Managing offshore multi-use settings: Use of conceptual mapping to reduce uncertainty of co-locating seaweed aquaculture and wind farms.

The offshore Multi-use Setting (MUS) is a concept that aims to co-locate marine industrial activities, including wind farms and aquaculture. MUS is considered an innovative approach to promoting efficiency in space and resource use whilst contributing global policy priorities. However, the impacts of MUS development across social, economic, and environmental domains are uncertain, hindering the commercialisation of the concept. In this study, we initially demonstrate the potential consequences of co-locating seaweed aquaculture and a wind farm as a step towards MUS. Using a hypothetical case study and modified Delphi methodology, 14 subject matter experts predicted potential outcomes across social and environmental objectives. Five Cognitive maps and impact tables of 58 potential consequences were generated based on experts' perspective on co-locating seaweed aquaculture and a wind farm. The findings highlight the potential to exasperate pressures in the area, including those already attributed to wind farm operations, such as species mortality and stakeholder conflict. However, it may also enhance social-ecological conditions, such as resource provisioning and promoting habitat functionality in the region, through the addition of seaweed aquaculture. The cognitive maps demonstrate the complexity of managing MUS implementation, where high degree of variability and uncertainty about the outcomes is present. The findings of this study provide the vital entry point to performing further integrative assessment and modelling approaches, such as probabilistic analysis and simulations, in support of MUS decision-making. The research also strongly recommends alternative strategies in the pursuit of combining seaweed production and wind farms to avoid significant financial (among many other) trade-offs and risks. More broadly, we have found that our approach's ability to visually represent a complex situation while considering multiple objectives could be immensely valuable for other bioeconomy innovations or nature-based solutions. It helps mitigate the potential for expensive investments without a comprehensive evaluation of the associated risks and negative impacts, as necessitated by the principles of sustainability in decision-making.

Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings.

BACKGROUND: Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. METHODS: A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. RESULTS: The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). CONCLUSION: Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.

Blenderized food tube feeding in very young pediatric patients with special healthcare needs.

BACKGROUND: Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS: In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS: Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION: Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.

The Effects of Holistic Admissions on Diversity in Nursing: A Literature Review.

BACKGROUND: The nursing profession does not reflect the diversity of the population they serve. Many health professions, including nursing, have altered their admissions practices to consider a holistic assessment of individuals. Quantitative data from students are not sufficient to develop a diverse student body. METHOD: A literature review was conducted using MEDLINE, CINAHL, ERC, ERIC, and Google Scholar. Original research articles on holistic admission (HA) processes and the effects on diversity in nursing were included in the review. Search terms were "holistic admission," "holistic review," and "nursing." RESULTS: There is a paucity of research regarding HA in nursing. The available literature suggests HA increases the odds of developing a more diverse student population. CONCLUSION: HA should be considered to increase diversity of students. Further research is needed regarding the effects of HA on diversity among nursing students. [J Nurs Educ. 2023;62(10):556-562.].

Artificial neural network approaches to identify maternal and infant risk and asset factors using Peridata.Net: a WI-MIOS study.

Objective: To analyze PeriData.Net, a clinical registry with linked maternal-infant hospital data of Milwaukee County residents, to demonstrate a predictive analytic approach to perinatal infant risk assessment. Materials and Methods: Using unsupervised learning, we identified infant birth clusters with similar multivariate health indicator patterns, measured using perinatal variables from 2008 to 2019 from n = 43 969 clinical registry records in Milwaukee County, WI, followed by supervised learning risk-propagation modeling to identify key maternal factors. To understand the relationship between socioeconomic status (SES) and birth outcome cluster assignment, we recoded zip codes in Peridata.Net according to SES level. Results: Three self-organizing map clusters describe infant birth outcome patterns that are similar in the multivariate space. Birth outcome clusters showed higher hazard birth outcome patterns in cluster 3 than clusters 1 and 2. Cluster 3 was associated with lower Apgar scores at 1 and 5 min after birth, shorter infant length, and premature birth. Prediction profiles of birth clusters indicate the most sensitivity to pregnancy weight loss and prenatal visits. Majority of infants assigned to cluster 3 were in the 2 lowest SES levels. Discussion: Using an extensive perinatal clinical registry, we found that the strongest predictive performance, when considering cluster membership using supervised learning, was achieved by incorporating social and behavioral risk factors. There were inequalities in infant birth outcomes based on SES. Conclusion: Identifying infant risk hazard profiles can contribute to knowledge discovery and guide future research directions. Additionally, presenting the results to community members can build consensus for community-identified health and risk indicator prioritization for intervention development.

