Accepted Safe Food‐Handling Procedures Minimizes Microbial Contamination of Home‐Prepared Blenderized Tube‐Feeding

Abstract

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.

The Microbial Quality and Safety of Blenderised Enteral Nutrition Formula: A Systematic Review

“…Three studies out of the eleven studies included were conducted in Iran [ 20 , 29 , 34 ] and two in the USA [ 25 , 28 ] ( Table 2 ). In addition, two other studies were conducted in Brazil [ 36 , 38 ], and one study each in Costa Rica [ 33 ], the Philippines [ 37 ], Saudi Arabia [ 35 ] and the UK [ 17 ].…”

“…For blenderised ENF, preparation techniques need to be established and caregivers taught how to prepare and administer ENF appropriately to reduce contamination. In addition, cleaning and sanitizing of kitchen equipment and surfaces needs to be embedded in the preparation of blenderised ENF [ 28 ]. Appropriate blenders and equipment need to be cleaned thoroughly through disassembling and effective sanitisation, alongside the need to ensure adequate home environments including water source, refrigeration temperature and storage capacity for blenderised ENF [ 28 ].…”

“…In addition, cleaning and sanitizing of kitchen equipment and surfaces needs to be embedded in the preparation of blenderised ENF [ 28 ]. Appropriate blenders and equipment need to be cleaned thoroughly through disassembling and effective sanitisation, alongside the need to ensure adequate home environments including water source, refrigeration temperature and storage capacity for blenderised ENF [ 28 ]. Brown et al [ 9 ], acknowledged that food safety is a concern in blenderised ENF; therefore, it is essential that the foods are cooked thoroughly, and are kept at the correct temperature.…”

“…For example, patients who acquire an infection may develop anxiety, discomfort, inconvenience, delayed recovery, loss of confidence in the healthcare system, increased morbidity and mortality [ 19 , 27 ]. However, there have also been reports of the positive role of some microbes in gastrointestinal health, improved gastrointestinal function and reduced enteral tube feeding intolerance in patients fed blendersied ENF [ 17 , 24 , 28 ]. Accordingly, the enteral formula industry has responded with many commercially-prepared whole food blends that are available in a ready to hang form [ 11 ], although there are reported risks of food-borne diseases associated with homemade blenderised formulas [ 17 , 24 , 29 ].…”

An Evaluation of the Nutritional Value and Physical Properties of Blenderised Enteral Nutrition Formula: A Systematic Review and Meta-Analysis

“…The main commercial ENF include standard polymeric, oligomeric, and monomeric diets (elemental formulas) and disease-specific formulas [ 3 , 6 , 9 , 10 ]. Despite the merits of using commercial ENF, including prevention of weight loss and reduced microbial risks compared with blended ENF [ 2 , 10 , 11 , 12 , 13 ], there is a growing preference to the use of blended ENF [ 3 , 14 ]. In some developing economies such as Iran, the use of blended ENF appears to be the primary enteral feed of choice and most hospitals are still using the traditional hospital prepared blended ENF [ 1 , 3 ].…”