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

Abstract

Background Underfeeding is common among adult patients receiving enteral nutrition. Constipation and diarrhea have been associated with low enteral nutrition volume in critically ill patients. In patients with diarrhea, Clostridium difficile is often suspected and tested for, although medications, illness, or enteral formulas are usually the cause. The use of bowel protocols to proactively address constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, thereby improving enteral nutrition, remains unclear. Objective To evaluate the efficacy of implementing protocols to decrease constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, and to deliver larger enteral nutrition volumes in a critical care unit. Methods A prospective convenience sample was used. The primary outcome was the proportion of patients receiving greater than or equal to 80% of their prescribed caloric volume 1 week (minimum 4 days) after initiating enteral nutrition. Rates of testing for hospital-onset C difficile infection were analyzed before and after the protocol was implemented. Results After the protocol was implemented, patients experienced significant increases in delivery of enteral nutrition volume—up to 78% of the goal volume (P = .048). The standardized infection ratio of hospital-onset C difficile infection decreased 43% (P = .04). Conclusions The implementation of bowel protocols improved delivery of total enteral volumes and reduced inappropriate testing for hospital-onset infections with C difficile, and they may improve patient safety and facilitate positive patient outcomes.

Estratégias educativas para prevenção de incidentes em unidades intensivas

“…Además, el uso de protocolos y diagramas de flujo demostraron ser estrategias educativas efectivas en la prevención de eventos adversos, como señala un estudio realizado en una UCI de un hospital de Estados Unidos, cuyo objetivo fue evaluar la eficacia de implementar protocolos para reducir el estreñimiento, la diarrea y la realización de exámenes inadecuados para detectar la infección por Clostridium difficile. El estudio demostró que después implementar los protocolos intestinales se registró un aumento en los volúmenes de dietas enterales totales de hasta el 78% del volumen objetivo (80%); una reducción del 54% de exámenes inadecuados para detectar infecciones hospitalarias por Clostridium difficile y una reducción del 43% en la infección (15) .…”

“…También se crearon algoritmos de protocolo para ayudar a orientar a los profesionales para que identifiquen correctamente el estreñimiento o la diarrea, e incluso una posible infección por Clostridium difficile (15) .…”

Development and implementation of a protocol for the prevention of Clostridioides difficile infections aimed at the improvement of nursing skills

“…Zdravstveni radnici često sumnjaju da je C. difficile primarni uzrok dijareje, međutim samo 20% dijareja kod hospitalizovanih pacijenata nastaje zbog ovog patogena. Većina slučajeva dijareje je povezana sa lekovima, formulama za enteralno hranjenje ili kao komplikacija osnovog obolenja [12]. U trenutno dostupnoj literaturi, brojne istraživačke studije fokusiraju se na prevenciju CDI i uvođenje algoritama koji uključuju upravljanje antibioticima, laboratorijsko testiranje i dezinfekciju bolničke sredine [9,13,14].…”

“…U trenutno dostupnoj literaturi, brojne istraživačke studije fokusiraju se na prevenciju CDI i uvođenje algoritama koji uključuju upravljanje antibioticima, laboratorijsko testiranje i dezinfekciju bolničke sredine [9,13,14]. Međutim, čini se da postoje nedostaci u stavljanju svih preventivnih paketa na jedno mesto i osnaživanju medicinskih sestara da svojim znanjem i kompetentnošću, pomognu u smanjenju HA -CDI [12].…”