Prelicensure Nursing Students' Attitudes Regarding Breastfeeding Education.

ABSTRACT: Breast milk feeding is vital to the health outcomes of the breastfeeding dyad. Nurses have a significant role to promote, educate, and support breastfeeding practices for breastfeeding dyads in diverse settings. Nurses should also promote breastfeeding awareness to normalize breastfeeding as the optimal food for infants. This pilot study investigated the effects of a basic breastfeeding educational module on the breastfeeding attitudes of prelicensure nursing students. There was a statistically significant change in attitudes from pretest and posttest. Developing a comprehensive breastfeeding module is a significant step to standardize education and promote breastfeeding best practices.

Pregnant Through the COVID-19 Chaos: Insights on How Women Use Information in the Perinatal Period During a Pandemic.

PURPOSE/AIMS: To gain insights in how women use technology to address health information needs during the prenatal and postpartum time frame. DESIGN: An exploratory qualitative study recruited pregnant and recent postpartum women to share their perspectives on information they needed and how they obtained it. METHODS: Women who were pregnant or <90 days postpartum (n = 26) were recruited via social media and invited to share their experiences. Design thinking methodology was used to develop questions to understand information needs in the perinatal period as well as in context of the COVID-19 pandemic. Verbatim transcripts were coded by the research team according to Braun and Clarke's reflexive thematic analysis. RESULTS: Five themes explain the experience of seeking information to support the perinatal period. Women explained the need for the following: (1) information and relationships are inseparable, (2) current practices leave needs unmet, (3) the pandemic exposes vulnerability in prenatal care, (4) left to figure it out alone, and (5) bridging the gap through technology. CONCLUSIONS: Aggregated findings suggest how usual care can be modified to improve support for women through personalized care, improved information support, and use of technology. The study findings inform innovative strategies using current technologies to improve health promotion in a dynamic health environment.

Health worker perspectives of Smart Triage, a digital triaging platform for quality improvement at a referral hospital in Uganda: a qualitative analysis.

BACKGROUND: Effective triage at hospitals can improve outcomes for children globally by helping identify and prioritize care for those most at-risk of death. Paper-based pediatric triage guidelines have been developed to support frontline health workers in low-resource settings, but these guidelines can be challenging to implement. Smart Triage is a digital triaging platform for quality improvement (QI) that aims to address this challenge. Smart Triage represents a major cultural and behavioural shift in terms of managing patients at health facilities in low-and middle-income countries. The purpose of this study is to understand user perspectives on the usability, feasibility, and acceptability of Smart Triage to inform ongoing and future implementation. METHODS: This was a descriptive qualitative study comprising of face-to-face interviews with health workers (n = 15) at a regional referral hospital in Eastern Uganda, conducted as a sub-study of a larger clinical trial to evaluate Smart Triage (NCT04304235). Thematic analysis was used to assess the usability, feasibility, and acceptability of the platform, focusing on its use in stratifying and prioritizing patients according to their risk and informing QI initiatives implemented by health workers. RESULTS: With appropriate training and experience, health workers found most features of Smart Triage usable and feasible to implement, and reported the platform was acceptable due to its positive impact on reducing the time to treatment for emergency pediatric cases and its use in informing QI initiatives within the pediatric ward. Several factors that reduced the feasibility and acceptability were identified, including high staff turnover, a lack of medical supplies at the hospital, and challenges with staff attitudes. CONCLUSION: Health workers can use the Smart Triage digital triaging platform to identify and prioritize care for severely ill children and improve quality of care at health facilities in low-resource settings. Future innovation is needed to address identified feasibility and acceptability challenges; however, this platform could potentially address some of the challenges to implementing current paper-based systems.

