Ascending contamination of a jejunostomy feeding reservoir

Alsenoy, Lauren Van; Leeuw, I. De; Delvigne, C; Woude, M. Van De

doi:10.1016/0261-5614(85)90050-0

Cited by 17 publications

(7 citation statements)

References 12 publications

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“…There are now numerous reports of infectious et 1981; L~~ et 1989; Thurn et complications in patients following the admin-istration of enteral feeds contaminated by bacteria (Pottecher et al, 1979; Casewell have been reported to be exogenous. However, the possibility of endogenous contamination of feeds was suggested in a case report by Van Alsenoy et al (1985) when they found that organisms from a patient's upper gastrointestinal tract appeared to have spread in a retrograde manner via the jejunostomy tube up the giving set into the nutrient feedingbag. This conflicted with the studies by Schreiner et al (1979) and Schroeder et al (1983) which demonstrated that endogenous bacteria did not travel up the feeding tube.…”

Section: Introductionmentioning

confidence: 70%

“…This conflicted with the studies by Schreiner et al (1979) and Schroeder et al (1983) which demonstrated that endogenous bacteria did not travel up the feeding tube. Van Alsenoy et al (1985) suggested that these conflicting results may relate to the use of fine bore nasogastric tubes by Schreiner et al (1979) and Schroeder et al (1983) whereas in their study a broad lumen catheter was used. Subsequently Elston-Hurdle et al (1989) reported that reservoir bags remained free from bacterial contamination for at least 24 h in 58 in vivo and 20 in vitro systems.…”

Section: Introductionmentioning

confidence: 70%

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Endogenous bacterial contamination of enteral tube feeding systems during administration of feeds to hospital patients

McKinlay

Anderton

Wood

et al. 1995

J Human Nutrition Diet

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The use of sterile, prepackaged enteral feeds has helped to reduce the risk of exogenous microbial contamination of enteral feeds but there is increasing evidence that endogenous contamination with bacteria from the patient's own flora may occur. The purpose of this study was to compare the levels and types of micro‐organisms present in residual feed in nutrient containers and giving sets when either 500 or 1000 ml prefilled, ready‐to‐hang nutrient containers were used to administer 1000 and 2000 ml quantities of feed to patients on hospital wards over 24 h using a single giving set over this period. Forty‐one adult patients were randomly allocated to receive either 1000 or 2000 ml of sterile undiluted, whole protein feed over 24 h from 1000 ml prefilled containers (Nutrison Steriflo, Cow and Gate Nutricia Ltd) or from 500 ml prefilled bottles (Osmolite, Abbott Laboratories Ltd). One giving set was used over 24 h for each patient. Samples of feed from the nutrient containers and the distal end of each giving set were sent for microbiological analysis immediately after removal from the patient. Control experiments demonstrated that there were no micro‐organisms in the unopened feed containers and that none was introduced during the feed sampling procedure. The percentage of days on which feed samples from the nutrient containers were contaminated was $lt; 10% for feeds administered at a rate of 1000 ml over 24 h and $lt; 23% for those administered at a rate of 2000 ml over 24 h irrespective of system, which may be attributed to increased handling of systems and reuse of the giving set. However, the percentage of days on which samples from the giving sets were contaminated was 43% for all systems. In fact, on an average of 33% of days it was found that the only feed sample that was contaminated was that collected from the giving set. Counts for these samples were $lt;103 cfu/ml and the main bacteria isolated included Klebsiella spp., Enterobacter spp., Escherichia coli, Streptococcus faecalis and Pseudomonas aeruginosa. These results further implicate retrograde spread of the patient's own flora as a possible source of microbial contamination of feed in the giving sets of enteral feeding systems.

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Section: Introductionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 70%

Endogenous bacterial contamination of enteral tube feeding systems during administration of feeds to hospital patients

McKinlay

Anderton

Wood

et al. 1995

J Human Nutrition Diet

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“…(1979 ) and Schroeder et al . (1983 ) demonstrated that endogenous bacteria did not travel from the gastrointestinal tract of patients up the feeding tube and into the feeding system, however, several other authors have reported that retrograde contamination of the feeding system does occur ( Van Alsenoy. et al ., 1985 ; Payne‐James et al ., 1992 ; McKinlay.…”

Section: Introductionmentioning

confidence: 99%

“…(1983 ) had previously demonstrated that bacteria did not travel up the feeding tube. Van Alsenoy. et al .…”

Section: Introductionmentioning

confidence: 99%

Enteral feeding tube guidewire—another factor in the retrograde contamination of enteral feeding systems?

