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Improper Reprocessing of Neonatal Resuscitation Equipment in rural Kenya compromises function: Recommendations for more effective implementation of Helping Babies Breathe

2015; Elsevier BV; Volume: 91; Linguagem: Inglês

10.1016/j.resuscitation.2015.02.037

1873-1570

Pegeen W. Eslami, Sherri Bucher, Rachel Mungai,

Infant Development and Preterm Care

Helping Babies BreatheR (HBB) is a newborn resuscitation (NR) educational and training program designed to teach basic knowledge and skills to providers in under-resourced settings. Launched in 2010, HBB has rolled-out in 70+ countries. There have been encouraging outcomes reported for global HBB implementation, including increased knowledge and skills in NR, and improved newborn survival.1Msemo G. Massawe A. Mmbamdo D. et al.Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training.Pediatrics. 2013; 131 ([originally published online January 21, 2013]): e353Crossref PubMed Scopus (257) Google Scholar, 2Shivaprasad S. Goudar M. Manjanuth S. et al.Stillbirth and newborn mortality in India after helping babies breathe training.Pediatrics. 2013; 131 ([originally published online January 21, 2013]): e344Crossref PubMed Scopus (149) Google Scholar, 3Hoban R. Bucher S. Neuman I. et al.'Helping babies breathe' training in sub-Saharan Africa: educational impact and learner impressions.J Trop Pediatr. 2013; 59 ([Epub 2013 Jan 17]): 180-186https://doi.org/10.1093/tropej/fms077Crossref PubMed Scopus (49) Google Scholar, 4Singhal N. Lockyer J. Fidler H. et al.Helping Babies Breathe: global neonatal resuscitation program development and formative educational evaluation.Resuscitation. 2012; 83 ([Epub 2011 Jul 19]): 90-96https://doi.org/10.1016/j.resuscitation.2011.07.010Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar In 2012 and 2013, with funding from Laerdal Foundation and UMass Medical School, we conducted initial and refresher HBB courses with subsequent follow-up visits in Kenya, at 3 rural hospitals in the former Central and Eastern Provinces. We highlight key, unexpected findings concerning improper reprocessing of neonatal resuscitation equipment. These observations have profound implications for NR implementation in resource-poor regions, and for the anticipated revision of the HBB curriculum. In Kenya, autoclaving or chemical disinfection are the usual methods of reprocessing of durable medical devices. We found 3 primary areas in which inappropriate methods were being utilized, with detrimental impact. First, non-HBB trained personnel, such as custodial staff or students, were frequently responsible for cleaning and disinfections of NR equipment that was in clinical use. Thus, despite training, there was a knowledge/skills gap in regards to reprocessing of HBB equipment. Second, both HBB-trained and non-HBB trained personnel believed that "more is better" in terms of the length of time that NR equipment, specifically resuscitators and suction devices, were soaked in Activated Glutaraldehyde Solution (AGS). One nurse we interviewed reported the NR equipment would sometimes soak for days, contrary to manufacturer recommendations of 20 min.5http://www.aspjj.com/emea/sites/www.aspjj.com.emea/files/pdf/AD-110030-01-CT_A%20Manual%20Solution_CIDEX_LD_0.pdfGoogle Scholar Further, we found that after being removed from chemical disinfectant, equipment was often not rinsed thoroughly with clean water. Finally, despite the fact that we had taught disassembly of the resuscitator in our HBB courses, even trained staff failed to consistently perform this crucial action, regardless of whether chemical or thermal disinfection was utilized. This includes failing to separate and remove, during reprocessing, the delicate yellow O-rings that act as gaskets. When the resuscitators were not fully disassembled, a sticky bond formed between the flexible O-ring and the fixed plastic structures of the device. This compromised bag inflation/reinflation, and, alarmingly, rendered subsequent bag-and-mask ventilation efforts ineffectual. Misuse of AGS also compromised the Penguin bulb suction devices, causing staining, stickiness, and weakening of a crucial hinge (Fig. 1). We suggest both immediate and longer-term action. In the short-term, implementers of HBB and other NR courses should ensure that the following concepts and skills are integrated into training and quality improvement efforts: (a) emphasis on the importance of proper reprocessing of all reusable NR commodities, regardless of device manufacturer or what cleaning/disinfection methods are used; (b) active practice to disassemble and reassemble the resuscitator (an informal video we created to demonstrate disassembly of the Laerdal resuscitator is available on Youtube at http://youtu.be/uwwbMzcYRrY); (c) proactive identification and discussion of local, context-specific gaps, barriers, and solutions to reprocessing. In the longer term, our findings suggest that issues surrounding reprocessing of NR commodities should be emphasized in the upcoming revision of the HBB curriculum. The authors declare no conflicts of interest. The project sponsor was not involved in drafting this Letter to the Editor. The opinions expressed herein are those of the authors alone, and do not necessarily represent the University of Massachusetts or Indiana University Schools of Medicine, or Laerdal Foundation for Acute Medicine.