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Analysis of Sites of Bacterial Contamination in an Enteral Feeding System

Elisabeth M. H. Mathus-Vliegen, MD, PhD^*, Marjan W. J. Bredius, MSc and Jan M. Binnekade, RN, PhD

From the ^* Department of Gastroenterology and Hepatology, Department of Microbiology, and Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Correspondence: E. M. H. Mathus-Vliegen, MD, PhD, Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic mail may be sent to e.mathus-vliegen{at}amc.uva.nl.

Background: Contamination of enteral feedings is an often overlooked source for bacterial infection in the intensive care unit. A new 1-L enteral feeding system with minimal chances of touching critical areas (Nutrison Pack) was compared with routinely used 0.5-L glass bottle systems. Methods: Patients admitted to intensive care were randomized to Pack or glass bottle feeding systems. Cultures were taken from the delivery sets 5 times during the day and from feeding containers and different sites of the system after 24 hours. Results: Bacteria were present in 3 of 112 glass bottles and in 2 of 95 Pack bags. True bacterial contamination (defined as >10² colony-forming units/mL, with same bacteria also present in the delivery set) was found in none of the Packs with a 12-h (69 Packs) or a 24-h (26 Packs) hanging time and in only 1 of the glass bottles with a hanging time of 24 hours, which exceeded the advised hanging time of 8 hours. In contrast, the contamination rate of delivery sets was 48%, with increasing bacterial counts over the day and 4 subsequent days. Bacteria mainly belonged to the group of potentially pathogenic bacteria (Enterobacteriaceae and Pseudomonaceae). They likely originated from throat, lungs, and stomach and grew into and along feeding tubes upwards until they reached the delivery set. Conclusions: Prolonged hanging times of Pack bags were safe with respect to bacterial contamination. However, the bacterial safety of enteral feedings is more likely to be endangered by the endogenous route of contamination rather than exogenous contamination, as high bacterial counts were found in feeding tubes and delivery sets as a result of retrograde growth.

Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 6, 519-525 (2006)
DOI: 10.1177/0148607106030006519


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