Food Safety in Healthcare Institutions; A Systematic Review

Abstract

Food safety in healthcare institutions constitutes a critical dimension of patient safety because hospitalized populations are disproportionately susceptible to foodborne infections, cross-contamination, and adverse outcomes arising from compromised immunity and clinical vulnerability. This systematic review synthesizes contemporary evidence on the prevalence, determinants, and outcomes of food safety practices in healthcare settings, with particular attention to the effectiveness of Hazard Analysis and Critical Control Point (HACCP) systems, food safety culture, staff training, and emerging digital technologies. Guided by PRISMA 2020, the review examined peer-reviewed studies published between 2020 and 2025 across major academic databases, including empirical and review-based research addressing hospital food hygiene, outbreak prevention, contamination control, and institutional determinants of compliance. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The evidence indicates that food safety performance in healthcare institutions is shaped by an interaction of behavioral, organizational, and contextual factors. Food handlers’ knowledge, attitudes, and practices consistently emerged as central determinants of hygienic compliance, while leadership commitment, continuous training, inspection frequency, and regulatory enforcement strengthened adherence to established standards. Infrastructure-related conditions, particularly water quality, sanitation, storage capacity, and temperature control, further influenced the success of preventive measures. The review also found that HACCP implementation and structured quality assurance systems were associated with reduced contamination rates and improved operational control, whereas predictive analytics, machine learning, and Industry 4.0 applications enhanced monitoring capability and decision quality. Overall, the findings demonstrate that effective food safety management in healthcare institutions requires more than procedural compliance; it depends on embedding safety within institutional governance, organizational culture, and technological systems. Strengthening staff competence, managerial accountability, regulatory oversight, and digitally enabled monitoring is therefore essential to minimizing hospital-related foodborne risks and protecting patient health.