Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil

Adegboye

et al. 2020

IJERPH

The use of blenderised enteral nutrition formula (ENF) is on the increase globally. However, concerns remain regarding the microbial quality and safety of blenderised ENF compared with standard recommendations and commercial ENF. Aim: This was a systematic review which sought to compare the microbial quality of blenderised ENF and commercial ENF and to evaluate the effect of storage time on blenderised ENF. Method: Four databases (Pubmed, EMBASE, PSYCInfo and Google scholar) were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes framework. Results: Eleven studies which met the criteria were included in the systematic review. Two major areas were identified; Microbial Quality of Blenderised ENF versus Commercial ENF; and The Effect of Storage Time on Microbial Quality of Blenderised ENF. Overall, 72.7% of the studies showed microbial contamination in blenderised ENF compared with 57.1% of commercial ENF, and the storage time was another important factor in the rates of contamination. The extent of handling or manipulation of the enteral formula was critical in determining the level of contamination. Conclusion: Preparation techniques for blenderised ENF need to be established and caregivers taught how to prepare and administer it appropriately in order to reduce contamination. Further, well-designed studies are required, which compare the microbial quality of blenderised ENF using adequate handling techniques and commercial ENF.

Section: Resultsmentioning

confidence: 99%

“…In the study by Pinto et al [ 36 ], the two types of enteral feeds showed contamination by coliforms and Pseudomonas spp. although there was no positive sample for Staphylococcus aureus and Salmonella spp.…”

Section: Resultsmentioning

confidence: 99%

The Microbial Quality and Safety of Blenderised Enteral Nutrition Formula: A Systematic Review

Adegboye

et al. 2020

IJERPH

“…Hospital kitchen appears to be a source of food contamination and occurrence of foodborne outbreaks in hospitalized patients in different countries (16)(17)(18)(19). Utensils, such as industrial blender and meat grinder, regardless of the contamination of raw food materials, could be the sources of pathogenic bacteria, because their cleaning and disinfection cannot accompany completely due to their designed structure (20,21).…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Molecular Diversity, and Antimicrobial Resistance Patterns of Pathogenic Bacteria Isolated From Medical Foods, Food Staff, Cooking Instruments, and Clinical Samples in a Teaching Hospital in Tehran, Iran

Gholam-Mostafaei

Alebouyeh

Zali

2017

Arch Clin Infect Dis

Background: Medical foods could be vehicles of pathogenic microbes for vulnerable people in the hospitals. Hospital kitchen is considered as the main source of this cross-contamination. Objectives: The current study aimed at investigating the frequency of bacterial species and their antimicrobial resistance patterns in foods, food handlers, and utensils compared with those of the clinical isolates in a hospital kitchen in Tehran, Iran. Methods: This cross sectional study was performed in a hospital in Tehran, Iran from April 2011 to January 2013. Accordingly, simple random sampling of raw and cooked food materials, swab samples of cooking utensils, and hands and noses of food staff were done. Clinical samples were collected from blood, urine, wound, and respiratory aspirates of patients with hospital acquired infections. Bacterial isolates were identified according to biochemical standard identification schema. Antimicrobial susceptibility of the strains was determined by disk diffusion method according to the CLSI (the clinical and laboratory standards institute) guidelines. Molecular diversity of indicator bacterial isolates of Staphylococcus aureus and Escherichia coli in the kitchen and those of the isolated ones from intensive care unit were also investigated by molecular typing method. The occurrence of cross-contamination was hypothesized based on the results of phylogenetic investigation and resistance biotyping. Results: Out of the 200 kitchen samples, S. aureus, E. coli, Acinetobacter spp., Pseudomonas spp., and Enterococcus spp. were isolated in frequencies of 15.5%, 8%, 2.5%, 0.5%, and 0.5%, respectively. Prevalence of multidrug resistant-methicillin resistant strains of S. aureus (MDR-MRSA) in the samples of the hospital kitchen vs the intensive care unit (ICU) was 18.7% (6/32), compared with 91.6% (22/24), respectively. Among the kitchen E. coli isolates, MDR pattern was detected in a frequency of 52.9%; the highest frequency was detected among the isolates of utensils. Although the results of the phylogenetic and resistance biotyping analyses did not confirm significant relationship between the isolates of the ICU and hospital kitchen, this similarity was confirmed among the strains isolated from the foods, food handlers, and utensils. In this regard, food staff and utensils were considered as the main sources of cross-contamination for S. aureus and E. coli, respectively. Conclusions: Weak health conditions of food workers and inadequate cooking to eliminate the contaminants during food processing were postulated as the main risk factors for transmission of these bacteria, through medical foods. into hospital.

“…In fact, pH may influence the growth of pathogenic microorganisms and their deterioration in handmade enteral diets (Silvia et al, 2007). Rates close to neutrality (6.5 to 7.5) are more favorable for the growth of most of them (Von Atzingen et al, 2007;Pinto et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Its analysis is important to assess the physiological acceptance capability of the diet and to avoid complications (Barrett et al, 2009 by providing a solubility environment to the nutrients. It is also crucial for the microbiological control of the solution (Klang et al, 2013;Pinto et al, 2015). Non-industrialized enteral diets with a pH rate favorable to microbiological growth may be an infection vector for patients undergoing enteral nutritional therapy if preventive hygiene measures are not applied during food handling (Blumenstein et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Osmolality and pH in handmade enteral diets used in domiciliary enteral nutritional therapy

et al. 2017

Patients who need prolonged domiciliary enteral nutritional therapy may benefit from handmade diets. However, the preparation of such diets might cause insecurity with regard to their nutritional composition and physical-chemical properties. Current study analyzes the osmolality and Hydrogen-Ion concentration (pH) on handmade enteral diets. To this purpose, six formulas and two juices, prescribed on discharge from hospital, were analyzed physically and chemically. Dsmolality and pH were respectively determined by cryoscopy and potentiometry. Most formulations were classified as isosmolar (with less than 400 mDsm/kg solvent), and only one was classified as slightly hyperosmolar, with rates ranging from 356.7 to 403.5 mDsm/kg solvent. Dn average, the standard formula presented higher osmolality than similar ones prepared for hyperglycemia. Among the juices, only one registered hyperosmolar concentration of 595.54 mDsm/kg solvent. All formulas presented pH rates classified as low acidity, ranging between 6.1 and 6.6, while the two juices had the lowest results, 4.73 and 4.66 each. The blend of ingredients used in handmade formulas and juices studied presented acceptable osmolality and pH rates for a safe administration and absence of gastrointestinal complications. Data showed here are consistent with an appropriate and healthy diet and contributed towards success in domiciliary enteral nutritional therapy.