Disinfection methods used in decontamination of bottles used for feeding powdered infant formula.

Infant susceptibility and the risks posed by infections associated with bottle-fed powdered infant formula (PIF) have received increased attention in recent years. Intrinsic contamination of PIF with pathogens has been reported and extrinsic contamination can be introduced from the handler or the environment during reconstitution. Recommended disinfection advice and bottle decontamination have changed in recent years and the aim of this study was to validate the efficacy of four current disinfection methods using bottles that had contained reconstituted PIF spiked with either a representative mixed bacterial culture or specific pathogens. Initially, bottles (n = 6) of reconstituted formula were spiked with 10(5) cfu/ml representative mixed culture. For subsequent experiments, reconstituted formula was spiked with either 10(2) and 10(4) cfu/ml of Enterobacter sakazakii (Cronobacter), Bacillus cereus and Staphylococcus aureus. Before disinfection, bottles were cleaned according to recommended guidelines. Disinfection procedures tested included a hypochlorite-based chemical solution and three heat-based methods. Bottles were sampled in four sites. Before cleaning and disinfection, the inner screw cap and inner-teat were the most heavily contaminated sites with 1.6-7.4 x 10(3) cfu/per-area-sampled; the bottle interior was more contaminated overall with 1.2 x 10(4) cfu/per-area-sampled. After disinfection, adherence to recommended procedures (combined with good hygiene) enabled effective decontamination to be achieved using all methods. Small differences in disinfection ability were not significant (p > 0.05). Cumulatively, 800 sites were sampled and no B. cereus or E. sakazakii were isolated. S. aureus was isolated from 0.1% of sites with one site exceeding 1 cfu/ml. Findings indicate the potential for bottle contamination and that strict adherence to four currently used methods allowed effective decontamination. This highlights the importance of effective consumer education by health care professionals.