Upload
bcpsqc
View
210
Download
0
Embed Size (px)
Citation preview
Successes and Barriers: Immunonutrition a in a
Community HospitalPatricia Caddy, BSc, CaRMS Candidate
Oct 30 2015, “10,000 Reasons to Race for Infection Prevention”
Vancouver Hilton Hotel
DisclosuresI did receive remuneration from SQAN for taking on this studentship.
I did not receive any money or sponsorships of any kind from any other groups, including Nestle.
Practical Implications of ImmunonutritionReducing surgical site infection results in:
- Decreased suffering for the patient
- Decreased length of hospital stay
- Decreased hospital cost per patient between $3,000 and $6,000.
Methods- Literature review
- Chart audit, May 2014 (when we first started using Impact AR) until March 2015
- Comparative analysis of demographic data
- E-survey to surgeons
Why? Kamloops - Busier pharmacies?
- lower mark-up?
- More diverse products in stock?
- Delivery service?
- Better transit?
- More affluent?
Why? Women- More likely to take a supplement in general?
- More likely to follow their surgeon’s advice?
- Caregivers/family more persistent/encouraging?
- Surgeon’s recommending to women more than men?
Why? Age- More mobile?
- Better able to get the drink home?
- More game to try something new?
- Better compliance?
The Survey: 4 Questions1)How often do you recommend Impact AR?
2)If you recommend Impact AR, why?
3)Under what circumstances do you recommend Impact AR?
4)What prevents you from recommending Impact AR to all patients?
Takeaways
4/35 SSIs in the non-Impact AR group.Cost of SSIs = $41,772 - $102,184Cost of providing Impact AR = $5,250
ReferencesMauskopf J, Candrilli S, Chevrou-Severac H, Ochoa J. Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer:
impact on hospital costs. WORLD JOURNAL OF SURGICAL ONCOLOGY. 2012;10:136.
Horie H, Okada M, Kojima M, Nagai H. Favorable Effects of Preoperative Enteral Immunonutrition on a Surgical Site Infection in Patients with
Colorectal Cancer Without Malnutrition. Surgery Today. 2006;36:1063-1068.
Ochoa JB, Makarenkova V, Bansal V. A rational use of immune enhancing diets: when should we use dietary arginine supplementation? Nutrition
in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2004;19:216-225.
Braga M, Gianotti L, Vignali A, Carlo VD. Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host
response and outcome after colorectal resection for cancer. Surgery. 2002;132:805-814.
Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative Use of Arginine-supplemented Diets: A Systematic
Review of the Evidence. Journal of the American College of Surgeons. 2011;212:385-399.e1.
Bansal V, Syres K, Makarenkova V, et al. Interactions between fatty acids and arginine metabolism: Implications for the design of immune-
enhancing diets.JOURNAL OF PARENTERAL AND ENTERAL NUTRITION. 2005;29:S75-S80.
Centers for Disease Control and Prevention (HHS). Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits
of Prevention;2010 ASI 4208-83. 2010.