Beattie

Anderton

1998

J Human Nutrition Diet

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Background: In vitro enteral feeding systems were used to investigate the effect that withdrawal of the guidewire from the feeding tube has on bacteria ascending from a patients’ stomach or intestine via the feeding tube to the giving set and nutrient container of the feeding system. Methods: Enteral feeding systems were assembled with the feeding tube running into nutrient broth contaminated with Klebsiella aerogenes. The enteral feeding tubes were held in different orientations (horizontal and vertical) to examine the effect in both prostrate and ambulant patients. The guidewire was removed either prior to or after the enteral feeding tube had been inserted into the K. aerogenes broth. Feed was then run through the systems for 24 h, with feed samples being collected from the distal (patient) end of the giving set at 0 and 24 h. Results: After 24 h, 103–108 c.f.u. (colony forming units) K. aerogenes/ml were detected in feed samples taken from the distal end of the giving set in systems where the guidewire had been removed after the enteral feeding tube had been inserted into the contaminated broth (both orientations), but K. aerogenes was not detected in samples from systems in which the guidewire had been removed before the end of the tube was inserted into the broth (both orientations). However, when the latter feed samples were enriched (i.e. incubated at 37 °C for a further 24 h to detect if very low levels of bacteria were present in the original sample), 40% of samples from systems with horizontally orientated tubes, and 20% from systems with vertically orientated tubes were positive for the test organism. K. aerogenes was not detected in any samples of feed taken from the nutrient container or just below the drip chamber. Conclusion: The results demonstrate: (i) that bacteria ascend the feeding tube over a 24‐h period (retrograde contamination) and (ii) removal of the guidewire can contribute to the colonization of the lumen of the feeding tube and distal end of the giving set with bacteria from a patients’ own flora.

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“…Water, nevertheless, is an essential requirement for microbial proliferation, 29 and although no study has yet assessed this, it seems reasonable to assume that equipment used for water administration may become contaminated with feed product and/or environmental bacteria through handling and during repeated connection to feeding tubes. This is even more feasible when considering that colonization of endogenous bacteria from nasogastric and gastrostomy tubes is an established method of contamination 30–34 . It remains unclear whether the extended reuse of feeding equipment used for water administration can be assumed to be free from risk, and studies to assess microbial contamination with current reuse practices are required.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background The reuse of enteral tube feeding (ETF) equipment is not recommended due to the risk of microbial contamination and subsequent risk of infection; however, this practice continues in many ambulatory settings. A systematic review of the literature was undertaken to review the evidence underpinning the cleaning and reuse of ETF equipment. Methods Studies that investigated the reuse, decontamination, and/or cleaning of ETF equipment were considered for inclusion. Electronic databases were searched (no limits were placed on date of publication, age, or duration of reuse). Extracted data were assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses recommendations. Results Ten studies met inclusion criteria: 3 investigated changes to clinical outcomes with extending reuse from 24 to ≤72 hours using water rinses; 5 considered the efficacy of various cleaning methods assessed in laboratory conditions; 2 used a combination of both approaches. Sufficient data to allow GRADE assessment was found only for bottle‐type containers. Conclusions A very low level of evidence supports the cleaning and reuse of rigid and "unspecified" bottle containers; no studies were found to inform the reuse of syringes used for bolus feeding or any equipment used for water infusion or flushes. There is an absence of literature evaluating the safety and clinical outcomes of cleaning and reusing ETF equipment, and research is required to support equipment reuse.

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Ascending contamination of a jejunostomy feeding reservoir

Cited by 17 publications

References 12 publications

Endogenous bacterial contamination of enteral tube feeding systems during administration of feeds to hospital patients

Endogenous bacterial contamination of enteral tube feeding systems during administration of feeds to hospital patients

Enteral feeding tube guidewire—another factor in the retrograde contamination of enteral feeding systems?

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

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