Uncertainty and perinatal post-traumatic stress disorder in the neonatal intensive care unit.

Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post-traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post-traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow-up support services to mitigate risk for PPTSD.

Impact of entrepreneurship training on clinician engagement in innovation creation: an evaluation of the Johns Hopkins Hexcite programme.

BACKGROUND: Academic health science centres are an ideal location to translate innovative discoveries into clinical practice. However, increased cost, decreased time and encroaching technology are few of the challenges that academic clinicians face in an increasingly digitised healthcare industry. Academic health science centres have begun creating training to involve clinicians in developing and deploying innovative solutions. Few of these programmes engage clinicians in interactive and interdisciplinary activities. APPROACH: Hexcite is a 16-week entrepreneurship training programme at Johns Hopkins. During the programme, clinicians with innovative clinical software ideas learn how to launch start-ups. Clinicians accepted into the programme team up with a business expert, design expert and technical expert. Teams participate in 15 expert-led interactive 3-hour workshops, interview potential customers, regularly pitch their ideas to industry experts and iteratively refine their products. METHODS: This report examined anonymous participant feedback, quantitative data from team productivity reports, and interview responses between 2015 and 2019. Outcomes were assessed using the Kirkpatrick Model. RESULTS AND CONCLUSION: Many clinicians reported improved understanding of team building, design thinking and marketing communications as well as increased involvement in innovation. Many teams received funding after Hexcite. Outcomes from previous cohorts will guide more robust evaluation measures for future cohorts.

Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding.

BACKGROUND: Guidelines for the reuse of enteral tube feeding (ETF) equipment guidelines are limited to manufacturer recommendations. ETF equipment reuse studies are needed as the enteral population has increased, along with blenderized tube feeding (BTF). METHODS: This experiment tested microbial contamination of a reusable gravity feeding bag and syringe after 15 BTF reuses and cleanings. Eight bags and syringes were filled with the BTF, held at room temperature for 20 min, and then emptied, washed, and air dried. After the last air drying, the inner surfaces of the bag and syringe were swabbed, and aerobic microbial counts were performed using serial dilutions and plate counts. RESULTS: The microbial counts for all syringes and six bags were <1 colony-forming unit (CFU)/cm2 ; one bag was <5 CFU/cm2 and one bag was 12.5 CFU/cm2 . No legal guidelines for surface cleanliness exist for the food sector. Several studies propose a safe microbial level to be <2.5 CFU/cm2 , and the European Commission recommended <10 CFU/cm2 . Based on these proposed guidelines, microbial counts of all syringes and seven bags were within the proposed guidelines, except for one bag just above 10 CFU/cm2 . CONCLUSION: The feeding bag used in this study may be used multiple times for BTF with a reduced risk of microbial contamination when manufacturer's cleaning guidelines are followed. Although bolus tube feeding is an off-label use for syringes, they are frequently used for BTF, and in this study the cleaning after 15 uses over 5 days was effective to reduce microbial counts.

An Adaptation of the Skin Safety Model to Guide Diaper Dermatitis Research in the NICU.

Diaper dermatitis is an ever-present condition among infants. Little is known about the prevalence among infants in the NICU. This article presents an adaptation of the skin safety model (SSM) for the infant in the NICU. The concepts of the model were extracted, defined, and integrated into an adapted SSM model to provide a focus on the infant with diaper dermatitis in the intensive care setting. It is essential to include all factors of the infant's clinical characteristics and hospital experience in the modeling to accurately predict risk of skin vulnerability in this infant population.

Blenderized food tube feeding in patients with head and neck cancer.

BACKGROUND: Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions. METHODS: In this open-label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement. RESULTS: Of the 16 patients who completed the 6-week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6-week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC. CONCLUSION: BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.

Do Single-Family Rooms Increase Parental Presence, Involvement, and Maternal Well-Being in Neonatal Intensive Care?

