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

Abstract

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.

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

“…4 Equally important is the certainty that patients will receive enteral formulations without the presence of contaminants that could negatively compromise their clinical evolution. 30,35 Therefore, knowledge of the risks to patients' health when using home-prepared enteral formulations, which are discussed in this study, can contribute to improvements regarding actions and the operationalization of appropriate programs as well as the development of protocols for hygiene criteria in this area, 12 which will ensure better microbiological quality of enteral formulations and greater safety for patients.…”

“…27,28 However, the international community still has doubts about microbiological safety, especially of blenderized formulations manipulated at home, since most of the studies were carried out in a hospital environment. 29,30 The expansion of home care for people worldwide, which was proposed by government agencies in plans for coping with noncommunicable chronic diseases, 31,32 requires greater knowledge about contamination in household preparations. Milton et al 2 analyzed the contamination of enteral formulas in preparation and after storage for two days, under refrigeration, in the kitchens of volunteers, and for non-HEN users, using a standard procedure to minimize bacterial growth.…”

“…One of the factors that contributed to these findings is that these enteral formulations are prepared from a mixture of several nonsterile foods that are rich in macronutrients and micronutrients, 15 which make these formulations excellent culture media and a source of microbial growth. 30,36 Therefore, it is essential to carefully select the foods used in these enteral formulations to ensure their suitability, safety, and integrity. 5 In addition, because HEPs and BEPs are more labor intensive, as they involve several steps and greater preparation, 5,6,16 hygiene care should be intensified by adopting simple measures that must be applied at all stages of preparation, from the acquisition of the raw materials to the filling of enteral formulations, in order to ensure the benefits of home-prepared EN.…”

“…Academic interest in this subject has previously been reported by North American and British researchers 27,28 . However, the international community still has doubts about microbiological safety, especially of blenderized formulations manipulated at home, since most of the studies were carried out in a hospital environment 29,30 …”

“…HEPs and BEPs were the enteral formulations that were most contaminated. One of the factors that contributed to these findings is that these enteral formulations are prepared from a mixture of several nonsterile foods that are rich in macronutrients and micronutrients, 15 which make these formulations excellent culture media and a source of microbial growth 30,36 . Therefore, it is essential to carefully select the foods used in these enteral formulations to ensure their suitability, safety, and integrity 5 …”