Chapter 1: Carry out client's dietary assessment

Nutrition and Dietetics professionals in Kenya play a critical role in managing clients’ health through precise dietary assessments. Carrying out an effective dietary assessment requires not only technical competence but also adherence to safety protocols that protect both the client and the practitioner. Personal Protective Equipment (PPE) forms a fundamental part of this process, ensuring hygienic and safe interactions during the data collection and physical examination stages. This chapter focuses on the understanding, selection, and importance of PPEs in the context of clients’ dietary assessment in Kenyan healthcare and community settings.

1.1 PPEs

Personal protective equipment (PPE) is the clothing and equipment a dietitian wears to protect the client and the practitioner from infection and injury during a dietary assessment. A dietitian takes diet histories at the bedside, measures weight, height and mid-upper arm circumference, checks feeding trays on a ward round, visits households and works in diet kitchens. Each of these tasks brings contact with body fluids, respiratory droplets, food residues or wet floors, so the choice of PPE follows the task and the infection risk of the client. This topic defines the key terms of the unit, describes the protective items a nutrition professional wears and explains why they matter.

1.1.1 Definition of terms

Three terms are used throughout this unit: nutrition, communicable diseases and non-communicable diseases. A shared understanding of them lets the dietitian record assessments, plan diets and report to the care team in the same language.

1.1.1.1 Nutrition

Nutrition is the process by which the body takes in food, digests it, absorbs the nutrients and uses them for energy, growth, repair and protection against disease. The nutrients are carbohydrates, proteins, fats, vitamins, minerals and water, and the body needs them in the right amounts. A person's nutritional status is the result of food intake, absorption and the body's demands at that time.

Poor nutrition takes two forms. Undernutrition includes wasting, stunting, underweight and micronutrient deficiencies. Overnutrition includes overweight and obesity. Both change how the body fights infection and how it copes with long-term illness, which is why nutrition is central to this unit.

Example: a client who has lost weight over three months because of poor appetite is assessed for undernutrition, while a client with a large waist and raised blood glucose is assessed for overnutrition and its effects.

1.1.1.2 Communicable diseases

Communicable diseases are illnesses caused by disease-causing organisms (pathogens) such as bacteria, viruses, protozoa, fungi and worms, which pass from an infected person, animal or contaminated source to another person. They are also called infectious diseases. The pathogen may travel through contaminated food and water, droplets from the airways, direct contact, the bite of an insect or contact with blood and body fluids.

Cholera, typhoid, tuberculosis, pneumonia and malaria are communicable diseases studied in this unit. Infection raises the body's demand for energy and protein, reduces appetite and can damage the gut, so a client with a communicable disease is at risk of undernutrition.

1.1.1.3 Non communicable diseases

Non-communicable diseases (NCDs) are long-lasting conditions that are not caused by an infectious agent and do not pass from one person to another. They develop slowly and result from a mix of inherited tendency, ageing, diet, physical inactivity, tobacco, alcohol and other lifestyle and environmental factors. Some need management for life.

Rheumatoid arthritis, osteoarthritis, gout, osteoporosis, obesity, diabetes, cancer, high blood pressure and heart disease are the NCDs covered in this unit. Food choices influence the cause, the course and the complications of each, which makes the dietitian part of the care team.

1.1.2 Types of PPEs

The type of PPE worn depends on the task, the setting and the way the client's illness spreads. A dietitian who reviews a food diary at a desk needs little protection, while one who assists a client with a cough, handles a wound dressing area or works with raw food needs more. Each item is put on before contact with the client and removed in a way that does not spread contamination, followed by hand washing.

Personal protective equipment (PPE) (Source: 5f700936fcc590f8)

1.1.2.1 Dust coat

A dust coat is a clean, long-sleeved, knee-length coat worn over everyday clothes. It protects the skin and clothing from splashes, food spills and contact with surfaces, and it marks the wearer as a health professional.

• Use: wear it for ward rounds, diet kitchen work and clinic consultations.
• Fit: the sleeves cover the forearms and the front fastens fully.
• Care: wash it regularly at a high temperature and change it at once when it is soiled with body fluids or food.
• Limits: do not wear it outside the work area, in the staff canteen or on public transport, because it can carry pathogens.
• Separation: keep the coat used for the diet kitchen apart from the one used at the bedside.

