Bacteriological safety of closed enteral nutrition delivery system

One of the most commonly reported side effects of enteral tube feedings is diarrhea, at times attributed to the bacterial contamination of tube feedings. A closed enteral delivery system has recently been devised. It consists of a cardboard Tetrapack containing the sterile enteral nutrition formula and and independent sterile administration set; together these constitute a closed Tetrapack-administration set enteral delivery system. The bacteriological safety of this system was evaluated in vitro under controlled laboratory conditions in a series of studies. There was no or bacteriologically insignificant bacterial contamination of the enteral nutrition formula, even with repeated use of one administration set for multiple containers over 24 h. Bacteriological growth in the enteral nutrition formula was directly related to the duration of the hanging time of a Tetrapack container. No bacterial growth occurred with hanging times less than 18 h; insignificant bacterial growth occurred by 24 h. A progressive time-related increase in bacterial growth occurred between 24 and 48 h. Our data indicate that the newly developed closed Tetrapack-administration set enteral delivery system is, and will remain, bacteriologically sterile if each Tetrapack container is allowed to hang for no longer than 24 h.