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BACKGROUND: In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. METHOD: This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. RESULTS: The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. CONCLUSIONS: This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

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RATIONALE: The ELAN Ecuadorian Study of Hospital Malnutrition returned a malnutrition rate of 37.1% in public hospitals of Ecuador [Gallegos Espinosa S, Nicolalde Cifuentes M, Santana Porbén S; para el Grupo Ecuatoriano de Estudio de la Desnutrición Hospitalaria. State of malnutrition in hospitals of Ecuador. Nutr Hosp (España) 2014;30:425-35]. Hospital malnutrition could be the result of institutional cultural practices affecting the patient's nutritional status. OBJECTIVES: To present the current state of food and nutritional care provided to patients assisted in public hospitals of Ecuador. MATERIAL AND METHOD: The state of food and nutritional care provided to 5,355 patients assisted in 36 hospitals of 23 provinces of the country was documented by means of the Hospital Nutrition Survey (HNS), conducted as part of the ELAN Study. HNS recorded the completion of nutritional assessment exercises, the use of food-bymouth, fasting, use of oral nutritional supplements, and implementation and conduction of Artificial nutritional schemes (Enteral/Parenteral); respectively. RESULTS: Less than 0.1% of clinical charts had a diagnosis of malnutrition included in the list of the patient's health problems. Less than half of the patients had been measured and weighted on admission. Serum Albumin values and Total Lymphocytes Counts were annotated on admission in only 13.5% and 59.2% of the instances, respectively. Current weight value was registered in only 59.4% of the patients with length of stay ³ 15 days. An oral nutritional supplement was prescribed in just 3.5% of non-malnourished patients in which significant metabolic stress and/or reduced food intakes concurred. Although up to 10 different indications for use of Artificial nutrition were identified in the sample study, any of these techniques was administered to just 2.5% (median of observed percentages; range: 1.3 - 11.9%) of surveyed patients. CONCLUSIONS: Currently, nutritional status of hospitalized patient is not included within therapeutic goals, nutritional assessment exercises are incomplete, and Artificial nutrition is not considered a therapeutic option. From these findings it can only be concluded that the nutritionist still has no place within medical care teams. Adoption of required measures in order to introduce "Food and Nutrition Good Practices" into the medical care in public hospitals of Ecuador is urgently needed.

Justificación: El Estudio ELAN Ecuatoriano de Desnutrición Hospitalaria en los hospitales públicos del Ecuador devolvió una tasa de desnutrición del 37.1% [Gallegos Espinosa S, Nicolalde Cifuentes M, Santana Porbén S; para el Grupo Ecuatoriano de Estudio de la Desnutrición Hospitalaria. Estado de la desnutrición en los hospitales del Ecuador. Nutr Hosp (España) 2014;30:425-35]. La desnutrición hospitalaria podría ser la resultante de prácticas culturales institucionales que afectan el estado nutricional del enfermo. Objetivos: Presentar el estado corriente de los cuidados alimentarios y nutricionales que se le ofrecen al enfermo atendido en los hospitales públicos del Ecuador. Material y Método: El estado de los cuidados alimentarios y nutricionales provistos a 5,355 enfermos atendidos en 36 hospitales de 23 provincias del país se documentó mediante la Encuesta de Nutrición Hospitalaria (ENH), conducida dentro del Estudio ELAN. La ENH registró el completamiento de los ejercicios de evaluación nutricional, el estado del uso de la vía oral, el tiempo de ayuno, el uso de suplementos dietéticos orales, y la implementación y conducción de esquemas de Nutrición artificial (Enteral/ Parenteral); respectivamente. Resultados: Menos del 0.1% de las historias clínicas tenía un diagnóstico de desnutrición dentro de las listas de problemas de salud del paciente. Menos de la mitad de los pacientes había sido tallado y pesado al ingreso. La Albúmina sérica y los Conteos Totales de Linfocitos estaban registrados en el momento del ingreso en solo el 13.5% y el 59.2% de las instancias, respectivamente. El valor corriente del Peso solo se anotó en el 59.4% de los pacientes con una estadía³ 15 días. Se indicó algún tipo de suplemento dietético en solo el 3.5% de los pacientes no desnutridos en los que concurrían estrés metabólico significativo y/o ingresos dietéticos disminuidos. A pesar de que se identificaron hasta 10 indicaciones diferentes para el uso de Nutrición artificial en la muestra de estudio, se le administró alguna de estas técnicas a solo el 2.5% (me diana de los porcentajes observados; rango: 1.3 ­ 11.9%) de los pacientes encuestados. Conclusiones: En el momento actual, el estado nutricional del paciente hospitalizado no se incluye dentro de los objetivos terapéuticos, los ejercicios de evaluación nutricional son incompletos, y la Nutrición artificial no se considera una opción terapéutica. De estos hallazgos solo se puede concluir que el nutricionista no ha encontrado cabida dentro del equipo de atención médica. Urge la adopción de las medidas requeridas para insertar las "Buenas Prácticas de Alimentación y Nutrición" dentro de la atención médica en los hospitales públicos del Ecuador.

