Enteral Feeding Set Handling Techniques

Lyman, Beth; Williams, Maria; Sollazzo, Janet; Hayden, Ashley; Hensley, Pam; Dai, Hongying; Roberts, Cristine

doi:10.1177/0884533616680840

Cited by 10 publications

(15 citation statements)

References 23 publications

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“…Other studies have demonstrated that bacteria enter the GI system through enteral feeding systems, especially when proper cleansing techniques are not followed. The greatest source of known enteral feeding system contamination has been poor hand hygiene by clinicians 8,41 . Osland et al recommended following the manufacturers' guidelines for the duration of equipment use, including cleansing and drying time 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The greatest source of known enteral feeding system contamination has been poor hand hygiene by clinicians. 8,41 Osland et al recommended following the manufacturers' guidelines for the duration of equipment use, including cleansing and drying time. 14 Their systematic review found variability in reuse practices for enteral feeding equipment in the outpatient setting.…”

Section: Potential For Gi Tract Contaminationmentioning

confidence: 99%

“…5 Bacterial transmission to the gastrointestinal (GI) tract has been linked to contaminated medical devices, such as enteral feeding sets and poor hand hygiene. [7][8][9] GI infections have also been linked to bacterial biofilm that forms inside of feeding tubes within 24 h, although research has been mostly limited to the neonatal population. 10,11 Although enteral feeding is known to alter the gut microbiota, 12,13 few studies have examined the impact of feeding tubes on specific microbial composition changes, 14 and none reported on reusable feeding tube stylets.…”

Section: Introductionmentioning

confidence: 99%

“…Gut translocation is often caused by Enterococcus or Streptococcus 5 . Bacterial transmission to the gastrointestinal (GI) tract has been linked to contaminated medical devices, such as enteral feeding sets and poor hand hygiene 7–9 . GI infections have also been linked to bacterial biofilm that forms inside of feeding tubes within 24 h, although research has been mostly limited to the neonatal population 10,11 …”

Section: Introductionmentioning

confidence: 99%

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Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

et al. 2022

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Background Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof‐of‐concept study aimed to identify potential microbial contamination of stylets before and after cleansing with 70% isopropyl alcohol to establish practice standards. Methods This prospective, exploratory pilot study sampled reusable feeding tube stylets using three different stylet sample sets. Set 1 included human participant stylets sampled for microbiome profile precleansing, and postcleansing and reinsertion into feeding tubes (n = 4). Sets 2 and 3 included stylets stored at the bedside. Set 2 included precleansed stylets for microbiome profiles (n = 5). Set 3 included precleansed and postcleansed stylets sampled for quantitative cultures (n = 5). Careful handling and storage protocols were used. Microbiome profiling used 16s ribosomal RNA gene amplicon sequencing. Results Bacterial species identified on stylets were primarily common microflora and opportunistic pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas fulva, Cutibacterium acnes, Prevotella melaninogenica, and Lactobacillus paracasei. Microbiological culturing of stylet samples (set 3) did not yield growth for 9/10 samples; Staphylococcus capitis was identified in one postcleansed sample. Mean bacterial species diversity (alpha diversity) decreased following alcohol cleansing (M = 2.54 pre, M = 1.5 post; P = 0.006). Conclusion The abundance of several potentially opportunistic pathogens indicated plausible risk for gut contamination secondary to reinsertion of stylets into small‐bore feeding tubes. Stylet cleansing with 70% isopropyl alcohol reduced bacterial burden on the stylets, although viability was unknown. Careful cleansing, handling, and storage protocols for reusable stylets are necessary to minimize contamination.

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Section: Discussionmentioning

confidence: 99%

Section: Potential For Gi Tract Contaminationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

et al. 2022

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“…Although there is a lack of robust evidence supporting water as a method of cleaning, it is recommended to rinse administration sets to help clear debris and to prevent mechanical obstructions. Lyman et al compared cleaning methods of pump feeding bags between uses, which tested (1) cleaning with sterile water, (2) refrigerating the bag between feedings, and (3) ready‐to‐hang (RTH) bags for bacterial growth 1 . RTH formula had the least bacterial growth; however, all three showed low bacterial growth overall.…”

Section: Section 1: Practice Recommendations For General Use Of Btfmentioning

confidence: 99%

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition

Epp,

Blackmer,

Church

et al. 2023

Nut in Clin Prac

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Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022–2023 Board of Directors.

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Revisiting the Evidence for the Reuse of Enteral Feeding Equipment in Ambulatory Patients: A Systematic Review

et al. 2020

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Background The reuse of enteral tube feeding (ETF) equipment is not recommended due to the risk of microbial contamination and subsequent risk of infection; however, this practice continues in many ambulatory settings. A systematic review of the literature was undertaken to review the evidence underpinning the cleaning and reuse of ETF equipment. Methods Studies that investigated the reuse, decontamination, and/or cleaning of ETF equipment were considered for inclusion. Electronic databases were searched (no limits were placed on date of publication, age, or duration of reuse). Extracted data were assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses recommendations. Results Ten studies met inclusion criteria: 3 investigated changes to clinical outcomes with extending reuse from 24 to ≤72 hours using water rinses; 5 considered the efficacy of various cleaning methods assessed in laboratory conditions; 2 used a combination of both approaches. Sufficient data to allow GRADE assessment was found only for bottle‐type containers. Conclusions A very low level of evidence supports the cleaning and reuse of rigid and "unspecified" bottle containers; no studies were found to inform the reuse of syringes used for bolus feeding or any equipment used for water infusion or flushes. There is an absence of literature evaluating the safety and clinical outcomes of cleaning and reusing ETF equipment, and research is required to support equipment reuse.

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Enteral Feeding Set Handling Techniques

Cited by 10 publications

References 23 publications

Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition

Revisiting the Evidence for the Reuse of Enteral Feeding Equipment in Ambulatory Patients: A Systematic Review

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