News from Japan Dietetic Association
  • Dietetics Activities Related to Food Supply System in a Japanese Hospital during COVID-19 Pandemic
     
    Japan, like the rest of the world, is facing a pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Japan has postponed the 2020 Olympics and declared a state of emergency beginning in April 2020 and by May 26 the infected cases in total were 16,600 (about one third of them in the Tokyo area) and the number of deaths was 846Many health facilities, especially acute-care hospitals, are becoming overwhelmed. In April 2020, the hospital in Tokyo with which we have a cooperative agreement recorded 52 coronavirus cases including both medical staff members and inpatients.   The hospital had to temporarily stop receiving outpatients and emergency patients.
     
    Japanese hospitalsfood supply system has to follow the HACCP system at all timesAll staff members have to be trained to implement proper procedures. The HACCP system helps to minimize risk when supplying food; especially in the hospital environment there are many risks of disease, so compliance with the HACCP system is critical. COVID-19 is a new type of virus; there is no vaccine or medicine as yet; and it is highly infectious in the community, especially among elderly people and people with impaired resistanceThe hospital’s kitchen staff includes many elderly people and unfortunately, we early detected one case of a part-time kitchen cleaning staff member with coronavirus; isolation was quickly implemented.  Coronavirus anxiety in a closed workplace is unavoidable.
     
    In this situation, the nutrition department immediately had to have a further solution to ensure maintenance of a safe food supply for patients and to prevent spread of nosocomial infection.
     
    Japan is used to natural disasters such as earthquakes and tsunamis, so nutrition management manuals for these cases are available. However, COVID-19 is new; there is no manual and it is a new situation for us. Our current experience which is shared below is still being gradually improved and needs to be flexible depending on each hospitals situation. We hope this experience will be useful for other nutrition departments in hospitals in dealing with the pandemic.
    1. Human resources
    Health check: for dietitians and kitchen workers, besides the usual health check list, we implemented a health check list for symptoms of COVID-19 such as fever, cough, headache, muscle ache, chills, smell disturbance, vomiting in staff members and people who live with them to be followed and reported to the hospital every day. If people have any abnormal symptoms, stopping work for inspection and tracking are required.
     
    Teamwork: Dietitians were also divided into two teams to be in the hospital to work on different days, and to implement distancing when communicating. Meetings are conducted online. Kitchen staff also work in shifts and teams. Changing the food supply system will help to reduce the number of kitchen staff members as much as possible to limit possible viral transmission among the staff members.
    1. Hygiene
    Almost all viruses (except norovirus), including coronavirus, will die at about 80 degrees Celsius. This means that all hygiene activities have to reach at least 80 degrees including sanitation by alcohol, drying tableware, steaming food, etc.
    The food supply system in hospitals needs to guarantee that the HACCP system is followedHowever, because kitchen and medical staff members may be temporarily replaced by new emergency staff who are not familiar with our procedures, we posted reminders that all staff must strictly follow procedures.
    1. Food supply system
    Because of coronavirus anxiety, our hospital decided to change temporarily to an outside food supply system. With this system, the kitchen staff can have more time to rest and maintain psychological stability.
    • Change to outside food supply system:
    + Commercial food stored at room temperature
    + Frozen foods can be stored for some days
    + Outside food center kitchen ships to hospital every day
    • Change menus: need to change the menus according to outside food supplement companies which have three main meal types including normal meal, soft meal and mixed meal. All use one-time plastic tableware. After patients finish meals, nurses have to dispose of all plastic tableware within the ward.  Hospital top management had to agree on and all medical staff need to know these modified menus before supplying them to patients.
    • Change nutrition products for enteral nutrition from paper type to one-time bag type to reduce risk of infection for patients and nurses.
    • The nutrition software including food orders, doctors’ orders, patients’ menus etc. also need to be adjusted according to the new menus.

    Dietitian supported to change kitchen tray to ward tray in Covid-19’s emergency

    Shigeru Yamamoto, Keiko Hirose, Thao Phuong Tran
     
    Jumonji University,
    Member of International Committee, Japan Dietetic Association