Catering Services

PART 1 – GENERAL PLANNING CONSIDERATIONS

1.1 CATERING SERVICES DEPARTMENT IN A HOSPITAL

A catering service department is concerned solely with the large-scale storage and production of food.

1.2 LOCATION & RELATIONSHIP TO OTHER DEPARTMENTS

The catering service unit should be on one level to facilitate an effective work flow. It should be located centrally to supply patients’ needs within the shortest time and have direct connection to most hospital corridors. Ideally it should also be on the same level as the wards in order to reduce reduce the transport distance for food and the movement of people. See FIGURE 1.1. If a multi-floor relationship with the service departments is unavoidable, the service elevators by which food must be transported to wards/divisions, must be close to the food service unit. The service elevators must be reliable and supported by emergency power. The transport corridors must be covered with an even surface, and ramps should be within the design tolerance required by the food trolleys. Alternative routes should be available in emergency situations. Due to the nature of the activities taking place in the catering department, it is a high fire-risk area. Fire-fighting vehicles should therefore need to have immediate and easy access to the unit. The unit should not be located where it may be exposed to airborne and waterborne contamination.

Figure 1

1.3 VEHICULAR ACCESS FOR DELIVERIES AND COLLECTIONS

The ground-floor level provides the most economic and convenient location, with easy access for delivery vehicles to the delivery bay. There should be sufficient space for parking and manoeuvring service and other vehicles. The unit should have easy access to a good road system to ensure safe and easy vehicular access for deliveries of supplies and refuse removal. The route through which the refuse is removed must be the shortest possible route to the refuse-removal area. The removal of refuse from the refuse-storage area to the central refuse-removal areas must take place through an exit door with a ramp.

1.4 TYPES OF CATERING SERVICES

The choice of a specific type of food system for a healthcare facility can currently be made from the following systems: • Conventional food system (the topic of this document) • Cook-freeze food system • Cook-chill food system.

This document only covers the conventional food system. The other two systems will be discussed briefly for clarity only.

1.4.1 CONVENTIONAL FOOD SYSTEM Cook-serve is the conventional system of catering currently in use in many hospitals. The system complies with the following criteria:

• Food is freshly prepared and cooked for each meal and served whilst hot to the patients and staff. • The conventional food system is a system with a continuous preparation period and a serving period. • Food is prepared according to standardised recipes and according to conventional or automated preparation methods. Food is freshly prepared for each meal and is directly portioned, dished up, garnished and served after the cooking process/preparation process which can also take place in batches. • The dishing-up and garnishing of complete meals in suitable crockery can take place individually and be transported on trays in suitable trolleys to the different service points for serving to the patient/client. • An alternative method is that food is portioned and garnished in mass portions in stainless steel food containers with lids, and transported to the service points in suitable food trolleys where it is dished up for serving to the patient/client. • With the pre-dished tray-food service system the trays with used crockery are placed back in the food trolley and transported back to the food-service unit where it is centrally washed up. Cups, saucers, bread plates and cutlery are washed and stored at the service points. • When food is served from food trolley containers at the service points, the washing-up procedure can be decentralised or partially decentralised:

(i) Decentralised procedure The cleaning and washing up of the food trolley and food trolley containers and all crockery takes place at the service points. The clean crockery is stored at the service points. The clean trolley with containers is taken back to the food-service unit.

(ii) Partially decentralised procedure Some crockery - such as cups, saucers, bread plates and cutlery - is washed and stored at the service points. The other used crockery is transported in the food-service unit, where it is cleaned and washed up, as well as the food trolley with food trolley containers.

Figure 2

1.4.2 COOK-FREEZE FOOD SYSTEM Cook-freeze means a catering system based on full cooking followed by fast freezing, and complies with the following criteria:

• The cook-freeze food system is a system in which the preparation period is separated from the serving period by a freezing process and frozen storage. • Food preparation takes place according to standardised recipes with adaptations where necessary to prevent the detrimental effect of freezing on some foods such as the stabilisation of starch products. • Food preparation takes place according to conventional or automated preparation methods. The food preparation and freezing can be geographically separated from the service point or client. • Portioning can be effected in single portions, as complete meals or in mass portions of a suitable size in different packaging materials. Laminated carton, aluminium or plastic containers can be used. • Reconstitution of frozen food takes place at the service points in convection ovens.

