Serving High-risk Foods in a High-risk Setting: Survey of Hospital Foodservice Practices Following a Hospital Outbreak of Listeriosis — New York City, February–April 2009

Background: During August–September 2008, a listeriosis outbreak occurred in a New York City (NYC) hospital. Five patients, all with medical conditions that put them at high risk for listeriosis, had laboratory-confirmed Listeria monocytogenes infection; three died.  The Listeria outbreak strain was isolated from tuna salad prepared in the hospital. Prepared ready-to-eat salads and deli meats present a high risk for Listeria contamination; risk increases with duration of refrigerated storage.

Objective: Because no foodborne illness risk management guidelines exist specifically for U.S. hospitals, we surveyed NYC hospitals to characterize policies and practices.
Methods: In February–April 2009, NYC’s 61 acute-care hospitals were asked to participate in a telephone survey regarding dietary and kitchen practices and policies. Questions focused on high-risk foods and policies restricting service of high-risk foods to pregnant or immunocompromised patients.

Results: Fifty-four (88.5%) of 61 hospitals responded (median bed capacity, 422; range 20–1,200). Overall, 81% reported serving ready-to-eat deli meats to patients, and 100% reported serving prepared ready-to-eat salads. Pregnant women, chemotherapy patients, and patients on immunosuppressive drugs were served ready-to-eat deli meats at 77%, 49%, and 59% of hospitals, respectively, and were served prepared ready-to-eat salads at 94%, 73%, and 89% of hospitals, respectively. Nine percent of hospitals reported a policy that ready-to-eat deli meats must be heated until steaming before serving. Median refrigerated storage time allowed for ready-to-eat deli meats and cold-prepared salads was 2 and 3 days, respectively.

Conclusions: Despite potential for severe outcomes of Listeria infection among hospitalized patients, the majority of NYC hospitals had no dietary or food preparation policies to minimize risk. Hospitals should implement policies to avoid serving high-risk foods to patients at risk for listeriosis.