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Featured Articles

October 3, 2018

Severe Infections Rising Among Americans with Diabetes

The number of Americans with diabetes who wind up in hospitals with serious infections, or who develop them while in the hospital, is on the rise. Between 2010 and 2015, the number of diabetics hospitalized for infections rose 52 percent (from 16 per 1,000 people to 24 per 1,000), according to researchers from the U.S. Centers for Disease Control and Prevention. "People with diabetes are more susceptible to in-hospital infections as compared with people without diabetes, and this risk is increasing," said lead researcher Jessica Harding, from the CDC's Division of Diabetes Translation. Read More

Opt-Out Testing for HIV, Hepatitis C Could Improve Diagnoses in the ED

A new study from screening results performed at a pair of Oakland-based hospital systems found that automated, routine testing for HIV and hepatitis C virus (HCV) conducted in integration with standard nursing workflow could increase the prevalence of caught diagnoses for both diseases. The obvious end-result would be more timely care for patients unlikely to be tested outside of an emergency department (ED) setting—namely, younger patients. Read More

Study Explores Impact of Hand-Drying Method on Contamination and Bacteria Levels in Hospital Washrooms

Laboratory and in situ studies have demonstrated that some hand drying methods are associated with a greater risk of dissemination of residual microbes from hands after (especially suboptimal) handwashing. In this latest study, supported by a grant from ETS, two toilets per hospital were observed – each had paper towel dispensers and jet air hand dryers, but only one of these was available to use at any given time – the hand drying method was changed every four weeks. The toilets were frequented by patients, visitors and staff. Bacterial contamination levels were measured over 12 weeks. Target bacteria included methicillin susceptible (MSSA) and resistant Staphylococcus aureus (MRSA), enterococci and enterobacteria, including ESBL (extended-spectrum β-lactamase) bacteria. Read More

  • September 25, 2018

    Recent Developments in Surgical Sepsis

    It is almost a century since Moynihan famously noted that, “every surgical operation is an experiment in bacteriology.” While the basic components of that experiment (the host, the bacterial flora and the factors which alter the balance between bacterial capacity for invasion and host resistance) have not changed, the outcome of surgical procedure, even when complicated by infection, has improved markedly. Read More

    Cath Lab Pre-Activation Beneficial But Not Routine in STEMI

    Fewer than half of patients with STEMI who were transported by emergency medical services had catheterization laboratory pre-activation before they arrived at the hospital, despite a suggestion of mortality benefit from cath lab pre-activation, according to a study published in JACC: Cardiovascular Interventions. Read More

    Hospitals Could Reduce HAIs by up to 55%

    A large systematic review and meta-analysis showed that hospitals could reduce health care-associated infections, or HAIs, by 35% to 55% with systematic implementation of evidence-based infection prevention and control measures.
    The findings were published in Infection Control & Hospital Epidemiology.
    Read More

    Biomarker-Guided Antimicrobial Stewardship: The Next Target, or Missing the Mark?

    Sepsis is a common and serious condition that can lead to significant morbidity and mortality. Because early and effective antibiotic therapy is a critical component of treatment, there is ongoing interest in increasingly rapid and reliable diagnosis. In conjunction with clinical evaluation, biomarkers have emerged as potentially useful diagnostic tools and may additionally have a role later in therapy to evaluate clinical response and guide cessation of antibiotics. Read More

  • September 13, 2018

    Clinical Education On-Demand! "Stressing the Dressing: Reducing Vascular Access Device Complications"

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    Vasopressors May Contribute to ICU-Related Weakness

    Treatment with vasopressor medications was associated markedly increased risk for developing intensive care unit (ICU)-associated weakness among critically ill patients on mechanical ventilation, researchers said. Read More

    Men Place Less Value on Care-Oriented Careers Like Nursing

    Men assign less importance to care-oriented careers than women do, possibly because men internalize different values than women, suggests new research from the University of British Columbia. While women are significantly underrepresented in science, technology, engineering and math (STEM) fields, making up just nine to 16 per cent of engineers and 21 per cent of computer programmers in the U.S., men are even more markedly underrepresented in healthcare, early education, and domestic (HEED) careers. They make up only 10 per cent of nurses and four per cent of preschool and kindergarten teachers in the U.S., according to the U.S. Bureau of Labor Statistics. Read More

