Spatial separation of catheterized patients Technique

Policies and Procedures on Infection Control Ministry of Health Malaysia 48

4.4.1 Introduction

Enteral Feeding is nutrition provided through the gastrointestinal tract, which includes feeding given via tube and oral. Enteral Feeding preparation and formulation is very complex and should be individualized according to patient’s disease conditions and needs. Contaminated formulas may cause gastrointestinal complications such as diarrhea and vomiting. Colonization of feeding tubes may cause tube occlusion and degradation while colonization of the stomach as been associated with nosocomial infections. Therefore, minimizing potential microbial contamination is crucial to ensure patient achieve optimal nutrition and prevent serious infection and complications related to enteral feeding. This will promote faster recovery rate, shorten hospital stay and reduce overall cost. The risk of contamination occurs during preparation, administration, and storage of the formula and the design of feeding system used. Powder or liquid concentrates prepared on-site poses high infection risk and commercially prepared feeds are known to have lower infectious complications. Bacterial contamination of enteral feeds most commonly arises from exogenous sources.

4.4.2 Routes Of Feeding

1. Oral 2. Tube Feeding a. Nasogastric - short term feeding for 4 to 6 weeks b. Enterostomy postpyloric - Long term feeding for 6 weeks c. GastrostomyDuodenostomyJejunostomyPercutaneous endoscopic gastrostomy Percutaneous endoscopic jejunostomy - Long term feeding

4.4.3 Causes Of Microbial Contamination And Preventive Measures

Personnel Causes of Contamination Preventive Measures 1. Health care worker with active diarrhea should not handle enteral formula until they have been cleared. 2. Open skin lesions should be covered to prevent potential contamination with bacteria.

4.4 Enteral Feeding

Policies and Procedures on Infection Control Ministry of Health Malaysia 49 Physical facility Touch contamination during preparation and administration Formula preparation Adding water or other substances, or using procedures that increases handling of formulas or administration systems increases the potential for contamination. A d m i n i s t r a t i o n a n d prolonged hang time Regardless of administration system, all tube-feeding formulas have risk of microbial growth. Prolonged hang time is associated with unacceptable microbial levels. Causes of Contamination Preventive Measures 1. There should be a room equipped with the necessary facilities for the preparation of enteral feeds following aseptic technique for the whole hospital and proper delivery system to the wards. 2. The preparation area should be clean and hand washing facilities must be made available. 1. Practice hand hygiene before handling formula or administration system. 2. Use disposable gloves. 3. Sanitise all equipments and surfaces used for formula preparation 4. When using decanted formula, sanitise the container before opening. 5. Avoid touching any part of container or the administration system that will come into contact with the formula e.g: the container feeding port, piercing pin on the feeding set. 1. Use commercial formulas and avoid blenderised foods. 2. Avoid adding water, colorants, medications or other substances directly to formula. 3. Use clean technique to add medication to the feeding tube if cannot be given by other route. 4. Use full strength formula. For GI intolerance, reduce administration rate instead of diluting the formula. 5. Reduce handling by using closed feeding system. 6. Label product, date and time of preparation on the container. 1. Limit hang time of refilled formula to 24 hours. 2. Limit hang time of decanted formula to 8 – 12 hours. 3. When using decanted formula, allow feeding to empty completely and rinse before adding fresh formula. 4. Avoid topping up freshly prepared formula until all the previous formula in feeding bag is completely administered. 5. Flush feeding tube with sterile boiled water. 6. Change feeding set every 24 hours.