Hospital FSDs fighting a battle against corrugated cardboard

With food allergies, picky patients and staffing shortages to contend with, it may be hard to imagine that one of the biggest pain points facing healthcare foodservice directors today is the corrugated cardboard box. But this simple delivery method is causing massive problems throughout their facilities, hospital operators tell FoodService Director.

“The fact of the matter is, cardboard is filthy,” says Eric Eisenberg, corporate executive chef for nutrition, catering, retail and conference services at Seattle’s Swedish Health Services. Corrugated products can sop up and retain liquids, dirt and insects—and worse—from hospital loading docks and anything they come in contact with during transit. It’s a fact that hospital certification boards like DNV GL and The Joint Commission are well aware of; and so they began requiring healthcare facilities to ban corrugated products from all patient units, including foodservice areas.

The problem for operators: Almost every product that enters their facility, from peanut butter to produce, arrives packaged in corrugated cardboard. Items that are double-boxed with an interior layer of smooth cardboard, such cereal boxes, are safe—but that’s the exception rather than the rule.

Christopher McCracken, director of nutrition services for UC San Diego Health system, has directed his staff to de-box individual items into large plastic containers—though that solution isn’t without hiccups. “If there’s ever a recall, I don’t know what’s affected because of the serial number,” he says. “Like individual [jars of] peanut butter—they don’t have that information on them.”

There’s also a freshness issue. Eisenberg says he has directed staff to rotate old items to the top when refilling the plastic boxes, but says he has no way of knowing if it’s actually happening. “That’s especially the case in places where the whole case isn’t necessarily distributed to a nutrition room,” he says. “In many hospitals, they have a floor stock person who goes around and replenishes supplies. If you’re topping off, how long has the stuff been in the bottom?”

De-boxing also requires two resources operators might be short on: manpower and space. McCracken says the state of California required his new facility to include a de-boxing room in its blueprints, though older hospitals are being grandfathered in. Eisenberg says he had a bit of a “d’oh” moment recently when he realized Swedish hadn’t planned for de-boxing space at a facility that’s already in the middle of construction.

Despite the headaches caused by corrugated cardboard, neither Eisenberg nor McCracken think the bans are a massive overreaction on the part of the certification boards. Eisenberg in particular cited a mock Department of Health survey at a Swedish facility several years ago where an inspector swept a storage room with a black light. “There, on a couple of cases, were little drips and drops and urine-soaked paw prints from rats and stuff—and you’re horrified,” he says. While that issue since has been corrected, “We’re a long way from having a perfect solution—but I think [de-boxing] is going to become a part of peoples’ regular process,” Eisenberg says. “I think, in healthcare, the idea of cardboard will go away.”