https://www.medpagetoday.com/upload/2011/4/4/Clin%20Infect%20Dis.-2002-O'Grady-1281-307.pdf

Guidelines for the Prevention of Intravascular Catheter-related Infections

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.

ESPEN guideline: Clinical nutrition in surgery

https://espen.info/documents/ENSurgery.pdf

ESPEN Guidelines on Enteral Nutrition: Surgery including Organ Transplantation

Microbial growth of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans was evaluated in a standard amino acid-dextrose-based total parenteral nutrition (TPN) solution, 10% lipid emulsion, and a combined TPN formulation containing amino acids, dextrose, and lipid emulsion. At an initial inoculum of 10(4) CFU/ml, all three bacterial organisms grew well in 10% lipid emulsion, died in the standard solution and grew only minimally or died in the combined formulation. C. albicans grew in all three formulations at an initial inoculum of 10(4) CFU/ml; however, at an initial inoculum of 10(2) CFU/ml, which approximates touch contamination, growth of Candida in the standard and combined formulations was less than 1 log at 24 hr in contrast to the 10% lipid emulsion which showed significant growth greater than 2 log at 24 hr. It is concluded that a 24-hr infusion time is safe for the combined TPN formulation used in this study. This should result in significant cost savings compared to the previously recommended 12-hr infusion time.

Microbial Growth Patterns in a Total Parenteral Nutrition Formulation Containing Lipid Emulsion

Objective To develop a sensitive and specific nutrition screening tool that conforms to the requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and is effective in any given hospital population. Design A two-step prospective evaluation was performed in two unrelated community hospitals to determine the effectiveness of a current nutrition screening tool, and to develop a new, more sensitive tool that permits efficient use of available personnel. Statistical analyses Standard calculations for sensitivity, specificity, positive predictive value, and negative predictive value were used to compare the results of various screening methods with those of full nutrition assessments. Stepwise discriminant analysis was used to determine specific parameters that contributed to the diagnosis of malnutrition and to derive a predictive equation based on these parameters. Methods In part 1, 100 patients admitted consecutively were evaluated using a subjective screening tool; the results were compared with those from full nutrition assessment of the same patients. Stepwise discriminant analysis identified three parameters most closely related to malnutrition, and a multivariant equation relative to nutrition risk was derived. In part 2, 151 randomly selected adult medical and surgical patients were evaluated at admission with the same screening tool used in part 1. Additionally, prealbumin level was determined on admission. The results of the screening, the discriminant analysis equation from part 1, and both methods incorporating the prealbumin level were compared with the results of a full nutrition assessment. Results In part 1, discriminant analysis identified total lymphocyte count, percentage weight loss, and serum albumin level as the three best indicators of malnutrition. A multivariant equation incorporating these objective parameters was derived. In part 2, the equation yielded better sensitivity and specificity results than other screening methods. Inclusion of prealbumin level did not improve screening methods. Conclusions The revised screening tool described can be used as the basis of an effective screening program that meets the proposed JCAHO nutrition care standards.

Developing an effective adult nutrition screening tool for a community hospital.

Background: The study was designed to quantitate factors such as preparation time, waste, and contamination associated with three different feeding systems for peptide-based diets, and to determine appropriate hang times. Methods: Intensive care unit patients were randomized to receive a peptide-based diet in 1500-mL prefilled, sterile closed-system containers (CS) infused more than 24 hours, as open systems decanted from cans (OS-Can), or as open systems mixed from powder (OS-Powder). Open-system groups were provided a 12-hour supply twice daily in commercially clean 1-L bags with preattached sets. Samples were taken for culture during preparation and after infusion. Preparation time, initial and final microbial concentrations, and total waste were quantified. Results: Preparation time was significantly shorter for CS than for OS-Can or for OS-Powder (2 minutes vs 7.5 minutes vs 13.0 minutes). Initially, 100% of the OS-Powder and 30% of the OS-Can bags were contaminated, with significant contamination ex...

Evaluation of "Closed" vs "Open" Systems for the Delivery of Peptide-Based Enteral Diets

One hundred fourteen patients scheduled to undergo elective cholecystectomy were prospectively randomized into one of four treatment groups to study the potential benefits of esophagogastric decompression with and without immediate postoperative enteral nutrition. Group I was the control, and patients received only iv fluids and were allowed to eat as tolerated. Group II patients received iv fluids and esophagogastric decompression. Group III patients received esophagogastric decompression and enteral sterile water through the duodenal feeding lumen. Group IV patients received esophagogastric decompression and infusion of an elemental diet through the feeding lumen. The surgical techniques were standardized for all patients. The results of the study indicated no statistically or clinically significant differences among any of the treatment groups regarding; (1) need for parenteral analgesics or antiemetics, (2) tolerance of regular diet, (3) postoperative day of discharge, and (4) postoperative day that o...

Michael F. Elmore

Papers

Microbial Growth Patterns in a Total Parenteral Nutrition Formulation Containing Lipid Emulsion

Developing an effective adult nutrition screening tool for a community hospital.

Evaluation of "Closed" vs "Open" Systems for the Delivery of Peptide-Based Enteral Diets

Esophagogastric decompression and enteral feeding following cholecystectomy: a controlled, randomized prospective trial

Bacterial contamination of enteral feeding reservoirs.