Clinical Dilemmas Closed-System Enteral Feedings: Point-Counterpoint Closed Systems: Point

The closed system of enteral feeding involves the use of a sterile feeding container that is spiked with a feeding set. Formula is infused to the patient without further manipulation of the system. Closed systems were preceded by open systems that are administered via the decanting of canned liquids or reconstituted powders into empty plastic feeding containers. These containers are reopened periodi-cally to add more formula. Closed-system feedings may be another way to improve efficiencies and patient outcomes via nutrition practice. Enteral Feeding Contamination Enteral feeding solutions support the growth of a wide variety of microorganisms, creating an under-appreciated risk factor for many patients. The microorganisms in contaminated feeding containers are those commonly isolated from the hospital or home environment. Food contamination is defined in Table 1, based on the 1995 Food and Drug Admin-istration guidelines for medical foods.' Formulas become contaminated with microorgan-isms due to faulty handling during mixing, trans-port to the patient floor, transfer to the feeding bag, storage, or administration. Water used to dilute or reconstitute formula may also contain significant amounts of gram negative organisms such as Esch-erichia coli, Pseiidomonas, and Enterobacter. Most open-system feeding containers are filled with enough formula to hang for 4 to 12 hours and are refilled with formula as needed. Some facilities man-date the rinsing of formula containers before refill-ing. Rinsing has not been found to be effective for eliminating bacteria: allowing for a continuous cul-ture to reside in the feeding reservoir. The use of food blenders and the addition of nutrient modules and food coloring to formulas have also been impli-cated in enteral feeding c ~ n t a m i n a t i o n. ~-