Microbiological quality and safe handling of enteral diets in a hospital in Minas Gerais, Brazil

Contamination of enteral diets represents a high risk of compromising the patient's medical condition. To assess the microbiological quality and aseptic conditions in the preparation and administration of handmade and industrialized enteral diets offered in a hospital in the Valley of Jequitinhonha, MG, Brazil, we performed a microbiological analysis of 50 samples of diets and 27 samples of surfaces, utensils, and water used in the preparation of the diets. In addition, we assessed the good handling practices of enteral diets according to the requirements specified by the Brazilian legislation. Both kinds of enteral diets showed contamination by coliforms and Pseudomonas spp. No sample was positive for Staphylococcus aureus and Salmonella spp. On the other hand, Listeria spp. was detected in only one sample of handmade diets. Contamination was significantly higher in the handmade preparations (p < 0.05). Nonconformities were detected with respect to good handling practices, which may compromise the diet safety. The results indicate that the sanitary quality of the enteral diets is unsatisfactory, especially handmade diets. Contamination by Pseudomonas spp. is significant because it is often involved in infection episodes. With regard to aseptic practices, it was observed the need of implementing new procedures for handling enteral diets.

Alimento para fins especiais: ingredientes, elaboração e aglomeração / Food for special needs: ingredients, development and agglomeration

OBJETIVO: Desenvolver uma dieta enteral nutricionalmente completa, com condições ajustadas de aglomeração, visando contemplar as características físicas e químicas desejadas para esse alimento especial. MÉTODOS: Como ingredientes foram utilizados maltodextrina, óleo de canola, triglicerídios de cadeia média, goma acácia, inulina e frutooligossacarídeos, proteínas do soro de leite, isolado proteico de soja, vitaminas e minerais. Após os ajustes das quantidades e proporções dos ingredientes, a formulação foi aglomerada e submetida às análises de composição centesimal, molhabilidade, densidade aparente, atividade de água, viscosidade e cor. RESULTADOS: Obteve-se uma fórmula contendo 1kcal.mL-1, normoproteica (3,9g.100mL-1) e normolipídica (3,9g.100mL-1). Após a aglomeração da dieta, observaram-se os seguintes resultados: molhabilidade de 0,262g.s-1, densidade aparente de 0,317g.cm-3e atividade de água de 0,393. A análise de cor indicou redução da luminosidade e aumento dos parâmetros de cor a*e b*, apresentando leve variação para o vermelho e forte presença do amarelo. CONCLUSÃO: Os ingredientes empregados, e suas respectivas proporções, bem como o processo de aglomeração, possibilitaram a obtenção de um alimento para fins especiais com propriedades bioativas. O processo de aglomeração possibilitou uma dieta de fácil reconstituição e utilização através de sondas, facilitando a infusão e, consequentemente, a diminuição de intercorrências.

OBJECTIVE: This study aimed to develop a nutritionally complete enteral diet, with adjusted agglomeration conditions, and determine the physical and chemical characteristics required by this special food. METHODS: The ingredients were maltodextrin, canola oil, medium-chain triglycerides, acacia gum, inulin, fructooligosaccharides, milk whey protein, soy protein isolate, vitamins and minerals. After the quantities and proportions of the ingredients were adjusted, the formula was agglomerated and analyzed for percent composition, moisture, apparent density, water activity, viscosity and color. RESULTS: The resulting diet contained 1Kcal.mL-1and normal protein (3.9g.100mL-1) and fat (3.9g.100mL-1) levels. After agglomeration, the following results were obtained: moisture 0.262g.s-1, apparent density 0,317g.cm-3and water activity 0.393. Color analysis indicated a decrease in luminosity and increase in a*and b*colors, presenting a slight variation towards red and a strong presence of yellow. CONCLUSION: The used ingredients and respective proportions, as well as the agglomeration process, resulted in a food for special needs with bioactive properties. The agglomeration process produced a diet that can easily be reconstituted and fed through catheters, facilitating infusion and consequently, reducing intercurrences.

Verificação das boas práticas de preparação e análise microbiológica de dieta enteral em serviço de nutrição e dietética de hospital privado / Microbiological analysis of enteral formulation and verification of good preparation practices in private hospitals

As formulações enterais são importantes para a recuperação de pacientes imunocomprometidos. São compostas por macro e micronutrientes sendo portanto, excelente meio para o crescimento de microrganismos. A contaminação destas formulações pode ocorrer em diferentes etapas do processamento. A presente pesquisa teve por objetivo avaliar as condições higiênico-sanitárias da dieta, bem como o percentual de conformidade das diferentes áreas envolvidas no processo de obtenção da mesma, por meio das boas práticas. Os métodos utilizados foram análise microbiológica, baseada na Resolução da Diretoria Colegiada (RDC) 12/01 e, para verificação das boas práticas de preparação, utilizou-se a RDC 63/00. Foi verificada uma contaminação por coliformes a 35ºC acima do padrão e um índice de 61% de Não-conformidades na preparação. As contagens de microrganismos, considerados não patogênicos, mas indicadores de condições higiênico-sanitárias inadequadas, sugerem necessidades de maiores cuidados durante o processamento da nutrição enteral (NE) e adequações nas boas práticas de produção da mesma.

Enteral formulations are important for the recovery of immunosupressed patients. They are composed by macro and micronutrients, constituting an excellent media for microorganism growth. Such diets' contamination can occur at different stages of processing. This research aims to verify the microbiological quality of enteral diet in private hospital, the percentage of conformity to the health norms in different areas of diets preparation and to isolate the higher risk stage. The methods applied were: microbiological analysis based in RDC Resolution...

Effects of an immune-enhancing enteral diet in gastrointestinal cancer patients / 肠外与肠内营养

Objectives:To evaluate if the administration of an enteral diet supplemented with glutamine,arginine and ? 3 fatty acids modulate the inflammatory and immune responses and the outcome after surgery. Methods:A prospective,randomized,double blind and clinical trial was performed.Eighty eight patients with gastrointestinal cancer were randomly divided itnto two groups.One group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and ? 3 fatty acids.Feedings were started within 48 hour after operation, and continued until day 8.All variables were measured before operation and on postoperative day 1,4 and 8.Blood was drawn at different time points to assess albumin, prealbumin and transferring.Immune responses was determined by phagocytosis ability,respiratory burst of polymorphonuclear cells, total lymphocytes, lymphocyte subsets, nitric oxide,cytokine concentration,immunoglobins,and inflammatory responses by plasma levels of C reactive protein and prostaglandin E 2. Results:Tolerance of both formula diets was excellent.There were significant differences in the immunological and inflammatory responses between the two groups.In supplemented group,the serum concentrations of IgA,IgG,IgM,phagocytosis and respiratory burst after surgery were higher and C reactive protein level was lower( P