    Caffeine Consumption May Extend Life Expectancy for People with Kidney Disease

    A new study in Nephrology Dialysis Transplantation indicates that consuming more caffeine may help reduce the risk of death for people with chronic kidney disease. An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality for people with chronic kidney disease remains uncertain. The researchers hypothesized that caffeine consumption might be associated with lower mortality among participants with chronic kidney disease. Read More

    Guidance for Preventing C. difficile in Neonatal Intensive Care

    Newborns require special diagnosis and treatment considerations for an infectious diarrhea known as Clostridioides difficile (C. difficile) infection, according to a new evidence-based white paper published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. The publication is in conjunction with the release of a companion review by the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC) and recommends against routine testing for C. difficile in neonatal patients and suggests evaluating first for more common causes of diarrhea. Read More

  • August 29, 2018

    Certain Antibiotic-Resistant Infections on the Rise

    Nearly six percent of urinary tract infections analyzed by a California emergency department were caused by drug-resistant bacteria in a one-year study period, according to new research in Annals of Emergency Medicine. The bacteria were resistant to most of the commonly used antibiotics. And, in many cases, patients had no identifiable risk for this kind of infection, the study found. Read More

    Therapeutic Algorithm May Guide Empiric Therapy in Pneumonia

    An algorithm based on risk factors for resistant pathogens and illness severity can simplify pneumonia treatment, improve the accuracy of empiric therapy, reduce mortality, and help avoid overusing broad spectrum therapy in some patients, according to new findings published in Clinical Infectious Diseases. Read More

    Investigating an Elizabethkingia anophelis Cluster in a Pediatric ICU

    Intensive care units (ICUs) are the last place infection preventionists want to see an outbreak. There is no “good” location for an outbreak, but an ICU is perhaps one of the worst, as the sickest, most vulnerable patients are cared for in such units. Like an oncology unit, an ICU experiencing cases of infection with an unusual organism can represent a canary in the coal mine. Elizabethkingia bacteria are found in soil, river water, and reservoirs; however, they tend to only cause disease for those with weakened immune systems. The most common manifestations are meningitis and respiratory infections. Read More

    Discharging Patients Home from ICU Poses No Added Risk

    Direct discharge home from the ICU does not increase health care utilization or mortality, according to research published in JAMA Internal Medicine. Read More

  • August 22, 2018

    TODAY - August 22nd Complimentary Clinical Education Webcast: "Stressing the Dressing: Reducing Vascular Access Device Complications" Featuring, Russel Nassof, JD - Space is limited! Register for the live event or to receive a recorded copy of the presentation.

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    Effectively Expressing Empathy to Improve ICU Care

    In nearly every intensive care unit (ICU) at every pediatric hospital across the country, physicians hold numerous care conferences with patients' family members daily. Due to the challenging nature of many these conversations -- covering anything from unexpected changes to care plans for critically ill children to whether it's time to consider withdrawing life support -- these talks tend to be highly emotional. Read More

    New Elective Gives UAH Students Preview of the Ups and Downs of Critical Care Transport Nursing

    If the idea of trying to save someone’s life isn’t panic-inducing enough, try doing it in mid-air with limited room to maneuver and the whir of helicopter blades drowning out any chance of direct communication. For Ron Bolen (MSN, RN, CCRN, CEN, CFRN), however, it’s all in a day’s work. And now he’s imparting that knowledge to a new generation of nursing students in his undergraduate-level Critical Care Transport Nursing course at The University of Alabama in Huntsville (UAH).  Read More

    Trust, Access Confer Success in Community-Based Hypertension Management

    Hypertension is a well-established, powerful risk factor for CVD and stroke, especially in black individuals, but the challenge lies in identifying and deploying the most efficient strategy to prevent and control BP. According to the CDC, 1 in 3 U.S. adults has hypertension, defined as 140 mm Hg over 90 mm Hg or above or use of antihypertensive medication, and nearly half of those with hypertension have not achieved control. In addition, an estimated 13 million U.S. adults with hypertension do not know that they have the condition and, thus, are not receiving treatment. Read More

