Low risk for microbial contamination of syringe and tube feeding bag surfaces after multiple reuses with home blenderized tube feeding

BackgroundEnteral tube feeding can require considerable amounts of plastic equipment including delivery sets and containers, often disposed of after a single feeding session because of bacterial contamination concerns. The aim of this research was to assess whether reuse of delivery sets and containers for up to 24 h is safe from a microbiological perspective.MethodsFour enteral tube feeding systems (FS) were tested under hygienic controlled or repeated inoculation challenge conditions using key foodborne pathogens, to assess bacterial growth over time (FS1: ready‐to‐hang, closed 1‐L system with delivery set reused, stored at room temperature [RT]; FS2: a prepared, powdered, open 1‐L system with delivery set and container reused, stored at RT; FS3 and FS4: prepared, powdered, open 200‐ml bolus systems with delivery set and container reused, stored at RT [FS3] and refrigeration [FS4]). Feed samples were cultured at 0.5, 6.5, 12.5, 18.5, and 24.5 h with >2 Δlog considered significant bacterial growth.ResultsUnder hygienic control, FS1, FS3, and FS4 were below the level of enumeration (<5 CFU/g) for all bacteria tested, at all time points. In FS2, significant bacterial growth was observed from 18.5 h. Under repeated bacterial inoculation challenge, no significant growth was observed in FS1 and FS4 over 24.5 h; however, significant growth was observed in FS2 after 6.5 h and in FS3 after 10–12 h.ConclusionWith hygienic handling technique, there is limited bacterial growth with reuse of delivery sets and containers over 24 h. Refrigeration between feeding sessions and using boluses of reconstituted powdered feed reduce bacterial growth risk.

Section: Challenge Bacteria Fs1 Fs2mentioning

confidence: 99%

Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours

Hubbard,

Van Wyk,

Grinyer

et al. 2023

“…3,15 Materials, such as bottles, syringes, and feeding bags, for enteral nutrition can be used to administer the formulations. 1,13,16 At home, enteral formulations are administered mainly in an open system, with the formulations being poured into rigid enteral nutrition bottles. 1,9,11 The closed system, with the use of ready-to-hang liquid and sterile CEFs, is most recommended, as it does not require prior handling and presents a lower risk of contamination.…”

Section: Introductionmentioning

confidence: 99%

“…1,9,11 The closed system, with the use of ready-to-hang liquid and sterile CEFs, is most recommended, as it does not require prior handling and presents a lower risk of contamination. 1,4 However, this system makes it difficult to individualize the dietary prescription and does not correspond to the reality experienced in the households of several developing countries, such as Brazil, 9,14,16 as it represents an expensive and difficult alternative for patients, especially those with low income. [17][18][19] Thus, the open administration system, especially with the use of HEPs and BEPs, remains a viable alternative for patients who require this type of nutrition care.…”

Section: Introductionmentioning

confidence: 99%

“…7,20,21 Although the open administration system is cheaper, it still comes at a high cost for families who need to purchase bottling materials, which are usually single-use, as recommended by manufacturers. 1,16,22 In this regard, studies have sought to assess the risk of contamination associated with the hygiene procedures and reuse of materials for bottling enteral formulations, 16,[23][24][25] although there are analyses in the literature concerning the risk of contamination in the different categories of enteral formulations during the home-handling process. 8,9,14,26,27 Therefore, this study aimed to assess the risk of microbiological contamination of enteral nutrition bottles by simulating the reality of home use conditions and hygiene procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Enteral formulations can be infused by bolus, by infusion pump, or through the gravitational method 3,15 . Materials, such as bottles, syringes, and feeding bags, for enteral nutrition can be used to administer the formulations 1,13,16 . At home, enteral formulations are administered mainly in an open system, with the formulations being poured into rigid enteral nutrition bottles 1,9,11 …”

Section: Introductionmentioning

confidence: 99%

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Assessment of the risk of contamination of enteral nutrition bottles based on the simulation of home use conditions and hygiene procedures

da Silva,

Medeiros,

Leobet

et al. 2024

BackgroundHome‐prepared enteral formulations are supplied to patients through enteral nutrition bottles, via a gravity bag or other container, which may be inadequately sanitized and reused more times than recommended by the manufacturer. Such procedures increase the risk of contamination and can compromise the patient's clinical outcome. In light of this, the present study aimed to assess the risk of contamination of enteral nutrition bottles by simulating home use conditions and hygiene procedures.MethodsA simulation of bottle usage was conducted across the three categories of enteral nutrition (homemade enteral preparations, blended enteral preparations, and commercial enteral formulas) for 3 days, using three hygiene procedures reported by caregivers: use of detergent (DET); use of detergent and boiling water (DET+BW); and use of detergent and bleach (DET+BL). The microbiological contamination was determined by the analysis of aerobic mesophilic microorganisms.ResultsThe bottles that were used for 3 days, regardless of the enteral nutrition category, were within the acceptable limit for aerobic mesophilic microorganisms (between <4 and 8.0 colony‐forming units [CFU]/cm2) when sanitized using the DET+BW and DET+BL procedures. The enteral nutrition bottles, when cleaned using the DET procedure during the 3 days of usage, showed low microbial contamination (between <4 and 3.0 CFU/cm2) in blended preparation and commercial formula only.ConclusionThus, regardless of the enteral nutrition category, we found that the bottles can be used for 3 days, as long as the DET+BW or DET+BL hygiene procedure is applied and safe food handling measures are adopted.

Comparison of microbiological loads of enteral products at two different ambient room temperatures

Yıldız Ilıman,

Yurttaş,

Ergül

et al. 2024

BackgroundDespite the high risk of bacterial contamination, no studies have been found that evaluate the optimal hanging time of open‐system enteral sets under room temperature and intensive care conditions. This study aims to determine the differences in microbial loads of solutions taken from open‐system enteral feeding sets hanging for 24 h under room temperature and intensive care conditions.MethodsThis study is a descriptive type of research. The study sample consisted of a total of 40 samples, with 20 samples under room temperature (25.2–23.3°C) and 20 samples under intensive care conditions (21.1–24.2°C). A simple random sampling method was used for sample selection. The assessment of microbial quality was based on the US Food and Drug Administration online Bacteriological Analytical Manual.ResultsIn this study, it was determined that 5% of the samples taken from intensive care and 15% of the samples taken at room temperature exceeded the accepted limit for aerobic mesophilic bacteria count. The count of catalase and coagulase‐negative Staphylococcus spp was 5% in intensive care samples and 40% in room temperature samples. The total coliform count was not detected in intensive care samples but was 35% in room temperature samples. Escherichia coli was not detected in either group.ConclusionDifferences in microbial loads were observed when commercial enteral solutions were administered using open‐system enteral feeding sets under room and intensive care conditions for 24 h. Therefore, large‐scale studies are needed to determine the safe use of open‐system enteral feeding sets under room temperature conditions.