Home parenteral nutrition (HPN) requires a team of clinicians to successfully manage and minimize the associated complications as discussed above. Home parenteral nutrition may be performed for many conditions as a short-term therapy or as a long-term therapy. As the parenteral nutrition formula is being adjusted in preparation for discharge from the hospital, the patient and caregiver will receive education on catheter care, operation of the infusion pump, parenteral nutrition set-up and disconnect procedures, maintenance of intake and output records, review of metabolic complications, and contact numbers for associated problems that may arise. All patients are monitored closely for electrolyte disturbances with routine blood draws to assure stability on HPN formula and clinic visits. If a patient needs readmission to the hospital, the nutrition support team and home nutritional support clinician will often work with the hospital team to provide continuity of care.
Facility-based case study: A comparison of the recovery of naturally occurring species of bacteria and fungi on semi-solid media when incubated under standard and dual temperature conditions and its impact on microbial environmental monitoring approach
ID Symonds, DL Martin and MC Davies
Abstract: This study compared the recovery of naturally occurring micro-organisms on tryptone soya agar (TSA) and Sabouraud dextrose agar (SDA), when incubated under three different temperature conditions. The micro-organisms were sourced directly from a factory environment. The incubation conditions employed were 20–25°C, 30–35°C and a combination of each, termed dual temperature incubation, for a period of 5 days.
The results demonstrated that TSA was the most effective medium for the primary isolation of both bacterial and fungal/yeast micro-organisms. Bacteria were recovered best at 30–35°C with human commensals providing the largest numbers, while fungi and yeasts showed best recovery at 20–25°C. The use of dual temperature incubation at 20–25°C for 3 days followed by 2 days at 30–35°C gave reduced recovery for both types of micro-organisms.
The authors recommend that similar studies should be considered for all manufacturing facilities in order to determine the optimal incubation temperature regime for the recovery of local, naturally occurring species of bacteria and fungi which may present a threat to aseptic manufacturing areas.
This process should be undertaken as part of an overall risk assessment for the establishment and maintenance of a viable environmental monitoring programme and may also be relevant to the incubation conditions employed in process simulation studies.