A Quality Improvement Approach to Validate Extended Hang Time for Enthral Feeding Systems

Abstract

LEARNING OUTCOME: To confirm the safety of adopting an extended hang time policy for a non air-dependent enteral feeding system.Studies have documented the benefits of “closed” system enteral feedings over “open” systems utilizing cans or powders. We previously demonstrated in our institution that a non air-dependent closed enteral feeding system could be safely hung at the bedside for longer than 24 hours without increased risk of contamination over similar open and air-dependent systems with shorter hang times (up to 24 hours). On the basis of this study tube feeding hang time policy was extended to “hang to completion or up to 48 hours.”This current quality assurance study validated the results of the previous study through assessment of the contamination rate and the number and type of manipulations to the containers and flow system. Fifty closed system, non air-dependent enteral feeding bags were observed for periods of up to 48 hours (mean 25.4). No manipulations due to container problems were observed. Within 2 hours of feeding discontinuation, samples were refrigerated, then processed to determine contamination rates by quantitative culture. One container in the observation group was excluded from analysis due to procedure violations while obtaining the culture sample. Results indicated 2 positive contaminations (4%). These contaminations were under the currently accepted standards of 103 cfu/mL (6.7×102; 2.8×102). Total time for bacterial grown in those two contaminated containers was 26.45 and 44.30 hours, respectively. This study validated the safety of the extended hang to completion policy of up to 48 hours. Additional benefits include reduced total manipulations and reduced formula waste.