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Thursday, June 20, 2013
I have a nephew who needs to be feed by stomach tube. He also takes medication by this same tube. The school he attends wants to do this while he is on the toilet. This seems very unclean to all of us in his family. Is this ok? Does this seem unclean?
Thank you for your good question! A gastrostomy tube is a tube surgically placed in a person's stomach. The opportunity for infection of the GI tract and the skin surrounding the tube is increased because the skin barrier is broken and there is direct access to the GI system. Most children with gastrostomy tubes are medically fragile and already at greater risk for infection as well as a much greater degree of illness from infection, making the use of clean feeding techniques essential to child safety.
It is absolutely unacceptable to feed the child in the bathroom. It is the dirtiest location in the school building! With every flush of a toilet thousands and thousands of bacteria are released into the air. Many of them are gram negative bacteria, including E. coli, which produce particularly harmful infections in both children and adults. In the past several years there have been numerous reports of severe illness and death from E. coli infections of the GI tract in the news media.
All tube feedings need to be done using clean techniques with a freshly cleaned counter space available for placing feeding supplies and formula. Those providing the feeding should wash their hands well and wear clean gloves. I have provided one article clearly describing the process, training, and documentation needed. Ferguson RW (2004). Gastrostomy tube feeding skills for the school nurse. School Nurse News, 21(5), 22-6.
It is critically important that this unhealthful and dangerous proposal be brought to the attention of the school or school district physician consultant and the principal because it violates the basic principles of clean technique, appropriate hygiene, and child safety. There should be a written policy for the training and oversight of personnel providing tube feedings/ gastrostomy feedings in the school, approved by the physician. In this case, I recommend that the parents request a letter from the school principal clearly acknowledging their concern and stating that the child will not be given medications or feedings in any restroom area. I also recommend that the parents perform unannounced spot checks of how the feeding is performed during the school year to assure compliance with accepted standards of tube feeding administration. Any observed violations of the clean and safe feeding procedure should be provided verbally and in writing to the principal and school board for corrective action. If not already available in the school, I recommend that the school acquire and follow the guidelines for care provided by the American Academy of Pediatrics in the two volumes entitles, Managing Chronic Health Needs in Child Care and Schools and Managing Infectious Diseases in Child Care and Schools (2nd ed.).
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University