Absence of Contamination In a Non Airdependent Enteral Feeding System Used With Immunocompromised Patients

Abstract

Open enteral feeding systems (decanted from cans) have been associated with significant bacterial contamination and nosocomial infection. Prevention of bacterial overgrowth and nosocomial infection requires meticulous handling technique and frequent formula refills. We evaluated the rate of bacterial contamination associated with prolonged hang time of a sterile, non air-dependent enteral closed system. Fifteen patients, all of whom were liver transplant recipients, were enrolled. The mean age of these patients was 49.5 years. Seven were male and eight were female. All were receiving immunosuppressive therapy. The hang time of the 1500 mL closed enteral feeding system ranged from 10 h to 35 h (mean 22.7 h, median 24.2 h), depending on individual patient flow rates. Administration sets were changed when the feeding containers were changed. At the conclusion of the feeding, the residual enteral feeding solution was cultured quantitatively for aerobic bacteria. Fifty-two bags were cultured and none were found to harbor bacteria. Five patients experienced nosocomial infections during the peritransplant period consisting of five surgical site infections, two C. difficile-associated, colitis, and one bloodstream infection. None of these infections were associated with the closed enteral feeding preparation. We conclude that when properly handled, non air-dependent enteral closed system feedings can be administered safely using prolonged hang times. These systems should be considered an advancement in the delivery of enteral nourishment to the immunocompromised patient.