The Effect of Two Tube-feeding Protocols on Bacterial Contamination and Diarrhea in ICU Patients

Abstract

Diarrhea, a serious outcome for patients, commonly occurs following institution of enteral feeding. One suggested etiology for the problem is bacterial contamination of the enteral feeding solution. The purpose of this study was to extend previous pilot research on the occurrence of bacterial contamination and diarrhea in tube-fed ICU patients by comparing two enteral feeding protocols. The protocols compared were the routine hospital protocol vs an aseptic protocol for the preparation and maintenance of enteral nutrition. A convenience sample of 63 ICU patients, who met the inclusion criteria, were followed from the first day of enteral feeding to the fourth day. All subjects received the same isotonic formula (Osmolite). Twenty-seven percent (n = 17) of subjects developed diarrhea. There were no significant differences in the incidence of diarrhea between the two protocol groups. Bacterial contamination was low (n = 9, 14%), and was not significantly different between protocol groups. Women had a significantly higher incidence of diarrhea (p = 0.02) as did subjects whose primary medical diagnosis was respiratory (p = 0.02). Subjects with a neurologic medical diagnosis had significantly less diarrhea (p = 0.05). Also, subjects receiving aminoglycosides (p = 0.02) or penicillin (p = 0.03) had a higher incidence of diarrhea. Serum albumin was significantly lower in patients with diarrhea (p = 0.05). This study indicates that the development of diarrhea in enterally fed patients is multifactorial.