Clinical and laboratory evaluation of a closed enteral feeding system under cyclic feeding conditions: a microbial and cost evaluation.

Cyclic feeding schedules are now commonly used in conjunction with closed enteral feeding systems. Some manufacturers and clinicians have speculated that closed system cyclic feeding may promote formula contamination via retrograde movement of bacteria during the "no-flow" periods. Using both laboratory and clinical settings, our study evaluated whether retrograde bacterial movement under "no-flow" conditions results in contamination of closed system feeding containers. The clinical phase was conducted with 57 closed system feeding containers used to feed nursing home residents. In both laboratory and clinical testing there was no evidence of container contamination at 36-48 h, nor was there evidence of retrograde movement of bacteria beyond the drip chamber. Formula waste and costs were also analyzed using several 24- or 36-h hang time scenarios. Provided the appropriate container size is used, potential cost savings between $67 to $135 per patient per month may be achieved with the 36-h hang time scenarios. Retrograde movement of bacteria does not appear to be a source of closed system feeding container contamination in systems that incorporate a drip chamber. Using the appropriate size feeding container and systems with at least a 36-h hang time will result in significant cost savings.