    If You’re a Nurse, You’re a Patient Advocate

    Most nurses don’t wear nursing caps any longer, but we still wear many hats. And the advocate hat is one we never take off. At times, the work we do is routine. At other times it is complex and critical. But it always is patient-centered. We are assessors, planners, providers and care evaluators. We are technicians and researchers, managers, leaders and educators. And we are nurse advocates. Read More

  • August 16, 2018

    Clinical Education Webcast: "Stressing the Dressing: Reducing Vascular Access Device Complications" Featuring, Russel Nassof, JD - Space is limited!

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    The Intensivist Shortage: Is There a Way Around It?

    In the ICU, the numbers just don't add up. There is a significant shortage of intensive care specialists, and despite efforts by hospitals to recruit more intensivists, there are not enough to provide quality care to intensive care unit patients. And according to one study, “the shortage of full-time intensivists is most likely 5-10 times more pronounced” than it is generally considered to be - because “the bulk of CCM board certificates are allocated to part-time physicians.” While a part-time intensivist is better than none, it is far from an ideal situation. Read More

    UCLA Pilot Project Fulfills Patient Wishes to Improve End-of-Life Experience

    Researchers at UCLA have launched a pilot project designed to fulfill small wishes from critically ill patients in hopes of improving their end-of-life experience. The program — offered to patients in the ICU — will expand later this year to include the oncology unit at UCLA Santa Monica Hospital.  Read More

    Engaging Leaders in CAUTI Prevention Efforts

    Including senior leaders in CAUTI prevention is a critical aspect of the design and implementation of infection prevention programs. Implementing a program to successfully reduce catheter-associated urinary tract infections requires a multipronged approach, dedicated resources, and leadership support from the highest levels of an organization. Senior leaders of healthcare organizations are responsible for navigating the constantly changing landscape of healthcare quality, financial, and regulatory issues. Read More

    Very Empty (and Very Full) Hospitals Have Lowest C. Diff Risk

    Patients are three times likelier to contract the dangerous infection when a hospital is at midlevel occupancy, a new way of tracking the data finds. Hospitals spend a lot of time and effort to protect their patients from developing new infections — especially dangerous ones that can pose a greater health threat than whatever brought that person in for care. But this massive effort has been missing a key element, according to University of Michigan and Rand Corp. researchers. Read More

  • August 8, 2018

    Clinical Education Webcast: "Stressing the Dressing: Reducing Vascular Access Device Complications" Featuring, Russel Nassof, JD - Space is limited!

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    PPE Donning and Doffing Reveals Gaps in Knowledge and Practice

    The best-designed and engineered items of personal protective equipment (PPE) will fail healthcare workers and their patients if the PPE is donned or doffed incorrectly and contamination is spread. Knowing that seeing is believing, researchers at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital secured the consent of healthcare personnel to videotape how they gowned and gloved, and other related clinical practices. Kang, et al. (2017) discovered that healthcare personnel contaminated themselves in almost 80 percent of the PPE simulations. Read More

    Travel Time Has Major Impact on Nurse Staffing Ratios in Neurocritical Care Units

    For specialist nurses on neurocritical care units, accompanying patients for imaging scans and other procedures has a major impact on nurse staffing ratios. "Patients in a neurologic critical care unit require more staffing to account for the frequent neurologic assessments, charting, and traveling," according to the workflow study. The study led to the addition of staff members, including a new "circulating nurse" position, with the goals of improving patient care and nurse retention rates.  Read More

    Not in The Medical Textbooks: How Doctors Find a Way to Tell Families That Their Relative Has Died

    One of the most overlooked aspects of medicine at public hospitals across India is the communication of the news of death. Unfortunately, there is nothing in the medical education curriculum about how to tell a patient’s family, friends and attendants that he or she has died. There is little to prepare doctors for the various difficulties they may face in conveying such news. Across the country, the news of death has increasingly led to violence against doctors. Read More

