Code Brown: A Review of Hospital-Acquired Malnutrition and Foodborne Outbreak Management in Emergency and Surgical Wards
Abstract
Background: Within the high-stakes environment of acute care, two intersecting crises silently compromise patient safety and outcomes: hospital-acquired malnutrition (HAM) and healthcare-associated foodborne outbreaks. Patients in emergency and surgical wards are uniquely vulnerable, facing metabolic stress, increased nutritional demand, and exposure to pathogens via food and feeding practices. These dual threats are often managed in professional silos, leading to fragmented responses that fail to address their systemic interdependence.
Aim: This narrative review aims to synthesize evidence on the epidemiology, etiology, and interprofessional management of HAM and foodborne illness within emergency and surgical settings.
Methods: A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science (2010-2024) was conducted.
Results: The review identifies a high prevalence of HAM upon admission and incidence during hospitalization, exacerbated by nil-by-mouth protocols, missed meals, and poor intake monitoring. Concurrently, outbreaks of pathogens like Norovirus and Salmonella are linked to hospital food systems. Key failures include disjointed communication between dietetic and infection control teams, inadequate nursing resources for feeding assistance, and management systems that prioritize cost and efficiency over nutritional safety and infection resilience.
Conclusion: HAM and foodborne outbreaks represent a "Code Brown" – a simultaneous metabolic and infectious emergency. Addressing them requires an integrated, hospital-wide strategy that repositions nutrition and food safety as inseparable components of clinical care, underpinned by interprofessional protocols, dedicated resources, and executive-level accountability.
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References
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Authors
Copyright (c) 2024 Saad Fahad Al-Shammari, Munawir Khalaf Munawir Aljohani, Abdullah Ali Ahmed Kinanah, Huda Ahmaed Ali Al Bishi, Nawaf Musleh Al- Thagafi, Ahmed Fahad Aldhafeeri, Abdulrahman Mohammed Falah Alsharari, Abdulaziz Mufattish Luwayfa Alsharari, Ali Mohammed Ali Alqahtan, Mohammad Frhan M Alsharari, Yazeed Awadh S Alotaibi, Rakan Nahes Alenzi
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