Tasmanian Health Organisation - North

WOMENS AND CHILDRENS SERVICES LAUNCESTON GENERAL HOSPITAL SDMS Id No.: SDMS Id No.297-001 WACS Policy No: 7.5-12

Infant Feeding Equipment: Care and Disinfection

SDMS Id Number Document No. Effective from Functional Sub Group Application: Summary: Replaces Doc No. Version No. Author Area Contact Applies to Policy Type Review Date P2010/0297-001 WAC Policy 7.5-2012 25 July, 2012 Womens and Childrens Services - Lactation Nurses, Midwives and Hospital Aides, WACS, LGH Care and disinfection of infant feeding equipment in the hospital setting. WACS Policy 4.4 Sterilising Artificial Infant Milk Feeding Equipment; WACS Policy 7.5 Care of Breastfeeding Expressing Equipment 1 Health and Hospital Northern Area Health Service Launceston General Hospital Jill Hanson & Dianne Haworth, Clinical Nurse Consultant: Lactation All Employees WACS, LGH All staff 25 July, 2015

Prepared by Through Through

Jill Hanson & Dianne Haworth Sue McBeath Amanda Dennis

Clinical Nurse Consultant: Lactation Co-Director, Nursing & Midwifery, WACS Co-Director, Medical, WACS

6348 8934 6348 8976 6348 8972

7 June 2012 21 August 2012 21 August 2012

Introduction/Purpose
To minimise the risk of bacterial or viral contamination by ensuring all infant feeding equipment is either single use or cleaned to appropriate standards.
Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

1 of 9

The patients in Ward 4N and 4K are our most vulnerable and thus equipment will be reprocessed to the highest standard at all times. In ward 4O, our well mothers need to be taught home appropriate care of their feeding equipment for their well babies, staff will model and provide anticipatory guidance to them in this endeavour.

Policy Statement
Infant feeding equipment in the hospital setting is classed as semi-critical under the Spaulding classification (1968). Semi critical items have contact with intact non sterile mucosa or non intact skin and therefore requires re processing in accordance with AS/NZS 4187 -2003 (CHRISP 2010). To comply, all re-usable infant feeding equipment in the healthcare environment requires thermal disinfection. The Miele Thermal Disinfector Unit meets minimum thermal reprocessing required for semi-critical items. All single-use items are managed as per manufacturer instructions.

Key Definitions
DHHS and the Agency refer to the entire Department of health and Human Services made up of Department Units responsible for policy, planning and performance; and interface with government, and Operational Units responsible for delivering services against policies, plans and standards set by the departmental units.

Principles
The hospital maintains compliance with available best-practice guidelines for care and disinfection of infant feeding equipment, together with BFHI standards for accreditation. If infant admitted to Ward 4N (Neonatal Unit), hospital-grade re-usable equipment will be used until infant ready for discharge. Please refer to document: QActivity_45N11_Best Practice Guideline_4N.doc The breast expression One-Day Disposable kits are designed to be used for 24 hours or eight expressing sessions. On Postnatal Ward 4O and Paediatric Ward 4K, parents who choose to feed their infants artificial milk are encouraged to bring in their own bottles and teats for use during hospitalisation. On Ward 4O, parents should be encouraged to use and learn about the disinfecting method they will be using at home. Chemical or bench-top steam sterilisation is available for parents use. Reusable bottles and teats should be washed well and disinfected after every use. Single use items (eg syringes, bottles) are to be discarded after each use.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

2 of 9

Implementation/Policy in Operation
1
a)

Disinfection methods:
Thermo-disinfection (Ward 4N, Ward 4K) The Miele is to be utilised for all re-usable infant feeding equipment disinfection purposes in 4N. Hospital owned infant feeding equipment in 4K is disinfected in the Miele after each use. Patients own feeding equipment is disinfected in the microwave sterilising unit or the Miele, depending on the size of the bottles (ie wide neck bottles do not fit in the Miele) The Miele Compact Thermo-Disinfector G7735 CD ensures hospital / commercial standard thermal disinfection at 80 for 10 minutes or 90 for 1 minute during the last cycle (as per the current standard AS/NZS 4187:2003 Cleaning, disinfecting and sterilizing reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities). The Miele is currently set to exceed this temperature by 3 degrees and therefore hold 83 degrees for 10 minutes (program 128). Disinfection in 4N with the Miele will occur at a minimum daily. This may be attended by the Hospital Aide Monday Friday mornings and by nursing staff in the evenings, weekends or public holidays. Equipment malfunction: o If the Miele is malfunctioning or not in use due to servicing requirements then single use bottles, caps, tops and teats are to be used to ensure infection control is maintained. o If ERROR report on printer r, then batch should be re-processed. o If personal ID of equipment dislodges during processing or becomes unreadable, discard, and reissue new items to the patient. Please refer to document: QActivity_45N11_Best Practice Guideline_4N.doc for more directions.

