Exploring Barriers and Facilitators for Food Safety in UK-Based Hospitals; Implications for Food Safety Culture

Introduction: Hospitals feed the most vulnerable in society and food safety is paramount, as healthcare associated foodborne outbreaks may have severe consequences. In recent years UK-hospital food safety incidents have continued to arise, including seven fatalities in 2019 due to Listeriosis. Safe food hygiene behaviours are underpinned by a positive food safety culture (FSC), however, limited research has been undertaken to determine behavioural/cognitive influences of FSC in UK hospitals.
Purpose: To establish an understanding of FSC amongst hospital caterers by determining cognitive/behavioural influences associated with FSC components, identifying facilitators and areas of good practice as well as key risks, barriers and components that may require improvement.
Methods: A review of FSC literature/hospital catering audits informed development of an exploratory discussion guide used to determine qualitative cognitive/behavioural influences associated with FSC components and was structured using the COM_B Model. Three focus groups were undertaken with hospital-catering managers (n=17); semi-structured interviews conducted involved hospital-catering food-handlers, supervisors and managers (n=15). A content analyses of transcribed data was undertaken using NVivo.
Results: Cumulatively hospital-caterers indicated their strong motivation towards positive food safety culture. Opportunity and capability to practice safe behaviours are influenced by factors such as ‘recruitment, retention and turnover, which is a difficult challenge’. The most predominant theme cited as a barrier to food safety in hospitals is when catering ’hand over’ food to wards, ‘that's where things sometimes deteriorate, and we lose control, things might not be done as they should be…for ward staff food safety is not their priority’. The COM_B model provided useful tool to identify areas for improvement, related to capability, opportunity and motivation.
Significance: New knowledge concerning FSC in hospitals will aid the development of a focussed FSC initiative to advance key food safety practices and reduce patients’ risk of foodborne disease.