Is a 24-h cyclic closed enteral feeding system microbiologically safe in geriatric patients?

Lafourcade, P.; Boulestreau, H.; Arnaud-Battandier, F; Rogues, Anne-Marie; Texier-Maugein, J; Pinganaud, G.; Bourdel-Marchasson, I.

doi:10.1054/clnu.2002.0545

Cited by 6 publications

(10 citation statements)

References 29 publications

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“…Commercially available ''ready to hang'' closed enteral feeding systems are designed to limit handling procedures to the introduction of the giving set spike into the pack. Although this may reduce the risk of microbiological contamination resulting from poor handling procedures before feeding, retrograde contamination of the set may occur, the risk of contamination increasing with duration of feed (114). Ongoing training of ward staff and careful instruction of home caregivers by specialist nurses is an additional important component in reducing bacterial contamination.…”

Section: Bacterial Contamination Of Feedsmentioning

confidence: 99%

Practical Approach to Paediatric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition

Braegger

Décsi

Dias

et al. 2010

J. pediatr. gastroenterol. nutr.

250

254

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Enteral nutrition support (ENS) involves both the delivery of nutrients via feeding tubes and the provision of specialised oral nutritional supplements. ENS is indicated in a patient with at least a partially functioning digestive tract when oral intake is inadequate or intake of normal food is inappropriate to meet the patients' needs. The aim of this comment by the Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition is to provide a clinical practice guide to ENS, based on the available evidence and the clinical expertise of the authors. Statements and recommendations are presented, and future research needs highlighted, with a particular emphasis placed on a practical approach to ENS.Among the wide array of enteral formulations, standard polymeric feeds based on cow's-milk protein with fibre and age adapted for energy and nutrient content are suitable for most paediatric patients. Whenever possible, intragastric is preferred to postpyloric delivery of nutrients, and intermittent feeding is preferred to continuous feeding because it is more physiological. An anticipated duration of enteral nutrition (EN) exceeding 4 to 6 weeks is an indication for gastrostomy or enterostomy. Among the various gastrostomy techniques available, percutaneous endoscopic gastrostomy is currently the first option. In general, both patients and caregivers express satisfaction with this procedure, although it is associated with a number of well-recognised complications. We strongly recommend the development and application of procedural protocols that include scrupulous attention to hygiene, as well as regular monitoring by a multidisciplinary nutrition support team to minimise the risk of EN-associated complications.

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Section: Bacterial Contamination Of Feedsmentioning

confidence: 99%

Practical Approach to Paediatric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition

Braegger

Décsi

Dias

et al. 2010

J. pediatr. gastroenterol. nutr.

250

254

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“…Other approaches that can be potentially effective in the management of complications and reducing the rates of infections are reducing the time of exposure to the different sources of contamination, like reducing the time of exposure after opening the formula and decreasing feeding hang time. 33 Other common complications that were reported in these settings might also include the development of mechanical complications.…”

Section: Discussionmentioning

confidence: 99%

Indications and long-term results of enteral feeding in infancy and childhood

Alsafadi¹,

Alzahrani

Alhayek³

et al. 2021

Int J Community Med Public Health

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Enteral feeding is more favorable than parenteral one because it can significantly intervene against the colonization of bacteria and preserve gut functions. However, this necessitates the presence of a good-functioning gastrointestinal tract. Young infants, critically ill children, and patients with neurological disabilities are the most probable candidates to perform enteral feeding. In the present literature review, we have discussed the indications and long-term results of enteral feeding in pediatric settings. Our results show that modality is a safe and efficacious modality in these settings with favorable outcomes and fewer adverse events and complications. Many indications were reported for the modality, and in general, children that usually suffer from severe weight deficit, weight faltering, and growth retardation are indicated to receive enteral nutrition. Some contraindications were also reported in the literature, and in general, conditions affecting the function and health status gastrointestinal tract should recommend against conducting approaches of enteral feeding. Different complications were reported, including mechanical, metabolic, infectious, gastrointestinal, and drug-related complications that might lead to worsened prognosis and can significantly impact the long-term outcomes of these patients. Therefore, paying adequate attention should be considered in these cases to prevent the development of these complications, and provide all the necessary procedures to potentially manage the expected adverse events.