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Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal management dietitian activities."

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BACKGROUND & AIM: Many disease outbreaks of food origin are caused by foods prepared in Food Service and Nutrition Units of hospitals, affecting hospitalized patients who, in most cases, are immunocompromised and therefore at a higher risk of severe worsening of their clinical status. The aim of this study was to determine the variations in temperature and the time-temperature factor of hospital diets. METHODS: The time and temperature for the preparation of 4 diets of modified consistency were determined on 5 nonconsecutive days in a hospital Diet and Nutrition Unit at the end of preparation and during the maintenance period, portioning and distribution at 3 sites, i.e., the first, the middle and the last to receive the diets. RESULTS AND DISCUSSION: All foods reached an adequate temperature at the end of cooking, but temperature varied significantly from the maintenance period to the final distribution, characterizing critical periods for microorganism proliferation. During holding, temperatures that presented a risk were reached by 16.7% of the meats and 59% of the salads of the general diet, by 16.7% of the garnishes in the bland diet and by 20% of the meats and garnishes in the viscous diet. The same occurred at the end of distribution for 100% of the hot samples and of the salads and for 61% of the desserts. None of the preparations remained at risk temperature for a time exceeding that established by law. CONCLUSION: The exposure to inadequate temperature did not last long enough to pose risks to the patient.

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OBJETIVO: O objetivo do estudo foi avaliar a aceitação de dietas de pacientes internados em um hospital público do município de Florianópolis, Santa Catarina. MÉTODOS: Realizou-se análise dos restos alimentares de pacientes internados em unidades de internação médica durante 15 dias, por meio do índice resto-ingestão. O índice foi determinado por tipos de dieta, classificadas em normal, especial com sal e especial sem sal. Enquetes de satisfação com pacientes avaliaram os fatores que influenciam a aceitação das refeições. RESULTADOS: O peso total distribuído correspondente a 1.877 refeições foi de 868kg e o peso dos restos totalizou 313kg. Foi encontrado um índice resto-ingestão de 36,09 por cento e um retorno de 53,68 por cento, 33,99 por cento e 33,84 por cento de dietas especiais com sal, normais e especiais sem sal respectivamente. A variedade, a quantidade e a apresentação das refeições foram avaliadas de forma positiva. A temperatura e o uso de temperos foram os aspectos de menor satisfação, representando 43,00 por cento e 34,30 por cento, respectivamente, para os critérios de regular a ruim. O índice resto-ingestão encontrado (36,09 por cento) estava acima do aceitável para uma população enferma (20,00 por cento), demonstrando uma perda considerável de alimentos. CONCLUSÃO: A partir dos resultados, observou-se a necessidade de avaliar os processos envolvidos na produção dessas refeições e de elaborar estratégias que estimulem a ingestão alimentar do paciente.

OBJECTIVE: This study assessed patients' acceptance of hospital foods in a public hospital located in Florianópolis, Santa Catarina, Brazil. METHODS: The leftover-ingestion index was used to analyze the volume of leftovers of hospitalized patients during 15 days. The index was determined by diet type: normal, special with salt and special without salt. Satisfaction questionnaires were administered to the patients and the factors that influence food acceptance were assessed. RESULTS: The total weight of 1,877 meals was 868kg and the weight of the leftovers was 313kg, thus a leftover-ingestion index of 36.09 percent. The percentage of leftovers of the special diets with salt, normal diets and special diets without salt were 53.68 percent, 33.99 percent and 33.84 percent, respectively. The patients were satisfied with the variety, amount and presentation of the meals but complained about the temperature and seasonings, with ratings of 43.00 percent and 34.30 percent, respectively. The leftover-ingestion index (36.09 percent) was above the acceptable index (20.00 percent) for a diseased population, indicating a considerable waste of food. CONCLUSION: The results show that it is necessary to assess the meal production processes and develop strategies that encourage the patients to eat.

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As a consequence of the increase in the number of immunocompromised patients, cases of aspergillosis, due to the opportunist character of this fungus, have increased considerably. Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger have been found in air and water samples of the majority of investigated hospitals. The aim of the present study was to investigate the presence of aspergilli in transplant patients areas at the Hospital Universitario of Bogotá, Colombia. Samples of air were collected using the MAS-100 Air Sampler from each of the investigated areas. A sample of 100 ml of water was also recovered from these areas. All samples were taken for triplicate and were cultured in 2% Sabouraud Dextrose Agar. The average of aspergilli in air samples was 2.8 CFU/l corresponding to A. flavus, A. niger, Aspergillus versicolor and Aspergillus terreus. In water samples, the average was 17.1 CFU/l corresponding to A. flavus and Aspergillus clavatus. Because potentially pathogenic Aspergillus species were found in the hospital areas were transplant patients are usually kept, active surveillance and a high clinical suspicion should be considered in those patients. Since Aspergillus infections haven't been found so far, a higher fungal load and other host factors might be needed to facilitate the infection.

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