities? A Comparison of Dementia-Specific and Nonspecific Facilities

While improved mealtime practices can reduce agitation, improve quality of life, and increase food intake for people in aged care, the degree of implementation of these strategies is unknown. This study describes food service practices in residential aged care facilities, focusing on units caring for people with dementia. An online survey was distributed to residential aged care facilities for completion by the food service manager (n = 2057). Of the 204 responses to the survey, 63 (31%) contained a dementia-specific unit. Most facilities used adaptive equipment (90.2%) and commercial oral nutritional supplements (87.3%). A higher proportion of facilities with a dementia-specific service used high-contrast plates (39.7%) than those without (18.4%). The majority of facilities had residents make their choice for the meal more than 24 h prior to the meal (30.9%). Use of high contrast plates (n = 51, 25%) and molds to reform texture-modified meals (n = 41, 20.1%) were used by one-quarter or less of surveyed facilities. There is a relatively low use of environmental and social strategies to promote food intake and wellbeing in residents, with a focus instead on clinical interventions. Research should focus on strategies to support implementation of interventions to improve the mealtime experience for residents.

The role of dietitians in residential aged care: How do cooks and chefs perceive their contribution?

OBJECTIVE

This study aimed to explore how dietitians could work with cooks and chefs to contribute to best practice.

METHODS

Data from interviews and focus groups comprising 38 chefs, cooks and food service managers were analysed. Inductive line-by-line coding of transcripts was conducted within a critical realist framework. Coding was completed independently by two authors before reaching consensus on themes.

RESULTS

Four main themes emerged: (i) knowledge sharing; (ii) communication; (iii) collaboration; and (iv) accessibility. Participants praised dietitians' knowledge and expertise, but some raised concerns about inconsistency in the advice they received.

CONCLUSION

Dietitians working in residential aged care are ideally positioned to act as advocates for residents and food services. However, findings suggest that experiences of working with dietitians are mixed. Aged care menu guidelines and quality measures could assist, not only in promoting a consistent approach to dietetic advice, but also a system for benchmarking satisfaction and best practice.

Engaging food service providers to change food service practices in aged care facilities

AIM

The present study describes the impact of a novel education program for food service staff from Australian aged care facilities (ACF) to facilitate improvements in food service practices. The purpose was to explore; (i) the impact of the intervention (ii) barriers and facilitators of the program from food service providers' perspectives and (iii) make program planning and practice recommendations.

METHODS

Participants completed pre- and post-program questionnaires, attended two focus groups on program process and impact and 4 months later reported through individual interviews on changes they had implemented. Results were triangulated between the questionnaires, focus groups and interviews and impacts and outcomes identified through directed content analysis.

RESULTS

Thirty senior-level chefs and a cook participated from 27 ACF from Victoria, Australia. Participation impacted on the menu, dining experiences and food service practices. All of the participants were enacting changes in their workplace 4 months later as change agents. A focus on skilling the participants as 'change agents', brokering ongoing peer-support and the celebrity and/or expert status of the facilitators were attributed to the success of the intervention.

CONCLUSIONS

This novel intervention empowered Victorian food service providers to make positive changes in ACF. Further research is required to measure if these self-reported changes are sustainable and relevant to other facilities and to establish the effect on food experience, satisfaction and well-being of residents.

Nutritional quality of lunches consumed by Korean workers: Comparison between institutional and commercial lunches

BACKGROUND/OBJECTIVES

The nutritional quality of lunches is an important factor related to workers' health. This study examined the nutritional quality of Korean workers' lunches with a focus on comparing institutional and commercial lunches.

SUBJECTS/METHODS

The data from a 1-day, 24-hour dietary recall from the 5^th Korea National Health and Nutrition Examination Survey (2010-2012) were analyzed. A total of 2,192 subjects aged 19 to 64 years, who had consumed lunches served by institutional or commercial food service vendors, were included for analysis. The nutritional quality of the lunches of the institutional lunch group (n=626) and the commercial lunch group (n=1,566) was compared in terms of the number of servings, food groups, nutrient intake, Nutrient Adequacy Ratio (NAR), and Mean Adequacy Ratio (MAR).

