Unofficial translation
In accordance with Article 7, subparagraph 103) of the Code of the Republic of Kazakhstan dated July 7, 2020 "On public health and healthcare system," I hereby ORDER:
1. To approve the attached nutrition standards in healthcare and education organizations.
2. The Committee on sanitary and epidemiological control of the Ministry of Healthcare of the Republic of Kazakhstan, in accordance with the procedure established by the legislation of the Republic of Kazakhstan, shall:
1) ensure the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) place this order on the Internet resource of the Ministry of Healthcare of the Republic of Kazakhstan after its official publication;
3) within ten calendar days after the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan, submit to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan information on the implementation of the measures provided for in subparagraphs 1) and 2) of this paragraph.
3. Control over the execution of this order shall be entrusted to the supervising Vice-Minister of Healthcare of the Republic of Kazakhstan.
4. This order shall enter into force upon expiry of ten calendar days after the date of its first official publication.
|
Minister of Healthcare of the Republic of Kazakhstan |
A. Tsoi |
"AGREED"
Ministry of Education and Science
of the Republic of Kazakhstan
| Approved by the order of the Minister of Healthcare of the Republic of Kazakhstan dated December 21, 2020 No. RK HM-302/2020 |
Nutrition standards in healthcare and education organizations
Chapter 1. General provisions
1. These Standards for nutrition in healthcare and education organizations (hereinafter referred to as the Standards) shall be developed in accordance with Article 7, subparagraph 103, of the Code of the Republic of Kazakhstan dated July 7, 2020 “On public health and healthcare system” (hereinafter referred to as the Code) and shall establish general requirements for the organization of nutrition in healthcare and education organizations.
2. Terms and definitions used in these Standards:
1) food (food) raw materials - products of animal, plant, microbiological, mineral, artificial or biotechnological origin and drinking water used for the production (manufacture) of food products;
2) food products for baby - specialized food products intended for baby food for children (for young children from 0 to 3 years old, preschool children from 3 to 6 years old, school children from 6 years old and older) that shall meet the corresponding physiological needs of the child body and shall not harm the health of the child of the appropriate age;
3) inspection - assessment of food quality and ready-made dishes according to organoleptic indicators;
4) a buffet - a catering enterprise (facility) that sells a limited range of catering products from semi-finished products of a high degree of readiness on the spot;
5) organization of education - legal entities, as well as branches of legal entities having the status of international schools, which implement one or more educational programs and (or) shall provide the maintenance and education of students, pupils, regardless of the form of ownership and organizational legal form, individual entrepreneurs without the education of a legal entity, implementing general education educational programs of preschool education and training;
6) healthcare organization - a legal entity carrying out activities in the field of healthcare;
7) food products of dietary therapeutic nutrition - specialized food products with a given food and energy value, physical and organoleptic properties, and intended for use in therapeutic diets;
8) food products of dietary preventive nutrition - specialized food products intended for correction of carbohydrate, fat, protein, vitamin and other types of metabolism, in which the content and (or) ratio of individual substances relative to their natural content shall be changed, and (or) the composition of which includes substances or components not originally present, as well as food products designed to reduce the risk of developing diseases;
9) food products of enteral nutrition - liquid or dry (restored to ready-to-eat) food products of dietary therapeutic or dietary preventive nutrition, intended for oral consumption directly or administration through a probe if it is impossible to provide the body with food substances and energy in the usual way.
Chapter 2. Procedure for catering in educational organizations
3. The general principles of catering in education organizations include the following:
1) compliance of energy value of children's nutrition with energy costs;
2) compliance of the chemical composition of food with physiological needs of the organism;
3) the maximum diversity of the diet, which shall be the main condition for ensuring its balance;
4) optimal power supply mode;
5) proper cooking, ensuring their high taste and preservation of the initial nutritional value;
6) taking into account the individual characteristics of children;
7) ensuring sanitary and hygienic food safety, including compliance with all sanitary and epidemiological requirements for the condition of the food unit, supplied food products, their transportation, storage, preparation and distribution of dishes.
4. An advanced seasonal (summer - autumn, winter - spring) two-week menu shall be compiled by the average health worker in accordance with the approved standards of the daily set of products. It shall be taken into account that part of the daily diet products (milk, bread, sugar, butter, and vegetables) shall be included in the menu daily, in quantities in accordance with the daily set standards. Other products (fish, cottage cheese, eggs, cheese, sour cream and others) shall not be included in the baby's diet every day, but shall be given out in full during the week.
