Biofilm Growth on the Lopez Enteral Feeding Valve Cultured in Enteral Nutrition: Potential Implications for Medical-Surgical Patients, Nursing Care, and Research

Headnote

Medical - surgical patients may receive enteral nutrition via feeding tubes. This research study determined Pseudomonas aeruginosa can develop a bacterial biofilm on the Lopez enteral feeding valve in 3 days when cultured in enteral nutrition. Biofilms can cause nosocomial infections.

The Lopez enteral feeding valve is one of the charter products of ICU Medical (San Clemente, CA) and has been available since 1990 (see Figure 1). The polycarbonate and polypropylene three-way stop-cock valve of this device creates a closed, enteral feeding-tube system. The nasogastric (NG) or percutaneous enteral gastrostomy (PEG) feeding tube (placed into the patient's stomach) and the enteral feeding tubing (connected to an enteral feeding re servoir) are joined by the Lopez valve. The medical-surgical nurse can swivel the stop-cock to gain access to the system. Because of its ease of use, nurses routinely use these devices for enterally fed patients. Their use has several benefits for patients, nurses, and health care facilities (Solseng, Vinson, Gibbs, & Greenwald, 2008).

The U.S. Food and Drug Administration (FDA) identified the Lopez valve as a Class III medical device. A Class III product can be used, non-sterile, for enteral feedings (FDA, 2007), but a sterile Lopez valve also is available (A. Burcar, personal communication, July 30, 2006). No FDA requirement exists for manufacturers' recommendations for changing frequency. Although the tubing, bag, and flush syringes are replaced commonly every 24 hours based on facility policy, facilities may use the Lopez valve indefinitely (P. Haffman, personal communication, May 16, 2005). The most common protocol in the acute care setting is a weekly replacement (ICU Medical, Inc., 2008).

Biofilm

Biofilms may form on medical devices when microorganisms adhere to these artificial surfaces (Cernohorska & Votava, 2002). These complex communities of bacterial cells form three-dimensional, multi-layered stru c ture s enclosed by a polymer matrix (Donlon, 2002). Biofilms on medical devices may cause acute or chronic infections, and are a notable source of nosocomial infections. Once established, the bacteria harbored inside the biofilm are less susceptible to antibiotics and are less exposed to the patient's immune response (Cernohorska & Votava, 2002), creating a public health and infection control problem (Capelli et al., 2007). The spread of antibiotic resistance is facilitated by biofilm because the efficient transfer of virulence...