Cronobacter Support
03-04-2009, 01:24 PM
2.2.7 Holding and feeding times
According to the FAO/WHO risk assessment for E. sakazakii in PIF, increased feeding durations are generally associated with increased risk due to possible bacterial growth. This risk is increased for warmer ambient temperatures (30 °C and 35 °C). However, when PIF is reconstituted with ³70 °C water, risk is dramatically reduced, and this risk reduction remains valid for feeding times of two hours. This finding has practical implications for the reduction of risk of E. sakazakii infection for slow-feeding infants and for infants in warm climates where ambient room temperature may be around 35 °C.
It is recommended that formula is not held at room temperature for more than two hours, even if water at no less than 70 °C is used to reconstitute PIF. This is because the feed may have become contaminated during preparation, or harmful bacteria may have been introduced into the cup or feeding bottle from the infant's mouth. Also, hot water (70 °C) may have activated bacterial spores of harmful bacteria in the formula. Holding prepared feeds above refrigeration temperature for extended periods provides the opportunity for such bacteria to grow.
2.2.8 Labelling of feed
Prepared feeds should be labelled with details of the infant formula, patient's name, preparer's name and preparation time and date. As care institutions look after many infants, feeds tend to be prepared in bulk. Adequate labelling will ensure traceability of all feeds.
2.2.9 Storage of prepared feeds
If feeds are not to be consumed within two hours after preparation, they should be quickly cooled immediately after preparation, and stored in a refrigerator (at a maximum temperature of 5 °C). Refrigerated storage, at temperatures lower than 5 °C, prevents or slows down growth of harmful bacteria. The FAO/WHO assessment showed a less than 1.3-fold increase in risk when prepared feeds were refrigerated properly.
Feed stored in the refrigerator should be used within 24 hours of preparation. Even if water no less than 70 °C was used to reconstitute PIF, spoilage bacteria may have survived that can grow at refrigeration temperatures and can cause feeds to spoil. The quality of reconstituted PIF may also deteriorate on prolonged storage. If there is an increased risk of microbial contamination in the preparation area or environment, then storage times should be reduced, or feeds made fresh and consumed immediately.
The refrigerator should be capable of bringing the formula to a temperature of no more than 5 °C within 1 hour of preparation. The temperature of the refrigerator should be monitored daily. Feeds should be cooled quickly before placing into the refrigerator as hot feeds will increase the refrigerator's temperature. Feeds can be rapidly cooled by placing under cold running water or in a bowl of cold water.
2.2.10 Re-warming stored feeds
Because of the possibility of growth of harmful bacteria at temperatures above 5 °C, stored formula should only be removed from the refrigerator and re-warmed immediately before feeding. Feeds should not be left warming for more than 15 minutes as re-warming for extended periods means that the feed will be held at a temperature that is ideal for the growth of harmful bacteria. Holding feed in bottle warmers for lengthy periods was reported as one of the probable causes of an outbreak of E. sakazakii infection (Gurtler, Kornacki and Beuchat, 2005).
2.2.11 Transporting prepared feeds
In many care settings, feeds are prepared in a central preparation area, and transported to different wards or areas of the facility. Transporting prepared feeds poses a risk of infection as it increases the time from preparation to consumption, providing the opportunity for growth of harmful bacteria.
Because of this potential for growth, feeds that will not be consumed within two hours of preparation should be quickly cooled and refrigerated until the temperature of the feed is reduced to a temperature of no more
than 5 °C. The cooled formula can then be transported to its destination. At the destination, feeds can be rewarmed for feeding (Section 2.2.10). Alternatively, feeds can be returned to a refrigerator and used within 24 hours from preparation.
If transport takes longer than 30 minutes, it is recommended that feeds are transported under refrigerated conditions in order to prevent feeds from warming up. If refrigerated transport is not available, feeds can be transported in a cooled container, such as a cool bag containing ice-packs.
According to the FAO/WHO risk assessment for E. sakazakii in PIF, increased feeding durations are generally associated with increased risk due to possible bacterial growth. This risk is increased for warmer ambient temperatures (30 °C and 35 °C). However, when PIF is reconstituted with ³70 °C water, risk is dramatically reduced, and this risk reduction remains valid for feeding times of two hours. This finding has practical implications for the reduction of risk of E. sakazakii infection for slow-feeding infants and for infants in warm climates where ambient room temperature may be around 35 °C.
It is recommended that formula is not held at room temperature for more than two hours, even if water at no less than 70 °C is used to reconstitute PIF. This is because the feed may have become contaminated during preparation, or harmful bacteria may have been introduced into the cup or feeding bottle from the infant's mouth. Also, hot water (70 °C) may have activated bacterial spores of harmful bacteria in the formula. Holding prepared feeds above refrigeration temperature for extended periods provides the opportunity for such bacteria to grow.
2.2.8 Labelling of feed
Prepared feeds should be labelled with details of the infant formula, patient's name, preparer's name and preparation time and date. As care institutions look after many infants, feeds tend to be prepared in bulk. Adequate labelling will ensure traceability of all feeds.
2.2.9 Storage of prepared feeds
If feeds are not to be consumed within two hours after preparation, they should be quickly cooled immediately after preparation, and stored in a refrigerator (at a maximum temperature of 5 °C). Refrigerated storage, at temperatures lower than 5 °C, prevents or slows down growth of harmful bacteria. The FAO/WHO assessment showed a less than 1.3-fold increase in risk when prepared feeds were refrigerated properly.
Feed stored in the refrigerator should be used within 24 hours of preparation. Even if water no less than 70 °C was used to reconstitute PIF, spoilage bacteria may have survived that can grow at refrigeration temperatures and can cause feeds to spoil. The quality of reconstituted PIF may also deteriorate on prolonged storage. If there is an increased risk of microbial contamination in the preparation area or environment, then storage times should be reduced, or feeds made fresh and consumed immediately.
The refrigerator should be capable of bringing the formula to a temperature of no more than 5 °C within 1 hour of preparation. The temperature of the refrigerator should be monitored daily. Feeds should be cooled quickly before placing into the refrigerator as hot feeds will increase the refrigerator's temperature. Feeds can be rapidly cooled by placing under cold running water or in a bowl of cold water.
2.2.10 Re-warming stored feeds
Because of the possibility of growth of harmful bacteria at temperatures above 5 °C, stored formula should only be removed from the refrigerator and re-warmed immediately before feeding. Feeds should not be left warming for more than 15 minutes as re-warming for extended periods means that the feed will be held at a temperature that is ideal for the growth of harmful bacteria. Holding feed in bottle warmers for lengthy periods was reported as one of the probable causes of an outbreak of E. sakazakii infection (Gurtler, Kornacki and Beuchat, 2005).
2.2.11 Transporting prepared feeds
In many care settings, feeds are prepared in a central preparation area, and transported to different wards or areas of the facility. Transporting prepared feeds poses a risk of infection as it increases the time from preparation to consumption, providing the opportunity for growth of harmful bacteria.
Because of this potential for growth, feeds that will not be consumed within two hours of preparation should be quickly cooled and refrigerated until the temperature of the feed is reduced to a temperature of no more
than 5 °C. The cooled formula can then be transported to its destination. At the destination, feeds can be rewarmed for feeding (Section 2.2.10). Alternatively, feeds can be returned to a refrigerator and used within 24 hours from preparation.
If transport takes longer than 30 minutes, it is recommended that feeds are transported under refrigerated conditions in order to prevent feeds from warming up. If refrigerated transport is not available, feeds can be transported in a cooled container, such as a cool bag containing ice-packs.