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Bacterial contamination of tube-feeding formulas
Abstract:
Bacterial cultures were made on tube-feeding formulas provided to 35 unselected adult patients on termination of the infusion. Bacteria were counted and identified using routine procedures. Formulas were classified as nonmanipulated, manipulated, or locally prepared. Medical records were reviewed to determine if diarrhea was present during the period that included 2 days on either side of the sampling day. A significant association was observed between the extent of bacterial contamination and the presence of diarrhea (p = 0.027). Locally prepared and manipulated formulas contained a significantly greater number of organisms when compared to nonmanipulated formulas (x2 = 17.81, p less than 0.001). Counts for two baseline and four termination cultures on locally prepared formulas exceeded the acceptable limit for coliform organisms in pasteurized milk according to public health standards. Eight additional cultures on commercial feeding formulas which were presumably sterile initially, exceeded these standards at the end of the administration period. Thus 12 of 35 formulas (34%) would not meet public health standards applicable to pasteurized milk. Use of sterile nonmanipulated formulas in a closed administration set is recommended, along with routine, periodic bacteriologic surveillance of enteral feeding programs.
Insights
Bacterial contamination in tube-feeding formulas is linked to patient diarrhea. Many formulas, especially locally prepared ones, exceed public health standards for bacterial counts, necessitating sterile feeding systems and surveillance.
Area of Science:
- Microbiology
- Clinical Nutrition
- Public Health
Background:
- Enteral feeding formulas are crucial for patients unable to consume food orally.
- Bacterial contamination of these formulas can pose a significant health risk.
- Understanding the sources and extent of contamination is vital for patient safety.
Purpose of the Study:
- To assess bacterial contamination levels in tube-feeding formulas.
- To determine the association between formula contamination and patient diarrhea.
- To evaluate compliance with public health standards for bacterial counts.
Main Methods:
- Bacterial cultures were performed on 35 tube-feeding formulas from adult patients.
- Formulas were categorized as nonmanipulated, manipulated, or locally prepared.
- Patient medical records were reviewed for the presence of diarrhea around the sampling day.
Main Results:
- A significant association was found between bacterial contamination levels and diarrhea (p = 0.027).
- Locally prepared and manipulated formulas showed higher bacterial counts than nonmanipulated ones (p < 0.001).
- 34% of formulas exceeded public health standards for coliforms, including initially sterile commercial formulas.
Conclusions:
- Bacterial contamination of enteral feeding formulas is a concern and linked to patient diarrhea.
- Locally prepared and manipulated formulas are more prone to contamination.
- Recommendations include using sterile, nonmanipulated formulas in closed systems and implementing regular bacteriologic surveillance.