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Clinical Research: Comparison of Open Versus Closed Systems of Intermittent Enteral Feeding in Two Long-Term Care Facilities

Health Sciences Centre, Winnipeg, Manitoba, Canada

Carolyn Vogt, RN, MN

University of Manitoba, Winnipeg, Manitoba, Canada

Verna Pangman, RN, MEd, MN

University of Manitoba, Winnipeg, Manitoba, Canada

Wendy Fallis, RN, MN

University of Manitoba, Winnipeg, Manitoba, Canada

Background: In the acute care setting, closed enteral feeding systems have been found to be cost effective when compared with traditional open systems. Because the majority of studies have been conducted in acute care, the following variables pertaining to the open and closed systems were studied in two long-term care facilities: nutritional intake, formula waste, bacterial contamination, diarrhea, nursing time, nursing satisfaction, and cost. Cost included formula, formula waste, and administration sets. Methods: An experimental, randomized crossover design with quantitative and qualitative data was used on a sample of 36 patients, mainly brain injured, who were receiving intermittent enteral feeding. The study was completed in 7 weeks. At the onset, patients were randomly selected to either the closed or open system. Crossover occurred in week 4. In weeks 2, 3, 5, and 6, data collection occurred. Time motion studies of 20 nurses were completed in week 6. Twenty-nine nurses completed the nursing satisfaction surveys in week 7. Results: No significant differences were found in the amount of formula infused and formula wasted. A significant difference (p = .001) in bacterial contamination was found, with a significant contamination rate of 78% in the open and 39% in the closed systems. No significant differences were noted in diarrhea. Time motion studies of 20 nurses revealed no significant differences. In the nursing satisfaction survey of a convenience sample of 29 nurses, nurses expressed more satisfaction with the open system than the closed. Cost analysis revealed that the closed system was more expensive at $7.85 (Canadian)/patient/d compared with the open at $4.78. Conclusions: Decisions relating to choice of enteral feeding systems for patients must include a thorough study of all pertinent variables. Significant differences between the two systems in relation to bacterial contamination and cost were found. The potential complications of bacterial contamination in open

Nutrition in Clinical Practice, Vol. 15, No. 6, 287-298 (2000)
DOI: 10.1177/088453360001500604


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