Objectives of this study were to determine whether single-family room (SFR) design enhances parental presence, involvement, and maternal well-being during neonatal intensive care hospitalization. An observational cohort including mothers of infants was randomly assigned to receive care in a tertiary-level open-bay (OB) (n = 35) or SFR (n = 36). Mothers were asked to complete daily diaries documenting parental presence, involvement in care, and questionnaires examining maternal well-being. Mother and father mean presence (standard deviation) was significantly higher in the SFR-17.4 (5.2) and 13.6 (6.8)-compared to OB-11.9 (6.3) and 4.6 (3.7) hours/day. Total time spent in care activities did not differ for mothers, except SFR mothers spent more time expressing breast milk (EBM). SFR fathers had greater involvement with care activities. There were no other significant differences. The SFR was associated with greater maternal presence, but not greater involvement in care activities except for EBM, nor improved maternal well-being. The SFR appears to have greater impact on fathers' involvement in care and comforting activities, although the amount of time involved remained quite low compared with mothers. Further studies examining ways to enhance parental involvement in the neonatal intensive care unit are warranted.

Sauna use as a lifestyle practice to extend healthspan.

Sauna use, sometimes referred to as "sauna bathing," is characterized by short-term passive exposure to high temperatures, typically ranging from 45 °C to 100 °C (113 °F to 212 °F), depending on modality. This exposure elicits mild hyperthermia, inducing a thermoregulatory response involving neuroendocrine, cardiovascular, and cytoprotective mechanisms that work in a synergistic fashion in an attempt to maintain homeostasis. Repeated sauna use acclimates the body to heat and optimizes the body's response to future exposures, likely due to the biological phenomenon known as hormesis. In recent decades, sauna bathing has emerged as a probable means to extend healthspan, based on compelling data from observational, interventional, and mechanistic studies. Of particular interest are the findings from large, prospective, population-based cohort studies of health outcomes among sauna users that identified strong dose-dependent links between sauna use and reduced morbidity and mortality. This review presents an overview of sauna practices; elucidates the body's physiological response to heat stress and the molecular mechanisms that drive the response; enumerates the myriad health benefits associated with sauna use; and describes sauna use concerns.

Breastfeeding and maternal attachment during infancy period among Jordanian mothers: A cross-sectional study.

AIMS: The aim of the current study was to examine the following hypotheses: 1. Mothers who breastfeed their infants from 2 to 12 months of age or who use a mixed-feeding method after birth will demonstrate greater attachment toward their infants than mothers who only formula-feed their infants, as measured by the Maternal Attachment Inventory (MAI). 2. A difference in maternal attachment levels will be observed between mothers who exclusively formula-feed their infants and those who exclusively breastfeed their infants from 2 to 12 months of age, as measured by the MAI inventory, controlling for infant temperament. METHOD: A cross-sectional, descriptive, comparative method was applied in different healthcare centers in Jordan from May 2016 to August 2016 in which the MAI inventory was employed to assess 258 Arabic-speaking mothers. One-way analysis of variance was used to detect the differences in maternal attachment between mothers using different feeding methods. RESULTS: The findings showed significant differences in maternal attachment between exclusive breastfeeding and exclusive formula-feeding mothers, and mixed-feeding mothers at 2 months (F = 24.36, P < .01). Moreover, there was a statistically significant difference in maternal attachment between the breastfeeding and the formula-feeding group (F = 24.358, p < .05) after holding temperament constant. CONCLUSION: The results of this current study may help to clarify one role of breastfeeding in shaping a mother's attachment. Healthcare providers need to understand the influences of these variables on maternal attachment and attachment to empower young mothers and counsel them appropriately.

Caregiver Presence and Involvement in a Canadian Neonatal Intensive Care Unit: An Observational Cohort Study.

