Comprehensive risk assessment and control measures in the food service chain of hospitals nutrition department: a case study in Al-Ahsa Governorate, Kingdom of Saudi Arabia

Abstract

Introduction: Ensuring hospital food safety is essential for patient health, infection control, and public trust. This study evaluates food exposure risks in two hospitals in Al-Ahsa Governorate, Saudi Arabia, focusing on critical control points during food processing and delivery.

Methods: Microbial analysis was conducted on food samples from various stages of food preparation, including raw meat, chicken, fish, and prepared meals. Temperature monitoring and chemical hazard assessments were also carried out, including pesticide residue and heavy metal analysis.

Results: The microbial analysis detected specific pathogens, including Salmonella, Listeria monocytogenes, Escherichia coli, and Staphylococcus aureus, along with yeasts and molds. Total bacterial counts (TBC) in raw meat, chicken, and fish ranged from 2.5 to 5.0 log cfu/g, while prepared meals had TBCs between 1.0 and 3.0 log cfu/g. No Salmonella or Listeria monocytogenes were detected. Chemical hazards, including mycotoxins in white flour and heavy metals, were within permissible limits. However, 12 pesticides were detected, with six exceeding European Food Safety Organization limits.

Discussion: Temperature monitoring revealed that hot foods cooled to unsafe levels during transport, and cold samples were not consistently maintained at SFDA-recommended temperatures. Hospitals generally comply with health regulations but improvements are necessary in temperature control and preventing chemical contamination of raw materials.

Keywords: critical control points; food safety; food service chain; hazard analysis; healthcare facilities; hospital nutrition; hygiene practices; quality assurance.

Figure 1

Comprehensive analysis of risk assessment matrix of physical risks in hospital environments and recommended control measures across hospitals in Al-hasa, Saudi Arabia. Hazard-A, Raw food contamination, facility infrastructure issues. Hazard-B, Freezer/cooler contamination, facility infrastructure flaws. Hazard-C, Food preparation area contamination risks. Hazard-D, Prepared food contamination and facility maintenance problems. Hazard-E, Prepared food contamination facility hygiene issues. Hazard-F, Patients’ meal contamination and facility equipment issues.

Figure 2

Flowchart representing the HACCP inspection process for hospitals, with six critical control points (CCPs) and monitoring steps.

Figure 3

Heatmaps of microbial load (log ×10 cfu/g) analysis of (A) raw meat, (B) raw vegetable, and (C) bakery materials (wheat flour) in hospitals of Al-Hasa Governorate, Saudi Arabia. HA, Hospital A; HB, Hospital B; TB, Total Bacterial Count; TMY, Total Mold and Yeast; TC, Total Coliform; SS, Staphylococcus spp.; LM, Listeria monocytogenes; M, Meat; C, Chicken; F, Fish; E, Fresh Egg; B, Bakery; WF, Wheat Flour; W, Whole Sample; S, Surface sample; CF, Cucumber Fruit; BC, Before Cutting; AC, After Cutting.

Figure 4

Heatmaps of comparative microbial profiles (log ×10 cfu/g) of (A) meal preparation and (B) bakery preparation areas in hospitals of Al-Hasa Governorate, Saudi Arabia. HA, Hospital A; HB, Hospital B; TB, Total Bacterial Count; TMY, Total Mold and Yeast; TC, Total Coliform; SS, Staphylococcus spp.; LM, Listeria monocytogenes; S, Soup; CV, Cooked vegetables; FS, Fresh salad; CR, Cooked Rice; CF, Cooked Fish; W, Whole sample; B, Bakery (wheat flour); BC, Before Cutting; AC, After Cutting.

Figure 5

Heatmaps of comparative microbial loads (log ×10 cfu/g) in critical control points (CCP) across hospitals in Al-Hasa Governorate, Saudi Arabia. HA, Hospital A; HB, Hospital B; TB, Total Bacterial Count; TMY, Total Mold and Yeast; TC, Total Coliform; SS, Staphylococcus spp.; LM, Listeria monocytogenes; RWH, Receiving worker’s hand; RCU, Containers before unloading; S, Swap; FCR, From the cold room; CFFR, Container from the freezer room; BUH, Butchers’ hands; BUM, Meat cutting board; BUC, Chicken cutting board; BUF, Fish cutting board; SB, Swap Before use; SA, Swap After use; BAH, Baker’s hands; BAC, Bakker’s cutting boards; VCU, Vegetable cutting board; VHW, Hands of vegetable preparation workers; PDS, Patient dish before serving; PPP, Plastic spoons for patients; PHD, Hands of food distributor; BCH, Cook’s hands; CCP1, Critical control point of receiving area; CCP2, Freezer and cooling rooms; CCP3, Butchery area; CCP4, Bakery preparation area; CCP5, Vegetable and salad preparation area; and CCP6, Patient meal dispensing area.