Neonatal resuscitation equipment maintenance to prevent infection

Manjari Quintanar Solares, MD, MPH

Siobhan Brown, MPH, CPH

May 2017

PATH/Jillian Zemanek

Devices and Tools Program, PATH

ID R513

Background

• Birth asphyxia is a leading cause of neonatal death.

• Global efforts such as Helping Babies Breathe (HBB) aim to increase access to neonatal resuscitation in any facility where a baby is born.

• These efforts include training skilled birth attendants and providing them with reusable neonatal resuscitation equipment.

• Maintenance and correct use of the equipment is key in providing high-quality neonatal resuscitation.

• Health workers need training to properly reprocess (clean and disinfect) reusable neonatal resuscitation equipment to make it safe for use with the next patient, and in this way decrease incidence of hospital-acquired infections.

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All photos: PATH/Manjari Quintanar Solares

Background

• Any object in a health facility can serve as a vehicle for transmission of hospital-acquired infections.

• Although resuscitation equipment may look clean, it can still harbor microorganisms (including the inside of the ventilation bag).

• Gram-negative bacteria thrive on insufficiently reprocessed or improperly stored medical equipment and are known to cause outbreaks.

• Adequate reprocessing of medical equipment is essential to helping newborns survive.

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PATH/Amy MacIver

Background

• To address this need, PATH led a consensus process with global experts to develop Reprocessing Guidelines for Basic Neonatal Resuscitation Equipment in Resource-Limited Settings, which support implementation of HBB.

• The guidelines provide several disinfection method options and may be adapted to the reality of each health facility.

• Job aids and training materials were also developed, available at: http://www.path.org/publications/detail.php?i=2601.

• French and Spanish translations are available as well.

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Content of guidelines

• Focus on basic neonatal resuscitation equipment to support HBB implementation.

• Overview of reprocessing materials and equipment.

• Space planning and workflow.

• Detailed, step-by-step reprocessing instructions for each piece of equipment.

• Training and supervision considerations.

• Considerations for health facility administrators and ministry of health officials.

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General job aid

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• General job aid provides a quick overview of all steps.

• Reprocessing guidelines include appendices with additional job aids specific to each disinfection method, chlorine dilution instructions, and disinfection logs, among others.

Outline of reprocessing stages and steps

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“DIRTY”

“CLEAN”

• Each facility should review this guide and existing national and/or facility policies and then choose their primary and secondary disinfection methods for the reprocessing of neonatal resuscitation equipment based on their unit/facility context.

• When developing a reprocessing plan, consider the following points:

o Availability of reprocessing materials and resources.

o Availability of medical equipment.

o Training/educational resources needed for reprocessing.

o Time needed for reprocessing.

o Space needed for reprocessing.

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Shaping the reprocessing plan

Pilot introduction through workshop in Uganda

• First “HBB Plus” workshop that included one full additional day of reprocessing training took place in September 2016.

• The Uganda Ministry of Health is now actively planning for the rollout of this training and is working to identify funding to support these efforts.

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• In collaboration with the Uganda Ministry of Health, conducted the first workshop to introduce the reprocessing guidelines in Uganda in August 2016.

• Ministry of Health officials, HBB master trainers, doctors, nurses, and midwifes from all levels of care attended the workshop.

Methods for incorporating reprocessing guidelines

• Integrate reprocessing into HBB training workshop (add a hands-on component).

• Build out reprocessing mentorship and Continuing Medical Education programs at the facility level.

• Incorporate reprocessing into quality improvement cycles (country or facility based).

Note: The job aid cannot be a standalone document—important to couple it with guidelines and training.

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Acknowledgement

Support for this project was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of HealthTech V Cooperative Agreement #AID-OAA-A-11-00051. The contents are the responsibility of PATH and do not necessarily reflect the views of USAID or the United States government.

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