Application of Hazard Analysis Critical Control Points system to enteral tube feeding in hospital

Abstract

An HACCP system was implemented for the quality assurance of preparation, storage and delivery of enteral feeds to patients in hospital. Routine methods of feed preparation, storage and delivery to patients were studied and a flow chart was initially made. After identifying hazards, an HACCP team was assembled, a flow chart was modified and critical control points were defined using a decision tree. Control measures for each step of the process and its monitoring and corrective measures to be applied were also defined. In addition, feed samples were analysed for microbiological quality and feed storage temperatures were also recorded, before and after the implementation of the HACCP system. When the control measures were applied and monitored, the hazard was reduced. Bacterial counts in feed were reduced from 105 cfu mL-1 to < 101 cfu mL-1. The results show that contamination of enteral feed may be reduced or eliminated if a systematic approach such as HACCP is applied effectively.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…Hospital‐prepared EN poses the risk for foodborne illness or nosocomial infection 38 , 53 , 54 . Blenders used in reconstituting formulas have been cited as a primary source of contamination 55 . Diluting formula hung for a period of time is no longer recommended because additions to the EN system increase risk of microbial growth.…”

A.S.P.E.N. Enteral Nutrition Practice Recommendations

“…The Hazard Analysis Critical Care Points (HACCP) system has been used to identify significant safety problems in EN administration as well as to highlight implementation of corrective practices. [67][68][69] Administration set hang time was increased from 4 hours to 8 hours following the results of a well-designed study of several EN formulas including a modular product, without a significant increase in microbial contamination, provided that the bag contained no more than a 4-hour amount of formula. 57 Even when EN formulas in cans are administered, quality control mechanisms are important.…”

Dietas enterais não industrializadas: análise microbiológica e verificação de boas práticas de preparação

“…Nesta pesquisa, com relação ao número de coliformes a 35ºC, três amostras do hospital HS estavam contaminadas com índices acima do padrão microbiológico definido 10 e, mesmo não havendo padrão para esse microrganismo nas dietas elaboradas nos hospitais HS e HP, ao analisá-los, encontrou-se contaminação em todas as amostras (Tabela 3), o que vem a corroborar os achados de Anderson et al 16 , ao relatarem contagens de coliformes totais (10 3 -10 5 UFC/mL) acima dos limites estabelecidos para o leite pasteurizado, em dietas preparadas nas cozinhas hospitalares. Também Oliveira et al 17 , em estudo realizado em hospitais de Governador Valadares (MG), encontraram em dietas não industrializadas em pó, valores de contaminação por coliformes totais acima de 10 4 UFC/mL. Igualmente, a pesquisa realizada por Carvalho et al 18 , resultou em 38,3% das dietas enterais contaminadas por coliformes totais logo após a manipulação, sendo que após 24h do término da administração das mesmas uma nova análise do material armazenado resultou em aumento da porcentagem para 44,7%.…”