Implementation of hazard analysis and critical control points (HACCP) for microbial safety of enteral feeding solutions at Imam Khomeini Hospital, Urmia, Iran

Enteral feeding solutions (gavage) play a vital role in supporting ICU patients who cannot eat by mouth. However, their preparation is vulnerable to microbial contamination, posing serious health risks. This study aimed to assess and improve the microbial safety of enteral feeding solutions prepared at Imam Khomeini Hospital in Urmia, Iran. A three-phase intervention was conducted involving microbial and PCR analyses, source identification, and corrective measures. Initial testing revealed high contamination levels: coliform bacteria (>5×103 CFU/mL), fungi (>3×103 CFU/mL), and total mesophilic bacteria (>104 CFU/mL). PCR analysis confirmed the absence of Escherichia coli and Klebsiella spp. Corrective actions-such as installing UV lighting, implementing enhanced cleaning protocols, and replacing the mixing device-were introduced. Post-intervention analyses showed complete elimination of detectable microbial contamination in the gavage solutions. This study demonstrates that implementing a HACCP-based approach can effectively eliminate microbial contamination in enteral feeding solutions. The findings support the development of national guidelines and highlight the importance of standardized safety practices to improve patient care in hospital settings.