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VOLUME 24 , ISSUE 8 ( August, 2020 ) > List of Articles

COMMENTARY

Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges

Saswati Sinha, Gunjan Lath, Sameer Rao

Citation Information : Sinha S, Lath G, Rao S. Safety of Enteral Nutrition Practices: Overcoming the Contamination Challenges. Indian J Crit Care Med 2020; 24 (8):709-712.

DOI: 10.5005/jp-journals-10071-23530

License: CC BY-NC 4.0

Published Online: 11-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Enteral nutrition (EN) has host of benefits to offer to critically ill patients and is the preferred route of feeding over parenteral nutrition. But along with the many outcome benefits of enteral feeding come the potential for adverse effects that includes gastrointestinal (GI) disturbances mainly attributed to contaminated feeds. Currently, EN is practiced using blenderized/kitchen prepared feeds or scientifically developed commercial feeds. Commercial feeds based on their formulation may be divided as ready-to-mix powder formulas or ready-to-hang sterile liquid formulas. A holistic view on potential sterility of EN from preparation to patient delivery would be looked upon. These sterility issues may potentially result in clinical complications, and hence process-related errors need to be eliminated in hospital practice, since immunocompromised intensive care unit patients are at high risk of infection. This review intends to discuss the various EN practices, risk of contamination, and ways to overcome the same for better nutrition delivery to the patients. Among the various types of enteral formulas and delivery methods, this article tries to summarize several benefits and risks associated with each delivery system using the currently available literature.


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  1. American Society for Parenteral and Enteral Nutrition Board of Directors and Standards Committee, Teitelbaum D, Guenter P, Howell WH, Kochevar ME, Roth J, et al. Definition of terms, style, and conventions used in A.S.P.E.N. Guidelines and standards. Nutr Clin Pract 2005;20(2):281–285.
  2. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580–637.
  3. Dhaliwal R, Cahill N, Lemieux M, Heyland DK. The canadian critical care nutrition guidelines in 2013: AN update on current recommendations and implementation strategies. Nutr Clin Pract 2014;29(1):29–43.
  4. McClave S, Martindale R, Vanek V, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of ritical care medicine (SCCM) and american society for parenteral and enteral nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40(2):159–211.
  5. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr 2009;28(4):387–400.
  6. Seres DS, Valcarcel M, Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap Adv Gastroenterol 2013;6(2): 157–167.
  7. Fernandez-Crehuet Navajas M, Jurado Chacon D, Guillen Solvas JF, Galvez Vargas R. Bacterial contamination of enteral feeds as a possible risk of nosocomial infection. J Hosp Infect 1992;21(2):111–120.
  8. Levy J, Van Laethem Y, Verhaegen G, Perpete C, Butzlet JP, Wenzel RP. Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: a study using plasmid fingerprinting. JPEN J Parenter Enteral Nutr 1989;13(3):228–234.
  9. Kohn CL, Keithley JK. Enteral nutrition. potential complications and patient monitoring. Nurs Clin North Am 1989;24(2):339–353.
  10. Sewify K, Genena D. Open vs closed tube feeding in critically ill patients–which is the best? J Nutr Food Sci 2017;7:621. DOI: 10.4172/2155-9600.1000621.
  11. Mehta Y, Sunavala JD, Zirpe K, Tyagi N, Garg S, Sinha S, et al. practice guidelines for nutrition in critically ill patients: a relook for indian scenario. Indian J Crit Care Med 2018;22(4):263–273.
  12. FAO. Enterobacter sakazakii and Other Microorganisms in Powdered Infant Formula. Rome, Italy: Food and Agriculture Organization of the United Nations; 2007. p. 81.
  13. Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr 2017;41(1):15–103.
  14. Wagner DR, Elmore MF, Knoll DM. Evaluation of “closed” vs “open” systems for the delivery of peptide-based enteral diets. JPEN J Parenter Enteral Nutr 1994;18(5):453–457.
  15. Herlick SJ, Vogt C, Pangman V, Fallis W. Comparison of open vs closed systems of intermittent enteral feeding in two long-term care facilities. Nutr Clinical Pract 2000;15(6):287–298.
  16. Anderton A, Aidoo KE. Decanting—source of contamination of enteral feeds? Clin Nutr 1990;9(3):157–162.
  17. Beattie TK, Anderton A. Microbiological evaluation of four enteral feeding systems which have been deliberately subjected to faulty handling procedures. J Hosp Infect 1999;42(1):11–20.
  18. Arevalo-Manso JJ, Martinez-Sanchez P, Juares-Martin B, Fuentes B, Ruiz-Ares G, Sanz-Cuesta BE, et al. Preventing diarrhea in enteral nutrition: the impact of the delivery set hang time. Int J Clin Pract 2015;69(8):900–908.
  19. Atkins A, Phillips W. Delivery of enteral nutrition improves after transition to a closed feeding system. Med Surg Mat 2015;24: 14–15.
  20. Okuma T, Nakamura M, Totake H, Fukunaga Y. Microbial contamination of enteral feeding formulas and diarrhea. Nutrition 2000;16(9): 719–722.
  21. Luther H, Barco K, Chima C, Yowler CJ. Comparative study of two systems of delivering supplemental protein with standardized tube feedings. J Burn Care Rehabil 2003;24(3):167–172.
  22. Phillips W, Roman B, Glassman K. Economic impact of switching from an open to a closed enteral nutrition feeding system in an acute care setting. Nutr Clin Pract 2013;28(4):510–514.
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