Document Type : Original Articles
Authors
- Mahsa Moazen 1
- Samane Rahmdel 2
- Seyedeh Maryam Abdollahzadeh 1
- Maryam Ranjbar Zahedani 1
- Seyed Mohammad Mazloomi 3
1 Department of Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Food Hygiene and Public Health, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
3 Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Nutrition and Food Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Although enteral feeding solutions are used to reduce the morbidity and mortality in many malnourished and hospitalized patients, microbial contamination of these products may lead to severe infections, especially in immune suppressed ones. The aim of this study was to evaluate the microbiological quality of commercial enteral feedings in two hospital settings in Shiraz. Methods: Twenty commercial enteral feedings were collected immediately after preparation and then homogenized and serially diluted on the same day. MPN methods were used to evaluate the total viable count and Escherichia coli count. They were also tested for total coliform (pour plate method) and the presence of coagulase positive staphylococci. The results were compared with standard limits. Results: All samples had a total viable count lower than 104 colony forming units (CFU) per g (the maximum recommended level of FDA standard).For all enteral feedings, coliform counts were not detectable (<10 CFU/g).Escherichia coli counts were also lower than those of Brazilian legislation (<3 CFU/g). Coagulase positive staphylococci were recovered just from one sample (5%). Conclusion: Freshly prepared commercial enteral feeding samples h ad a cceptable m icrobial q uality. S uch p roducts are considered to be more acceptable than hospital prepared ones. However, further steps involved in the preparation and administration of commercial feedings can be sources of microbial contamination. Thus implementation of hygienic practices and monitoring procedures during preparation and administration can be suggested.
Keywords
- Jalali M, Sabzghabaee AM, Badri SS, Soltani HA,
- Maracy MR. Bacterial contamination of hospitalprepared
- enteral tube feeding formulas in Isfahan,
- Iran. J Res Med Sci 2009; 14(3): 149-56.
- Desport JC, Mounier M, Preux PM, Makabakayele K,
- Camus A, Gayaud JP, et al. Evaluation of the microbial
- safety of a new 1.5 L enteral feeding diet reservoir
- system. ClinNutr 2004; 23(5): 983-8.
- Roy S, Rigal M, Doit C, Fontan JE, Machinot S, Bingen E, et al. Bacterial contamination of enteral nutrition in
- a paediatric hospital. J Hosp Infect 2005; 59(4): 311-6.
- Oliviera MH, Bonelli R, Aidoo KE, Batista CRV.
- Microbiological quality of reconstituted enteral
- formulations used in hospitals. Nutrition 2000; 16(9):
- -33.
- Mokhalalati JK, Druyan ME, Shott SB, Comer
- GM. Microbial, nutritional and physical quality of
- commercial and hospital prepared tube feedings in
- Saudi Arabia. Saudi Med J 2004; 25(3): 331-41.
- Patchell CJ, Anderton A, Holden C, MacDonald
- A, George RH, Booth IW. Reducing bacterial
- contamination of enteral feeds. Arch Dis Child 1998;
- (2): 166-8.
- Carvalho M, Moraist T, Amaral F, Sigulem D. Hazard
- analysis and critical control point system approach in
- the evaluation of environmental and procedural sources
- of contamination of enteral feedings in three hospitals.
- J Parenter Enteral Nutr 2000; 24(5): 296-303.
- Oie S, Kamiya A, Hironaga K, Koshiro A. Microbial
- contamination of enteral feeding solution and its
- prevention. Am J Infect Control 1993; 21(1): 34-8.
- Sullivan MM, Sorreda-Esguerra P, Santos EE, Platon
- BG, Castro CG, Idrisalman ER, et al. Bacterial
- contamination of blenderized whole food and
- commercial enteral tube feedings in the Philippines.
- J Hosp Infect 2001; 49(4): 268-73.
- Feng P, Weagant SD, Grant MA, Burkhardt W.
- Enumeration of Escherichia coli and the coliform
- bacteria. Food and Drug Administration; c2002
- [updated 2013 Feb; cited 2013 May]. Available from:
- http://www.fda.gov/Food/FoodScienceResearch/
- LaboratoryMethods/ucm064948.htm
- Institute of Standards and Industrial Research of
- Iran. Microbiology of food and animal feeding stuffs-
- Horizontal method for the enumeration of coagulase
- âpositive Staphylococci (Staphylococcus aureus and
- other species) - part 3: Detection and MPN technique
- for low numbers. Tehran, Iran 2006; Number 6806-3.
- US Food and Drug Administration. Food composition,
- standards, labeling and economics: compliance
- program guidance manual. In: Compliance program
- guidance manual. USA; 2006.program 7321.002.
- Borges LJ, Campos MRH, Andre MCDPB, Serafini AB.
- Microbiological quality and phenotypic characterization
- of microorganisms isolated from enteral feeding, food
- handlers and environments of two public Brazilian
- hospitals. J Food Saf 2010; 31(1): 125-31.
- Fagerman KE. Microbiologic monitoring of enteral
- nutrient solutions overdue in the United States. Am J
- Infect Control 1992; 20(6): 330-1.
- Anderton A. Bacterial contamination of enteral feeds
- and feeding systems. ClinNutr 1993; 12: S16-S32.
- Bastow MD, Greaves P, Allison SP. Microbial
- contamination of enteral feeds. Hum Nutr: ApplNutr
- ; 36(3): 213-7.
- Moghadam AD, Chabok SY, Ramezani F, Leili
- EK, Rahimi V. Evaluation of nutritional quality and
- microbial contamination of enteral feeding solutions
- in hospitalized patients referred to neurosurgical ICU
- of Poursina Hospital in Rasht. Pajoohandeh J 2010;
- (5): 213-9. (In Persian)
- Lopes KRR, Streit IB, Luchese RH, Ayub MAZ.
- Evaluation of the microbial contamination of hospitalmade
- enteral feedings.AlimNutr 1997; 8(1): 75-82.
- Jay JM, Loessner MJ, Golden DA. Modern food
- microbiology. 7th ed. New York: Springer; 2005.