• Cystic Fibrosis (CF) patients may have high nutritional requirements due to reduced lung function, infections and malabsorption, amongst other causes.

• Patients can have frequent and long inpatient admissions and they often like to bring food into hospital with them as per their preference, which can support them in achieving their nutritional requirements.

• Additional facilities for food storage and heating are available on the CF Unit, these facilities differ to those elsewhere in the Trust as the unit was funded by and continues to be supported by the CF@FP charity.

• These guidelines highlight how food safety will be managed to minimise the risks to patient safety.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

Cystic Fibrosis (CF) patients may have high nutritional requirements due to reduced lung function, infections and malabsorption, amongst other causes. The Cystic Fibrosis Trust Standards of Care (2024) state that ‘Provision should be made for inpatients to have a choice of high-quality food and fluids to meet individual requirements’.¹ The catering team are highly supportive of the additional needs of CF patients, and extra provisions have been made accordingly (see section 2).

It is recommended that all patients are served food from the Trust’s patient menus which are provided by the ward staff, two meals in advance. This ensures that the food offered to patients meets nutritional guidelines. There is clear information provided to patients about ingredients and allergies. Food is produced in a safe, controlled environment and there is a fully documented food safety system in place from supplier through to patient meal service. This ensures that food provided in the hospital is traceable, nutritious, and compliant with Food Safety Regulations. By adhering to this practice, the Trust aims to minimise risks to patients and staff related to foodborne illnesses, cross-contamination, and dietary restrictions.

While it is recommended that all patients are served food from the Trust’s patient menus to ensure nutritional guidelines are met and food safety is maintained, it is recognised that CF patients can have frequent and long inpatient admissions and they often bring food in with them as per their preferences, which can support them in achieving their nutritional requirements (which are often increased compared to the general non-CF population).

Furthermore, the facilities that are available to patients on the CF Unit differs to those elsewhere in the Trust as the unit was funded by and continues to be supported by the CF@FP charity. The following additional facilities exist on the CF Unit:

• Each inpatient room is equipped with a refrigerator for storage of individual food and medication.

• Microwave facilities are available in the CF Unit kitchen (staff heat food on behalf of the CF patients due to the risk of cross-infection).

• A stock of microwavable food and noodle pots are kept in the CF Unit kitchen for patients to have on request.

• A snack trolley is available for patients to select from on request.

Additionally, the Trust is aware that patients regularly order food from takeaway or grocery delivery services to the unit, and relatives and carers bring in food from external sources.

There are potential risks to both patient safety and the Trust in allowing patients to bring in food from outside of the hospital both from a food safety and an allergen perspective. As these practices are outside of the Trust’s Ward Food Safety Guidelines and the Trust’s ‘Standard Operating Procedure for Bringing Food and Drink Items into Hospital’, and as patients are supported with the heating of certain foods from outside of the hospital, individualised CF Unit Food Management guidelines are required to optimally manage these risks.

The aims of this guideline are:

• To minimise the food safety risk to patients;

• To ensure that that patients and their relatives/ carers/ friends are aware of the risks in bringing in food to the hospital and are aware of the food hygiene practices required; and

• To ensure patients are aware of their responsibility in managing food brought into the hospital.

Main Kitchen

• All patients will be provided with appropriate menus and meals as per the rest of the hospital.

• A list of extra foods which the kitchen can provide at mealtimes is displayed in each of the inpatient rooms. The kitchen will aim to meet these requests if they are able to do so.

• Patients may request additional portions by writing ‘x2’ onto the menus next to the requested food item.

• Any patient meals that have not been consumed should be returned to the kitchen on the food trolley an hour after its arrival on the CF Unit.

• Under no circumstances should hospital meals be reheated.

• Patients should be referred to the Catering Manager if they have any concerns regarding food quality.

CF Unit Kitchen Cupboards

• There are locked cupboards in the CF Unit kitchen to store foods purchased for the unit by the CF@FP charity only.

• These provide a cool, dry place for appropriate storage of ambient foods.

• These foods are subject to the same criteria as patients’ own foods:

  • They must be packaged and clearly dated.

  • Any opened or expired foods must be disposed of.

  • They must be checked by staff daily.

• These foods are for CF inpatients only.

• Patients’ personal food items are not permitted in these cupboards but should be stored appropriately in their rooms.

CF Unit Snack Trolley

• A lockable snack trolley is available on the CF Unit and is offered to patients 1-2 times each day. As the snack trolley is funded by the CF@FP charity, patients are limited to 3 items per day.

• The snack trolley must not be taken into patients’ rooms. Staff should inform the patient which snack options are available and the staff member should remove the chosen items and pass them over to the patient. The staff member should maintain hand hygiene between patients.

