Introduction and objectiveBottles used in Home Enteral Nutrition (HEN) are essential for the safe administration of enteral formulas at home; however, information on their use, hygiene practices, and microbiological contamination remains limited. This study evaluated the microbiological contamination of bottles used in HEN and the practices related to their use and hygiene in the home setting.MethodologyA total of 51 bottles used in households were analyzed for mesophilic aerobes microorganisms, coagulase-positive Staphylococcus, and Escherichia coli. Information on bottle use and caregivers hygiene procedures was also collected.ResultsIt was found that 80.39% (n=41) of the bottles were contaminated by at least one of the microorganisms analyzed. Mesophilic aerobes microorganisms were the most prevalent, being detected in 76,47% (n=39) of the samples, with microbiological counts of 2.68 ± 2.86. Regarding the duration of use, the most frequent period reported for bottle reuse was three days (39.21%), followed by one day (37.25%). Concerning hygiene practices, most households cleaned the bottles using only running water (64.70%), while 29.41% reported washing with water and detergent. Only 5.88% of households performed a complete cleaning procedure, which included washing with water and detergent followed by sanitization with hot water.ConclusionBottles used in HEN showed a high rate of microbiological contamination, and the hygiene practices adopted in households were often inadequate. These findings highlight the need to establish standardized hygiene protocols and provide guidance to caregivers in order to improve the safety of enteral formulas handled at home environment.

INTRODUCTION:In home enteral nutrition (HEN), the reuse of packaging and administration materials beyond the recommended period, combined with inadequate hygiene practice, increase the risk of microbiological contamination. This study assessed the risk through a simulation that reproduced real-world usage conditions and hygiene practices adopted in the home environment. METHODS:A quantitative experimental study evaluated bottles, feeding sets, and bags applied to 3 categories of HEN: enteral preparation with food (EPF); mixed enteral preparation (MEP), and commercial powdered enteral formula (CEF). Over 3 days, 4 hygiene practices were tested: water (WAT); detergent (DET); detergent + boiling water (DET + BW); detergent + chlorine sanitizing solution (DET + CS). Enteral formulas were prepared daily under safe conditions, and microbiological analyses were performed in triplicate before and after use. RESULTS:Results suggest that reusing bottles and feeding sets for up to 3 days may be microbiologically safe with MEP or CEF when food safety are followed. With EPF, microbial growth increased from the 2nd day, especially under WAT. DET + CS performed best, ensuring safety for up to 3 days (bottles and feeding sets) and 2 days (feeding bags), which were more prone to contamination. CONCLUSION:Reuse for up to 3 days may be microbiologically safe for bottles and feeding sets with MEP or CEF when food safety practices are followed, with DET + CS being the most effective method. In contrast, materials associated with EPF, especially feeding bags, show greater microbial growth from the 2nd day onward, requiring caution.

BACKGROUND:Studies show increased use of home enteral nutrition (HEN) owing to its benefits. However, knowledge about the sanitary risks of handling home-prepared formulas remains limited despite their high contamination rates. This study aimed to assess the sanitary risks in the handling of home-prepared enteral formulations by analyzing contamination levels at different handling points and their relationship with food safety criteria. METHODS:This is an analytical cross-sectional study in 77 households of patients receiving HEN, with a collection of 268 samples from handling countertops, blenders, enteral feeding bottles, and handlers' hands. Microbiological analyses were performed for aerobic mesophilic, coagulase-positive Staphylococci and Escherichia coli (E coli). At the same time, compliance with food safety criteria was assessed using a validated checklist. RESULTS:Blenders showed the highest contamination, with greater aerobic mesophilic counts than enteral feeding bottles (P = 0.031), whereas handlers' hands had the highest coagulase-positive Staphylococci levels (P < 0.001). Preservation was adequate, but cleaning compliance was low (8.2%-17.3%). Inadequate cleaning of countertops was associated with higher E coli counts (P = 0.044), and poor cleaning of feeding bottles was linked to increased aerobic mesophilic counts (P = 0.019). Additionally, inadequate blender cleaning was associated with elevated levels of all analyzed microorganisms (P < 0.05). CONCLUSION:Cleaning failures were the main sanitary risk in HEN handling, with blenders and handlers' hands identified as key contamination points. Strengthening food safety practices is essential to ensure the benefits and safety of HEN.

BACKGROUND:Home enteral nutrition (HEN) offers clinical benefits and is increasingly used, although handling-related health risks remain unclear. This study assessed food safety in HEN using a new contamination risk classification. METHODS:First, the inter-rater reliability of the Food Safety for Handling HEN checklist was analyzed in 25 households by four evaluators. Then, contamination risk classification was proposed in 64 households, relating food safety adequacy to unacceptable microorganisms in samples of enteral formulations. Food safety was also assessed in these households based on adequacy percentage and contamination risk, considering three HEN categories (food based, mixed, and commercial). RESULTS:The inter-rater reliability indicated substantial agreement (≥0.61) in 88% of the evaluations using the 95% confidence interval. In the proposed classification of contamination risk, households were categorized as high risk (food safety adequacy <57.00%) and low risk (food safety adequacy ≥57.00%; p = 0.0011; Spearman R = -0.428) of contamination. The households that handled commercial enteral formulas (72.75%) showed a higher percentage of compliance compared with preparations with foods (58.68%) and mixed ones (57.27%; p = 0.009). However, all evaluated households were classified as low contamination risk. CONCLUSION:Although it is necessary to improve food safety, especially in the handling of enteral formulations containing food, the three categories of manipulated enteral formulations have proven to be safe options for home use. Furthermore, the proposal for classifying the risk of contamination can be considered a useful tool for identifying the level of contamination risk in handling the HEN.

