Enteral tube feeding: using good practice to prevent infection

Abstract

Enteral tube feeding is the delivery of nutritionally complete feed via a tube into the gut. It is used for patients who are unable to meet their nutritional needs orally. Enteral feeding can be given through a variety of different tubes that access the gastrointestinal tract either via the stomach or the small bowel. The contamination of enteral feed can often be overlooked as a source of bacterial infection. Enteral feeds can become contaminated in a variety of different ways. Most often infections result in extended lengths of stay in hospital and patients also need additional therapies and treatments in order to resolve these infections. Healthcare-associated infections not only affect the patients who acquire them but also have an impact on the staff involved in their care. Each acute trust will have its own local policies and guidelines regarding enteral feeding and infection control and prevention. These local documents will be based on national initiatives and guidelines. It is important for nurses to refer to their local policies and guidelines before they start a patient on enteral feeding to ensure that they are doing so in the safest manner possible. Nurses' practice is key to preventing bacterial contamination in such patients.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

“…These errors may not sound as serious as drug administration errors, for example, however the effects of such misconducts can be very serious to patients. (289,290) The reuse of devices may affect their integrity and increase the likelihood of bacterial contamination. (290) Another product that must be used only once is the syringe used to flush catheters.…”

“…(289,290) The reuse of devices may affect their integrity and increase the likelihood of bacterial contamination. (290) Another product that must be used only once is the syringe used to flush catheters. If syringes must be reused, they must be washed right after use with soap and water.…”

“…There are multiple ways EN can be contaminated in a hospital, home or clinic, such as: (290) -Poor hand washing: lack of hand washing can lead to contamination of enteral nutrition, tube, system, and EN container. (290) -Inadequate cleaning of reusable devices during and after use: the system and the infusion pump must be kept clean while in use, and completely cleaned after feeding is completed. (287) -Inadequate installation of enteral feeding: handling of the catheter and container without the appropriate technique.…”

“…(288,291) The expertise of the nurse is vital to prevent bacterial contamination in enteral nutrition. (290) Training of the nursing staff on proper handling procedures and enteral nutrition einstein (São Paulo). 2020;18:1-50 SGA: Subjective Global Assessment; PG-SGA: Patient-Generated Subjective Global Assessment; RDA: Recommended Daily Allowance; ONT: oral nutrition therapy; EN: enteral nutrition; GVHD: graft-versus-host disease; PNT: parenteral nutrition therapy.…”

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

“…Enteral tube feeding (ETF) has historically been considered a potential source of infection due to the risk of bacterial contamination of feed products and administration equipment 1–3 . Although closed feeding systems using sterile ready‐to‐hang (RTH) feeding products have been recommended and widely adopted in recent decades for their superior microbial safety, 4–6 the older‐style open feeding systems remain in use in many areas of clinical nutrition practice.…”