Abstract
The use of blenderised enteral nutrition formula (ENF) is on the increase globally. However, concerns remain regarding the microbial quality and safety of blenderised ENF compared with standard recommendations and commercial ENF. Aim: This was a systematic review which sought to compare the microbial quality of blenderised ENF and commercial ENF and to evaluate the effect of storage time on blenderised ENF. Method: Four databases (Pubmed, EMBASE, PSYCInfo and Google scholar) were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes framework. Results: Eleven studies which met the criteria were included in the systematic review. Two major areas were identified; Microbial Quality of Blenderised ENF versus Commercial ENF; and The Effect of Storage Time on Microbial Quality of Blenderised ENF. Overall, 72.7% of the studies showed microbial contamination in blenderised ENF compared with 57.1% of commercial ENF, and the storage time was another important factor in the rates of contamination. The extent of handling or manipulation of the enteral formula was critical in determining the level of contamination. Conclusion: Preparation techniques for blenderised ENF need to be established and caregivers taught how to prepare and administer it appropriately in order to reduce contamination. Further, well-designed studies are required, which compare the microbial quality of blenderised ENF using adequate handling techniques and commercial ENF.
Highlights
Enteral feeds are used in different clinical settings to support people who are malnourished or unable to maintain their own nutrition, and are usually in the form of pre-packaged, ready-to-use liquid feeds in most high-income countries [1,2,3]
While Madden et al [17] showed that the impact of storage time on bacterial colony-forming units (CFU) varied with an increase in colonies on some agars but, overall, was not significantly different, Milton et al [28] observed that no sample had zero aerobic microbial counts no substantial increase in microbial counts was observed during the 48 h
The results of the studies included in this review showed varied outcomes in terms of the levels of bacterial contamination of blenderised enteral nutrition formula (ENF) compared with commercial ENF
Summary
Enteral feeds are used in different clinical settings to support people who are malnourished or unable to maintain their own nutrition, and are usually in the form of pre-packaged, ready-to-use liquid feeds in most high-income countries [1,2,3]. These feeds are mostly sterile or microbial free preparations and nutritionally complete with energy, protein, vitamins and trace elements [1,4]. Public Health 2020, 17, 9563; doi:10.3390/ijerph17249563 www.mdpi.com/journal/ijerph
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