title: A microbiologic study of enteral feeding hang time in a burn hospital: can feeding costs be reduced without compromising patient safety?
abstract: BACKGROUND
  Procedural changes for hospitalized patients must always balance safety with fiscal constraints. Microbiologic contamination of enteral feeding solutions has been previously associated with nosocomial infections. Formula manipulation and hang time contribute to microbial load, and there is considerable variation in hang time recommendations in the medical literature. With cost containment in mind, the purpose of this performance improvement study was to determine if an increase in hang time of a modular tube feeding product would increase microbial load or affect the nosocomial infection rate in pediatric burn patients.
  
  
  METHODS
  This biphasic trial initially evaluated the microbial load of the feeding after delivery of two 4-hour aliquots into a container using the same delivery set (total hang time of 8 hours; number of tests = 20). Second, once this feeding procedure was deemed microbiologically safe, tube feedings were administered to patients, and both microbial load and nosocomial infection rate were monitored for 1 year.
  
  
  RESULTS
  Contamination levels at the end of the 8-hour period using the same feeding set with 2 consecutive 4-hour feeding aliquots (number of tests = 38) were lower than standard recommendations. The hospital's nosocomial infection rate was not altered by this procedural change, and feeding-set expenses were reduced.
  
  
  CONCLUSIONS
  The hang time of our enteral feeding administration set can be increased safely from 4 hours to 8 hours, with the tube feeding preparation added as two 4-hour aliquots without a significant change in microbial load or nosocomial infection rate, thus promoting simultaneous fiscal responsibility and patient safety.
authors.affiliation: Chair, Infection Control Committee, Shriners Hospitals for Children, 3229 Burnet Ave, Cincinnati, OH 45229, USA. aneely@shrinenet.org
authors.forename: Alice N
authors.initials: AN
authors.lastname: Neely
authors.forename: Theresa
authors.initials: T
authors.lastname: Mayes
authors.forename: Jason
authors.initials: J
authors.lastname: Gardner
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kagan
authors.forename: Michele M
authors.initials: MM
authors.lastname: Gottschlich
mesh_terms: D002053:Burn Units / Q000191:economics / Q000592:standards*; D002056:Burns; D003428:Cross Infection / Q000517:prevention & control; D004750:Enteral Nutrition / Q000191:economics* / Q000592:standards*; D005516:Food Microbiology; D005526:Food, Formulated / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D013997:Time Factors