• As per all food on the CF Unit:

  • Items must be packaged and clearly dated.

  • Any opened or expired foods must be disposed of.

  • They must be checked by staff on a daily basis.

• These foods are for CF inpatients only.

If patients wish to bring in food from outside of the hospital, the risks of doing so must be discussed with a member of the nursing team and the CF Unit External Food Consent Form must be signed and saved onto the patient’s record on Epic. See Appendix A for the consent form (adapted from the Trust’s ‘Standard Operating Procedure for bringing food and drink items into hospital’³)

• Tinned and packaged foods that do not need to be refrigerated are considered the safest items to be brought into hospital by patients and their visitors.

• Any food brought onto the CF Unit must be transported at an appropriate and safe temperature. Any chilled items should still be chilled when they arrive on the unit.

• Chilled food should be discarded 2 hours after removal from a refrigerated environment. The patient is responsible for discarding the food.

• Hot food can be kept for 2 hours from the time of cooking before it must be discarded. The patient is responsible for discarding the food.

• Any food brought in must have a clear ‘best before’, ‘use before’ or expiry date displayed on the packaging.

• Patients and visitors should be made aware that any opened perishable foods that are not dated or that are out-of-date must be discarded. The patient is responsible for discarding the food.

• A black bin is available in the patient’s room for the disposal of food waste.

• Posters are displayed in patient rooms to remind them to complete to the consent form and dispose of food after 2 hours

• The reheating of homemade food is not permitted as we cannot be certain that the conditions under which they were produced were safe, or that they have been stored and transported appropriately.

Arrival on to the CF Unit

All patients’ own foods must be kept in their own rooms, either in the refrigerator if the food is chilled, or in the drawers or on shelving if the food is ambient. Foods must be covered. Cling film is available upon request.

Refrigerators

• Refrigerated food must be kept at a temperature of between 0 ^oC to 5^oC.

• Refrigerator temperatures need to be recorded twice daily, with the initials or name of the person undertaking the check also being recorded.

• If a refrigerator cannot maintain a temperature of below 5^oC, it cannot be used for food storage and any food in the refrigerator should be discarded.

• Calibrated thermometers should be used to complete the temperature check, and these should be kept on the top shelf of the refrigerator. Electronic indicators on the refrigerators are not adequate.

• Refrigerators must be deep cleaned in between patient use.

• All refrigerators must have an annual electrical test.

In accordance with the Cystic Fibrosis Unit Risk Assessment Record (November 2018) the following control measures must be in place:

• If patients are storing their own medication in the refrigerators alongside food, the medication must be stored within a plastic basket with holes to allow sufficient ventilation.

• The medication basket must be kept on a shelf above any food to minimise the risk of food contamination.

• The refrigerator and basket must be deep cleaned between patient use. This must be documented on the cleaning procedure.

Please review the Risk Assessment Record for any further changes regarding this control measure.

Food can only be heated in the CF kitchen for CF patients. The Trust’s Catering and Food Safety Guidelines should be applied for any medical outliers on the CF Unit.

Food Hygiene and Allergen Training

Staff members who serve food are required to complete Food Hygiene and Allergen training in order to ensure that food regulations are met and food is prepared and heated in a safe manner.

Available Heating Equipment

Microwave

• Food is only to be heated using an industrial strength microwave. The CF Unit kitchen is currently equipped with a microwave that meets these criteria. In the event of this breaking down, a new industrial strength microwave should be obtained as soon as possible as food should not be heated in a standard household microwave.

Kettle

• A kettle is also available should this be the recommended heating method as per the manufacturers’ guidelines.

Heating Protocols

• Hand hygiene before and after food preparation is of utmost importance. Please see the FHFT Hand Hygiene Infection Prevention and Control Manual⁴ for guidance on hand hygiene.

• Food should be heated using the manufacturers’ guidelines.

• A food temperature probe is kept in the kitchen. Once heated, all meals need to be checked in the middle of the food to assess their temperature.

• Food must be heated to a temperature above 75^oC in order for it to be safe to serve to patients.

• A clear and accurate record of all food heated must be kept. This should include the date and time of heating, a description of the food, the temperature achieved, the name of the individual heating the food and the patient’s name.

• The temperature probe should be cleaned after each use using a probe wipe.

Foods Forbidden to Heat

• Food where there is no guidance regarding how to safely heat in a microwave or using a kettle

• Food that has been unsealed for more than 24 hours

• Expired food

• Any hospital meals from the main kitchen

• Any homemade food

• Leftover takeaway food

• Patients should be encouraged to consume food from one of the patient menus. If this is not possible, the nursing staff responsible for the care of the patient concerned must explain all points stated on the form to the patient and their relative/friend/carer and answer any questions to ensure all parties concerned are clear about the risks and their responsibilities.

