Araştırma Makalesi
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INVESTIGATION OF CONTAMINATION LEVELS IN ENTERAL NUTRITION PRODUCTS: THE CASE OF INTENSIVE CARE

Yıl 2024, Cilt: 13 Sayı: 1, 158 - 164, 27.03.2024
https://doi.org/10.37989/gumussagbil.1320458

Öz

In recent years, patient safety has emerged as a paramount concern within the healthcare delivery system. Enteral nutrition, which is frequently employed in intensive care units, brings forth various risks pertaining to patient safety. One of these risks involves the contamination of enteral solutions with pathogenic microorganisms. This study scrutinized the presence of total aerobic bacteria (TAMB), coliforms, Staphylococcus aureus (S.aureus), and Escherichia coli microorganisms in samples derived from enteral solutions.The study was designed as an experimental research. Samples of enteral nutrition formulas were collected from enteral feeding sets that had completed a 24-hour infusion period. These samples were analyzed for total aerobic mesophilic bacteria, Staphylococcus aureus, coliforms, and Escherichia coli. In this study, it was determined that the count of aerobic bacteria exceeded 10³ CFU/mL (>10³) in 4 samples (40%), while 1 sample was within an acceptable range (9x10² CFU/mL). Catalase and coagulase tests were performed on the black-colored colonies observed in the Bacteriological Analytical Manual, and the test results were evaluated as negative.Therefore, coagulase-negative Staphylococcus species were identified in 5 samples (50%). According to the microbiological analysis results, no coliforms or E. coli bacteria (<10 CFU/mL) were detected in any of the samples.The research findings revealed that the examined enteral nutrition products exceeded the accepted food safety limits in terms of contamination levels for certain microbiological species. Conducting studies to identify and prevent the sources of this contamination can lead to an improvement in the microbiological quality of enteral solutions.

