Behnam Bahramian - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mahboobe Sarabi-Jamab - Department of Food Biotechnology, Research Institute of Food Science and Technology, Mashhad, Iran
Elyas Nattagh-Eshtivani - Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mitra Rezaie - Corresponding author: Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Background: All types of enteral feeding (EF) formulations, whether blenderized tube feeding (BTF) at hospital kitchen, or commercial enteral feeding (CEF), contains nutrients. The nature of these foods (in terms of pH, nutrient contents, water activity, etc.) is so that if they become contaminated, would immediately grow pathogens inside and put the patient at the risk of infection. This systematic review aimed to investigate the microbial safety of BTF and CEF used in hospitals. Methods: Literature search was conducted in four English databases, including Scopus, PubMed, Science Direct, and Google Scholar, using multiple keywords, such as enteral nutrition, blenderized formulas, home enteral nutrition, enteral formula, EF, blenderized enteral formula, blended feeds, blenderized home-made food, CEF, microbial contamination, and bacterial contamination. Finally, ۱۶ eligible studies were selected for the systematic review. Results: Out of ۱۳۲ retrieved articles, ۱۶ were selected and reviewed CEF was mostly exposed to contamination with total coliforms, Staphylococcus aureus, mesophilic bacteria, and Escherichia coli. In addition, contamination with gram-negative bacteria, Bacillus cereus, mold, and yeast was detected. Most BTF contamination was caused by total coliforms, mesophilic bacteria, Listeria spp., B. cereus, mold, and yeast. Conclusion: Due to the nonconformity of hygienic guidelines, the microbial safety of EF solutions in hospitals and homes are relatively low, which may lead to foodborne diseases. Therefore, a hazard analysis and critical control point (HACCP) system is essential in every hospital kitchen.

Enteral nutrition, Hazard analysis and critical control points, Foodborne diseases, Hospitals, Nutrients