Background: The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food-borne illness is a concern of blenderized tube-feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. Methods: Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus, and coliforms at baseline, 24-hour, and 48-hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. Results: No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >10 4 , and at 48 hours, 6/50 (12%) exceeded 10 4 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 10 5 CFU/mL. Samples exceeding 10 4 CFU/mL were likely contaminated by common endospore-forming bacteria found in soil or by bacteria in milk that was close to its expiration date. Conclusion: In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 10 5 CFUs. Established safe food-handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food-borne infection in HEN patients.

Background: Guidelines for the reuse of enteral tube feeding (ETF) equipment guidelines are limited to manufacturer recommendations. ETF equipment reuse studies are needed as the enteral population has increased, along with blenderized tube feeding (BTF).Methods: This experiment tested microbial contamination of a reusable gravity feeding bag and syringe after 15 BTF reuses and cleanings. Eight bags and syringes were filled with the BTF, held at room temperature for 20 min, and then emptied, washed, and air dried. After the last air drying, the inner surfaces of the bag and syringe were swabbed, and aerobic microbial counts were performed using serial dilutions and plate counts. Results:The microbial counts for all syringes and six bags were <1 colonyforming unit (CFU)/cm 2 ; one bag was <5 CFU/cm 2 and one bag was 12.5 CFU/cm 2 . No legal guidelines for surface cleanliness exist for the food sector. Several studies propose a safe microbial level to be <2.5 CFU/cm 2 , and the European Commission recommended <10 CFU/cm 2 . Based on these proposed guidelines, microbial counts of all syringes and seven bags were within the proposed guidelines, except for one bag just above 10 CFU/cm 2 . Conclusion:The feeding bag used in this study may be used multiple times for BTF with a reduced risk of microbial contamination when manufacturer's cleaning guidelines are followed. Although bolus tube feeding is an off-label use for syringes, they are frequently used for BTF, and in this study the cleaning after 15 uses over 5 days was effective to reduce microbial counts.

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