Bacterial Contamination of Enteral Feeding Reservoirs

Abstract

The recent report by Donius' regarding contamination of prefilled enteral feedings is particularly timely. Prefilled enteral feedings are gaining acceptance whereas the concern regarding clinical septicemia resulting from contaminated feedings is increasing. We agree that contaminated feedings are problematic, but we question the conclusions drawn from the study data. In the Donius study, samples were taken from the distal end of the feeding port with no commensurate samples actually taken from the feeding reservoir. The data confirm contamination of the distal port and show that the degree of contamination is progressive over time. However, on the basis of this observation, it may be inappropriate to state that the refillable bags and prefilled containers were contaminated. Our own clinical investigations show that closed-system containers remain free from contamination even after extended periods at the bedside.2~3The effect of a contaminated distal port is unclear.Some authors have reported retrograde contamination of the feeding reservoir,4~5 but others have not considered this a problem.6 Payne-James and colleagueS5 postulate that the presence of a drip chamber may break the continuous column of formula that would be necessary for retrograde contamination to occur. Although not specifically mentioned, the administration sets used in the Donius study were designed for use with pumps and therefore probably contained drip chambers. Regardless of the overall implications, we value investigations that draw attention to any underappreciated clinical risk. Contaminated feedings are associated with infectious complications.7,8,9 With enteral feeding gaining acceptance as a preferred feeding method in critically ill patients, investigators must begin to focus on developing new delivery systems that reduce risk and improve cost efficiency. Ms Donius should certainly be commended for her efforts in this arena. REFERENCESDonius MA: Contamination of a prefilled ready-to-use enteral feeding system compared with a refillable bag. JPEN 17:461-464, 1993 2. Elmore MF, Wagner DR, Knoll D: Extended hang times and bacterial contamination in large volume "closed" vs "open" enteral delivery systems. Presented at the 18th Clinical Congress of the American Society for Parenteral and Enteral Nutrition, San Antonio, Texas, 1994 3. Wagner DR, Elmore MF, Knoll DM: Evaluation of "closed" vs "open" systems for the delivery of peptide-based enteral diets. JPEN 18:453-457, 1994 4. Van Alsenoy J, DeLeeuw I, Delvigne C, et al: Ascending contamination of a jejunostomy feeding reservoir. Clin Nutr 4:95-98, 1985 5. Payne-James JJ, Rana SK, Bray MJ, et al: Retrograde (ascending) bacterial contamination of enteral diet administration systems. JPEN 16:369-373, 1992 6. Schroeder P, Fisher D, Volz M, et al: Microbial contamination of enteral feeding solutions in a community hospital. JPEN 7:364-368, 1983 7. Levy J, Laetham YV, Verhagen G, et al: Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infections: A study using pl...