Figure 3

1.4.3 COOK-CHILL FOOD SYSTEM Cook-chill means a catering system based on the full cooking of food followed by fast chilling and storage in controlled low-temperature conditions above freezing point (0°C to 3°C) and subsequent thorough reheating close to the consumer before consumption. Cook-chill systems comply with the following criteria:

• With a cook-chill food system the preparation period is separated from the serving period by a temporary cooling process and cooled storage. • Food is prepared by conventional or automated preparation methods, using standardised recipes. Food is cooked to a temperature of 80% after which it is cooled in a cooling tunnel or cooling room. Complete meals can be portioned or cooled in suitable crockery in which it is served. • Complete meals cooled in suitable crockery, can be heated in the food service unit and transported on trays in trolleys to the service points for serving to patients. • Food cooled in mass portions can be dished up in the food service unit in suitable crockery, assembled on trays and transported in trolleys to the service points, where it is heated and served to patients/clients. The cleaning and washing up takes place partially decentralised, as described in the conventional food system. • Food can alternatively be heated in mass portions at the service points (such as in a cafeteria system), dished up and served. The cleaning and washing up takes place decentralised or partially decentralised, as described in the conventional food system.

Figure 4 PART 2 – FUNCTIONAL REQUIREMENTS

2.1 ACTIVITY SPACES IN THE CATERING SERVICE UNIT

The activities in a catering department are distinct and sequential. See FIGURE 3.1.

FIGURE 5 FIGURE 6 FIGURE 7

The activities taking place in the catering department are categorised under the following zones: • Deliveries and receiving • Storage areas • Preparation areas • Cooking area • Dishing up • Washing up • Trolley parking • Offices • Staff facilities • Support spaces.

In order to align this design guide with the DoH (2001), the numbering code guide in the DoH document will be used in this document. See TABLE 2.1 for the codes. The colour selected for each zone is arbitrary and only used to visualise relative positions of zones and activities and their relationship to their adjacent activities.

 Figure 8

2.2	WORK FLOW THROUGH A CATERING SERVICE UNIT

The work flow illustrated in FIGURE 2.1, if applied to the zones and activities in TABLE 2.1, could be illustrated as follows: Figure 9 The above work flow and spatial relationship could be translated into the following designs: LAYOUT 2.2, a theoretical design; LAYOUT 2.3, an as-built illustration.

Figure 10 Figure 11

PART 3 – GENERAL DESIGN CONSIDERATIONS

3.1 IMPROVED HYGIENIC CONDITIONS

The operating procedure for hygiene control falls outside the scope of this guideline.

Planning and design features to support hygiene control should include the following: • Containment of steam and moisture. • Building and layout details that would facilitate easy cleaning. • Selection of suitable building materials and finishes. • Selection of fixtures, fittings and equipment with suitable detail, materials and finishes for easy cleaning, and prevention of build-up of harmful organisms. • Hand washing remains one of the most significant ways in which cross-infection through contact can be avoided. To enhance this, hand-wash facilities should be available in appropriate places and be accessible. • The selected system for soap and towel dispensers is a hospital policy and dictates the type of dispenser to be specified.

3.2 OCCUPATIONAL HEALTH AND SAFETY

Planning and design features to support occupational health and safety include the following: • Selection of floor finishes with a non-slip finish. • Selection of fixtures, fittings and equipment with suitable detail, materials and finishes to prevent personal injury through accidents or misuse. • Provision of suitable and adequate facilities to support and encourage a high level of personal hygiene, with special reference to hand hygiene. • Provision of adequate dispensing points for the appropriate personal protection (PPE) items. • Ill-considered dimensions and layouts of fixtures and fittings could have a significant effect on occupational health and the safety of staff

3.3 CHANGE AND TECHNOLOGY

Although it is difficult to predict future trends in catering department technology, it is advisable to allow some flexibility and adaptability in space requirements, electrical consumption and layout, and also in air-handling capacity.

Current trends that need to be considered are the following: • The facility should be able to reasonably accommodate access and positioning of possible outsize equipment. Consideration for this possibility should be given from (and including) point of delivery to point of positioning. • Possible future extensions and/or enlargement of the facility should be considered during the design stage. • An element of adaptability should be incorporated in the layout, particularly with regard to equipment, where improved models are continuously being developed. • Engineering services and catering equipment will normally have a much shorter life than the building fabric, and access for plant removal and replacement should therefore form part of the design concept.

3.4 SHARED SERVICES

The planning and design of the facility should take cognisance of the policies regarding the following services, which could have an influence on the layout: • Waste management • Staff ablution facilities • Staff catering facilities • Administration (IT, tel, data, fax, etc.) • Communications • HVAC systems • Hot water, steam, compressed air systems • Power supply and standby power facilities • Fire detection and prevention • Security

3.5 ERGONOMIC AND USER-COMFORT CONSIDERATIONS

Workspaces should be sufficiently flexible and adaptable to accommodate adequate working spaces for individual comfort. See ANNEXURE A for ergonomic requirements.

