Microbial growth in clinically used enteral delivery systems

      This paper is only available as a PDF. To read, Please Download here.


      Potential contamination of enteral formulas has led to the development of policies limiting formula hangtimes. However, enteral administration bags can easily become contaminated during formula refilling. We prospectively studied enteral formula contamination when the hangtime of a prefilled 1000 ml pouch was compared with the standard 4-hour hangtime of a refilled enteral administration bag. Samples of formula collected from different locations along the enteral delivery system were cultured during 57 days of enteral hyperalimentation in 19 patients. The overall enteral formula contamination rate was 61%, where the greatest microbial growth occurred in reconstituted enteral formulas. The presence of microbial growth did not differ between canned formulas administered according to a 4-hour hangtime and the prefilled pouch. Greatest growth in all cases was at the distal tubing hub, where contamination during system manipulation or from the patient probably occurred. Use of prefilled enteral administration bags may dekay formula contamination in the administration reservoir. A change in equipment design that would decrease the need to manipulate feeding sets or feeding tube connections should be further investigated.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baldwin B.A.
        • Zagoren A.J.
        • Rose N.
        Bacterial contamination of continuously infused enteral alimentation with needle catheter jejunostomy-clinical implications.
        J Parenter Enteral Nutr. 1984; 8: 30-33
        • deVries E.G.E.
        • Mulder N.H.
        • Houwen B.
        • deVries-Hospers H.G.
        Enteral nutrition by nasogastric tube in adult patients treated with intensive chemotherapy for acute leukemia.
        Am J Clin Nutr. 1982; 35: 1490-1496
        • Schroeder P.
        • Fisher D.
        • Volz M.
        • Paloucek J.
        Microbial contamination of enteral feeding solutions in a community hospital.
        J Parenter Enteral Nutr. 1983; 7: 364-368
        • Iannini P.B.
        • Mumford F.
        • Buckalew F.
        Microbial contamination of enteral liquid nutrition systems.
        in: Proceedings of the Ross Laboratories Workshop on contamination of enteral feeding products during clinical usage. Ross Laboratories, Columbus, Ohio1983: 11-15
        • White W.T.
        • Acuff T.E.
        • Sykes T.R.
        • Dobbie R.P.
        Bacterial contamination of enteral nutrient solutions: a preliminary report.
        J Parenter Enteral Nutr. 1979; 3: 459-461
        • Kotilainen H.R.
        • Gantz N.M.
        Contamination of enteral feedings: An evaluation of environmental and procedural sources.
        in: Proceedings of the Ross Laboratories Workshop on contamination of enteral feeding products during clinical usage. Ross Laboratories, Columbus, Ohio1983: 16-19
        • Byrum B.
        Characteristics of bacterial growth in readyto-feed nutritional products inoculated with rapid growers.
        in: Proceedings of the Ross Laboratories Workshop on contamination of enteral feeding products during clinical usage. Ross Laboratories, Columbus, Ohio1983: 6-10
        • Fagerman K.E.
        • Paauw J.D.
        • McCamish M.A.
        • Dean R.E.
        Effects of time, temperature, and preservative on bacterial growth in enteral nutrient solutions.
        Am J Hosp Pharm. 1984; 41: 1122-1126
        • Hostetler C.
        • Lipman T.O.
        • Geraghty M.
        • Parker R.H.
        Bacterial safety of reconstituted continuous drip tube feedings.
        J Parenter Enteral Nutr. 1982; 6: 232-235
        • Keohane P.
        • Attmill H.
        • Love M.
        • Silk D.
        Enteral diet preparation technique-significant advantage in bacterial contamination and nitrogen balance.
        J Parenter Enteral Nutr. 1984; 8: 85
        • Schreiner R.L.
        • Eitzen H.
        • Gfell M.A.
        • et al.
        Environmental contamination of continuous drip feedings.
        Pediatrics. 1979; 63: 232-237
        • Anderson K.R.
        • Norris D.J.
        • Godfrey L.B.
        • Avent C.K.
        • Butterworth C.E.
        Bacterial contamination of tube-feeding formula.
        J Parenter Enteral Nutr. 1984; 8: 673-678
        • Furtado D.
        • Parrish A.
        • Beyer P.
        Enteral nutrient solutions (ENS): In vitro growth supporting properties of ENS for bacteria.
        J Parenter Enteral Nutr. 1980; 4: 594
        • Fason F.
        Controlling bacterial growth in tube feedings.
        Am J Nurs. 1967; 67: 1246-1247
        • Pemberton L.B.
        • Lyman B.
        • Covinsky J.
        • Mandal J.
        • Lander V.
        An evaluation of a closed enteral feeding system.
        Nutr Support Serv. 1985; 5: 36-42
      1. 21 CFR 113.3. Subpart A.

        • Krey S.H.
        • Porcelli K.A.
        • Lockett G.M.
        Enhancing enteral nutrition delivery: Development of an enteral preparation facility.
        J Am Diet Assoc. 1985; 85: 693-697