    Antimicrobial Lock Solutions Are Cost-Effective for Preventing Central Line-Associated Bloodstream Infections

    Antimicrobial lock solutions are an effective clinical and cost-effective strategy for preventing central line-associated bloodstream infections (CLABSI), according to new findings published in Clinical Infectious Diseases. Recent studies show that the prophylactic use of antimicrobial locks can reduce the incidence of CLABSI, and the Centers for Disease Control and Prevention (CDC) recommends their use in patients who have experienced multiple prior episodes of CLABSI. Read More

  • August 1, 2018

    Clinical Education Webcast: "Stressing the Dressing: Reducing Vascular Access Device Complications" Featuring, Russel Nassof, JD - Space is limited!

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    Single-Room ICU Design Contributes to the Reduction of Cross-Transmission of MDROs

    Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU. The researchers conclude that single-room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria. Read More

    Adrenaline Use Discouraged as Heart Attack Treatment

    A new study shows that using adrenaline in cardiac arrests nearly doubles the survivors’ risk of severe brain damage. The study included 8,007 patients in cardiac arrest who were allocated randomly to be given either adrenaline or a salt-water placebo. All those involved in the trial, including ambulance crews and paramedics, were unaware which of the two treatments the patient received. Read More

    New Prevention Bundle Significantly Reduces Pediatric Health Care-Associated Viral Infections

    Pediatric health care-associated viral infections, or HAVIs, were significantly reduced by the development, implementation and refinement of targeted prevention practices, according to findings published in Infection Control & Hospital Epidemiology. “The application of standard prevention bundles has proven successful in the reduction of other health care-associated infections, such as central line-associated bloodstream infections or catheter-associated urinary tract infections, but the application of a comprehensive bundle to prevent HAVI has not been previously described." Read More

    Nursing Notes Can Predict Survival Rates of ICU Patients

    Sentiments in the notes of ICU nurses are good indicators of whether patients will survive, according to researchers from the University of Waterloo in Ontario, Canada. Hospitals can already predict the 30-day survival of ICU patient through severity of illness scores, which include lab results, vital signs and physiological and demographic characteristics gathered within 24 hours of admission. Using a large publicly available ICU database, researchers looked at patient data from 2001 to 2012, considering 27,000 patients and the nursing notes. The study was recently published in the journal PLoS One. Read More

  • July 25, 2018

    Clinical Education Webcast: "Stressing the Dressing: Reducing Vascular Access Device Complications" Featuring, Russel Nassof, JD - Space is limited!

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    Reducing Delirium in Older Patients After Surgery

    A drug that reduces delirium in postoperative patients may work by preventing the overactivity of certain receptors in brain cells, according to a new study published in June 2018 in the Online First edition of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA). The researchers say the findings could lead to more widespread use of the drug, dexmedetomidine, and speed the development of new treatments for postoperative delirium with fewer side effects. Read More

    Pediatric Sepsis Care Within an Hour Decreases Chance of Death, Largest Ever Analysis Finds

    More than 1 in 10 children hospitalized with sepsis die, but when a series of clinical treatments and tests is completed within an hour of its detection, the chances of survival increase considerably, according to a new analysis led by the University of Pittsburgh School of Medicine. Read More

    Diaries Can Help ICU Patients, Families

    The care of patients in the Intensive Care Unit involves some advanced measures, like sedation. That can lead to some frightening memories and some mental health concerns after discharge. "Patients have a number of issues after they've been released from ICU, including depression and anxiety," CRMC Critical Care Educator April Jarvis said. It's called Post-Intensive Care Syndrome, and it's so new, there isn't a lot of data on it. Craig heard an idea at a conference about how something as simple as keeping a diary can help patients. Read More

    Infection Prevention Staffing Needs May Be Underestimated

    A comprehensive assessment of health care organization composition and structure is necessary before determining infection preventionist (IP) staffing needs, according to a study published recently in the American Journal of Infection Control. Providence St. Joseph Health System in Renton, Wash., and colleagues describe a large nonprofit health care system's approach at quantifying the actual number of IP and relative support staff needed to build and sustain effective infection prevention programs. Read More

