Annette Bourgault, PhD, RN, CNL, FAAN
Associate Professor
University of Central Florida, College of Nursing, Orlando, United States
Orlando, Florida
Disclosure information not submitted.
Chirajyoti Deb, PhD, MS
Translational Medicine Research
Arnold Palmer Hospital Specialty Diagnostic Laboratory (APHSDL), Orlando Health
Orlando, Florida, United States
Disclosure information not submitted.
Lillian Aguirre, DNP, APRN, CCNS, CCRN
Clinical Nurse Specialist - Trauma/Burn Critical Care
Orlando Regional Medical Center, Orlando Health
Orlando, Florida, United States
Disclosure information not submitted.
Rui Xie, PhD
Assistant Professor
University of Central Florida
Orlando, Florida, United States
Disclosure information not submitted.
Kimberly Rathbun, BSN, RN,
Pre-Doctoral Fellow; PhD Student; Graduate Student Research Assistant
University of Central Florida
Orlando, Florida
Disclosure information not submitted.
Veronica Pemberton, BS
Laboratory Technician
Arnold Palmer Hospital Specialty Diagnostic Laboratory (APHSDL), Orlando Health
Orlando, Florida, United States
Disclosure information not submitted.
Mary Lou Sole, PhD, RN, CCNS, FAAN, FCCM
Dean and Professor, Orlando Health Endowed Chair in Nursing
University of Central Florida, College of Nursing
Orlando, Florida, United States
Disclosure information not submitted.
Title: Microbiome Analysis Informs Small-Bore Feeding Tube Stylet Cleansing and Storage Practices
Introduction: Small-bore feeding tubes positioned with stylets are commonly used to provide nutrition. Stylets are often reused. Guidelines for stylet cleansing are vague and 39% of nurses report no stylet cleansing between uses. We hypothesized that cleansing reusable feeding tube stylets with 70% isopropyl alcohol would eliminate microbial contamination.
Methods: Prospective exploratory three-phased study: Phase 1) Cortrak feeding tube stylets cleansed with 70% isopropyl alcohol were reinserted into patient feeding tubes daily over a five-day period (n=4). Swabs and saline rinses of the distal stylet tip (~10 inches) were obtained for microbiome analysis before and after use. Phases 2 and 3 were convenience samples from stylets stored at the bedside. Phase 2): pre-cleansing samples for microbiome profiling (n=5) and Phase 3) pre- and post- cleansing samples for quantitative cultures (n=5). Microbiome analysis was performed using 16s rRNA gene sequencing on Illumina’s MiSeq system. Microbial taxonomic profile at the species level with relative abundances were generated and analyzed for alpha diversity (Shannon diversity index). ANOVA compared pre-and post-samples, within and between subjects. P< 0.05 was significant.
Results: Human commensal bacteria and opportunistic pathogens including Streptococcus pneumoniae, Staphylococcus aureus, Cutibacterium acnes, and Prevotella melaninogenica were identified. Skin and environmental bacteria were found in some samples. Alpha diversity (mean species diversity) was lower following alcohol cleansing (M=2.54 pre, M=1.5 post, p=0.008). No viable microbes were observed in 9/10 culture samples; Staphylococcus capitis was identified by culture on one stylet following alcohol cleansing.
Conclusions: Several potentially opportunistic pathogens could lead to infection. We were unable to quantify or confirm microbial viability. Presence of bacteria post-alcohol cleansing suggested nonsufficient cleaning and/or possible contamination during cleansing/sampling. Appropriate stylet handling and storage are necessary to avoid contamination. The stylet should be cleansed with 70% isopropyl alcohol prior to every use and storage.