Proje Numarası

Yok

Kaynakça

  • 1. Groher, M.E. and Groher, T.P. (2012). “When Safe Oral Feeding Is Threatened: End-of-Life Options and Decisions”. Topics in Language Disorders, 32, 149–167. https://alliedhealth.ceconnection.com/files/TLD0212D-1337959485357.pdf
  • 2. McClave, S.A, Taylor, B.E, Martindale, R.G. and Warren, M.M. (2016). “Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient”. J Parenter Enteral Nutr, 40, 159–211. https://doi.org/10.1177/0148607115621863
  • 3. Delgado, G.E, Lopez, G.J, Torres, T.B. and Gomez, H.E. (2021). “Risk factor of hyperglycemia with enteral nutrition in nondiabetic patients in clinic university hospital”. Clinical Nutrition ESPEN, 46, 629–630.
  • 4. Cadena, A.J, Habib, S, Rincon, F. and Dobak, S. (2020). “The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review”. J Intensive Care Med, 35 (7), 615–626.
  • 5. Seron-Arbeloa, C, Zamora-Elson, M, Labarta-Monzon, L. and Mallor-Bonet, T. (2013). “Enteral nutrition in critical care”. Journal of clinical medicine research, 5, 1–11. https://doi.org/10.4021/jocmr1210w
  • 6. Murray, K. and Mehta, S. (2018). “Home parenteral nutrition for patients with intestinal failure due to advanced cancer”. Br J Nurs, 27, 1-8. https://doi.org/10.12968/bjon.2018.27.Sup4a.S1
  • 7. Moreira, T.V,. and McQuiggan, M. (2009). “Methods for the assessment of gastric emptying in critically ill, enterally fed adults”. Nutrition in Clinical Practice, 24, 261-273. https://doi.org/10.1177/0884533609332176
  • 8. Wanden-Berghe, C, Patino-Alonso, M.C, Galindo-Villardón, P. and Sanz-Valero J. (2019). “Complications Associated with Enteral Nutrition: CAFANE Study”. Nutrients, 11, 2041. https://doi.org/10.3390/nu11092041
  • 9. Orlandoni, P, Peladic, N.J, Di Rosa, M. and Venturini, C. (2019). “The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia”. Clinical nutrition, 38, 1871–1876. https://doi.org/10.1016/j.clnu.2018.07.010
  • 10. White, J.V, Guenter, P, Jensen, G. and Malone, A. (2012). “Academy of Nutrition and Dietetics Malnutrition Work Group”. A.S.P.E.N. J Acad Nutr Diet, 112, 730-8. https://doi.org/10.1177/0148607112440285
  • 11. Bankhead, R, Boullata, J, Brantley, S. and Corkins M. (2009). “Enteral nutrition practice recommendations”. JPEN J Parenter Enteral Nutr, 33, 122-167. https://doi.org/10.1177/0148607108330314
  • 12. Petrov, M. S, Correia, M. I. and Windsor, J. A. (2008). Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance. JOP : Journal of the pancreas, 9(4), 440–448.
  • 13. Johnson, T.W, Milton, D.L, Johnson, K. and Carter, H. (2019). “Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding”. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition, 34, 257–263. https://doi.org/10.1002/ncp.10226
  • 14. Malhi, H. (2017). “Enteral tube feeding: using good practice to prevent infection”. British journal of nursing, 26, 8–14. https://doi.org/10.12968/bjon.2017.26.1.8
  • 15. Weerawardhana, P, Meegoda, L. and Goonewardena, S. (2021). “A tool for assessing nurses' knowledge and practices on enteral nutrition therapy: a modified Delphi study”. Clinical Nutrition ESPEN, 46, 648. https://doi.org/10.1016/j.clnesp.2021.09.302
  • 16. Salizar, M.L, Noriedayu, M.R. and Aniawanis, M. (2021). “Community nurses' knowledge and nursing care skills on enteral nutrition: A knowledge transfer programme”. Enfermeria Clinica, 31 (2), 286-290. https://doi.org/10.1016/j.enfcli.2020.09.017
  • 17. U.S. Food and Drug Administration (FDA). Erişim tarihi: 1 Aralık 2022. Available from: https://www.fda.gov/
  • 18. Anonim. Merck gıda mikrobiyolojisi uygulamaları, Başak Matbaacılık, Ankara, 2005.
  • 19. Stichler, J.F. (2016). “Patient Safety: A Priority for Healthcare and for Healthcare Design”. HERD: Health Environments Research & Design Journal, 9, 10-15. doi:10.1177/1937586716646648
  • 20. Ho, S.S, Tse, M.M. and Boost, M.V. (2012). “Effect of an infection control programme on bacterial contamination of enteral feed in nursing homes”. J Hosp Infect, 82, 49-55. doi: 10.1016/j.jhin.2012.05.002.
  • 21. Galindo, C.S, Beux, M.R, Costa, R.L. and Uniat, K.C. (2021). “Home-prepared enteral tube feeding: evalution of microbial contamination, hygiene and the profile of the food handler”. Nutrition in Clinical Practice, 36, 704-717. https://doi.org/10.1002/ncp.10577
  • 22. Jalali, M, Sabzghabaee, A.M, Badri, S.S. and Soltani, H.A. (2009). “Bacterial contamination of hospital-prepaed enteral tube feeding formulas in Isfahan, İran”. JRMS, 14, 149-156.
  • 23. Moazen, M, Rahmdel, S, Abdollahsadeh, S.M. and Ranjbar MZ. (2014). “Microbiological quality of commercial enteral feedings used in two public hospitals in Shiraz, Iran”. Journal of Health Science Surveillance System, 2, 49-53.
  • 24. Adibi, S, Afshari, A, Norouzy, A. and Nematy, M. (2023). “Microbiological quality of hospital prepared blenderised tube feeding”. Journal of Human Nutrition and Dietetics, 36, 181-190. https://doi.org/10.1111/jhn.13066
  • 25. Baniardalan, M, Sabzghabaee, A.M, Jalali, M. and Badri, S. (2014). “Bacterial safety of commercial and handmade enteral feeds in an İranian teaching hospital”. International Journal of Preventive Medicine, 5, 604-610.
  • 26. Pinto, R.O.M, Correia, E.F, Pereira, K.C. and Sobrinho PSC. (2015). “Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil”. Brazilian Journal of Microbiology, 46, 583-589. https://doi.org/10.1590/S1517-838246220131141
  • 27. Johnson, T.W, Milton, D.L, Johnson, K. and Carter H. (2019). “Comparison of microbial growth between commercial formula and blenderized food for tube feeding”. Nutrition in Clinical Practice, 34, 257-263. https://doi.org/10.1002/ncp.10226
  • 28. Sullivian, M.M, Sorreda-Esguerra, P, Santos, E.E. and Platon, B.G. (2001). “Bacterial contamination of blenderized whole food and commercial enteral tube feedings in the Philippines”. Journal of Hospital Infection, 49, 268-273. https://doi.org/10.1053/jhin.2001.1093
  • 29. Lakananurak, N, Nalinthassanai, N, Suansawang, W. and Panarat, P. (2020). “Optimal hang time of enteral formula at standart room temperature and high temperature”. World Journal of Clinical Cases, 8, 4410-4415. https://doi.org/10.12998/wjcc.v8.i19.4410
  • 30. Oliviera, M.H, Bonelli, R, Aido, K.E. and Batista, C.R.V. (2000). “Microbiological quality of reconstituted entral formulations used in hospitals”. Nutrition 16:729-733. https://doi.org/10.1016/s0899-9007(00)00378-6
  • 31. Milton, D.L, Johnson, T.W, Johnson, K. and Murphy, B. (2020). “Accepted safe food-handling procedures minimizes microbial contamination of home prepared blenderized tube-feeding”. Nutrition in Clinical Practice, 35, 479-486. https://doi.org/10.1002/ncp.10450.
  • 32. Sinha, S, Lath, G. and Rao, S. (2020). “Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges”. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24, 709–712. https://doi.org/10.5005/jp-journals-10071-23530
  • 33. Sewify, K. and Genena, D. (2017). “Open vs closed tube feeding in critically ill patients–which is the best?”. J Nutr Food Sci, 7, 621. DOI:10.4172/2155-9600.1000621.
  • 34. Korkmaz, B.O, Aydın, A. and Kılıç, N. (2021). “Enteral beslenme ürünlerinin mezofilik aerobik bakteri ve Cronobacter sakazakii kontaminasyonu yönünden incelenmesi”. Food and Health, 7, 39-44.
  • 35. Aslantaş, O. ve Yıldız, S. (2008). “Türkiye’de kullanılan enteral beslenme ürünlerinin mikrobiyolojik açıdan incelenmesi”. Beslenme ve Diyet Dergisi, 36, 23-30.
  • 36. Mokhalalati, J.K, Druyan, M.E, Shott, S.B. and Comer, G.M. (2004). “Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia”. Saudi Med J, 25, 331-41.
  • 37. Milton, D, Murphy, B, Johnson, T.W. and Carter H. (2022). “Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding”. Nutrition in Clinical Practice, 37, 907-912. https://doi.org/10.1002/ncp.10835

ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ

Yıl 2024, Cilt: 13 Sayı: 1, 158 - 164, 27.03.2024
https://doi.org/10.37989/gumussagbil.1320458

Öz

güvenliği öncelikli konulardan biridir. Yoğun bakım ünitelerinde sıklıkla uygulanan enteral beslenme, hasta güvenliği ile ilgili çeşitli riskleri de beraberinde getirmektedir. Enteral solüsyonun patojen mikroorganizmalar ile kontamine olması bu risklerden biridir. Bu çalışmada enteral solüsyonlardan alınan örneklerde toplam aerobik bakteri (TAMB), koliform, Staphylococcus aureus (S.aureus) ve Escherichia coli (E.coli) mikroorganizmalarının varlığı incelenmiştir. Araştırma deneysel tasarımlı olarak planlanmıştır. Yirmi dört saat infüzyon süresini tamamlamış enteral beslenme setlerinden alınan örnekler toplam aerobik mezofilik bakteri, Staphylococcus aureus, koliform ve Escherichia coli bakımından analiz edilmiştir. Bu çalışmada aerobik bakteri sayısının 4 örnekte (%40) 10³ kob/mL’yi aştığı (>10³), 1 örneğin ise kabul edilebilir seviyede (9x10² kob/mL) olduğu belirlenmiştir. Baird Parker agarda (BPA) siyah görünümlü kolonilere katalaz ve koagülaz testi uygulanmış ve test sonuçları negatif olarak değerlendirilmiştir. Bu nedenle 5 örnekte (%50) koagülaz negatif Staphylococcus sp. belirlenmiştir. Mikrobiyolojik analiz sonuçlarına göre örneklerin hiçbirinde koliform ve E.coli bakterisi (<10 kob/mL) tespit edilememiştir. Araştırma sonucunda incelenen enteral beslenme ürünlerinin bazı mikrobiyolojik türlerde kontaminasyon düzeylerinin kabul edilen besin güvenliği sınırlarını aştığı belirlenmiştir. Bu kontaminasyon kaynaklarının belirlenmesi ve önlenmesine yönelik çalışmaların yapılması ile enteral solüsyonlarda mikrobiyolojik kalitenin gelişmesi sağlanabilir.