  • July 19, 2018

    Intensive Care Patients' Muscles Unable to Use Fats for Energy

    The muscles of people in intensive care are less able to use fats for energy, contributing to extensive loss of muscle mass, finds a new study co-led by UCL, King's College London and Guy's and St Thomas' NHS Foundation Trust. Intensive care patients can lose 20% of their muscle mass in just 10 days, which can contribute to long-term disability. Nutrition and exercise programmes designed to prevent this muscle loss have largely been unsuccessful, and this new finding, published in Thorax, helps explain why. Read More

    Probiotic-Based Sanitation Reduces Hospital Infections Better Than Chlorine

    The Probiotic Cleaning Hygiene System (PCHS), a microbial-based decontamination strategy which is comprised of detergents that contain spores of Bacillus probiotics, is an effective and safe system for controlling contamination in the hospital setting and effectively reducing the risk of healthcare-associated infections (HAIs), according to a multicenter study published in PLoS One. Additionally, the probiotic-based cleansing system demonstrated little to no impact on worsening the risk of antibiotic resistance, which is a common issue associated with chemical-based cleansers. Read More

    The Modern Day Critical Care Team and Their Charge

    When pediatric critical care began, the major interventions were limited to endotracheal intubation, mechanical ventilation, volume resuscitation, and cardiac infusions. The primary outcome desired at that time was survival. As diagnostics, monitoring technology, and pharmaceutical options improved, along with our understanding of fundamental pediatric physiology, the focus of outcomes has evolved from survival alone to the functional status of survivors of critical illness. Read More

    Over Half Of Patients And Families Hesitate To Raise ICU Safety Concerns, Study Finds

    Imagine you're in the intensive care unit at the bedside of your loved one, and you think you see a medical mistake — a wrong pill, an unwashed hand. Do you speak up? Even if you're afraid that might annoy or alienate the medical team? It's a delicate question, and a new study out of Beth Israel Deaconess Medical Center — the first ICU study of its kind — documents just how delicate. The researchers surveyed more than 100 family members in the ICU and more than 1,000 online about whether they'd feel comfortable speaking up about various concerns. Read More

  • July 11, 2018

    A Taste of Flight Medicine: Nursing Students Learn What it's Like to Work Inside an Air Ambulance

    About 50 nursing students saw what it’s like Thursday to work inside the confined space of an air ambulance. A team from IU Health Lifeline Critical Care Transport landed at Ivy Tech’s south campus in the Vigo County Industrial Park and allowed students to look inside the high-tech helicopter. Flight nurse Blake Randolph said the teams work in 12-hour shifts, and the job is not one for beginners in the nursing field. Read More

    Microfluidic Chip to Detect Sepsis Proves Successful in Clinical Study

    Two years after inventing a microfluidic chip believed to help detect a life-threatening blood infection, researchers in the Texas Tech University Department of Chemistry & Biochemistry and the Texas Tech University Health Sciences Center (TTUHSC) are finally seeing their product work successfully for human patients. The chip, invented by associate professor Dimitri Pappas and graduate student Ye Zhang, detects sepsis, a potentially fatal condition in which the body's immune system goes into overdrive trying to kill a blood-borne bacterial infection. Read More

    Top Stories in Infectious Disease: CMS Policy Fails to Significantly Impact Infection Prevention, New App Developed for Deciding Antibiotic Treatments

    Among the top stories in infectious disease is the impact of CMS policy on infection prevention measures, the results of using an institution-specific antibiotic app, and new developments in the quest for a Zika vaccine. Other top stories include the first known case of pre-exposure prophylaxis failure in a developing country and the discovery that most armadillos in a certain region of the Brazilian Amazon carry leprosy. Read More

    Audit And Feedback Does Not Increase ICU Mortality

    Audit and feedback as part of antimicrobial stewardship programs has no impact on mortality rates in the ICU and can be safely implemented in this setting, according findings from a systematic review and meta-analysis published in Clinical Infectious Diseases. “The best available data does not suggest that antimicrobial stewardship, in the form of audit and feedback, significantly increases or decreases mortality in the ICU setting.” Read More

