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ELECTRONIC ARTICLE:
Barbara C.C. Lam, Josephine Lee, and Y.L. Lau
Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection
Pediatrics 2004; 114: e565-e571 [Abstract] [Full text] [PDF]
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[Read P3R] Pediatric tube feedings isn't a Low-risk contacts
Eduardo O. Duque-Estrada   (7 November 2004)

Pediatric tube feedings isn't a Low-risk contacts 7 November 2004
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Eduardo O. Duque-Estrada,
Prof. of Pediatrics
Teresopolis school of Medicine, Rio de Janeiro, Barzil

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Re: Pediatric tube feedings isn't a Low-risk contacts

duque{at}cremerj.com.br Eduardo O. Duque-Estrada

Dear Sirs, We agree that the Hand Hygiene Practices it's the most important measure in preventing hospital-acquired infection, mainly on Neonatal Intensive Care Unit. The study Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection (PEDIATRICS Vol. 114 No. 5 November 2004, e565) it´s confident that hand-washing compliance must be continuos. We disagree on tube feedings isn't a Low-risk contacts. (Table 1) The microbially contaminated tube feedings can contribute to undesirable outcomes. These outcomes range from foodborne infections and food poisoning to other serious complications, including the following GI symptoms, e.g., abdominal distention, vomiting, and diarrhea (1-4), GI colonization (5,6), Infection and sepsis (2,4,6-9)and Increased mortality (2) The FDA, according to the Orphan Drug Act Amendments of 1988, recognizing that microbial contamination is a hazard for medical foods, has implemented specific recommendations for microbial quality at the time of manufacture.(10) Touch (or contact) is the most significant source of contamination in the clinical environment. Unless clinicians take meticulous preventive measures, formula and the feeding tube can be touch-contaminated at nearly every point in preparation and delivery. Prof. EO. Duque-Estrada Pediatrics Department Teresópolis School of Medicine, Rio de Janeiro, Brazil. REFERENCES 1. Anderson KR, Norris DJ, Godfrey LB, et al: Bacterial contamination of tube-feeding formulas. JPEN 1984;8:673-678. 2. Freedland CP, Roller RD, Wolfe BM, Flynn NM: Microbial contamination of continuous drip feeding. JPEN 1989;13:18-22. 3. Kohn CL: The relationship between enteral formula contamination and length of enteral delivery set usage. JPEN 1991;15:567-571. 4. Navajas M F-C, Chacon DJ, Solvas JFG, et al: Bacterial contamination of enteral feeds as a possible risk of nonsocomial infection. J Hosp Infect 1992;21:111-120. 5. Schreiner RL, Eitzen H, Gfell MA, et al: Environmental contamination of continuous drip feeding. Pediatrics 1979;63:232-237. 6. Thurn J, Crossley K, Gerdts A, et al: Enteral hyperalimentation as a source of nosocomial infection. J Hosp Infect 1990;15:203-217. 7. Casewell MW, Cooper JE, Webster M: Enteral feeds contaminated with Enterobacter cloacae as a cause of septicaemia. Br Med J 1981;282:973. 8. Levy J, Van Laethem Y, Verhaegen G, et al: Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: A study using plasmid fingerprinting. JPEN 1989;13:228-234. 9. Pingleton SK, Hinthorn DR, Liu C: Enteral nutrition in patients receiving mechanical ventilation. Am J Med 1986;80:827-832. 10. Food and Drug Administration: Compliance Program Guidance Manual CPGM 7321.002 chap 21, 1995.