1.1.2.2 Face mask

A face mask covers the nose and mouth and reduces the spread of respiratory droplets to and from the wearer. A surgical mask protects the client from the wearer's droplets and shields the wearer from splashes. For clients with suspected or confirmed tuberculosis, health workers wear a particulate respirator such as an N95 or an equivalent, which filters very small airborne particles, while the client wears a surgical mask.

• Fit: the mask covers the nose, mouth and chin and is pressed to the face along the nose bridge.
• Handling: hold the ties or ear loops when putting the mask on or removing it.
• Replacement: change the mask when it becomes damp, soiled or damaged.
• Disposal: discard a single-use mask in the waste bin and wash the hands afterwards.
• Not a substitute: a mask does not replace hand washing, ventilation or keeping a sensible distance from a coughing client.

1.1.2.3 Hand gloves

Disposable gloves protect the hands from blood, body fluids, wounds, soiled linen and food waste. They are single-use items: a pair is discarded after one task and is not worn for a second client.

• When to wear: when touching broken skin or body fluids, handling soiled feeding equipment or clearing a tray used by a client with a diarrhoeal illness.
• Hand hygiene: wash or sanitise the hands before putting gloves on and after taking them off.
• Change: put on a fresh pair for each client and each task.
• Size: choose a size that fits closely and does not tear.
• Allergy: a client or worker allergic to latex is given non-latex gloves.
• Not needed: routine interviews and measuring on intact skin do not need gloves, as hand hygiene gives enough protection.

1.1.2.4 Closed shoes

Closed shoes cover the whole foot. They protect against hot liquids, dropped utensils, broken glass and sharps, and against contact with spills on ward and kitchen floors.

• Sole: a non-slip sole reduces the risk of falling on wet floors.
• Material: leather or a washable synthetic material wipes clean.
• Fit: shoes fit well enough for walking and standing for long periods.
• Cleaning: wipe or wash the shoes regularly and keep a pair for the workplace.
• Open footwear: sandals and open-toed shoes are not suitable at work.

Other items used in higher-risk settings

Some tasks call for extra protection. A waterproof apron or gown protects the clothing when a client has an open wound or when splashes are likely during assisted feeding. Goggles or a face shield protect the eyes from splashes of body fluids. A head cover keeps hair out of food in the diet kitchen, and shoe covers are used in clean areas. These items are chosen after a short risk assessment rather than being worn for each client.

1.1.3 Importance of PPEs

PPE is a physical barrier that lowers the risk of infection and injury. It works together with hand hygiene, safe handling of food and equipment and sensible spacing between people.

• Protection of the practitioner: gloves, masks and gowns reduce contact with pathogens from clients with conditions such as tuberculosis, diarrhoeal disease or HIV.
• Protection of the client: a clean coat, clean hands and a mask protect a weak client, such as one on cancer treatment or a malnourished child, from infection carried by the practitioner.
• Prevention of cross-contamination: changing gloves and cleaning equipment between clients stops pathogens from moving from one person to the next, including between households during community visits.
• Food safety: clean protective clothing, a head cover and clean hands help keep pathogens out of feeds, diet kitchen preparations and supplements.
• Compliance with workplace policy: health facilities set infection prevention rules and an employer's safety policy expects staff to use the protective equipment provided.
• Professional image and client confidence: clients are more open in an assessment when they see that the dietitian follows safety routines.
• Injury prevention: closed shoes and aprons reduce burns, cuts and slips during kitchen and ward work.

Chapter Summary

This chapter focused on the comprehensive process of carrying out a client's dietary assessment within the context of nutrition related to communicable and non-communicable diseases. It began by defining key terms such as nutrition, communicable diseases, and non-communicable diseases, followed by an overview of personal protective equipment including dust coats, face masks, hand gloves, and closed shoes, emphasizing their importance in safeguarding health during assessments. The transmission cycle and routes of communicable diseases were explored, highlighting oral-faecal, airborne, and vector-borne diseases as primary types. Attention then shifted to non-communicable diseases, detailing conditions such as rheumatoid arthritis, osteoarthritis, gout, osteoporosis, obesity, diabetes, cancer, blood pressure disorders, and heart disease. The chapter concluded with guidance on formulating a nutrition diagnostic statement for clients, structured around identifying the problem, determining its etiology, and recognizing associated signs and symptoms. This holistic approach equips health practitioners with the knowledge to assess dietary needs effectively in relation to disease prevention and management.