管灌配方由於提供充足營養素，是微生物生長的好環境，為避免灌食配方受到污染，造成管灌病患腸胃道感染，故需要注意灌食配方製作及使用過程的食品衛生，以減少因管灌食品被微生物汙染。連續管灌是提供腸道功能不佳、無法耐受間歇管灌病人及腸胃手術後開始灌食的病人腸道營養支持的重要方式。連續灌食是將管灌配方放置於灌食袋含輸注管套件(Kangaroo 1000 mL pump set)以幫浦控制灌食速度，24小時連續進食。灌食袋為雙層袋，若於袋外空間放置冰塊，以降低食品溫度而達抑菌效果為何，缺乏實證，本研究目的將評估灌食袋外置放冰塊對灌食配方衛生品質與安全影響，做為臨床是否使用以降低灌食配方溫度抑制微生物生長的參考。 本研究結果顯示，在實驗室模擬灌食機連續灌食情況下，於開放系統，每4或8小時更換一次灌食袋外層的冰柱，灌食袋內配方中心溫度可維持在15℃以下。每4小時換一次冰柱，袋內配方中心溫度可穩定維持在10~12℃ 左右，保冷效果更好。不論有無加冰，液體配方生菌數並不受影響。但於粉末配方，於室溫連續灌食至24小時，其生菌數已接近標準臨界值。每4小時更換一次灌食袋外層放置的冰柱，更能明顯延緩袋內配方生菌數的增殖。臨床上，連續灌食液體配方，約4-8小時更換一次配方，冰柱約8小時換一次，經連續灌食24小時後，9人約有4人(44%)配方生菌數超過標準，且此4人本身皆有感染的情況。因此建議有嚴重感染的個案，除了每4小時更換一次冰柱和縮短配方更換的時間；另外在操作時需更小心，以減少污染的情形。 結論: 灌食機連續灌食情況下，灌食袋外層加冰柱可明顯降低袋內配方中心溫度在15℃以下。 尤其連續灌食粉狀配方時，建議每4小時更換一次灌食袋外層放置的冰柱，更能明顯延緩袋內配方生菌數的增殖。
Due to the adequate nutrients of tube feeding formula, which also provide suitable environment for the growth of microorganisms. In order to avoid contamination of the formula, causing patient’s gastrointestinal infections from tube feeding. It is important to control the food hygiene during production and the use of tube feeding to minimize microbial contamination. Continuous tube feeding is an important method to provide sustained enteral nutrition for the inpatient with intestinal dysfunction, intolerant of tube feeding, or right after gastrointestinal surgery and needs force-feeding. Continuous-feeding tube is placed in the feeding bag containing with infusion kit (Kangaroo 1000 mL pump set), which pumps up food for 24 hours. The double layer feeding bag is surrounded with ice cubes to lower food temperature for bacteriostasis. However, the result of bacteriostatic effect is lack of empirical proof. The purpose of this study is to evaluate food hygiene and safety on feeding bag surrounded with ice cubes . In order to establish clinical references of whether the bacteriostasis is effective by lowering food temperature on feeding bag. Result : According to the study, the formula central temperature can be maintained below 15 ℃ with laboratory simulation of continuous-feeding system by replacing the icicles of the outer layer of tube-feeding bag every 4 to 8 hours. By changing icicles every 4 hours, it resulted in better cold maintenance with central temperature around 10 ~ 12 ℃. It made no impact on the number of microorganisms in liquid formula with or without icicles. However, in powdered formulas, the number of microorganisms was close to the criterion limit after 24 hours of continuous-feeding in room temperature. The proliferation of microorganisms in formula was significantly inhibited while replacing icicles every 4 hours. Clinically, continuously-fed liquid formula was replaced about 4-8 hours and icicles every 8 hours. There were 4 of 9 people (44%) had infections and their formula number of microorganisms failed to meet the criterion after 24-hour continuous feeding. It was recommended that the icicles should be replaced every 4 hours and the frequency of changing feeding bag should be increased for patient with serious infections. Also, careful administration is critical to reduce contamination. Conclusion: With continuous feeding, placing icicles in the outer layer of the tube feeding bag significantly reduced the central temperature to 15 ℃. Furthermore, the proliferation of the number of microorganisms in continuous-fed powdered formula was significantly reduced while changing icicles from the outer layer of tube feeding bag every four hours.
