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Contamination of gastrostomy feeding systems in children in a home-based enteral nutrition program
L Bott1, M O Husson, D Guimber
1Nestlé Clinical Nutrition, Noisiel, France.
Insights
Gastrostomy feeding systems in children are frequently contaminated, especially before feeding begins. Using closed enteral feeding systems is recommended for home-based nutrition programs to prevent contamination.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Control
- Home Healthcare
Background:
- Limited data exists on enteral feeding system contamination in pediatric gastrostomy patients.
- No data is available for home-based care settings.
Purpose of the Study:
- To assess the risk of microbial contamination in enteral feeding systems used by children receiving gastrostomy tube feeding at home.
- To identify factors influencing bacterial colonization in these systems.
Main Methods:
- Analyzed 5 sample types from 20 pediatric patients before and after enteral feeding.
- Identified and quantified microorganisms.
- Evaluated factors like acid suppressive therapy, feeding system type, and manipulation errors.
Main Results:
- 85% of gastrostomy samples showed microbial overgrowth (>10(4) cfu/mL) before feeding.
- 45% of feeding lines had overgrowth post-feeding, often with the same bacteria from the gastrostomy.
- Closed systems remained sterile despite manipulation errors.
Conclusions:
- Retrograde contamination of gastrostomy feeding systems is common in home care.
- Closed enteral feeding systems are recommended to minimize contamination risk in home-based nutrition programs.
Background:
There are few data concerning the risk of contamination of enteral feeding systems via gastrostomy in children, and none for conditions that pertain to home-based care.
Methods:
To investigate the risk of contamination of enteral feeding systems during the home-based care of 20 children receiving gastrostomy tube feeding, five samples were taken for analysis: two samples before the enteral feeding period (gastrostomy, enteral feeding system) and three after this period (gastrostomy, distal giving set, liquid remained in container). Microorganisms were identified and counted. Different factors were studied to elucidate their role in bacterial colonization: acid suppressive therapy, gastrostomy tube or button, hanging feeding time, rate of enteral feeding, gastric pullulation and retrograde contamination, manipulation error, and use of open or closed enteral feeding systems.
Results:
Overgrowth was defined as a microorganismal load exceeding 10(4) colony-forming units (cfu)/mL. Overgrowth was present in 85% of gastrostomy samples before enteral nutrition started. Most microorganisms belonged to gastric flora. Some bacteria had an environmental origin or derived from cutaneous flora. Forty-five percent of the lines showed overgrowth at the end of enteral nutrition period, mainly with the same microorganism found in the gastrostomy. Closed enteral bags remained sterile, even if manipulation error occurred. Duration, rate of enteral feeding, and acid suppression treatment were not risk factors for overgrowth.
Conclusions:
Retrograde contamination of gastrostomy feeding systems occurs frequently. The preferential use of closed enteral feeding systems is recommended for home-based enteral nutrition programs.