5. The standards for the nutrition of children in educational organizations shall be regulated by the Regulation of the Government of the Republic of Kazakhstan No. 320 dated March 12, 2012 “On approval of the size, sources, types and rules for the provision of social assistance to citizens receiving social assistance”.
6. The daily diet adjusted for the food set shall provide for discrepancies with physiological dietary standards of no more than ± 10 percent (hereinafter referred to as %), but in full accordance with the weekly standard.
7. When organizing meals, recipes of official sources shall be used (recipe collection, methodological recommendations, monographs), on the basis of which a dishes file shall be compiled, which has a reference to the official source. In the absence of some products, they shall be replaced by others being equivalent in chemical composition. To preserve the full-fledged composition of the diet, food replacement tables shall be used in accordance with the requirements of regulatory legal acts in the field of sanitary and epidemiological well-being of the population.
8. Based on the perspective menu approved by the education management body, a daily menu shall be drawn up, which shall be approved by the head of the education organization. After approval of the daily menu, all changes to it shall be made by the head of the organization.
9. For some categories of children with certain types of diseases, gentle (dietary) nutrition shall be organized. The number of people in need of a certain diet and the duration of its receipt shall be determined on the basis of the results of an annual in-depth medical examination of children, also on the basis of certificates provided by parents. Preparation of dietary dishes shall be carried out on the basis of existing regulatory and technical documents.
10. In organized children's groups, a diet is being developed, which, in turn, shall provide for the formation of a set of products intended for the nutrition of children for a day or another fixed period of time.
11. When designing menus, the following shall be taken into account:
1) duration of children's stay in educational organizations;
2) age category;
3) physical activity of children.
12. Taking into account the age of children in the menu, the following requirements shall be met:
1) by weight of portions of dishes;
2) their nutritional and energy value;
3) daily need for essential vitamins and trace elements.
13. The menu shall contain the following information:
1) on the quantitative composition of dishes;
2) energy and nutritional value, including the content of vitamins and minerals in each dish.
14. In the menu, it shall not be allowed to repeat the same dishes or culinary products on the same day or on the next 2-3 days.
15. When developing menus for feeding children, freshly prepared dishes shall be used that are not subjected to repeated heat treatment and warming up frozen dishes.
16. Every day, a menu approved by the head of the education organization shall be posted in the dining room, which indicates information about the volumes of dishes and the names of culinary products.
17. For students of the first shift, general education organizations shall provide one or two meals a day - the second breakfast or the second breakfast and lunch, for students of the second shift - the afternoon, for groups of the extended day - the second breakfast, lunch and afternoon. With the whole day stay of children, at least five times food shall be provided. The intervals between meals shall not exceed 3.5-4 hours.
18. Children's breakfast in preschool educational institutions shall consist of a hot dish (porridge, casserole, curd and egg dishes and others), a sandwich with butter or cheese and a hot drink. Lunch shall include salad or serving vegetables, the first dish (soup), the second (side dish and dish of meat, fish or poultry), a drink (compote or jelly). Midday shall include a drink (milk, sour milk drinks, juices, tea) with bakery or confectionery products without cream, curd or cereal casseroles and dishes shall be allowed. Dinner shall include fish, meat, vegetable and curd dishes, salads and hot drinks.
19. In a preschool organization operating for 8 hours or more, the menu shall provide for daily use in the nutrition of children: milk, sour milk drinks, meat (or fish), potatoes, vegetables, fruits, bread, cereals, butter and vegetable oil. The remaining products (cottage cheese, sour cream, poultry, cheese, egg, juices, etc.) shall be included 2-3 times a week.
20. When organizing meals for children in preschool educational organizations operating in a short-term stay mode, meals and foods shall be included in the menu, taking into account the mode of work of the preschool organization and the regime of meals for children.
21. In specialized preschool organizations and groups for children with chronic diseases (diabetes mellitus, food allergies, often sick children), children's nutrition shall be organized in accordance with the principles of therapeutic and preventive nutrition of children with appropriate pathology on the basis of relevant nutritional standards and menus.
22. The multiplicity of meals and the diet of children for individual meals (breakfast, second breakfast, lunch, afternoon, dinner, second dinner) shall be determined by the time of stay of children and the mode of work of the preschool organization.
