Implementation of a Bowel Protocol to Improve Enteral Nutrition and Reduce Clostridium difficile Testing

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Infectious Disease

Background:

• Underfeeding is prevalent in adult patients receiving enteral nutrition.
• Low enteral nutrition volumes are linked to constipation and diarrhea in critically ill patients.
• Diarrhea often prompts Clostridium difficile testing, though other factors are common causes.

Purpose of the Study:

• To assess the effectiveness of bowel protocols in reducing constipation, diarrhea, and inappropriate Clostridium difficile testing.
• To determine if these protocols enhance enteral nutrition delivery in critical care units.

Main Methods:

• A prospective convenience sample was utilized for the study.
• The primary outcome measured was the percentage of patients achieving at least 80% of their prescribed caloric volume within one week of initiating enteral nutrition.
• Hospital-onset Clostridium difficile infection testing rates were compared before and after protocol implementation.

Main Results:

• Following protocol implementation, patients received significantly more enteral nutrition, reaching 78% of the goal volume (P = .048).
• The standardized infection ratio for hospital-onset Clostridium difficile infection decreased by 43% (P = .04).

Conclusions:

• Bowel protocols effectively improved the delivery of total enteral volumes.
• These protocols reduced inappropriate testing for hospital-onset Clostridium difficile infections.
• Implementation may enhance patient safety and lead to better patient outcomes.