title: Bacterial contamination of ready-to-use 1-L feeding bottles and administration sets in severely compromised intensive care patients.
abstract: OBJECTIVE
  In intensive care patients, enteral feeding requires sterile feedings because of infectious complications and adequate supplements to meet nutritional needs. Heretofore, prepacked, large-volume formula containers were developed, but bacterial contamination occurred in 4% to 15%. Our objective was to investigate the microbial contamination rate of 1-L feeding bottles and newly designed administration sets over hanging times of 24 hrs in the intensive care unit (ICU).
  
  
  METHODS
  A prospective observational cohort study of patients admitted to the ICU of a university hospital.
  
  
  METHODS
  All consecutive patients fed via a nasojejunal tube for at least 4 days.
  
  
  METHODS
  Cultures of feeding bottles, administration sets, and gastric and tracheobronchial aspirates at day 0, 1, 2, 4, and 7.
  
  
  RESULTS
  A total of 4% of feeding bottles and 74% of infusion sets contained >10(2) colony forming units (CFU)/mL. Gastric and bronchial aspirates were positive in 90% and 92%, respectively. Bacterial counts of feeding bottles were 10(2)-10(5) CFU/mL, and the main bacteria isolated included Enterobacter cloacae, Klebsiella oxytoca, and enterococci. One third of all cultured bacteria in feeding bottles, administration sets, stomach, and lungs belonged to the Enterobacteriaceae family, which was held responsible for the nosocomial infections in the ICU. None of the 1-L feeding bottles with a hanging time of 19-24 hrs was contaminated. Only bottles that had to be exchanged because of need for a faster rate of infusion proved to be contaminated, apparently without clinical consequences. With time and the increasing severity of disease, the administration sets became contaminated at an increasingly faster rate and with higher bacterial counts mainly through retrograde growth of endogenous bacteria. The final step of bottle contamination might have been the bacterial transfer by nurses' hands.
  
  
  CONCLUSIONS
  Despite an almost ideal design of the enteral nutrition delivery system, a 4% contamination rate of initially sterile feedings with clinically relevant bacteria and the fact that only manipulated systems showed bacterial growth are of concern.
authors.affiliation: Department of Gastroenterology and Hepatology, the Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Mathus-Vliegen
authors.forename: J M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: R J
authors.initials: RJ
authors.lastname: de Haan
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004750:Enteral Nutrition / Q000009:adverse effects*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D007902:Length of Stay; D008168:Lung / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology*; D013997:Time Factors