Risks of microbiological contamination of enteral feeds during the set up of enteral feeding systems

Four enteral feeding systems were compared in terms of their ability to limit the chance of introducing microbial contamination during the set up of the systems. The systems incorporated a variety of containers and giving sets, thus resulting in different methods of assembly. The systems were tested under ward conditions in two hospitals and under the worst possible conditions in a simulated ward study. The Steriflo system performed best. Even in the worst possible situation, counts remained very low and the number of Steriflo feeds remaining sterile throughout the feeding period was more than 85% ( P < 0.05). The Bag system performed worst: at the end of the recommended feeding period counts of more than 1000 colony forming units/ml were obtained and the number of sterile feeds was significantly lower than for the other systems ( P < 0.05). Crown cork bottle and Container performed equally well, but not as well as the Steriflo system. Taking <100 micro‐organisms/ml as a criterion, the differences however were not statistically significant. Decanting of sterile feeds was shown to impose a risk of introducing microbial contaminants to enteral feeds. This however was shown to be strongly dependent on the system design. The results obtained in the hospital trials clearly show that enteral feeding systems can be set up safely when hygienic procedures are followed carefully. When systems were handled with contaminated hands, as simulated in a laboratory trial, the chance of introducing microbial contamination in the feeds increases significantly. Taking into account that hygienic procedures are not always adhered to in hospitals, it is concluded that the Steriflo system offers the best chance, compared with other currently available systems, that enteral feeds will remain microbiologically safe throughout feeding. Practical implications of these findings are discussed.