Efficacy of protocols for cleaning and disinfecting infant feeding bottles in less developed communities.

Although breastfeeding is the best choice for most infants, infant formula is used widely, commonly introduced during the neonatal period, and usually given to infants in bottles that can be difficult to clean. We artificially contaminated infant feeding bottles with low and high inocula of bacterial enteric pathogens and evaluated the efficacy of several cleaning and chlorine disinfection protocols. Rinsing with soapy water followed by tap water was the most effective cleaning method and reduced pathogen load by 3.7 and 3.1 log(10)s at the low and high inoculum levels, respectively. Submersion in 50 ppm hypochlorite solution for 30 minutes produced a 3.7-log(10) reduction in pathogens, resulting in no identifiable pathogens among bottles. This result was comparable to boiling. When combined with handwashing, use of safe water, and appropriate storage of prepared infant formula, these simple, inexpensive practices could improve the microbiological safety of infant formula feeding in less developed settings.

Survival and growth of Shigella flexneri, Salmonella enterica serovar enteritidis, and Vibrio cholerae O1 in reconstituted infant formula.

Formula feeding is an alternative method to prevent mother-to-child infection with human immunodeficiency virus through breast-feeding in developing countries. Growth of bacterial pathogens in reconstituted infant formula has become a health hazard when contaminated water is used for rehydration. This study was conducted to assess bacterial safety risk of using contaminated water to reconstitute infant formula. Survival and growth characteristics were determined for three bacterial pathogens, Vibrio cholerae O1, Shigella flexneri, and Salmonella enterica serovar Enteritidis, inoculated into sterile tap water (3.2-3.4 log10 colony-forming units [CFU]/ml) and infant formula (1.5-1.7 and 3.2-3.4 log10 CFU/ml) and incubated at 4 degrees C or 30 degrees C for up to 24 hours. Vibrio cholerae O1 was the most sensitive of the three pathogens when inoculated into water, with no viable cells detected within 2 hours at 4 degrees C or 30 degrees C. The rate of inactivation in water was greater at 30 degrees C than at 4 degrees C. Vibrio cholerae O1, Shigella flexneri, and Salmonella enterica serovar Enteritidis grew rapidly in infant formula at 30 degrees C, reaching populations of 9.2, 8.7, and 9.2 log10 CFU/ml, respectively, at 24 hours. Populations of all three pathogens did not change significantly after incubating infant formula for 24 hours at 4 degrees C, but continuously decreased in water throughout incubation for 24 hours, regardless of temperature. Results suggest that unless refrigerated, reconstituted infant formula should be consumed soon after preparation to avoid increased risk of illness associated with increases in populations of pathogenic bacteria that may be introduced by contaminated water.