Parenteral feeding

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Conclusion

Many factors affect the nutritional status of a patient coming into hospital, including increasing age, illness, an inability to cope, drug treatment and socioeconomic factors. As the care of health-related problems is increasingly being managed in primary care settings, patients who are admitted to hospital are often acutely ill before admission and may already have some signs of malnutrition. Once in hos- pital, the risks increase due to episodes where patients are placed on ‘nil by mouth’ for investigations or procedures required to investigate and treat their illness or disease. In addition, appetite often decreases when a person is ill. Therefore it is not surprising that some patients may leave hospital in a more malnourished state that when they arrived.

Providing an appropriate and timely level of nutritional support is essential to maximise the patient’s nutritional status and recovery from illness. The use of a step-by-step approach is often the safest means of progressing – from oral supplementation to parenteral nutrition. However, it is essential to consider the risks that accompany artificial nutritional support as the provision of nutritional care via enteral or parenteral feeding tubes is not without complications. Therefore the balance of risk versus benefit must be considered for each patient before nutritional support is commenced. Nurses play a

Patient monitoring

Enteral feed should be stored and administered at room temperature to avoid gastric discomfort associ- ated with the administration of cold feed. The patient should be positioned with the head and shoul- ders raised to an angle of at least 30° and be monitored closely for any potential side effects (as discussed above) during feeding and for at least an hour on completion of the feed. While nutritional support is being provided, the patient should be monitored to check for:

•

changes in weight;

•

changes in oral intake;

•

fluid balance;

•

electrolyte deficiencies;

so that their feeding regimen can be adjusted accordingly.

If a decision is made that nutritional support is no longer required, there is usually a gradual reduc- tion in feed with continued monitoring, to ensure that patients can maintain their nutritional status without support. In the same way that nutritional support is escalated using a step-by-step approach, so it is sensible to reduce it using the same approach.

Now visit the companion website and test yourself on this chapter:

57

www.wileyfundamentalseries.com/medicalnursing

central role in many of these discussions as they often have a more holistic view of the patient and any family or carers involved. It is essential that nurses are represented within multidisciplinary teams and act as the patient’s voice if and when the patient is unable to represent their own view, to ensure that the appropriate level of nutrition is provided by the appropriate route.

References

Age Concern (2006) Hungry to be Heard: The Scandal of Malnourished Older People in Hospital. London: Age Concern England.

Best, C. (2008) Nutrition: A Handbook for Nurses. Chichester: Wiley Blackwell.

Brady, M., Kinn, S. & Stuart, P. (2003) Preoperative fasting for adults to prevent perioperative complications Cochrane Database System Review, (4):CD004423..

Braga, M., Ljungqvist, O., Soeters, P., Fearon, K., Weimann, A. & Bozzetti, F. (2009) ESPEN Guidelines on Parenteral Nutrition: Surgery. Clinical Nutrition, 28:378–86.

Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects No. 41. London: HSMO.

Department of Health (2007) Improving Nutritional Care: A Joint Action Plan from the Department of Health and Nutrition Summit Stakeholders. London: Department of Health.

Elia, M. (2003a) Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the ‘Malnutri- tion Universal Screening Tool’ (‘MUST’) for Adults. Malnutrition Advisory Group (MAG). Redditch, Worcester- shire: BAPEN.

Elia, M. (2003b) The ‘MUST’ report: nutritional screening of adults: a multidisciplinary responsibility. A report by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition. Redditch, Worces- tershire: BAPEN.

Hospital Caterers Association (2004) Protected Mealtimes Policy. London: HCA.

Jeffries, D., Johnson, M. & Ravens, J. (2011) Nurturing and nourishing: the nurses’ role in nutritional care. Journal of Clinical Nursing, 20(3–4): 317–30.

Ljungqvist, O., Fearon, K. & Little, R.A. (2006) Nutrition in surgery and trauma. In: Gibney, M.J., Elia, M., Ljungvqist, O. & Dowsett, J. (eds), Clinical Nutrition (Chapter 19). Oxford: Nutrition Society/Blackwell.

National Institute of Clinical Excellence (2006) Nutrition Support for Adults. Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Clinical Guideline No. 32. London: NICE.

National Patient Safety Agency (2005) Reducing the Harm Caused by Misplaced Nasogastric Tubes. Patient Safety Alert 05. London: NPSA.

National Patient Safety Agency (2011) Reducing the Harm Caused by Misplaced Nasogastric Feeding Tubes in Adults, Children and Infants. Patient Safety Alert NPSA/2011/PSA00. London: NPSA.

Patients Association (2010) Listen to Patients, Speak up for Change. London: Patients Association.

Powell-Tuck, J. Gosling, P., Lobo, D. et al. (2011) British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients. Redditch, Worcestershire: BAPEN.

Pratt, R.J., Pellowe, C.M., Wilson, J.A. et al. (2007) epic2 National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection, 65S:S1–64.

Royal College of Nursing (2007) Nutrition Now. London: RCN.

World Health Organization (1996) Anthropometric reference data for international use: recommendations from a WHO Expert Committee. American Journal of Clinical Nutrition, 64:650–8.

Principles of infection prevention and control

Sile Creedon ¹ and Maura Smiddy ²

1School of Nursing and Midwifery, University College Cork, Cork, Ireland

2Department of Epidemiology and Public Health, University College Cork, Cork, Ireland

5

Contents

Introduction 59

Physiology associated with infection 59 Overview of common microbiology

and pathogenic organisms 62

Frequently encountered pathogenic

microorganisms 63

Infection control principles 64

Asepsis 66

Decontamination 66

Healthcare waste management 72

Isolation of patients 72

Care bundles 73

Conclusion 76

References 76

Having read this chapter, you will be able to:

•

Define healthcare-associated infections and differentiate between endogenous and exogenous infections

•

Discuss colonisation versus infection

•

Describe how infections are transmitted

•

Identify frequently encountered pathogenic microorganisms

•

Identify techniques used and indications for healthcare workers to engage in hand hygiene

•

Describe and discuss standard precautions, including the use of personal protective equipment, decontamination and waste management

•

Describe transmission based precautions

Learning outcomes

Fundamentals of Medical-Surgical Nursing: A Systems Approach, First Edition. Edited by Anne-Marie Brady, Catherine McCabe, and Margaret McCann.

© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.

59

Introduction

The prevention and control of infection is a fundamental element of nursing practice, and all healthcare professionals have the responsibility to adhere to evidence-based guidelines in order to control infec- tion in clinical settings. A healthcare-associated infection is defined as ‘a localized or systemic condition that results from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) and . . . that was not present or incubating at the time of admission to the hospital’ (Horan et al. 2008, p. 1).