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

YOK

Kaynakça

  • 1. Groher, M.E. and Groher, T.P. (2012). “When Safe Oral Feeding Is Threatened: End-of-Life Options and Decisions”. Topics in Language Disorders, 32, 149–167. https://alliedhealth.ceconnection.com/files/TLD0212D-1337959485357.pdf
  • 2. McClave, S.A, Taylor, B.E, Martindale, R.G. and Warren, M.M. (2016). “Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient”. J Parenter Enteral Nutr, 40, 159–211. https://doi.org/10.1177/0148607115621863
  • 3. Delgado, G.E, Lopez, G.J, Torres, T.B. and Gomez, H.E. (2021). “Risk factor of hyperglycemia with enteral nutrition in nondiabetic patients in clinic university hospital”. Clinical Nutrition ESPEN, 46, 629–630.
  • 4. Cadena, A.J, Habib, S, Rincon, F. and Dobak, S. (2020). “The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review”. J Intensive Care Med, 35 (7), 615–626.
  • 5. Seron-Arbeloa, C, Zamora-Elson, M, Labarta-Monzon, L. and Mallor-Bonet, T. (2013). “Enteral nutrition in critical care”. Journal of clinical medicine research, 5, 1–11. https://doi.org/10.4021/jocmr1210w
  • 6. Murray, K. and Mehta, S. (2018). “Home parenteral nutrition for patients with intestinal failure due to advanced cancer”. Br J Nurs, 27, 1-8. https://doi.org/10.12968/bjon.2018.27.Sup4a.S1
  • 7. Moreira, T.V,. and McQuiggan, M. (2009). “Methods for the assessment of gastric emptying in critically ill, enterally fed adults”. Nutrition in Clinical Practice, 24, 261-273. https://doi.org/10.1177/0884533609332176
  • 8. Wanden-Berghe, C, Patino-Alonso, M.C, Galindo-Villardón, P. and Sanz-Valero J. (2019). “Complications Associated with Enteral Nutrition: CAFANE Study”. Nutrients, 11, 2041. https://doi.org/10.3390/nu11092041
  • 9. Orlandoni, P, Peladic, N.J, Di Rosa, M. and Venturini, C. (2019). “The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia”. Clinical nutrition, 38, 1871–1876. https://doi.org/10.1016/j.clnu.2018.07.010
  • 10. White, J.V, Guenter, P, Jensen, G. and Malone, A. (2012). “Academy of Nutrition and Dietetics Malnutrition Work Group”. A.S.P.E.N. J Acad Nutr Diet, 112, 730-8. https://doi.org/10.1177/0148607112440285
  • 11. Bankhead, R, Boullata, J, Brantley, S. and Corkins M. (2009). “Enteral nutrition practice recommendations”. JPEN J Parenter Enteral Nutr, 33, 122-167. https://doi.org/10.1177/0148607108330314
  • 12. Petrov, M. S, Correia, M. I. and Windsor, J. A. (2008). Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance. JOP : Journal of the pancreas, 9(4), 440–448.
  • 13. Johnson, T.W, Milton, D.L, Johnson, K. and Carter, H. (2019). “Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding”. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition, 34, 257–263. https://doi.org/10.1002/ncp.10226
  • 14. Malhi, H. (2017). “Enteral tube feeding: using good practice to prevent infection”. British journal of nursing, 26, 8–14. https://doi.org/10.12968/bjon.2017.26.1.8
  • 15. Weerawardhana, P, Meegoda, L. and Goonewardena, S. (2021). “A tool for assessing nurses' knowledge and practices on enteral nutrition therapy: a modified Delphi study”. Clinical Nutrition ESPEN, 46, 648. https://doi.org/10.1016/j.clnesp.2021.09.302
  • 16. Salizar, M.L, Noriedayu, M.R. and Aniawanis, M. (2021). “Community nurses' knowledge and nursing care skills on enteral nutrition: A knowledge transfer programme”. Enfermeria Clinica, 31 (2), 286-290. https://doi.org/10.1016/j.enfcli.2020.09.017
  • 17. U.S. Food and Drug Administration (FDA). Erişim tarihi: 1 Aralık 2022. Available from: https://www.fda.gov/
  • 18. Anonim. Merck gıda mikrobiyolojisi uygulamaları, Başak Matbaacılık, Ankara, 2005.
  • 19. Stichler, J.F. (2016). “Patient Safety: A Priority for Healthcare and for Healthcare Design”. HERD: Health Environments Research & Design Journal, 9, 10-15. doi:10.1177/1937586716646648
  • 20. Ho, S.S, Tse, M.M. and Boost, M.V. (2012). “Effect of an infection control programme on bacterial contamination of enteral feed in nursing homes”. J Hosp Infect, 82, 49-55. doi: 10.1016/j.jhin.2012.05.002.