BACKGROUND: Presence in the neonatal intensive care unit (NICU) is a vital step for caregivers initiating involvement, such as skin-to-skin contact, holding or singing/reading to their newborn. Little is known about caregiver presence and involvement in Canadian NICU's context by caregiver type (mother, father, other), and the association between maternal presence and key maternal and newborn characteristics. PURPOSE: The primary objective was to examine the presence and involvement of family caregivers in the NICU. The secondary objective was to examine the relationship between maternal presence and maternal and newborn characteristics. DESIGN AND METHODS: A prospective observational cohort study in an open bay setting of an Eastern Canadian NICU. Presence (physically present at the newborn's bedside) and involvement (e.g., skin-to-skin, singing/reading) were tracked daily by families in the NICU until discharge. Demographic information was also collected. RESULTS: Participants included 142 mothers and their newborns. Mothers were present 8.7 h/day, fathers were present 4.1 h/day, and other caregivers were present 1.8 h/day in the NICU in the first 34 days. Mothers were involved in care activities 50% of the time they were present in the NICU, whereas fathers and other caregivers were spending 20% and 6% of their time respectively. Regression identified maternal age, distance to home, parity, birthweight, and length of stay to be statistically significant variables related to maternal presence. CONCLUSIONS: There is variation in presence and involvement by caregiver type. Targeted interventions to maintain and increase mothers, fathers and other caregivers' presence and involvement in care throughout their stay in the NICU are recommended.

Maintaining Maternal-Newborn Safety During the COVID-19 Pandemic.

COVID-19, the disease caused by the SARS-CoV-2 virus, was declared a global pandemic by the World Health Organization on March 11, 2020. In addition to older individuals and those with underlying chronic health conditions, maternal and newborn populations were also identified as being at greater risk. It became critical for hospitals and clinicians to maintain the safety of individuals in the facility and minimize the transmission of COVID-19 while continuing to strive for optimized outcomes by providing family-centered care. Rapid change during the pandemic made it appropriate to use the plan-do-study-act (PDSA) cycle to continually evaluate proposed and standard practices. Our team established an obstetric COVID-19 unit for women and newborns, developed guidelines for visitation and for the use of personal protective equipment, initiated universal COVID-19 testing, and provided health education to emphasize shared decision making.

Impact of Perioperative Multidisciplinary Rehabilitation Pathway on Early Outcomes after Robot-assisted Radical Cystectomy: A Matched Analysis.

OBJECTIVE: To investigate the effect of incorporating physical rehabilitation, nutrition and psychosocial care as part of the "NEEW" (Nutrition, Exercise, patient Education and Wellness) on perioperative outcomes after robot-assisted radical cystectomy. METHODS: Patients were divided into 2 groups: pathway group (NEEW in addition to enhanced recovery after surgery), vs prepathway group, before NEEW initiation (enhanced recovery after surgery only). Propensity score matching was performed (ratio 1:2 ratio). Perioperative outcomes were analyzed and compared. Multivariate analyses were modeled to assess for association between NEEW pathway and postoperative outcomes. RESULTS: One hundred and niney-two were included in the study: 64 patients (33%) in the pathway group vs 128 patients (67%) in the prepathway group. Pathway group had shorter median inpatient stay (5 vs 6 days, P <.01), faster bowel recovery (3 vs 4 days, P <.01), and better pain scores, and demonstrated fewer 30-day high grade complications (5% vs 16%, P = .02). On multivariate analysis, the NEEW pathway was associated with shorter hospital stay (1.75 days shorter), faster bowel recovery (1 day faster), longer functional mobility time (4 minutes longer) and less pain scores (average 1 point less). CONCLUSION: Standardized perioperative pathway with weekly multidisciplinary team meeting was associated with improved short-term perioperative outcomes after robot-assisted radical cystectomy.

Accepted Safe Food-Handling Procedures Minimizes Microbial Contamination of Home-Prepared Blenderized Tube-Feeding.

BACKGROUND: The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food-borne illness is a concern of blenderized tube-feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. METHODS: Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus, and coliforms at baseline, 24-hour, and 48-hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. RESULTS: No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >104 , and at 48 hours, 6/50 (12%) exceeded 104 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 105 CFU/mL. Samples exceeding 104 CFU/mL were likely contaminated by common endospore-forming bacteria found in soil or by bacteria in milk that was close to its expiration date. CONCLUSION: In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 105 CFUs. Established safe food-handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food-borne infection in HEN patients.