23. To ensure a diverse and full-fledged diet of children in preschool organizations and at home, parents shall be informed about the child's food range by hanging a daily menu in each group cell. The daily menu shall indicate the name of the dish and the volume of the serving, as well as the replacement of dishes for children with food allergies and diabetes mellitus.
24. All foods and dishes used in nutrition in educational organizations comply with the hygienic requirements for the quality and safety of food products in force in the Republic of Kazakhstan in accordance with the Unified list of goods subject to sanitary and epidemiological supervision (control) at the customs border and customs territory of the Eurasian Economic Union, approved by the Decision of the Commission of the Customs Union dated May 28, 2010 No. 299 and technical regulations in the field of food safety.
25. Incoming food products shall be accompanied by documents certifying their safety in accordance with the Law of the Republic of Kazakhstan dated July 21, 2007 "On Food Safety" and technical regulations of the Customs Union and the Eurasian Economic Union in the field of food safety.
26. The range of basic food products for use in nutrition in educational organizations and the list of products and dishes that shall not be allowed for sale in catering organizations of general education organizations shall be formed in accordance with sanitary and epidemiological requirements approved in accordance with Article 95, subparagraph 13) of the Code of the Republic of Kazakhstan.
27. In the production (manufacture) of food products for baby food, the use of food (food) raw materials containing a genetically modified organism (hereinafter referred to as GMO) shall not be allowed.
28. When producing food products for baby food, it is not allowed to use food (food) raw materials obtained using pesticides in accordance with Annex 10 to the technical regulations of the Customs Union "On Food Safety" (TR CU 021/2011).
29. Food products for baby food shall meet the following requirements:
1) cookies for baby food, not exceeding 25% of added sugar;
2) bakery products for baby food, containing salts not more than 0.5%.
30. Food products for baby food shall not contain:
1) ethyl alcohol more than 0.2%;
2) natural coffee;
3) apricot kernels;
4) vinegar;
5) sweeteners, with the exception of specialized food products for dietary therapeutic and dietary preventive nutrition.
31. In the production (manufacture) of food products for baby food, the use of benzoic, sorbic acids and their salts shall not be allowed.
32. In the production (manufacture) of food products for children's food for children of preschool and school age, the following types of food (food) raw materials shall not be allowed:
1) products of slaughter of productive animals and poultry subjected to repeated freezing;
2) raw materials from fish and non-fish objects of fishing, subjected to repeated freezing;
3) meat of productive animals of mechanical balling and meat of poultry of mechanical baking;
4) collagen-containing raw materials from poultry meat;
5) blocks frozen from various types of veined animal meat, as well as by-products (liver, tongue, heart) with shelf life of more than 6 months;
6) veined beef with a mass fraction of connective and adipose tissue above 20%;
7) veined pork with a mass fraction of adipose tissue over 70%;
8) veined lamb with a mass fraction of adipose tissue above 9%;
9) meat of bulls, cartilages and skinny animals;
10) by-products of productive animals and poultry, with the exception of liver, tongue, heart and blood;
11) eggs and meat of waterfowl;
12) concentrated diffusion juices;
13) vegetable oils with a peroxide number of more than 2 mmol of active oxygen/kilogram (hereinafter referred to as kg) of fat (with the exception of olive oil); olive oil with a peroxide number greater than 2 mmol active oxygen/kg fat;
14) vegetable oils: cotton;
15) hydrogenated oils and fats;
16) burning spices (pepper, horseradish, mustard).
33. Nutrition in educational organizations shall be organized in a canteen working on raw materials or in a buffet.
34. In educational institutions with more than 100 students, canteens shall be provided.
35. Canteens shall have a set of equipment and premises in accordance with the requirements of the current sanitary rules.
36. Tableware, appliances and containers shall be made of materials allowed for contact with food products in accordance with the hygienic standards of Article 12 of the Unified sanitary, epidemiological and hygienic requirements for goods subject to sanitary and epidemiological supervision (control), approved by the Commission of the Customs Union dated September 23, 2011 No. 797.
37. The use of deformed tableware, aluminum cutlery, plastic cutting boards and pressed plywood, with cracks and mechanical damage shall not be allowed.
38. Before entering work, the staff of the catering unit shall undergo a medical examination and hygienic training in accordance with the documents of the state sanitary and epidemiological rationing system.