• If patients, and /or their relatives, friends and carers, choose to ignore the above advice or refuse to sign the consent form, the details will be documented in the patient’s record by the nurse caring for that patient.

• The waiver form can be found under “Consent Forms” on Epic, saved under the title ‘CF Unit External Food Consent Form’

• The patient, any relatives/friends/carers and the nurse caring for the patient must read the form and sign the declaration stating that they understand and accept the risks associated with bringing external food onto the unit and the responsibility to manage that food safely.

• Once the form is signed on Epic, an entry should be added the patient’s notes stating that the consent form has been completed. This will be completed by the nurse caring for the patient.

Compliance with these guidelines will be monitored through audit by the Cystic Fibrosis team and any incident forms completed due to non-adherence.

Information for patients, relatives, carers and visitors bringing food and drink items into the Cystic Fibrosis Unit

The following information provides guidance for staff and patients if a patient/relative/carer/visitor brings food or drink onto the ward.

1. The Trust provides a variety of high quality, safe and nutritious food and drinks to patients in hospital. Great care is taken to provide food which is appropriate for the needs of individual patients.

2. Suitable choices are available for all special dietary requirements whether medical, religious, cultural, conscientious, or personal. Diet is a fundamental part of patient care that can aid recovery. Where a patient has an allergy or multiple allergies for foods outside of the 14 listed allergens, please discuss on admittance with both the clinical and ward host teams so that we can ensure that it is documented and we can try and ensure provision is covered and discuss what options are available. An allergy-free menu is also available.

3. Fresh fruit, drinks and snacks are freely available, however, if patients or their relatives/carers/visitors do wish to supplement the hospital diet with additional items, it is essential that they follow these simple rules.

4. Always check with nursing staff what food and drink the patient is allowed because:

a) Patients may have swallowing difficulties and need a specially prepared diet.

b) Patients with diabetes may not be allowed sugary foods / drinks.

c) Patients may not be allowed to eat or drink at all e.g. prior to theatre / other procedures.

d) Patients may be severely immunocompromised therefore food brought in from outside poses a high risk to their health and wellbeing as the food chain is not controlled.

5. Ambient foods

We recommend that food consumed is provided by the hospital for the reasons set out above, but if a patient’s condition permits, any of the following items of food or drink may be brought in and stored within the drawers or shelves in the inpatient rooms of the Cystic Fibrosis Unit:

1. Biscuits

2. Individually wrapped cakes or cereal bars

3. Sweets / chocolate / crisps

4. Fruit squash / cordials / mineral water / flavoured water

5. Individual cartons / cans of juice or soft drinks

6. Whole, washed, fresh fruit (not pre-cut or ready sliced, no melon)

7. Tinned fruit

Make sure that any fresh fruit is provided in small quantities, which can be consumed within 24hrs to ensure freshness and avoid bruised or mouldy items. Please note that fresh fruit can be susceptible to listeria-type bacteria so please refer to details below.

All food must be kept covered and preferably stored within an airtight container to prevent contamination from the environment. The patient/relative is responsible for checking the use by dates or best before dates before eating these items.

6. Higher risk foods brought in from outside the hospital

Chilled and hot food containing protein (e.g. sandwiches, salads, cream cakes, curries etc.) pose a greater risk the patients, as patients’ immune systems are often compromised. Chilled and hot foods can be susceptible to bacteria that can cause food poisoning and foodborne illnesses. One type of bacteria that is of particular risk is Listeria, which grows at very low temperatures.

Please note the following types of foods have been associated with Listeriosis outbreaks in the UK and should ideally not be brought in:

To reduce the risk of foodborne illness from hot and chilled foods not provided through the patient menu or CF kitchen, strict handling and temperature control measures are needed to ensure that the food is safe to eat.

The following precautions must be followed by patients/carers/visitors to reduce the risk

Chilled Food

• Chilled food items must be stored within inpatient room refrigerators between a temperature range of 0°C and 5°C.

• All food must be kept covered to prevent contamination from the environment.

• The patient is responsible for checking the use by dates or best before dates before eating these items.

• Chilled food should not be left at room temperature due to the high risk of multiplication of bacteria and must not be reheated and eaten. Sandwiches should be eaten as quickly as possible after making/production (maximum of 2 hours from production to eating).

• The patient must discard chilled foods after the 2-hour time limit. A black bin is available in the patient’s room for the disposal of food waste.

• The Trust does not accept responsibility for the safe handling or temperature maintenance of chilled food items which are not provided through the hospital menu.

Hot Food

• All hot food items intended for patient consumption should be cooked to a core temperature exceeding 75°C. Prior to eating, the food must be maintained at a temperature no lower than 63°C. Furthermore, food should remain covered and be held for a maximum duration of two hours from the point of cooking to the time of consumption.

