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Microfiber and steam for a neonatal service: An improved and safe cleaning methodology

2017; Elsevier BV; Volume: 45; Issue: 1 Linguagem: Inglês

10.1016/j.ajic.2016.06.041

1527-3296

Elizabeth Gillespie, Lama Tabbara, Carmel Scott, Anita Lovegrove, Despina Kotsanas, Rhonda L. Stuart,

Advanced Sensor and Energy Harvesting Materials

In 2013, cleaning in our neonatal service was undertaken using a traditional method involving detergent and water. When babies were found to be colonized with vancomycin-resistant Enterococcus (VRE), a second step for disinfection, using hypochlorite, followed cleaning. In November 2013, an outbreak in our neonatal intensive care unit (NICU) with a vanB VRE also involved our step-down special care nurseries. Forty-four babies were colonized with VRE.1Lister D. Kotsanas D. Ballard S. Howden B. Carse E. Tan K. et al.Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service.Am J Infect Control. 2015; 43: 1061-1065Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Immediately following the outbreak, a staged introduction of cleaning without chemicals commenced using microfiber-steam technology.2Gillespie E. Lovegrove A. Kotsanas D. Health care workers use disposable microfiber cloths for cleaning clinical equipment.Am J Infect Control. 2015; 43: 308-309Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Monash Health is Victoria, Australia's, largest health service. Monash Newborn consists of a 60-bed level-3 NICU and 2 special care nurseries (level 2) with capacity for 14 beds and 6 beds at 2 separate campuses. In early 2014, cleaning with microfiber-steam technology began to be implemented across the special care nurseries and the intensive care unit.1Lister D. Kotsanas D. Ballard S. Howden B. Carse E. Tan K. et al.Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service.Am J Infect Control. 2015; 43: 1061-1065Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Microfiber alone, dampened with water, was used to clean sensitive research and audiometry equipment.2Gillespie E. Lovegrove A. Kotsanas D. Health care workers use disposable microfiber cloths for cleaning clinical equipment.Am J Infect Control. 2015; 43: 308-309Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This delicate equipment could not be disinfected with hypochlorite. To allow the continued and safe developmental testing of babies, the new cleaning method was introduced specifically for this equipment.2Gillespie E. Lovegrove A. Kotsanas D. Health care workers use disposable microfiber cloths for cleaning clinical equipment.Am J Infect Control. 2015; 43: 308-309Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The benefits and method of using microfiber-steam technology without chemicals, has been reported previously.2Gillespie E. Lovegrove A. Kotsanas D. Health care workers use disposable microfiber cloths for cleaning clinical equipment.Am J Infect Control. 2015; 43: 308-309Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 3Gillespie E. Brown R. Treagus D. James A. Jackson C. Improving operating room cleaning results with microfiber and steam technology.Am J Infect Control. 2015; 44: 120-122Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar For implementation in our NICU, biomedical engineering professionals provided advice on the use of steam to clean isolettes. This was particularly focused on the prevention of damage to electrical wiring, accidents, or costly repairs. The suite of isolettes in use across the 3 campuses incorporated 4 different brands of isolette and all were considered in the review. An assessment of noise levels was also undertaken because additional noise created by the use of steam machines was a unique concern for neonates that was not previously considered.4American Academy of Pediatrics Noise: a hazard for fetus and newborn.Pediatrics. 1997; 100: 724-727Crossref PubMed Scopus (431) Google Scholar Noise levels were assessed outside visiting hours. Measurements were made inside and outside isolettes, with and without the steam machine in use. Regular VRE screening of the unit had been undertaken since the initial outbreak in 2013 as a monitoring strategy and to ensure ongoing transmission had been halted. During April 2016, a scheduled screening for VRE was undertaken in the level-3 nursery of Monash Newborn. One week later a follow-up screen of all babies in the level-3 nursery was repeated. The biomedical engineering advice for the 4 different types of isolettes resulted in steam cleaning being limited to the wheels, the cabinet, and the canopy of the isolettes. Dampened microfiber alone is used where steam cannot be used. Informative posters were developed for cleaning staff that included information for each type of isolette, and clarified where cleaning with steam could be used and areas to be avoided. The noise assessments revealed that during steam use, there was a small intermittent increase of 5-6 dB above the constant ward background level. Noise levels inside an isolette were measured at 16-19 dB less than outside the isolette. Normal ward levels were above the 50-dB level recommended for neonates by the American Academy of Pediatrics.4American Academy of Pediatrics Noise: a hazard for fetus and newborn.Pediatrics. 