RESULTS

The NAR and MAR were significantly higher in the institutional lunches than in the commercial lunches, but more than half of workers in both groups obtained over 65% of their energy from carbohydrate. The average sodium intake from the lunches exceeded the daily intake goal (2,000 mg) in both groups. More than half of workers in both groups presented less than one-third of their respective recommended daily intake of riboflavin and calcium. With the exception of riboflavin, the nutrient intake from lunches accounted for more than 35% of the daily nutrient intake.

CONCLUSIONS

The overall nutritional quality of institutional lunches was higher than that of commercial lunches. However, institutional lunches had room for improvement in terms of nutritional quality.

Public Daycare Noncompliance with Prescribed Lunch Menus and Dietary Guidelines

OBJECTIVE

In Brazil, menus for public child daycare centers (PDC) must be planned by a nutritionist in order to meet the infants' nutritional needs and to conform to dietary recommendations. Failure to follow them may jeopardize the infants' health and growth. Therefore, the objectives of this study were to investigate the compliance of actually served lunch menus with the prescribed menus, according to age (7- to 12-month-olds and 13- to 24-month-olds) and whether prescribed and served menus followed the recommended dietary guidelines.

METHODS

Five PDCs were randomly selected for observation, out of 14 existing in the city of Concordia, Brazil. Data collection was carried out during 6 consecutive weeks in September (fall/winter menus) and October (spring/summer menus) in order to cover the menus representative of the entire year.

RESULTS

Of 60 lunches recorded, only 20% of them matched the prescribed ones entirely; none of the lunches served to infants aged 7-12 months did so. Fourteen food items were prescribed 157 times throughout the year. Omission (number of times on menu but not served) was the most frequent form of noncompliance in the younger group: 62.4% (98/157). Foods more frequently omitted by the cooks were beef, pork, chicken, and lentils. Compliance with dietary guidelines was higher in the prescribed menus and in those actually served to the 13- to 24-month-old age group.

CONCLUSIONS

Infants in the 7- to 12-month-old group may be more vulnerable to nutritional inadequacies because menus served to them were less compliant with the prescribed menus. Dietetics professionals should improve the variety of foods on the menus as well as supervise their execution.

Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals

OBJECTIVE

To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France.

DESIGN

A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals.

MAIN OUTCOME MEASURE

Food-related cost of meals.

ANALYSIS

Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively.

RESULTS

The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes.

CONCLUSIONS AND IMPLICATIONS

Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals.

Teachers' interaction with children in the school meal situation: the example of pedagogic meals in Sweden

OBJECTIVE

School meals are also a teaching occasion in which children learn about food and meals, which is referred to as "pedagogic meals" in Sweden. The aim of the present article was to study how the pedagogic meal is practiced in preschool and school settings, with focus on how teachers acted when interacting with the children.

DESIGN

Observations, interviews, and focus group interviews.

SETTING

School canteens.

PARTICIPANTS

Three schools.

PHENOMENON OF INTEREST

Teaching in the school meal situation.

ANALYSIS

Social constructionism, new social studies of childhood.

RESULTS

The teachers took on 3 different roles. The sociable teacher role entailed turning the school lunch into a social occasion, the educating teacher role involved educating the children, and the evasive teacher role was not associated with the definition of a pedagogic meal. The teacher roles, which ranged from adult-oriented to child-oriented, and which varied in the level of interaction with the children, were summarized in a framework named the Adult- to Child-oriented Teacher Role Framework for School Meals (ACTS).

CONCLUSIONS AND IMPLICATIONS

To realize the potential of pedagogic meals, teachers must be educated and become aware of the effects of their behaviors. In this situation, the ACTS framework can constitute a useful tool.

Nutritional quality and acceptability of a weekly vegetarian lunch in primary-school canteens in Ghent, Belgium: 'Thursday Veggie Day'

OBJECTIVES

To determine the nutritional adequacy and acceptability to children of vegetarian lunches served on 'Thursday Veggie Day' - a public health initiative in Ghent (Belgium) primary schools.

