Fact sheetDiet specifications

Published on 1 Jul 2017


General diet - low microbial

This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.

Aim

To provide a diet that limits foods that are at high risk of carrying food-borne disease.

Characteristics

Avoids food with a high bacterial or fungal load. Sterile diets are no longer used because there is no evidence to support their use.

Indications

  • With neutropenia (neutrophil count ≤ 1000 cells/μL)
  • Who are severely immunosuppressed (e.g. some patients post-transplant or those undergoing some cancer treatments)
  • With poor gut integrity.

Other risk factors that may need to be considered are age, pregnancy and polypharmacy.

However, as food safety management has improved, the standard hospital diet may be considered safe for the vast majority of immunocompromised patients.

Nutritional adequacy

Nutritionally adequate.

Precautions

Patients ordered this diet must be supervised by a dietitian. As these patients are often malnourished, nutritional supplements may be required. All salads and sandwiches must be served within 24 hours of preparation and contain allowed ingredients. Bottled water must be replaced as needed (at least daily), not topped up or refilled.

Food safety practices must ensure that clean, dry utensils are always used so that bulk packs are not contaminated.

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes

All well-cooked meat, poultry, seafood and vegetarian dishes

Serve eggs that are cooked until the white is firm and yolk begins to thicken

Undercooked meat, poultry or seafood

Raw tofu, smoked fish, tempeh

Raw or soft-boiled eggs

Sauces, gravies All cooked All others
Starchy vegetables / pasta / rice All cooked All others
Vegetables

All cooked and canned vegetables

Vegetables that can be sanitised whole#

All others including fresh fermented vegetables and pickles
Soups All hot soups including pasteurised miso products without kelp/seaweed Cold soups
Sandwiches

Sandwiches must be made on site, contain allowed ingredients and used within 24 hours

Pasteurised meats and poultry (cooked in bag) and sliced acceptable with correct food hygiene practices#

Hard boiled eggs, canned fish

Commercially manufactured and packaged hard cheese (e.g. cheddar)

Cottage cheese may be used if served on the day the package is opened

Canned pâté and meat spreads

Unpasteurised processed meats and poultry (e.g. some hams, chicken roll)

Smoked meat and fish

All other pâté and meat spreads (e.g. those requiring refrigeration)

Leafy green vegetables, e.g. lettuce, baby spinach, parsley, rocket

Salads, dressings

Vegetables and fruit that are canned or can be sanitised# as a whole uncut item e.g. tomato, cucumber, zucchini, capsicum, carrot, orange

Salads must be made on site, contain allowed ingredients and used within 24 hours

Canned salads (e.g. mixed beans, potato salad)

Portion packs of commercially manufactured mayonnaise, dressings and condiments

Unwashed raw vegetables and sprouts, including mushrooms

Leafy green vegetables e.g. lettuce, baby spinach, parsley, rocket

Salad dressings made with blue cheese or raw eggs

Unpasteurised sliced processed meats and poultry (e.g. some hams, chicken roll)

Compound salads e.g. potato salad and coleslaw

Cooked and peeled prawns to be served cold

Breads, cereals

All breads, pre-packaged, processed and ready-to-eat including raisin or fruit bread

Cooked breakfast cereals (e.g. porridge, semolina)

Plain commercially manufactured breakfast cereals without dried fruit, coconut or nuts (e.g. corn flakes, wheat biscuits, puffed rice)

Raw oats

Raw muesli including Bircher

All other breads and cereals

Spreads

Large commercially manufactured brands of jam, nut butters and pastes, yeast spreads, marmalade, chocolate hazelnut spread, mayonnaise

Spreads in portion control packs or bulk containers which have been handled in a way to prevent contamination

Canned pâté and meat spreads

Pasteurised honey (including portion control packs) and honey as an ingredient in a cooked meal

Other spreads including tahini and hummus
Hot breakfast choices

All cooked breakfast items

Pure maple syrup

Pure golden syrup

All others
Fruit

Sanitised whole fresh fruit (e.g. apples, oranges, mandarins, pears, kiwi fruit, stone fruit, grapes etc.)

Bananas served whole (unpeeled and uncut)

All canned or stewed fruit

Fruit from bulk packs must be used within 48hrs of decanting

Cooked dried fruit (e.g. muffins and cakes containing dried fruit)

Cut fruit

Fresh fruit with a rough texture (e.g. raspberries, strawberries, rockmelon)

Uncooked dried fruit

Yoghurt

Commercially manufactured yoghurts, including those with fruit

Yoghurt from bulk packs must be used within 48 hours after decanting

All other yoghurts, including home made and probiotic yoghurts
Desserts

Desserts and puddings served hot e.g. sticky date pudding, apple crumble

Heat-treated portion-control cold desserts e.g. custard, creamy rice

Shelf-stable commercially manufactured cakes, pastries and puddings

Pastries with fillings cooked in e.g. apple Danish

Other commercially manufactured ice creams using allowed ingredients

Desserts containing uncooked eggs e.g. mousse

Pastries filled with cream or custard after cooking e.g. profiterole

Ice cream with dried fruits, coconut and nuts

Milk and cheese

All pasteurised milk and milk products including cream and sour cream

Commercially manufactured and packaged hard cheese (e.g. cheddar) including cheese slices

Cottage cheese may be used if served on the day the package is opened

Surface-ripened cheese (e.g. brie, camembert, blue)

Soft and semi soft cheese unless used as an ingredient in a cooked dish

Beverages

Pasteurised fruit juices in sealed portions

Cordial made with potable water and chilled once prepared

Bottled or portion controlled water

Drinks made with chocolate powder

Tea, coffee, carbonated drinks, commercially manufactured energy drinks

Fresh and unpasteurised juices

Herbal teas

Fermented drinks e.g. kombucha

Wine and beer as a beverage

Biscuits All baked, shelf-stable portion packs of biscuits and crackers All others
Miscellaneous

Nutritional supplements

Salt

Cream

Plain commercially manufactured popcorn

Sugar and artificial sweeteners

Chocolate with allowed ingredients

Confectionery with allowed ingredients

Potato crisps

Baked, shelf-stable muesli bars

Raw nuts and nuts in shells

Raw oysters

Herbs, spices and pepper

Raw coconut

# As per NSW Food Authority vulnerable population requirements.

References

  1. Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
  2. Centers for Disease Control and Prevention. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR 2009;58(RR-4):1-207.
  3. NSW Food Authority. Guidelines for food service to vulnerable persons. Sydney: NSW Food Authority, 2015. [Accessed 7 May 2021].
  4. Memorial Sloan Kettering Cancer Centre. Low-Microbial Diet. New York; 2017. [Accessed 23 June 2017]
  5. UC San Diego Health. Low Microbial Diet Guidelines. California; 2016. [Accessed 23 June 2017].
  6. Lund, B M. Microbiological food safety and a low-microbial diet to protect vulnerable people. Foodborne Pathogens and disease. 2014 June;11(6):413-24.
  7. Lund, B.M Microbiological Food Safety for Vulnerable People. Int J Environ Res Public Health. 2015 Aug 21;12(8):10117-32.
  8. Lund, B. Microbiological safety of food, particularly for vulnerable people. J Fam Med Dis Prev. 2016:2:035
  9. Doron, S and Snydman, D. R. Risk and Safety of Probiotics. Clinical Infectious Diseases. 2015;60(S2):S129-34.
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