  • 21. Galindo, C.S, Beux, M.R, Costa, R.L. and Uniat, K.C. (2021). “Home-prepared enteral tube feeding: evalution of microbial contamination, hygiene and the profile of the food handler”. Nutrition in Clinical Practice, 36, 704-717. https://doi.org/10.1002/ncp.10577
  • 22. Jalali, M, Sabzghabaee, A.M, Badri, S.S. and Soltani, H.A. (2009). “Bacterial contamination of hospital-prepaed enteral tube feeding formulas in Isfahan, İran”. JRMS, 14, 149-156.
  • 23. Moazen, M, Rahmdel, S, Abdollahsadeh, S.M. and Ranjbar MZ. (2014). “Microbiological quality of commercial enteral feedings used in two public hospitals in Shiraz, Iran”. Journal of Health Science Surveillance System, 2, 49-53.
  • 24. Adibi, S, Afshari, A, Norouzy, A. and Nematy, M. (2023). “Microbiological quality of hospital prepared blenderised tube feeding”. Journal of Human Nutrition and Dietetics, 36, 181-190. https://doi.org/10.1111/jhn.13066
  • 25. Baniardalan, M, Sabzghabaee, A.M, Jalali, M. and Badri, S. (2014). “Bacterial safety of commercial and handmade enteral feeds in an İranian teaching hospital”. International Journal of Preventive Medicine, 5, 604-610.
  • 26. Pinto, R.O.M, Correia, E.F, Pereira, K.C. and Sobrinho PSC. (2015). “Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil”. Brazilian Journal of Microbiology, 46, 583-589. https://doi.org/10.1590/S1517-838246220131141
  • 27. Johnson, T.W, Milton, D.L, Johnson, K. and Carter H. (2019). “Comparison of microbial growth between commercial formula and blenderized food for tube feeding”. Nutrition in Clinical Practice, 34, 257-263. https://doi.org/10.1002/ncp.10226
  • 28. Sullivian, M.M, Sorreda-Esguerra, P, Santos, E.E. and Platon, B.G. (2001). “Bacterial contamination of blenderized whole food and commercial enteral tube feedings in the Philippines”. Journal of Hospital Infection, 49, 268-273. https://doi.org/10.1053/jhin.2001.1093
  • 29. Lakananurak, N, Nalinthassanai, N, Suansawang, W. and Panarat, P. (2020). “Optimal hang time of enteral formula at standart room temperature and high temperature”. World Journal of Clinical Cases, 8, 4410-4415. https://doi.org/10.12998/wjcc.v8.i19.4410
  • 30. Oliviera, M.H, Bonelli, R, Aido, K.E. and Batista, C.R.V. (2000). “Microbiological quality of reconstituted entral formulations used in hospitals”. Nutrition 16:729-733. https://doi.org/10.1016/s0899-9007(00)00378-6
  • 31. Milton, D.L, Johnson, T.W, Johnson, K. and Murphy, B. (2020). “Accepted safe food-handling procedures minimizes microbial contamination of home prepared blenderized tube-feeding”. Nutrition in Clinical Practice, 35, 479-486. https://doi.org/10.1002/ncp.10450.
  • 32. Sinha, S, Lath, G. and Rao, S. (2020). “Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges”. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24, 709–712. https://doi.org/10.5005/jp-journals-10071-23530
  • 33. Sewify, K. and Genena, D. (2017). “Open vs closed tube feeding in critically ill patients–which is the best?”. J Nutr Food Sci, 7, 621. DOI:10.4172/2155-9600.1000621.
  • 34. Korkmaz, B.O, Aydın, A. and Kılıç, N. (2021). “Enteral beslenme ürünlerinin mezofilik aerobik bakteri ve Cronobacter sakazakii kontaminasyonu yönünden incelenmesi”. Food and Health, 7, 39-44.
  • 35. Aslantaş, O. ve Yıldız, S. (2008). “Türkiye’de kullanılan enteral beslenme ürünlerinin mikrobiyolojik açıdan incelenmesi”. Beslenme ve Diyet Dergisi, 36, 23-30.
  • 36. Mokhalalati, J.K, Druyan, M.E, Shott, S.B. and Comer, G.M. (2004). “Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia”. Saudi Med J, 25, 331-41.
  • 37. Milton, D, Murphy, B, Johnson, T.W. and Carter H. (2022). “Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding”. Nutrition in Clinical Practice, 37, 907-912. https://doi.org/10.1002/ncp.10835
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Gıda Özellikleri, Klinik Beslenme, Yoğun Bakım Hemşireliği
Bölüm Araştırma Makaleleri
Yazarlar