• The patient is responsible for discarding the food after the 2-hour time limit. A black bin is available in the patient’s room for the disposal of food waste.

• The Trust does not accept responsibility for the safe handling or temperature maintenance of hot food items brought in from outside the hospital.

Please note the above rules for hot and cold foods include:

• any food or drinks purchased from restaurants, cafes, coffee shops, retail outlets or charity cake sales (including on-site facilities).

• any take-aways or food deliveries.

• ‘homemade’ food prepared and brought in by a patient’s relative/carer/visitor.

7. Heating of food in the Cystic Fibrosis Unit kitchen

The Cystic Fibrosis Unit staff are permitted to heat tinned and packaged food that has clear manufacturers’ instructions for heating using a microwave or boiling water from a kettle only.

The following foods are forbidden to be heated on the Cystic Fibrosis Unit:

• Food where there is no printed guidance regarding how to safely heat in a microwave or using a kettle.

• Unsealed food.

• Expired food.

• Any hospital meals from the main kitchen.

• Any homemade food.

• Takeaway food.

This is because these foods pose a higher risk of foodborne illness, contamination, and cross-infection, which could compromise patient safety.

IN THE INTEREST OF PATIENT SAFETY, THE TRUST:

• Does not permit nuts, peanuts and nut, or peanut products to be brought onto the ward as this may cause an allergic reaction.

• Does not permit visitors to eat and drink within the direct clinical area.

• Does not permit food to be offered or shared with other patients.

• Assumes that the person bringing in the food from home is aware of any allergies that the patient receiving the food may have and as such has avoided use of those ingredients and had clear segregations of the allergen when producing and cooking the food.

• Red wrist bands must be worn by patients who have allergies to indicate any food or medicine they are allergic to. Therefore, if food is brought in for patients, the nurse looking after the patient must reiterate to the person who is bringing in food for the patient, that this patient has allergies.

• The Trust is not obliged to provide plates and cutlery for food brought in from home.

The risks associated with bringing food or drink from outside of the hospital lies with the individual patient and their relatives, carers, or visitors. The role of the Trust is to make individuals aware of the risks posed to them by consuming food prepared or purchased outside of the catering system. The Trust cannot control the risks from food brought into the hospital from either an allergen or a food hygiene perspective.

It is essential that good hygiene and temperature control practices are followed during the preparation and cooking of food and at the time that it is given to the patient on the ward. It is also important that the patient understands that they are responsible for disposing of the food or drinks at the 2-hour point. The Trust does not accept liability for untoward effects resulting from consumption of food or drink brought in from outside the hospital.

If patients, and/ or those supporting them choose to ignore this advice, the nurse responsible for the patient will document these details in the patient’s medical record.

If you wish to bring food or drink from outside of the hospital, please complete the section below to confirm you have read and understood the information above and you understand the risks from a foodborne illness and confirm that all necessary and recommended precautions have been taken to minimise this risk. Please ensure that you communicate this information to any friends, relatives or carers who may visit you. If they plan to bring in food, we kindly request that they also sign the section below.

These measures are in place to protect patient safety and minimise risks during a hospital stay.

NB: This is an example Document do not print.

Patient to complete:

I have read and fully understand the ‘Information for patients, relatives, carers and visitors bringing food and drink items into the Cystic Fibrosis Unit’, and I will follow the guidance recommended. . I understand that bringing in and consuming food and drink prepared outside of the hospital carries an increased risk from a foodborne illness. I also understand and am aware of my responsibilities from both a food hygiene and an allergen awareness perspective to both myself, other patients and staff.

Name................................................ Signature................................... Date ……………

Relative/carer/visitor to complete (if applicable):

I have read and fully understand the ‘Information for patients, relatives, carers and visitors bringing food and drink items into the Cystic Fibrosis Unit’, and I have and will follow the guidance recommended. I understand that bringing in food from outside of the hospital increases the risk to the patient from a foodborne illness. I also understand and am aware of my responsibilities from both a food hygiene and an allergen awareness perspective to both the patient, other patients and staff.

Name................................................ Signature................................... Date ……………

Nursing staff to complete:

I can confirm that I have informed the patient/carer/relative/visitor of the ‘Information for patients, relatives, carers and visitors bringing food and drink items into the Cystic Fibrosis Unit’, particularly around the controls needed regarding time and temperature for hot and cold foods. The patient is aware that they are responsible for disposing of chilled/hot food or drinks at the 2-hour point. The patient is also aware that the Trust accepts no responsibility for any untoward effects upon the patient resulting from eating or drinking items that have not been provided by the Trust’s catering department or CF@FP.

Name................................................ Signature................................... Date ……………