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“…The distal end of the delivery set was inoculated before the beginning of each feeding session (a total of five times in 24.5 h), to simulate repeat contamination over time, due to the user contaminating the connector when reattaching to the feeding tube before each feeding session. The feed itself was not inoculated in this feeding system, as it is provided sterile and it was not a realistic scenario that the feed would be a source of contamination 20,21,29,33,59 (see Figure 1A). The inoculation of FS2 replicated that of FS1, except that the prepared powdered feed was inoculated directly with 1 ml of bacterial suspension and inverted to distribute the inoculum before the feeding session began, instead of inoculation of the foil seal of the feed container (see Figure 1B).…”

Section: Contamination Of the Enteral Feeding Systemsmentioning

confidence: 99%

“…The methodology employed is based on many studies published in the literature, 10,20,21,56 which have shaped the design and safe use of enteral feeding administration equipment over the last 40 years, and so the data produced can be considered to be robust and transferable to real-life clinical practice. However, other methods used previously 21,23,24,37,56,59 to swab a patient's enteral feeding equipment or take samples of feed from systems being used in clinical practice have been shown to produce data for similar evaluations of bacterial growth, although these data do not appear to differ significantly from that produced in laboratory tests. 20,23,59 The hygienic control testing provided evidence for the inherent presence and growth of the seven bacteria under investigation only, and the inoculated challenges provided data on the growth of the seven challenge bacteria only.…”

Section: Challenge Bacteria Fs1 Fs2mentioning

confidence: 99%

Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours

Hubbard,

Van Wyk,

Grinyer

et al. 2023

Nut in Clin Prac

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BackgroundEnteral tube feeding can require considerable amounts of plastic equipment including delivery sets and containers, often disposed of after a single feeding session because of bacterial contamination concerns. The aim of this research was to assess whether reuse of delivery sets and containers for up to 24 h is safe from a microbiological perspective.MethodsFour enteral tube feeding systems (FS) were tested under hygienic controlled or repeated inoculation challenge conditions using key foodborne pathogens, to assess bacterial growth over time (FS1: ready‐to‐hang, closed 1‐L system with delivery set reused, stored at room temperature [RT]; FS2: a prepared, powdered, open 1‐L system with delivery set and container reused, stored at RT; FS3 and FS4: prepared, powdered, open 200‐ml bolus systems with delivery set and container reused, stored at RT [FS3] and refrigeration [FS4]). Feed samples were cultured at 0.5, 6.5, 12.5, 18.5, and 24.5 h with >2 Δlog considered significant bacterial growth.ResultsUnder hygienic control, FS1, FS3, and FS4 were below the level of enumeration (<5 CFU/g) for all bacteria tested, at all time points. In FS2, significant bacterial growth was observed from 18.5 h. Under repeated bacterial inoculation challenge, no significant growth was observed in FS1 and FS4 over 24.5 h; however, significant growth was observed in FS2 after 6.5 h and in FS3 after 10–12 h.ConclusionWith hygienic handling technique, there is limited bacterial growth with reuse of delivery sets and containers over 24 h. Refrigeration between feeding sessions and using boluses of reconstituted powdered feed reduce bacterial growth risk.

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Is a 24-h cyclic closed enteral feeding system microbiologically safe in geriatric patients?

Cited by 6 publications

References 29 publications

Practical Approach to Paediatric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition

Practical Approach to Paediatric Enteral Nutrition: A Comment by the ESPGHAN Committee on Nutrition

Indications and long-term results of enteral feeding in infancy and childhood

Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours

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