39. The medical officer of the educational organization shall monitor compliance with the requirements of sanitary regulations; periodically shall check the correctness of laying products and the output of finished dishes by the inspection commission (the composition of which shall be determined by order of the administration of the organization of education); shall provide control over the collection and storage of daily samples; shall examine the entries in the wish and reviews log; shall provide control over the inspection of the food unit workers for injuries and purulent diseases of the skin of the hands, open parts of the body, as well as patients with angina and cataralic phenomena of the upper respiratory tract. Employees who shall have cuts, abrasions, burns, furuncles, suppressions shall not be allowed to work.
40. The cook shall ensure compliance with storage conditions and terms of sale of food products; shall use process charts (dishes file cabinet) when preparing dishes, complies with cooking technology; shall provide collection and storage of daily samples; shall observe personal and industrial hygiene.
Chapter 3. The procedure of nutrition organization in healthcare organizations
41. The organization of therapeutic nutrition shall consist of the following main sections that require specific implementation in each healthcare organization:
1) clinical issues of the organization, which shall include the principles of building medical nutrition, the system of its purpose, the diet regime and nutritional standards;
2) technical issues of the organization, covering the methods of compiling menus, the system of prescribing, the discharge of products, the organization of the technological process in the kitchen, the system of food delivery from the kitchen, food quality control and the organization of patient care;
3) issues of medical nutrition management and training;
4) sanitary and technological issues of the organization, which shall include the system for building catering units and transporting food, equipment and equipment, sanitary requirements for the maintenance of the catering unit.
42. Each health organization shall establish basic, permanent diets and use other diets as needed. It shall also be possible to make certain adjustments to the prescribed diet in connection with special indications. Additional prescriptions or restrictions in the diet shall be made by prescribing products with certain therapeutic properties (cottage cheese, liver, milk, watermelon, apples, garlic and others), or by adding or restricting food substances (proteins, fats, carbohydrates, salts, vitamins).
43. Upon admission of the patient to the healthcare organization, medical nutrition shall be prescribed by the doctor on duty. The prescribed diet shall be entered in the medical history and simultaneously in the consolidated order for all admitted patients, which shall be sent to the catering unit at the set time.
44. The administration of the diet to the patient shall be carried out individually in accordance with the specific objectives of the integrated treatment.
45. The dietary nurse of the food unit, based on information received from all departments, shall compile a summary of the presence of patients who are on nutrition.
46. Based on the combined information, the dietary sister, with the participation of the production manager (chef) and accountant, shall make a menu layout according to the established form for the nutrition of patients the next day under the guidance of the dietary doctor.
47. The menu layout shall be compiled according to the combined seven-day menu (autumn-summer and winter-spring), taking into account the average daily set of food products, shall be approved daily by the head of the health organization and shall be signed by a nutritionist, accountant, production manager (chef). In the layout menu, the dietary sister in the numerator places the number of food products to prepare one portion of each dish, in the denominator the accountant (calculator) shall indicate the number of products necessary to prepare all portions of this dish.
48. Based on the totals, shall be issued a request for food from the warehouse (storeroom).
49. Some amendments shall be introduced to the prescribed diet depending on the personality of the patient and the nature of the course of the pathological process. Such amendments shall be introduced by supplementing certain products with certain therapeutic properties (e.g. cottage cheese, liver, milk, apples, etc.), excluding from the diet, if required, an appropriate amount of other products, as well as by adding or restricting food substances (proteins, fats, carbohydrates, water, vitamins, mineral salts).
50. The quantity of the diets applied in each organization of health care shall increase in process of introduction of the differentiated clinical nutrition and also as a result of development of new clinically reasonable diets. It shall be necessary in all cases to maintain the nomenclature of diets, denoting new diets with the same numbers with an additional letter denoting the option.
51. For children on mixed feeding, the volume of the mixture shall be calculated individually. Children who shall be exclusively breastfeeding do not receive adapted milk mixtures. Milk formula for children shall be selected taking into account pathological conditions and diseases. Certain types of products of children's dietary therapeutic and child dietary preventive nutrition for young children shall comply with the requirements established in Annex 3 to the technical regulations of the Customs Union "On safety of certain types of specialized food products, including dietary therapeutic and dietary preventive nutrition" (TR CU 027/2012).
52. At least four meals per day shall be established in all healthcare organizations, according to indications in individual departments or for certain categories of patients, more frequent meals shall be used (five to six meals per day).
53. The feeding time of patients shall be determined by the number of meals and the general daily routine in health organizations.