3.6 MAINTENANCE AND CLEANING

• The catering department requires conditions of cleanliness and safety with means for maintenance and routine inspection that minimise disruption and risk of contamination. • Materials and finishes should be selected to minimise maintenance and be compatible with their intended function. • Building elements that require frequent redecoration or are difficult to service or clean should be avoided. • Special design consideration should be given to corners, partitions, counters and other elements which may be subjected to heavy use. • Engineering services and catering equipment will normally have a much shorter life than the building fabric, and access for plant removal and replacement should therefore form part of the design concept. • Pipe and cable runs must not be routed over cooking or preparation equipment; and pipe insulation must be easily cleaned, impervious to water, and sealed to prevent the harbouring of pests and insects as far as is reasonably practicable. • The finishes of all equipment and service connections must be able to withstand frequent cleaning. • Electrical socket outlets, light fittings and switches should be splash-proof. • Switch rooms should be accessible only from the circulation area, outside food production areas.

3.7 PEST CONTROL

• Catering departments are very prone to infestation, and service ducts, trunking, channels, casings, pipework and insulation should be designed and installed to prevent the ingress of rodents and insects. • Overhanging roofs, light fittings, girders and beams should be protected to prevent the entry of birds. • All outer doors should be pest-proof, particularly sliding doors and roller shutters. • Where electric fly-killing units are used they should be carefully sited to ensure maximum effect and to prevent contamination of food, utensils, work surfaces and production lines. • Ceiling voids and ducting must be accessible from outside the high-risk areas for inspection or treatment purposes. • The space surrounding equipment must allow access for engineering/ maintenance staff and for regular cleaning. The provision of flexible service connections to each unit and the use of lockable castors or integral rollers will allow equipment to be moved to enable cleaning machines to pass over the whole floor area.

3.8 STRUCTURE AND LAYOUT (EXISTING VS FUTURE EXTENSIONS) • Possible future extensions and/or enlargement of the facility should be considered during the design stage. • An element of adaptability should be incorporated in the layout, particularly with regard to equipment, for which improved models are continuously being developed. • Engineering services and catering equipment will normally have a much shorter life than the building fabric, and access for plant removal and replacement should therefore form part of the design concept.

3.9 PLANT AND SERVICES

The various areas within the catering services unit should accommodate the equipment manufacturer's recommendations, as space requirements may vary from one manufacturer to another. All items of equipment will need to be itemised and the dimensions of all equipment obtained from manufacturers to ensure they can be suitably housed.

The following requirements are relevant: • doors are to be sized to allow passage of equipment; • electricity loads need to be estimated and catered for; • weight loads need to be estimated and checked structurally; • equipment requiring services such as water and special power need to be accommodated at an early stage; • all cooking equipment should be located to have service/maintenance access; • space allowed for and around equipment should be sufficient to allow for the physical equipment as well as circulation/working space around the equipment; • the spaces should be able to reasonably accommodate access and positioning of possible outsize equipment, including point of delivery to point of positioning; and • the area should be designed to allow for periodic ease of routine cleaning or, particularly in dirty areas, for handling of accidental spillages 1. PART 4 – CATERING SERVICES AREA DETERMINATION

4.1 DETERMINANTS OF SIZE AND LAYOUT

The size of a catering services unit in a hospital is unique to that hospital, as the size, layout and function of the catering department is defined in the Operational Policy Statement that guides the operational management of the hospital. The operational policies specific to the catering department precede the sketch-design stage. These policies are developed by the project team in consultation with health service stakeholders, who should have the knowledge and experience to analyse the various processes in and related to the catering services unit.

These operational policies define the “What, How, When, Where, Who and With What” of any activity and/or process and are major space determinants which could significantly affect the planning and design of the catering services unit, as they can have an impact on the size, configuration and the nature of accommodation.

Operational policies will vary from unit to unit, depending on a wide range of factors, both external and internal to the catering services unit.

4.1.1 DETERMINING FACTORS EXTERNAL TO THE CATERING DEPARTMENT Examples of these space determinants could include the following: • Number of patients and staff to receive meals • Type of patient (religion/age/culture) • Type of menu • Type of food preparation system • Space availability • Access to the site • Amount of space needed for waste management • Staff facilities to be shared with adjacent departments.

