title: Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?
abstract: OBJECTIVE
  To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload.
  
  
  METHODS
  A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload.
  
  
  RESULTS
  One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced.
  
  
  CONCLUSIONS
  Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.
authors: Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney University, Sydney, New South Wales, Australia. kiranbal@rediffmail.com
authors: Kiran Kumar
authors: KK
authors: Balegar V
authors: Mohammad Irfan
authors: MI
authors: Azeem
authors: Kaye
authors: K
authors: Spence
authors: Nadia
authors: N
authors: Badawi
mesh_terms: D001291:Attitude of Health Personnel; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control; D015931:Intensive Care, Neonatal / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D008297:Male; D008485:Medical Audit; D017283:Neonatal Nursing / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D009517:New South Wales; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000451:nursing; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013997:Time Factors; D016526:Workload