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Contamination of enteral feedings and diarrhea in patients in intensive care units
D B Mickschl1, L J Davidson, D J Flournoy
1University of Oklahoma College of Nursing, College of Medicine, Veterans Administration Medical Center.
Insights
Enteral feeding contamination did not significantly increase diarrhea in critically ill patients. However, patients with diarrhea showed lower serum albumin and transferrin levels, suggesting other factors may be involved.
Area of Science:
- Critical Care Medicine
- Infectious Disease Control
- Nutritional Support
Background:
- Diarrhea is a common complication in critically ill patients receiving enteral nutrition.
- Enteral feeding solutions can become contaminated, raising concerns about infection and patient outcomes.
- Understanding factors contributing to diarrhea is crucial for optimizing patient care in intensive care units.
Purpose of the Study:
- To evaluate the impact of enteral feeding solution contamination on diarrhea incidence in critically ill patients.
- To compare diarrhea rates between aseptic and routine enteral feeding protocols.
- To identify potential contributing factors to diarrhea in this patient population.
Main Methods:
- A study involving 36 adult intensive and coronary care unit patients receiving enteral feeding.
- Comparison of aseptic versus routine enteral feeding protocols.
- Microbial cultures of feeding formulas collected during the initial four days of feeding.
Main Results:
- A significantly higher rate of formula contamination was observed in the routine protocol group compared to the aseptic group (p < 0.05).
- No significant difference in diarrhea incidence was found between patients receiving contaminated versus non-contaminated formula.
- Patients experiencing diarrhea exhibited significantly lower serum albumin and transferrin levels (p < 0.05).
Conclusions:
- Enteral feeding solution contamination, under the studied conditions, did not significantly increase the incidence of diarrhea.
- Lower serum albumin and transferrin levels in patients with diarrhea suggest potential links to nutritional status or other underlying factors.
- Further research is warranted to explore the multifactorial etiology of diarrhea in critically ill patients and refine nursing practices for enteral feeding.
Abstract:
To investigate the effect of contamination of enteral feeding solutions on the incidence of diarrhea in critically ill patients, 36 adult intensive and coronary care unit patients received enteral feeding by an aseptic or a routine protocol. Cultures of formula were obtained on the first 4 days of enteral feeding. A significantly greater incidence of contamination was found for the routine protocol group than for the aseptic protocol group (p less than 0.05); however, differences in incidence of diarrhea between subjects who did and did not receive contaminated formula were not significant. Subjects who had diarrhea also had significantly lower (p less than 0.05) serum albumin and transferrin levels. The effects of severity of illness, osmolality, and rate of formula administration on incidence of diarrhea were investigated, and these were not found to be significant factors. Implications for nursing practice and further research are generated.