4.1.2 DETERMINING FACTORS INTERNAL TO THE CATERING DEPARTMENT Examples of these space determinants could include the following: • Types of food preparation equipment to be used • Number of and type of cooking system • Type of food delivery system to be used • Type of washing-up system or procedure • Anticipated inventory storage • Anticipated volume of consumable supplies • Instrument inventory • Equipment inventory • Projected workload • Staffing structure • Staffing policy - number of staff to be accommodated.

4.2 CATERING SERVICES AREA DETERMINATION

The Bertha Gxoba Hospital in Germiston has 300 beds, and is included in this study for its detailed areas. See LAYOUT 4.1 figure 12

The IUSS spatial measurement assignment, initiated by the NDoH, and executed by CSIR Building Science and Technology, yielded the information as per TABLE 4.1. Chris Hani Baragwanath’s kitchen and Bertha Gxoba’s kitchen (LAYOUT 4.1) are also included in this table.

Although the data is not sufficient to provide scientifically sound results, it is an indication of estimated average sizes of kitchens. The data also gives no indication of the efficiency of the layouts. figure 13

Based on the information in TABLE 4.1, the CSIR IUSS measurement team calculated the net kitchen area per bed as per the produced a linear graph. See TABLE 4.2.

Figure 14

If this data is captured on a linear graph with a deviation of 10% in both directions, a range of area estimates can be obtained which serves as a guide to calculate kitchen area per bed.

Figure 15 PART 5 – INDIVIDUAL SPACE REQUIREMENTS

The discussion on individual space requirements is based on a layout of the Chris Hani Baragwanath hospital. See FIGURE 5.1.

The following shortcomings in the original design are highlighted: • A separate fish freezer is required (not included in this layout). • The activity flow of food and refuse should not cross.

For the purpose of this design guide, the refuse collection point and trolley wash areas have been moved to the returns entrance.

Although a variety of loose items are listed under ‘Fixtures, Fittings & Equipment’, these items do not form part of the building contract. Their inclusion in this document is merely to provide an overview of space requirements.

Figure 16 Figure 17

A1.2 FUNCTION Receipt of provisions. There are three main groups of goods delivered to the kitchen: • Vegetables (fresh and frozen) • Raw meat and fish (fresh and frozen items) • Packaged and dry goods, including dairy.

A1.3 REQUIREMENTS An under-cover delivery platform to be the height of a standard delivery vehicle (height approx 1 500mm). The ramps for mobile trolleys and platforms must slope conveniently and must be calculated in accordance with the platform height. Platform to have a rubber protection-strip and a set of stairs next to the ramp. The receiving area and the storage area must be on the same level to facilitate the transport of supplies, for example, and the storage of trolleys. Lockable roll-up steel door to B1 (pre-preparation area / veg cleaning area).

  A1.4 FIXTURES, FITTINGS AND EQUIPMENT Writing board. Wall-mounted electric clock with battery back-up, as per electrical engineer’s specification. Stainless steel wash-up sink. Goods-receiving platform scale. Preparation table. Tables with splash back and mild steel coated backing for sound deadening. Insectocuter (double tube). Stainless steel wall-mounted hand-wash basins.

A1.5 SERVICES Hot and cold water. Waste drainage. Smoke detection. Adequate lighting and ventilation (mechanical/natural). Figure 18

B1.2 FUNCTION Space for de-crating and pre-cleaning of vegetables. A pre-cleaning wet area for washing, peeling, cutting, chopping, prior to storage.

B1.3 REQUIREMENTS Should have easy access to dry store and vegetable cold room. The area generates a lot of waste or refuse and should be located close to the vegetable store and should have easy access to the refuse-disposal area.

B1.4 FIXTURES, FITTINGS AND EQUIPMENT Paper-towel dispenser Soap dispenser Clinical hand-wash basin Stainless steel pot-wash sink Work surface, stainless steel with opening for refuse bin Vegetable washers Cutting machines Stainless steel basin with elbow-action mixer, soap and paper-towel dispenser Refuse bin on dolly.

B1.5 SERVICES Floor drain Adequate lighting and ventilation (mechanical/natural) Hot and cold water Waste drainage Smoke detection. Figure 19 B2.2 FUNCTION Space for removing contents from packaging.

B2.3 REQUIREMENTS Should have easy access to dry store and dairy cold room. The area generates a lot of waste or refuse and should be located close to the vegetable store and should have easy access to the refuse-disposal area.

B2.4 FIXTURES, FITTINGS AND EQUIPMENT Refuse bin on dolly.

B2.5 SERVICES Adequate lighting and ventilation (natural or mechanical) Smoke detection.