1. Bethlehem University Faculty Of Nursing And Health Sciences Handling of equipment Prepared By: Azizah Zahikah. Supervised by: Dr. Hania Al Jouzi. MS.Amal Abu Nijmeh. Date :31/1/08

2. Introduction Equipment in the NICU can easily become colonized with bacteria & micro-organisms. Schedules should be established for routine cleaning for all patient care equipment. Frequency of cleaning will vary with type of equipment and with potential for contamination. Appropriate levels of sterility, disinfection and decontamination are to be applied to all equipment used. Each patient must have his / her equipment disinfected or discarded on discharge

3. Handling of equipments In handling of equipments in NICU we should answer the following questions : 1.What are the equipments? 2.Aim of cleaning? 3.How to clean.? 4.When to clean? 5.Who? 6.Where?

4. Introduction What are the equipments used in NICU ? Incubators Nebulizers Respiratory support equipment Other equipments[ stethoscopes, face masks, laryngoscopes, suction devices etc]

5. Incubator maintenance Aim: To protect the newborn against infection risk of the environment- several elements of an incubator can represent a contamination source. Doorknobs, incubator tops, humidifiers, ports etc.

6. What: -Open incubator -Close incubator When: 1-when the infant leaves the ward. 2-every week in case of prolonged hospitalization. Who: The cleaning &maintenance is made be qualified personnel (nurse) or by an assistant nurse. [In some ICU it is customary that most patients equipments are cleaned by a member of the ward team]. Where: In a room exclusively intended for maintenance.

7. How: -Turn off the incubator & let it cool before starting maintenance. -wash hands with a soft soap. -Wear over –gown & gloves. -proceed through the different step, starting with the dirtiest parts. -dismantling of all detachable parts. Decontamination: *water resistant parts in the wash tub: Renew bath for each incubator. *non-water resistant parts: -spray. -contact duration: 15 min.

8. Cleaning: Clean all parts & main structure with rag paper (change it for each incubator). Use a brush for places difficult to reach Proceed from inside to outside, to the frame then to the wheels. Portholes & porthole cuffs & sleeves are easily contaminated, often heavily: cuffs should be replaced on a regular schedule or cleaned & disinfected frequently If the incubator has a fan it should be cleaned & disinfected. The manufacturer instructions should be followed to avoid equipment damage. The air filter should be maintained as recommended by the manufacturer instruction. (at least change every 3 months ) -use only sterile water to fill bottles used for humidification

9. Rinsing & drying : Rinse all parts. Let the removable parts to drain on the clean side of the sink. During that wipe all parts carefully with a clean absorbent cloth, which must be renewed frequently for –optimal dryness. Incubators not in use should be dried by running the incubator hot without water in the reservoir for 24 hours after disinfection.

10. Stocking: In a clean storage room. Or in the infants room. Put a protection sheet on the incubator. Follow up: Write down date of the maintenance Reservoir should be filled with steril water only, and they should drained and refilled with sterile water every 24 hours. Waterproofed mattresses replaced when waterproof covering is broken

11. Ventilator sets Nebulizers and attached tubing must be regularly sterilized, or decontaminated and disinfected. Ventilator set do not need changing more frequently than every 48 hours and should be cleaned and high level disinfection for each use. Only sterile water should be used for nebulizers. Residual water should be discarded when the containers are refilled. water condensed in tubing loops should be removed and discarded.

12. Other equipment Schedules should be established for routine cleaning for all patient care equipment. Frequency of cleaning will vary with type of equipment and with potential for contamination

13. Reusable Items Reusable items must be thoroughly decontaminated and then undergo disinfection before each use. Where the manufacturer advises that a particular piece of equipment be sterilized before use, that advice must be followed.

14. Disposable Items Disposable items such as airway equipment that are placed in direct contact with the respiratory tract, e.g. endotracheal tubes and airways, which are labeled by the manufacturer as disposable or single use, should not be reused or recycled.

15. Others Resusitators, face masks, laryngoscopes, and other items in direct contact with neonates should be dismanteled, thoroughly cleaned, and sterilized if possible. Alternately, the equipment may be subjected to high level disinfection with liquid chemicals. Equipment for respiratory or oxygen therapy should be sterilized or discarded after use.

16. Others Suctioning equipments should be replced and sterilized daily. Stethescopes and similar types of diagnostic instruments should be wiped with alcohol; before use. Stethescopes should be always individual to the patient and never shared. The use of health care worker’s own stethescope between patients should not be permitted.

17. Conclusion Person in charge of cleaning and disinfection of equipment may be a part of the working team. Cleaning regimens should be designed to ensure that surfaces and equipments are cleaned adequately & regularly. Most studies highlights that the cleaning of patient equipment in the NICU is often inadequate and fails to eliminate micro-organisms, and may even cause further contamination because ward staff are inappropriately trained in equipment cleaning or in the safe use of detergent.

18. Conclusion However, where units have a designated person trained in equipment cleaning they have reported significant reduction in health care acquired infection {HCAI}.

19. References Callaghan C (2007)infection control in neonatal intensive care unit.nursing standard 22’1. Malik et Al 2003. Penna et Al 2001, Golan et Al 2005. Zafar et Al 2002. Horton and Parker 2002 Guidelines for perinatal care, Americam Academy of pediatrics

20. Thank you for keeping our NICU clean