Merve Yurttaş 0000-0003-4162-3741

Alev Yıldız Ilıman 0000-0001-7957-8873

Dursun Fırat Ergül 0000-0001-6670-4877

Proje Numarası Yok
Yayımlanma Tarihi 27 Mart 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 13 Sayı: 1

Kaynak Göster

APA Yurttaş, M., Yıldız Ilıman, A., & Ergül, D. F. (2024). ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 13(1), 158-164. https://doi.org/10.37989/gumussagbil.1320458
AMA Yurttaş M, Yıldız Ilıman A, Ergül DF. ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. Mart 2024;13(1):158-164. doi:10.37989/gumussagbil.1320458
Chicago Yurttaş, Merve, Alev Yıldız Ilıman, ve Dursun Fırat Ergül. “ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13, sy. 1 (Mart 2024): 158-64. https://doi.org/10.37989/gumussagbil.1320458.
EndNote Yurttaş M, Yıldız Ilıman A, Ergül DF (01 Mart 2024) ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13 1 158–164.
IEEE M. Yurttaş, A. Yıldız Ilıman, ve D. F. Ergül, “ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 13, sy. 1, ss. 158–164, 2024, doi: 10.37989/gumussagbil.1320458.
ISNAD Yurttaş, Merve vd. “ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13/1 (Mart 2024), 158-164. https://doi.org/10.37989/gumussagbil.1320458.
JAMA Yurttaş M, Yıldız Ilıman A, Ergül DF. ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2024;13:158–164.
MLA Yurttaş, Merve vd. “ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 13, sy. 1, 2024, ss. 158-64, doi:10.37989/gumussagbil.1320458.
Vancouver Yurttaş M, Yıldız Ilıman A, Ergül DF. ENTERAL BESLENME ÜRÜNLERİNDE KONTAMİNASYON DÜZEYLERİNİN İNCELENMESİ: YOĞUN BAKIM ÖRNEĞİ. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2024;13(1):158-64.