To know the profile of food and enteral formulation handlers is important to promote more effective health education actions for these individuals. This study aimed to develop instruments to evaluate the profile of food handlers in households (PFH) and in food service establishments (PFSE), as well as the profile of handlers of enteral formulations in households (PEFHH). A scoping review was carried out to identify questions about the profile of food and enteral formulation handlers evaluated in studies in thein the main national and international databases. From 47 selected articles, 66 questions were identified. Of these, 17, 22, and 18 questions were established to assess the PFH, PFSE, and PEFHH, respectively. The instrument questions were subdivided by subject into personal data, sociodemographic and professional characteristics, and general information. Some questions differ between instruments due to segment specificities. The proposed instruments are novel tools. Through a scoping review and expert consultations, a comprehensive set of questions was identified and organized into instruments tailored to each specific segment. These tools will be valuable for nutritionists, researchers, and other professionals involved in assessing and addressing the needs of food handlers.

Context The safety of enteral formulas is important to restore and maintain the health of patients.Objective A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home.Data sources A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature.Data extraction Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used.Data analysis Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent.Conclusions A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions.Systematic Review Registration PROSPERO registration no. CRD42022367573.

BACKGROUND:Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN).METHODS:This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases.RESULTS:The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended.CONCLUSION:The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.

The objective of this study was to evaluate good hygiene practices in food trucks, and to verify if there is a difference between the evaluation made by internal auditors and by that of an external auditor. The transversal study was conducted in 95 food trucks in the city of Curitiba, Brazil. A checklist for good hygiene practices was applied during the work routine by internal auditors (owner or manager of each food truck) who evaluated their own food trucks and by an external auditor (who did not work directly with the food trucks) who assessed all the food trucks under study. There was significant difference (p < .01) in the assessment of good hygiene practices between the external and internal auditors. The external auditor was more critical in rating the specific good hygiene practices than the internal auditors (p < .01), indicating their impartial assessment of the routine activities and of the good hygienic practices in the food trucks. This study revealed the importance of internal and external auditors in the evaluation of sanitary risks in food trucks and demonstrated that external auditors are less prone to bias. We concluded that external audits are an effective tool for improving food safety in street food.

BACKGROUNDLittle is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics.METHODSWe evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire.RESULTS82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training."CONCLUSIONRegardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

The purpose of the study was to identify the socioeconomic and professional profile of owners and food handlers of food trucks in a capital in the south of Brazil, as well as to evaluate the knowledge of these individuals regarding food safety. A total of 119 individuals in Curitiba, Brazil, participated in the study. For data collection, was elaborated a questionnaire about the socio-demographic, professional profile and food safety knowledge, which was filled by the participants during events. The majority of the individuals were owners (75.63%), of the male gender (69.75%), aged between 30 and 44 years-old (56.30%) and with complete/incomplete higher education (55.46%). The participants answered of the questions of food safety correctly (76.63%). There was a significant difference regarding food safety knowledge among the participants related to the level of education (p=0.0054), length of service in the food segment (p=0.0267), and the completion of courses related to the food area (p=0.0016). These results emphasize the need for continuous education and for the development of new strategies for food safety training, in order to improve the knowledge of street food workers.

ABSTRACT Objective To evaluate the job satisfaction of nutritionists who work in food service in the state of Paraná (Brazil). Methods A survey was carried out with 249 nutritionists through a semi-structured online questionnaire, which assessed their profile, professional activities, and job satisfaction. The Mann-Whitney and Kruskal-Wallis tests and the ordinal logistic regression at a 5% significance level were applied to evaluate the differences and relationship between job satisfaction and the independent variables. Results The average age of the survey participants was 31.9±6.4 years, the majority was female (95.58%), and graduated between 2000 and 2016 (90.36%). The survey revealed that 55.41% of the nutritionists were satisfied at work, 33.68% were indifferent, 6.86% were highly satisfied, and 4.04% were dissatisfied. The variables that influenced job satisfaction the most were age, years of training, income, and workdays in the week. Income explained satisfaction positively. There was statistical difference in relation to the satisfaction of participants regarding their knowledge on food service (p=0.0350), completion of postgraduate courses (p=0.0082), and interest in working in an area of nutrition other than food service (p<0.0001). Conclusion Although most professionals are satisfied, many were indifferent to job satisfaction, which may reflect a low perspective on their current job or poor experience in the food service. These results suggest the need for further actions aiming at raising nutritionists’ perceived professional importance.