Home‐Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler

Abstract

Background Little is known about the risk to patients’ health when using home‐prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home‐prepared enteral tube feeding and explore associations between those differences and food handlers’ characteristics. Methods We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire. Results 82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony‐forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase‐positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home‐prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables “monthly family income” and “food training.” Conclusion Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Microbiological quality of enteral formulations handled at home: A systematic review

“…6,11 Patients receiving HEN use three types of formulations: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). 12 These formulations differ according to their composition. Some preparations only contain food; blended preparations contain food and added nutrients; and commercial formulas, which are chemically defined, are either ready for consumption or are reconstituted with water.…”

“…18 The main factors responsible for contamination are the quality of the raw materials, the quality of water used for dilution, the hygiene conditions of the environment and of the handlers, and the method of administration. 12,16,19 Despite the aforementioned evidence, little is known about the risk of bacterial contamination when comparing different types of enteral formulations prepared at home. However, the administration of contaminated enteral formulations can compromise the patient's clinical evolution, particularly if the patient is in a fragile condition and more susceptible to gastrointestinal disorders, such as nausea, vomiting, and diarrhea.…”

“…5 Hence, bearing in mind the benefits of HEN for patients, as well as the risks of the contamination of enteral formulations in relation to patient health outcomes, it is necessary to evaluate the levels of microbiological contamination present in home-prepared enteral formulations to be aware of the reality of the existing situation and also to establish appropriate guidelines for those responsible for preparing these formulations. 12 In addition, knowing the microbiological quality of different enteral formulations in HEN can help professionals make the most appropriate decisions and choices regarding nutrition therapy and also to counsel and train food handlers. Clinical, social, and health factors are all relevant when aiming for a better quality of life and safety for patients.…”

Macronutrients and energy in home‐prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis

“…8 Home EN patients can use three categories of enteral formulations, which are classified according to their composition as follows: homemade enteral preparations (HEPs), which are made from food; blended enteral preparations (BEPs), which are made from food preparations with added commercial enteral formulas (CEFs) or isolated nutrient modules; and CEF that is either ready for consumption or can be consumed after reconstitution with water. [9][10][11] These enteral formulations should provide adequate nutrition support to maintain or restore the nutrition status of patients receiving home EN. 12 For dietary prescription and the calculation of the patient's nutrition needs, food composition tables and/or the nutrition information available on labels can be consulted.…”

“…When choosing home EN, discussions should include any concerns about factors such as the patient's underlying diseases, the likelihood of tolerating feeding based on absorptive capacity, the method of administration, and any plans to meet energy and nutrition needs 8 . Home EN patients can use three categories of enteral formulations, which are classified according to their composition as follows: homemade enteral preparations (HEPs), which are made from food; blended enteral preparations (BEPs), which are made from food preparations with added commercial enteral formulas (CEFs) or isolated nutrient modules; and CEF that is either ready for consumption or can be consumed after reconstitution with water 9–11 . These enteral formulations should provide adequate nutrition support to maintain or restore the nutrition status of patients receiving home EN 12 …”