Decanting versus sterile pre-filled nutrient containers--the microbiological risks in enteral feeding

Area of Science:

• Microbiology
• Healthcare Engineering
• Patient Safety

Background:

• Enteral feeding is common in clinical settings.
• Microbiological contamination of enteral feeds poses a significant patient risk.
• Different enteral feeding systems vary in their assembly and contamination potential.

Purpose of the Study:

• To compare the microbiological risk associated with assembling and operating four distinct enteral feeding systems.
• To evaluate the impact of assembly methods and hand contamination on bacterial levels in enteral feeds.
• To assess the role of system design in preventing contamination.

Main Methods:

• A simulated ward study was conducted over 24 hours.
• Four enteral feeding systems (two ready-to-hang, two requiring decanting) were tested.
• Assembly protocols included manufacturer's instructions with gloved or contaminated hands, and direct contamination of components.

Main Results:

• Ready-to-hang systems showed lower contamination, especially when manufacturer's instructions were followed with gloves.
• Decanting from bottles or cans with contaminated hands led to significant bacterial growth (up to 9.3 x 10^5 cfu ml(-1)).
• The 'pack' ready-to-hang system demonstrated no detectable contamination even with deliberate hand contamination.

Conclusions:

• System design is critical in minimizing bacterial contamination of enteral tube feeds.
• Ready-to-hang enteral feeding systems are preferable to reduce microbiological risk.
• Strict adherence to manufacturer's instructions and use of gloves are advised when decanting is unavoidable.