Anderton, A. & Beattie, T. K., Division of Environmental Health,John Anderson Building, University of Strathclyde, Glasgow, G4 ONG

 

        Reports of contaminated enteral feeds continue to appear (Anderton 1995) in spite of the many publications emphasising the need for good hygiene practices when assembling feeding systems and the recommendations by a number of feed/system manufacturers that hands should be washed and systems disinfected during assembly.

 

        It was therefore agreed by PEN Group that there should be a survey of members to gather information on cleaning and disinfection of systems during assembly. Survey forms were distributed to 400 members of PEN Group and 111 replies were received (28% response). Of the 110 relevant replies received (one was marked ‘not applicable’) 24 contained multiple copies of the questionnaire relating to different wards in one hospital, or were clearly marked to show that the reply given was relevant to all wards in the hospital, with the number of wards being quoted. It is appreciated that many of the remaining forms may also relate to all the wards in various hospitals but as this information was not requested on the questionnaire it has not been possible to calculate the total number of wards covered in the study. 

        The results were therefore separated into ‘individual forms’ and ‘multiple forms’ in case there were any major differences between these groups. However, as can be seen from Table 1, the results were broadly similar with an average of 75% of respondents replying ‘no’ to the question ‘Do you disinfect equipment and/or systems during assembly?’

        Table 1 “Do you disinfect equipment and/or systems during assembly?” – Responses

 

         one form marked ‘not applicable’ therefore it was not included in the analysis

        The most commonly reported method of disinfection was the use of alcohol impregnated wipes (39/60; 65%), with 21 (35%) respondents indicating that they used the small pre-injection swabs (eg Sterets) and 18 (30%) the larger ‘wipes’ (eg Alcowipes, Azowipes). Other methods used to clean and/or disinfect systems/equipment included the use of a disinfectant spray (eg. 70% methylated spirits), Chlorhexidine, Hibiscrub, soap and water or just water. The use of disinfectants to clean
syringes was also mentioned.

 

        Responses indicating which parts of the system were cleaned were as follows: can tops (16), bottle rims (14), bottle tops (11), bottle shoulders (7), bottle opener (14), feeding pump (9) and feeding tube connector (1). One respondent stated that they would only disinfect ring-pull cans for immunocompromised patients and jejunal patients. Another said that they would only clean the surface of a can or bottle if it looked dirty. Several respondents also volunteered the information that hands would be washed prior to handling feed/systems (4) or that sterile gloves would always be worn (2). It is well known that the assembly and manipulation of enteral feeding systems are potential routes for microbial contamination of the feed administered to the patient. The PEN Group of the BDA (Anderton, Howard & Scott, 1986) and a number of manufacturers of enteral tube feeds/systems recommend the use of alcohol impregnated wipes to disinfect bottle and can tops prior to decanting feeds and/or assembling systems. It is therefore a matter of concern that only 25% of respondents indicated that systems or equipment were disinfected at any stage during assembly of the systems. These poor hygiene practices during the assembly and manipulation of systems may help to explain the fact that reports of contaminated feeds being administered to patients continue to appear (Anderton, 1995) particularly if lack of disinfection of systems is combined with omitting to wash/disinfect hands and/or wear disposable gloves when assembling the systems.

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