DESIGN

A comparison of food leftovers from main courses on regular days and Thursdays was made using a visual plate waste method. The nutritional value of the vegetarian meat analogue and meat components of main courses served on five 'Thursday Veggie Days' and five comparable conventional main courses was evaluated using three criteria (maximum 30 % of energy from fat, maximum of one-third of fat as saturated fat and minimum 1.5 g of dietary fibre per 420 kJ).

SETTING

Two canteens from primary schools in Ghent, Belgium, participating in the 'Thursday Veggie Day' campaign.

SUBJECTS

Primary-school children aged between 6 and 12 years.

RESULTS

In total, 1242 and 472 main course plate waste observations of conventional and vegetarian menus, respectively, were evaluated. There was no significant difference in plate waste between vegetarian (16.7 %) and conventional (17.3 %) main courses. Overall, the five vegetarian components were found to be nutritionally adequate with a mean score of 2.2 out of 3, compared with 0.4 for the meat component. However, three of the vegetarian components provided >30 % of energy from fat and, in one, the amount of saturated fat exceeded one-third of total fat.

CONCLUSIONS

Vegetarian canteen meals offered as part of 'Thursday Veggie Day' appear to be nutritionally appropriate and as acceptable as conventional main courses to children in primary schools in Ghent.

Associations among school characteristics and foodservice practices in a nationally representative sample of United States schools

OBJECTIVE

Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices.

DESIGN

Secondary analysis of cross-sectional data.

SETTING

Nationally representative sample of public and private elementary, middle, and high schools.

PARTICIPANTS

Data from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis.

MAIN OUTCOME MEASURES

Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices.

ANALYSIS

Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices.

RESULTS

Public schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements.

CONCLUSIONS AND IMPLICATIONS

Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition.

Assessment of the Microbiological Quality of Ready-To-Use Vegetables for Health-Care Food Services

The microbiological quality of ready-to-use (RTU) vegetables, including chopped lettuce, salad mix, carrot sticks, cauliflower florets, sliced celery, coleslaw mix, broccoli florets, and sliced green peppers was determined before and after processing. Microbial profiles were obtained 24 h after processing and on days 4, 7, and 11 after storage at 4 and 10°C to simulate temperature abuse. In addition, the microbial profiles of four RTU vegetables, coleslaw mix, salad mix, cauliflower florets, and sliced green peppers were determined 7 days after distribution to a select group of Ontario hospitals. RTU vegetables, with the exception of green peppers, showed up to a 1-log decrease in aerobic colony counts after processing. These counts increased to preprocessing levels after 4 days of storage at both 4 and 10°C. RTU vegetables stored at temperature abuse conditions (10°C)had significantly higher counts (P < 0.001) on days 4 to 11 as compared to those stored at 4°C. Green peppers had the highest bacterial counts while cauliflower and chopped lettuce had the lowest counts at both storage temperatures (P < 0.05). Increased levels of Listeria monocytogenes in RTU vegetables were associated with temperature abuse. Levels of >100 MPN/g for L. monocytogenes were detected in 8 of 120 (6.7%) samples stored at 10°C but not in 175 samples stored at 4°C after 7 days (P < 0.05). Overall, L. monocytogenes was detected in 13 of 120 (10.8%) RTU vegetables stored for up to 11 days at 10°C and 5 of 176 (2.8%) samples stored at 4°C (P < 0.05). E. coli was detected in 2 of the 120 (1.7%) processed RTU vegetables after day 7 of storage at 10°C and 1 of the 65 (1.5%) unprocessed vegetables from the same batches of vegetables used for processing. This indicator organism was not detected in RTU vegetable samples stored at 4°C or in any of the RTU vegetable samples obtained from hospital coolers. Other pathogenic bacteria, such as Salmonella spp., Campylobacter spp., Yersinia enterocolitica (serotype O:3) and verocytotoxigenic E. coli (VTEC) were not detected in any of the RTU vegetables tested, Recommendations regarding processing, distribution, and storage of these products are presented.