M. Chikhi

Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey

BACKGROUND & AIMS A food quality control and improvement permanent process was initiated in 1999. To evaluate the food service evolution, protein-energy needs coverage were compared in 1999 and 2008 with the same structure survey in all hospitalized patients receiving 3 meals/day. METHODS Nutritional values of food provided, consumed and wasted over 24h including non-exclusive nutritional support were calculated individually. Nutritional needs were estimated as 110% of Harris-Benedict formula for energy and 1.2 or 1.0 g protein/kg/day for patients <65 or ≥65 years old, respectively. Multivariate analysis identified factors associated with low nutritional intake in both populations standardized to body mass index (BMI) of 1999s patients. RESULTS Out of 1677 patients, 1291 were included. Mean BMI was higher in 2008 than 1999 (P<0.001). The proportion of underfed patients was unchanged (69 vs. 70%, NS). The consumption of ≥1 oral nutritional supplements (ONS) daily increased the protein needs coverage from 80% to 115% (P<0.001). The year 1999, high BMI, 1st week of hospital stay, specific diet, ONS absence and low meal quality were associated with low nutritional intakes. CONCLUSION The nutritional needs coverage could have improved in 2008 if BMI was similar to 1999s. ONS consumption is associated with a lower risk of underfeeding in hospitalized patients.

Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study

Background Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population. Methods and findings Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis. Conclusion Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.

Prescription and indication for oral nutritional supplements in a Swiss university hospital: a prospective survey

AIMS OF THE STUDY Patients with an acute or chronically negative nutritional balance are at nutritional risk. Oral nutritional supplements (ONS) are simple and effective medical treatments of nutritional risk. In the ambulatory setting, in Switzerland, ONS are reimbursed by public insurance under conditions defined by Swiss Society for Clinical Nutrition. The reimbursement requires a medical prescription for ONS and their delivery at the patients home by a homecare service. The indication for the ONS, defined as a Nutritional Risk Screening-2002 (NRS-2002) score ≥3, must also be present. This survey aimed to document: (i) the existence of a medical prescription for ONS during hospitalisation and discharge for home, (ii) the adequacy of the indication for ONS during hospitalisation and at discharge for home, and (iii) the continuation or not of ONS treatment 1 month after discharge for home. METHODS This prospective survey included adult patients hospitalised in the departments of surgery, medicine or rehabilitation and who were about to receive ONS for the first time. Patients already on ONS, with major consciousness disorders, who refused to take ONS or to participate to the survey were excluded. The existence of a medical prescription for ONS and the adequacy of the indication (Nutritional Risk Screening-2002 [NRS-2002] score ≥3) were evaluated at first ONS delivery and at hospital discharge. At home, the continuation of ONS consumption was evaluated by the homecare service 1 month after discharge. Results are presented as mean ± standard deviation or frequencies and percentages, and comparisons between patients with and without ONS at discharge for home. RESULTS A total of 416 patients (age 71.7 ± 14.1 yr, 52.6% male, body mass index 23.6 ± 5.2 kg/m2) were included. At the first delivery of ONS, 44.5% (n = 185) of patients had no medical prescription for the supplements, and 82.7% (n = 344) had an NRS-2002 score ≥3. Out of 207 patients discharged for home, only 24.2% (n = 50) had an adequate homecare ONS prescription and 68% (n = 141) had a NRS-2002 score ≥3. One month after discharge for home, 76% (n = 29) were still taking ONS. CONCLUSIONS In our survey, only few patients receiving ONS during the hospital stay had a medical prescription for ONS during the hospitalisation and at discharge for home. For most patients receiving ONS during hospitalisation and at discharge for home, an NRS-2002 score of ≥3 was present. If a medical prescription was provided, ONS were generally continued one month after discharge for home. CLINICAL TRIAL REGISTRATION NUMBER NCT02476110.

OR048: Healthcare-Associated Infections (HCAI) are Associated with Insufficient Dietary Intake

OR048 HEALTHCARE-ASSOCIATED INFECTIONS (HCAI) ARE ASSOCIATED WITH INSUFFICIENT DIETARY INTAKE A.-M. Makhlouf1, R. Thibault1,2, M. Kossovsky3, J. Iavindrasana4, M. Chikhi1, R. Meyer5, D. Pittet6, W. Zingg6, C. Pichard1. 1Nutrition Unit, University Hospital of Geneva, Geneva, Switzerland; 2Nutritional and digestive rehabilitation, Clinique Saint-Yves, Rennes, France; 3Rehabilitation and Geriatrics, 4Business Intelligence Division, 5Department of Informatics, 6Infection Control Programme, University Hospital of Geneva, Geneva, Switzerland

PP171-SUN IDENTIFICATION OF THE RISK OF NOSOCOMIAL INFECTIONS WITH THE NUTRITIONAL RISK SCORE (NRS)-2002 IN HOSPITALIZED PATIENTS

of PEM as distinct diagnosis is hardly accomplished in most hospitals. The department of medicine of our hospital is documenting the risk for PEM by the Nutrition Risk Score 2002 (NRS) since the year 2011 in the electronic health record. With the present study we aimed at reporting NRS and displaying PEM systematically as distinct diagnosis. Methods: NRS was repositioned and integrated in the medical history of our electronic health record (Phoenix 6.32.3.4) by July 2012. The doctor has to tick the nutritional and health status score of the NRS and the system then calculates the total score (+ 1 point for age 70 years). The score is automatically converted into the corresponding ICD-10 codes for PEM, i.e. E43 (NRS 5) or E44.0 (NRS = 4) or E44.1 (NRS = 3) and directly transferred as separate diagnosis to the list of diagnoses. The nutritional assessment by the dietitian and appropriate nutritional therapy are mandatory. Not completed NRS are weekly reported to the responsible doctor. Results: The table summarises the number of cases coded with PEM.