Sanitary risk in the handling of home‐prepared enteral formulations: A cross‐sectional assessment of microbiological contamination and food safety

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.