Today on the blog we discuss the latest guidance on decontamination in neonatal intensive care units (NICUs). We share how using the right disinfectant with the correct application can help reduce the risk of environmental contamination.

Last month, the UKHSA issued some new good practice guidance for the decontamination of incubators and other neonatal equipment in neonatal intensive care units (NICUs). The good practice guidance has been triggered by the emergence of a multidrug-resistant Staphylococcus capitis clone. The guidelines covers the key steps required to keep incubators clean and disinfected, both during the stay of patients and when they are discharged, in order to reduce the risks of multidrug-resistant Staphylococcus capitis and other organisms in neonatal units.

S. capitis is one of a large group of Gram-positive bacteria called ‘coagulase-negative staphylococci’ (CoNS). CoNS are generally considered to have limited capacity to cause infections. However, one particular clone of S. capitis, called NRCS-A, has emerged as a cause of neonatal infection. S. capitis NRCS-A is resistant to multiple antibiotics, including key frontline agents used to treat neonates.

Like other staphylococci, S. capitis has the capacity to survive on dry surfaces for extended periods and we know that bacteria on surfaces can find their way into susceptible sites on patients and cause infections.

RELATED STUDY: The role of dry surface biofilm in spreading hospital pathogens

In a neonatal setting, incubators are one of the biggest challenges to effective cleaning and decontamination. They have a complex design, with lots of touch surfaces (some of which are difficult to access), and have extended contact with neonates who may be shedding microbes. S. capitis has been linked with contamination of various incubator surfaces, including door ports. But it’s not only incubators: S. capitis has also been identified on various other items in the neonatal environment including stethoscopes, blankets and other shared equipment.

The guidance focusses on the principles of effective practices for cleaning and disinfection of neonatal incubators, accepting that the evidence base is limited. The principles are equally relevant for the cleaning and disinfection of other items in the neonatal environment. Key guidance points include:

Protocol

• Manufacturer guidance must be followed carefully
• Appropriate cleaning and disinfection products should be used
• The external surfaces should be cleaned daily and touch points should be cleaned at least 3 times a day
• A full terminal disinfection should be undertaken when a patient is discharged, or every 7 days if the patient stays that long
• Following good cleaning practice, including cleaning from clean to dirty, cleaning in a S shape pattern and taking care not to go over the same area twice

Resources

• Sufficient time and space should be provided for incubator decontamination
• Enough incubators should be provided to help with availability at short notice allowing other incubators to be sufficiently cleaned

Technique and training

• Staff should receive adequate training
• Ensure staff practice good hand hygiene and safe use of gloves
• Ensure that parents and carers are aware of the importance of a clean environment

It also important to consider the efficacy of the product being used to clean and disinfect incubators and other pieces of equipment in NICUs. Clinell Universal has broad efficacy against a wide range of microorganisms including S. capitis. When tested against EN standard 13727 in dirty conditions, Clinell Universal passed with a 15 second contact time. Coupled with education on the correct application of disinfectant wipes (such as Clinell Universal) this offers an effective way to clean and disinfect incubators and other equipment in NICUs.

RELATED CONTENT: Improving surface hygiene in a neonatal unit

Some of these points are certainly easier than others to implement. Focusing on choosing the right disinfectant product (in terms of its efficacy and material compatibility) and the correct application (supported by training) will help to reduce environmental contamination and the potential risk of S. capitis and other infections in neonatal settings.

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