Microbial Contamination of Enteral Feeding Products in Thermoneutral and Hyperthermal ICU Environments

Abstract

CFUs in enteral formula did not differ between open and closed feeding systems in either environment for up to 8 hours; however, the addition of modulars to open systems may result in an unacceptable risk of contamination in hyperthermal environments.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…Between 0% and 57% of enteral formulas prepared in the hospital and over 80% of those prepared in the home have been found to be contaminated with bacteria 39 , 67 . ‐ 69 EN preparation may include the mixing, reconstitution, or dilution of modular products and formula with sterile water, and/or pouring the formula into an administration container. The sterility of the commercially available liquid EN products, as well as that of the sterile bags and administration sets, is disrupted by any manipulation, which increases the risk for contamination.…”

“…Perry and colleagues 57 compared closed EN systems with open systems and open systems with modular additives in a critical care burn unit. No microbial growth was found in closed and open systems in the thermoneutral and hyperthermal critical care, nonpatient environment, although humidity was not reported.…”

Microbial Contamination of Enteral Nutrition Mixtures in a Hyperthermal Environment

“…We read with interest the report by Perry et al 1 entitled “Microbial Contamination of Enteral Products in Thermoneutral and Hyperthermal ICU Environments.” Burn intensive care units (BICUs) provide a unique environment in which room temperatures are commonly maintained at ≥32°C (≥90°F). The microbial burden of enteral nutrition (EN) has not been previously examined in hyperthermal environments.…”

“…A limitation acknowledged by Perry et al 1 was that the species of contaminating bacteria were not determined. In addition, the batch of MTF prepared for the hyperthermal environment had greater contamination at baseline (2.6 log CFU/mL) compared with the MTF batch prepared for standard room temperature sampling (1.0 log CFU/mL).…”

“…No clinical illness has heretofore been ascribed to EN practices at the U.S. Army Institute of Surgical Research Burn Center. Based on the findings reported by Perry et al, 1 MTF supplementation at the U.S. Army Institute of Surgical Research Burn Center was suspended, pending further evaluation. To further explore risks associated with this practice, we designed a study to determine the incidence of contamination exceeding 4.0 log CFU/mL following mock‐clinical preparation practices, identify the contaminating bacterial species, and, if applicable, localize and mitigate any sources of contamination.…”