Disinfection of surfaces and instruments in neonatal units

Birth asphyxia, characterized by the newborn's inability to breathe immediately after birth, is one of the critical consequences of adverse intrapartum events. This tragic phenomenon is associated with a significant number of neonatal deaths, with over 662,000 cases recorded annually worldwide, a figure that accounts for nearly a quarter of all neonatal deaths in neonatology units. It is also worth noting that more than 98% of these deaths occur in low- and middle-income countries, highlighting the critical need for adequate interventions and resources in these regions.

Birth asphyxia is a leading cause of neonatal death that can often be prevented by providing basic neonatal resuscitation.

During use, resuscitation equipment becomes contaminated with maternal and neonatal bodily fluids, which poses an infection risk to the next newborn requiring resuscitation if the equipment is used without proper reprocessing or after improper storage.

This risk is particularly concerning for newborns, as they are much more vulnerable to infections than older children and adults. Like all reusable medical equipment, neonatal resuscitation equipment must undergo a thorough, multi-stage process known as "reprocessing" to clean it and either sterilize it or disinfect it to a high level, and store it appropriately to make it safe for use on the next patient. OXOKLIN High-level disinfectant

Proper disinfection of medical equipment and thorough cleaning of the healthcare facility environment are essential to helping newborns survive and are relatively simple ways we can protect newborns from contracting infections while in the unit. KLINTENSIV® – Concentrated disinfectant detergent

Three main causes of neonatal mortality

The three major causes of neonatal mortality are prematurity, perinatal events, and infections. Experts from around the world gathered in 2010 to create an educational intervention, Helping Babies Breathe (HBB), to reduce mortality from perinatal events by teaching birth attendants how to resuscitate newborns. The Helping Babies Breathe strategy has been implemented in over 80 countries worldwide, with over 500,000 local providers trained. It has been shown to reduce neonatal mortality and improve the capacity for neonatal care.

Given that infection is one of the other leading causes, interest has grown in ways to mitigate this widespread and complex problem. Clean and functional resuscitation equipment is important for preventing the consequences of both perinatal events and infections, and in low-resource settings, there is concern that vital, reused resuscitation equipment is subjected to suboptimal disinfection in the newborn nursery.

Disinfection of equipment, instruments, and surfaces in neonatal units

Medical equipment is manufactured for single use or for multiple patients. Most hospitals use a combination of both. Disinfection methods often follow the manufacturer's recommendations, which are based on the Spaulding criteria and local guidelines from authorized bodies. In high-resource hospitals, single-use equipment is disposed of after one use. This is particularly true for neonatal resuscitation equipment.

Much of the reusable equipment used in healthcare facilities, including surgical instruments, undergoes sterilization. Certain equipment, including endoscopy instruments, may undergo high-level disinfection rather than sterilization. There are several steps involved in reprocessing, including: (1) pre-cleaning; (2) cleaning; (3) inspection and functional testing; and (4) storage.

Disinfection of equipment and instruments in neonatal units

For the disinfection of equipment and instruments, three options are presented: disinfection with professional solutions; thermal disinfection by boiling; and sterilization by autoclaving.

Newborn lives could be saved if there were more sustainable and equitable access to life-saving equipment, regardless of the hospital where the children are born. This includes adequate resources for disinfecting surfaces and instruments. Case reports from neonatal care settings raise concerns that a lack of effective reprocessing increases infection rates in this vulnerable population. DESOGEN® – Concentrated high-level disinfectant

Each healthcare facility must consider both patient volume and the available resuscitation equipment to best determine the necessary workflow to ensure that sterilized/disinfected equipment is always ready for use.

Additionally, staff responsible for disinfecting the spaces must ensure that all sanitation steps are performed consistently immediately after the equipment is used to avoid damaging it. For example, in busy units where multiple staff members are responsible for reprocessing, it is recommended that a specific person on each shift be tasked with reprocessing on different days and that sufficient time be specifically allocated in their schedule for reprocessing.

Sterilization of instruments in neonatal units

Sterilization is the preferred method for preparing resuscitation equipment for reuse because it destroys all microorganisms, including bacterial endospores. High-pressure steam sterilization (autoclaving) is an effective method for sterilizing neonatal resuscitation equipment.

Dry heat sterilization methods should never be used for resuscitation equipment (only metal and glass can be safely subjected to dry heat sterilization). It is essential that the equipment be well cleaned and dried before sterilization.

Some debris, such as fatty substances, can protect microorganisms from the effects of steam, thereby preventing sterilization.

When an autoclave (steam sterilizer) is used for resuscitation equipment, the manufacturer's instructions for optimal functionality must be followed.

If sterilization is not possible, high-level disinfection must be performed to make the equipment safe for reuse. Disinfection destroys all microorganisms except some bacterial endospores.

There are several options for the disinfection process. Selection of the best method is based on the resources available in the healthcare facility.

Warnings regarding the use of chemical disinfectants:

• All high-level disinfectants must be used in a well-ventilated area, away from patients.
• Do not use expired chemical products.
• Do not refill a commercial chemical container with the same chemical product or a different chemical product. Refilling containers could lead to erroneous information regarding the contents, chemical concentration, or expiration date. Furthermore, refilling a container with a different chemical could cause a harmful chemical reaction.
• Never leave equipment soaking in a chemical disinfectant for longer than the specified time. Overexposure to chemicals can damage the equipment and will reduce its lifespan.
• Enzymatic detergent is not a disinfectant and should not be used for disinfection; however, it is an extremely useful product for the process of cleaning organic materials. KLINOZYME – Concentrated tri-enzymatic detergent