Implementation of hazard analysis and critical control points (HACCP) for microbial safety of enteral feeding solutions at Imam Khomeini Hospital, Urmia, Iran

Mohammad  Yousefi; Kave  Koorehpaz; Morteza  Bagheri; Yaghob  Sharifi; Amir  Rahimirad; Yousef  Roosta

doi:10.18502/ijm.v17i4.19251

Mohammad Yousefi Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
Kave Koorehpaz Department of Theriogenology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
Morteza Bagheri Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
Yaghob Sharifi Department of Microbiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Amir Rahimirad Food and Drug Administration, Urmia University of Medical Sciences, Urmia, Iran
Yousef Roosta Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

DOI: https://doi.org/10.18502/ijm.v17i4.19251

Keywords: Enteral nutrition; Hospitals; Food contamination; Hazard analysis and critical control points; Polymerase chain reaction

Abstract

Background and Objectives: Enteral feeding solutions (gavage) play a vital role in supporting ICU patients who cannot eat by mouth. However, their preparation is vulnerable to microbial contamination, posing serious health risks. This study aimed to assess and improve the microbial safety of enteral feeding solutions prepared at Imam Khomeini Hospital in Urmia, Iran.

Materials and Methods: A three-phase intervention was conducted involving microbial and PCR analyses, source identi- fication, and corrective measures. Initial testing revealed high contamination levels: coliform bacteria (>5×10³ CFU/mL), fungi (>3×10³ CFU/mL), and total mesophilic bacteria (>10⁴ CFU/mL). PCR analysis confirmed the absence of Escherichia coli and Klebsiella spp. Corrective actions—such as installing UV lighting, implementing enhanced cleaning protocols, and replacing the mixing device—were introduced.

Results: Post-intervention analyses showed complete elimination of detectable microbial contamination in the gavage solu- tions.

Conclusion: This study demonstrates that implementing a HACCP-based approach can effectively eliminate microbial con- tamination in enteral feeding solutions. The findings support the development of national guidelines and highlight the impor- tance of standardized safety practices to improve patient care in hospital settings.