1997; 100: 724-727Crossref PubMed Scopus (431) Google Scholar Refer to Table 1.Table 1Results of noise level testing in Monash newborn*Recommended levels in a neonatal unit = 50 dB or less.Area testeddB readingTime of reading (sec)Neonatal intensive care unit conditions outside visiting hours without steam in use639Inside incubator in neonatal intensive care unit without steam in use444General ward with fridge compressor active without steam in use617Outside cot whilst floor being steam cleaned6517At wet/dry vacuum cleaner and no steam in use8071 m above floor attachment whilst producing steam704At floor buffing machine whilst in useNo steam in use736Inside incubator whilst floor buffing machine in use and no steam in use5712* Recommended levels in a neonatal unit = 50 dB or less. Open table in a new tab At the scheduled VRE screen, 66 babies in the unit were included and 1 baby was found to be colonized with vanA VRE. This baby had been in the unit for 3 weeks and had been delivered by normal vaginal delivery. Screening of all babies in the nursery, 1 week later, showed no other babies with VRE. Refer to Figure 1. We describe the additional considerations when introducing a novel cleaning methodology in what is among our highest-risk clinical areas. We are not aware of any other neonatal service using this methodology to clean the environment or equipment. Despite the benefits and use of this cleaning in other high-risk clinical areas of Monash Health, the implementation across all sites of the neonatal service took more than 2 years. Forty beds across 2 adult intensive care units, 30 operating rooms, and more than 2,000 inpatient beds are now cleaned using this technology.2Gillespie E. Lovegrove A. Kotsanas D. Health care workers use disposable microfiber cloths for cleaning clinical equipment.Am J Infect Control. 2015; 43: 308-309Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 3Gillespie E. Brown R. Treagus D. James A. Jackson C. Improving operating room cleaning results with microfiber and steam technology.Am J Infect Control. 2015; 44: 120-122Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Delays in implementation in the neonatal service were initially related to concerns about steam safety and the possibility of damage to electrical wiring or an explosion as a result of damaged wiring. Concerns of adverse developmental effects in newborns caused by excessive noise from steamers produced the longest delays. However, these delays were confined to the level-3 nursery at a single campus. Both level-2 nurseries located at 2 separate campuses did not delay the implementation of microfiber-steam chemical-free cleaning and were not concerned with noise levels. The delays in the level-3 nursery related to concerns for the very premature, high-risk babies. Since introducing this cleaning methodology, an isolette manufacturer has conveyed concerns about the use of bleach as a safe and effective method of cleaning. This manufacturer and its competitors have become aware that their equipment is increasingly showing signs of premature fatigue in response to greater chemical use. Chemical absorption and degradation of some plastics is already known.5Browne A. Niven S. Galloway T. Rowland S. Thompson R. Microplastic moves pollutants and additives to worms, reducing functions linked to health and biodiversity.Curr Biol. 2013; 23: 2388-2392Abstract Full Text Full Text PDF PubMed Scopus (716) Google Scholar Equipment cleaning instructions frequently do not recommend the use of harsh chemicals such as bleach because of its capacity to damage sensitive equipment is recognized. The concept that absorption of chemicals into plastic materials and its potential for chemical inhalation with long-term effects on newborns needs further research. The implementation of the cleaning methodology using microfiber dampened with water provides a safe and effective method of cleaning both equipment and the environment. The real or potential risk of inhalation of chemicals is eliminated. This cleaning system provides the capacity to clean sensitive equipment where other mechanisms, using chemicals, cannot be employed.