Existence of advanced glycation / lipoxidation end-products in parenteral nutrition solutions and effects of infusion conditions on their levels

Abstract Infusion solutions must be stable from the production stage until the infusion stage. Some infusion fluids contain degradation products, known as advanced glycation end products (AGEs); however, it is unknown whether AGEs exist in parenteral nutrition solutions. We aimed to investigate this question and test the effect of infusion conditions on AGE formation in parenteral nutrition solution. Nine parenteral nutrition solutions were supplied by the pharmacy with which we collaborated. To simulate the infusion conditions, the solutions were held in a patient room with standard lighting and temperature for 24 hours. Samples were taken at the beginning (group A) and the end (24th hour, group B) of the infusion period. The degradation products were 3-deoxyglucosone, pentosidine, N-carboxymethyl lysine, and 4-hydroxynonenal, which we investigated by high-performance liquid chromatography-mass spectrometry (LC-MS) and Q-TOF LC/MS methods. Two of four degradation products, 4-hydroxynonenal and N-carboxymethyl lysine, were detected in all samples, and Group B had higher levels of both compounds compared to Group A, who showed that the quantities of these compounds increased in room conditions over time. The increase was significant for 4-hydroxynonenal (p=0.03), but not for N-carboxymethyl lysine (p=0.23). Moreover, we detected in the parenteral nutrition solutions a compound that could have been 4-hydroxy-2-butynal or furanone

[Single Patient Room Design in the Neonatal Intensive Care Unit - Parent Perceptions of Open Ward vs. Single Patient Room Units]. / Die Einrichtung von Einzelzimmern auf neonatologischen Intensivstationen - Auswirkungen auf die Betreuung aus Sicht der Eltern.

BACKGROUND: Single patient room design is not yet implemented in German neonatal intensive care units. Surveys from other countries revealed positive and negative implications on the staff, the patients and their families. The survey examines the perceptions of parents who experienced both facilities - the traditional multipatient ward and the individual patient room - during their babies' hospital stays. METHODS: A standardized questionnaire was used to assess the perceptions of parents. The results were compared to international surveys. RESULTS: During their stay in the single patient room, parents noticed improvements in privacy and data protection and a reduction in harmful environmental stimuli affecting their babies. These results are comparable to those of international surveys. CONCLUSIONS: Single patient room design is mostly perceived as an improvement by parents. The room design can complement an implemented concept of developmental and family-centered care.

Particle counting and microbiological air sampling: results of the simultaneous use of both procedures in different types of hospital rooms.

INTRODUCTION: In order to assess the relationship between the concentrations of airborne fungi and particles, particle counting was combined with fungal air sampling in several rooms of a hospital. METHODS: Concentrations of ≥0.5µm particles (P05) and ≥1µm particles (P1) were measured using a particle counter; fungal air sampling was performed with volumetric air samplers, which impacted air on Rodac plates with Sabouraud chloramphenicol agar. Particle counts were categorised according to ISO 14644-1 standard cut-off points; their association with fungal detection was assessed with Fisher's exact test. RESULTS: Forty-two simultaneous samplings were carried out: 24 in operating rooms, 13 in rooms for burns or haematology patients, 3 in pharmacy clean rooms, and two in other procedure rooms. Filamentous fungi were recovered in 5 samples, which also had higher particle counts. No fungi were detected in 12 samplings with both P05 and P1 concentrations below the maximum for class 6 clean rooms; 4 of 7 samplings with both concentrations within the range for class 8 clean rooms were positive for fungi. The association between fungal detection and higher particle counts was statistically significant, both for P05 (p=.004) and P1 (p=.003). There was a partial overlap between the concentrations of particles of samplings which were positive or negative for fungi. CONCLUSIONS: There is a relationship between the concentrations of P05 and P1 and airborne fungi in hospital rooms. When both P05 and P1 concentrations are below the maximum for class 6 clean rooms, a negative fungal detection can be predicted.

Hospital room design and health outcomes of the aging adult.

OBJECTIVE: To determine differences in the rate of falls, healthcare-acquired infections (HAIs), and the degree of social isolation in hospitalized older adults admitted to private versus semi-private rooms. BACKGROUND: The American Institute of Architects recommends that private rooms become the industry standard for all new construction of acute care hospitals. Healthcare design researchers contend that private rooms decrease infection, facilitate healthcare workers' efficiency, provide space for families, and afford greater access to privacy. Although links between room type and health outcomes have been described in the literature, the actual relationship between these two variables has not been determined, nor is it clear whether a one-size-fits-all approach to hospital design is appropriate for all patient populations, particularly older adults. METHODS: This retrospective case comparative design utilized a sample of patients admitted to the University Medical Center of Princeton in 2006 and received full internal review board approval. Patient records were randomly selected through the admission/discharge/transfer system of the hospital and then divided into two groups based on room type. Data collected included demographics, incidence of falls, HAIs, and risk of social isolation. RESULTS: All patients were more than 65 years old and had been admitted to the hospital for a variety of diagnoses. Length of stay was between 3 and 10 days. There was no significant difference between the type of room and the likelihood of falling (p = .37), however the relative risk of falling in a private room was 4.01. There was no significant difference in the occurrence of HAIs based on room type (p = 1.0). The risk-of-social-isolation variable was unable to significantly affect which hospitalized older adults would suffer a negative outcome, fall, or HAI (p = .52). CONCLUSION: Room type may play a role in the occurrence of falls in hospitalized older adults, but room type alone does not increase the chance of acquiring an infection in the hospital. Nor does the risk of social isolation affect the likelihood of an adverse outcome.

Family presence and environmental factors at the time of a patient's death in an ICU.

BACKGROUND: In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions. METHODS: A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths. RESULTS: Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions. CONCLUSIONS: The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.

Prevalence of Clostridium difficile on a mixed-function ward for the elderly.

We studied the prevalence of Clostridium difficile over a period of 2 months on a mixed-function geriatric ward. Seven (14%) of the 49 patients were long-stay but the remainder were in hospital for acute illness or required a short period of active rehabilitation. Although 69% patients had recently received antibiotics, from only two (4%) was C. difficile isolated from their faeces. Our results show that C. difficile is not endemic in patients on all geriatric wards as has been previously suggested.