Reuse and Cleaning of Enteral Feeding Equipment

Enteral feeding is a potential source of infection due to the risk of bacterial contamination of feed products and enteral feeding equipment (Osland E. , 2008); (Osland, Andersen, Coleman, & Marshall, 2021). It may occur as a part of feed preparation, administration, or with retrograde bacterial growth migrating from the feeding tube into the delivery set over time (Osland E. , 2008). 

Equipment used to administer enteral feeding may include syringes, feeding sets (bag with tubing), adaptors, tube extensions, and enteral feeding pumps. Bacteria can accumulate at the distal end of the feeding tube and the Y-port of feeding sets which can be increased with handling and extended hang times (Mathus-Vliegen, Bredius, & Binnekade, 2006). Enteral feeding equipment is generally intended for single use. Despite limited evidence, however, they are often reused due to cost, supply shortages, and environmental impact. 

There is limited evidence on the safety and clinical outcomes of cleaning and reusing enteral feeding equipment in the home setting. It is uncertain whether enteral feeding equipment reuse up to 72 hours leads to the development of adverse gastrointestinal symptoms (diarrhea and vomiting) or gastrostomy site infection. Evidence on the effectiveness of cleaning methods for feeding sets when evaluated by bacterial count is also uncertain. No studies have evaluated the reuse of syringes for bolus feeding (Osland, Andersen, Coleman, & Marshall, 2021). It is also unclear whether the formula type (i.e. specialty or elemental formula) increases plasticizer leaching in feeding sets to impact the reuse of enteral feeding equipment.

Enteral feeding equipment that is reused should be sufficiently cleaned to reduce the risk of bacterial contamination of subsequent feeds. 

• Feeding pumps should be cleaned and serviced according to the manufacture guidelines to maintain function and warranty. 
• Feeding equipment such as syringes, feeding sets, adaptors, and tube extensions should be cleaned using warm soapy water, scrubbing for 30 seconds or more, and rinsing with hot water. 
• Rinsing equipment with sterile water between bolus feeding may further limit contamination (Osland, Andersen, Coleman, & Marshall, 2021).

Table 14: Equipment Reuse Recommendations for AHS Pediatric Home Nutrition Support Programs:

See Equipment Supply Quotas for details and exceptions.