  • July 5, 2018

    4 Ways Nurses Can Fight Alarm Fatigue

    The American Association of Critical Care Nurses recently released a practice alert to help hospitals manage the clinical alarms that notify providers when patients' conditions change. The flood of noisy alarms during long shifts often results in providers feeling fatigued, delaying or reducing their response to the alarms, which threatens patient safety.The nurse association's alert is meant “to help nurses provide the safest patient care possible when managing clinical alarms in acute and critical care environments." Read More

    Hospitals Are Learning From Industry How to Cut Medical Errors

    When Virginia Mason committed itself to improving safety. It used an unlikely model: the Toyota Production System (TPS), the Japanese carmaker’s “lean” manufacturing techniques. Nearly every part of the hospital, from radiology to recruitment, was analysed and standardised. Staff were trained to raise safety concerns. Today Virginia Mason prides itself on its safety record—and sells its take on Toyota to hospitals across the world. Read More

    Technology to Help Busy Nurses Keep an Eye on Elderly has Seen Number of Falls Decrease

    El Camino Hospital, in the heart of Silicon Valley, has a problem. Its nurses - tending to patients amid a chorus of machines, monitors and devices - are only human. One missed signal from, say, a call light - the bedside button that patients press when they need help - could set in motion a chain of actions that end in a fall. "As fast as we all run to these bed alarms, sometimes we can't get there in time," says Cheryl Reinking, chief nursing officer at El Camino. Like most other US hospitals, El Camino had invested time and money in fall-prevention efforts, such as the call lights, but the various methods had not been effective enough. Read More

    Infection Prevention and Control: Remember Your ABC’s!

    Hand hygiene remains the most critical part of any IPC plan. Over the past 30 years of my professional career, performing hand hygiene has become so easy with the ubiquitous presence of alcohol foam containers for easy access. Yet it is still difficult to convince people of the importance of hand hygiene. I should not belabor the point; I am confident that your IPC practitioners do a great job of constantly reminding you of the importance of hand hygiene. Read More

  • June 27, 2018

    How Can We Keep Nurses From Burning Out?

    The nursing shortage has become a crisis. As the U.S. population ages, the number of people that require care is growing. Simultaneously, nurses are retiring in droves. The Bureau of Labor Statistics estimates that by 2022, 1.2 million roles for Registered Nurses (RNs) will be left vacant. The demand for nurses has outweighed the supply of new nurses for years, but recently, the issue has reached a fever pitch. Read More

    New Studies Illustrate Need for Rigorous Review of Infection Preventionist Staffing Models Across Healthcare Systems

    Severe gaps in staffing and outdated coverage benchmarks point to the critical need for evaluating and updating standards for infection preventionist (IP) staffing levels, according to two new studies that explored infection prevention and control resourcing across a variety of healthcare settings. A comprehensive staffing and coverage assessment conducted at Providence Health & Services, a large nonprofit healthcare system, revealed that actual IP labor needs were 31 to 66 percent higher than the current benchmarks system wide. Read More

    Study Reveals New Way to Inhibit Capillary Leakage in Sepsis

    Leakage from the blood capillaries is a key mechanism leading to septic shock and multiorgan failure, which affect millions of patients annually worldwide. However, there is no effective way to inhibit the vessel leakiness. A new study by scientists at the University of Helsinki and Wihuri Research Institute demonstrates that vascular leakage can be inhibited by targeting vascular integrins. Increased capillary permeability and subsequent leakage from the capillaries is associated with numerous difficult-to-cure diseases, including acute respiratory distress syndrome (ARDS), severe Dengue fever and malaria, and sepsis. Read More

    New Guidelines Address All Components of Nutrition for Critically Ill Patients

    A new nutrition bundle strives to ensure that critically ill patients receive adequate nutrition while hospitalized and seeks to reduce adverse outcomes related to malnutrition. More than half of patients admitted to critical care units are malnourished, which increases their risk for serious complications and contributes to longer hospital stays and higher healthcare costs. Yet many of those eligible to receive enteral feedings do not receive adequate nutrition while hospitalized. Read More