54. For five-fold meals, a second breakfast shall be introduced, and for six-fold meals, a second dinner with a more or less even distribution of the daily diet.
55. Average daily food sets shall be the basis for the formulation of therapeutic diets in health organizations. The standards of nutrition of patients in health-care organizations shall be established by the Resolution of the Government No. 128 dated January 26, 2002 “On approval of natural standards for nutrition and minimum standards for equipping state healthcare organizations with soft equipment”.
56. In the absence of a complete set of products on the food unit provided for by the combined seven-day menu, it shall be possible to replace one product with another while maintaining the chemical composition and energy value of the therapeutic diets used.
57. For each dish prepared in healthcare organizations, a layout card shall be compiled (on the back of the card, the cooking technology of the dish is described).
58. The general management of nutrition in health organizations shall be carried out by the head or his deputy for the medical part, and in departments - by the heads of departments.
59. To coordinate all work on the use of therapeutic nutrition in multidisciplinary health organizations, a Council for therapeutic nutrition (hereinafter referred to as the Council) shall be created, which shall develop measures on the main issues of the organization of therapeutic nutrition. The Council shall consist of the head of the health organization or its deputy for the medical part, a nutritionist (other specialist doctor), heads of the departments of gastroenterology (therapy), intensive care, surgery, pediatric department, dietary sister, production manager (chef, cook) and representatives of interested non-governmental organizations.
60. The tasks of the Council shall include improving therapeutic nutrition, monitoring compliance with the compilation of average daily food sets, creating an effective organization of therapeutic nutrition, introducing new technologies for dietary and enteral nutrition, developing a range of diets, mixtures for enteral nutrition to be introduced in this organization, a promising menu, a file cabinet of dishes and a set of mixtures for enteral nutrition.
61. All issues related to the organization of therapeutic nutrition in health organizations shall be systematically (at least 2 times a year) heard and resolved at meetings of the Council.
62. Direct scientific, methodological and organizational management of therapeutic nutrition in health organizations shall be carried out by a nutritionist. In health organizations in which the post of nutritionist shall not be provided, the management of therapeutic nutrition shall be entrusted to one of the treating doctors or the dietary sister.
63. The head of the hospital kitchen shall be assigned to the dietary sister, who works under the medical supervision of the doctor. The functions of the dietary sister shall include monitoring the sanitary and hygienic process in the kitchen, quality check of products at their arrival in the warehouse and kitchen, control over the correct storage of food, the correct departure of food from the kitchen, organization of food distribution in buffets, as well as control over timely carrying out of preventive medical examinations of food unit employees and prevention of work of persons who have not undergone preliminary or periodic medical examination.
64. Direct cooking shall be carried out under the guidance of the senior cook-foreman.
65. Laying food in the boiler shall be carried out in the presence of a dietitian (dietary sister). The foodstuffs shall be pre-weighed regardless of the fact that they were received by weight from the warehouse (storage room).
66. Control of ready food before delivery it in offices shall be made by the doctor on duty and once a month - the head (or his deputy for medical work) and also carried out by the dietitian, the dietary sister, the manager of production (or the chef) regardless of the test made by the doctor on duty.
67. Sanitary minimum classes shall be included in the training plan of the kitchen production personnel.
68. Foodstuff for cooking in the organizations of healthcare shall be accepted in the presence of the documents confirming their compliances (veterinary certificate, veterinary references, the declaration on compliance, the certificate of conformity, the certificate of state registration).
69. Not allowed:
1) use of poultry meat for the production of food products, except for chilled poultry meat, mechanical baking and collagen-containing raw materials from poultry meat;
2) use of food raw materials containing GMO and (or) components obtained from GMO for production of food products of dietary therapeutic and dietary preventive nutrition for infant nutrition.
70. In food units, health organizations strictly shall be observed:
1) requirements for the arrangement of the catering unit, sanitary maintenance and cooking technology, provided for by the current sanitary rules for catering enterprises and healthcare facilities;
2) requirements for the conditions and shelf life of food products;
3) requirements for mandatory preventive and medical examinations of employees of the catering unit, dispensers and buffets.
71. In the absence of centralized delivery of food products, special transport (covered) shall be allocated for their transportation. It shall not be allowed to use special transport for other purposes (transportation of laundry, equipment, patients).
72. Thermos, trolleys, marmite carts or tightly closing utensils shall be used to transport finished food from the food unit to the buffet compartments.