b)

Bench-top or microwave steam Steriliser (Ward 4O and 4K only) Before use: Wash all items in hot soapy water and rinse Check bowl and lid is dry, if not, empty water and dry with paper towel Pour exactly 90 ml of water into bowl (or as per manufacturers instruction) When finished: Wait for steriliser to switch off Take care when opening lid in case of escaping heat and steam

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

3 of 9

 Leave steriliser to cool for at least 10 minutes before next use, to allow thermostat to reset Pour away any remaining water, rinse and wipe dry with paper towel. Monthly: Bench-top steam steriliser: pour 200ml vinegar mixed with 200ml cold water into steriliser. Allow to stand in the unit until any lime-scale has dissolved. Empty the unit and rinse thoroughly. This procedure may be carried out by the Hospital Aide. c) Chemical disinfection (if requested by patient, Ward 4O and 4K only) All containers should be for individual patient-use only and clearly named. Scrupulously clean after patient discharge and leave to air dry. Prior to any item being placed in chemical disinfectant, items should be scrupulously clean. If organic matter is left on equipment, disinfection is not guaranteed. Items are to be completely submerged and left to soak in chemical disinfectant for 1 hour. Items may be left in solution till next feed, or removed, dried and stored in separate lidded container prior to next use. Container and all contents to be thoroughly washed in hot soapy water and rinsed daily. Chemical disinfection solution to be changed daily and made up as per manufacturers instruction. Date and time of change of solution should be noted on the container. Parents are educated regarding this, then encouraged to become independent with the procedure prior to discharge.

Bottles, caps and tops

Ward 4O uses disposable bottles and tops these are single use as per manufacturers instructions. Wards 4N and 4K utilise re-usable equipment, only utilising disposable bottles as part of expressing collection kits. Careful cleaning of re-usable bottles, caps and tops is followed by thermo-disinfection.

Hospital teats are treated as single-patient use

After each use the reusable teat is rinsed, and scrupulously cleaned with hot water and a detergent wipe using mechanical action (including forcing water through the teat hole to removed residual milk). Dry teat with paper towel, place in Zip lock bag awaiting disinfection. Parents requiring teats should be issued with two zip lock bags, one for teats awaiting disinfection, the second for disinfected teats ready for use by the patient, labelled with the date of disinfection.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

4 of 9

 Teats are sterilised as per parent preference if baby on Ward 4O. If baby is Ward 4N patient, thermo-disinfection of teats in Miele is required. Ward 4K owned teats are disinfected in Miele, patient owned teats can be in steam steriliser or Miele as size dictates. Parents requiring issue of hospital owned teats, may be given 2 teats (Ward 4O) or 3 - 6 teats (Ward 4N only) to allow for greater convenience with sterilising between each use. At patient discharge, the teat/s may be disposed of, or the parent may choose to take home.

One-Day Disposable Expressing Kits

Mothers who are expressing breastmilk while in hospital are provided with a disposable expressing kit to be used for 24 hours as per manufacturer instructions. Provide the mother with: A zip-lock plastic bag or storage container labelled with mothers name, date and time of issue EBM labels and EBM register pages as needed Spare bottles or storage containers for expressed breastmilk Access to detergent-based wipes LGH patient pamphlet Expressing for your Premature or sick Infant if appropriate.

Instruct mother on cleaning and storage of expressing kit: The tubing does not need to be cleaned as it does not come in contact with breastmilk - disconnect prior to washing. Rinse expressing kit, wipe out with detergent-based wipes and rinse again. Dry well with paper towel Place in zip-lock bag Discard the expressing kit after 24 hours and issue another if still required.

Electric Breastpumps
Wipe the pump after each patient use, using anti-bacterial wipes. The protective membrane and cap (Medela Symphony breastpump only) is to be changed weekly, washed and sent to CSSD to be autoclaved.

Nipple Shields
Nipple shields are for single patient-use only. In Ward 4O and 4K, after use the shield should be rinsed, wiped with detergentbased wipes, rinsed again, dried with paper towel and stored in zip-lock bag.

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

5 of 9

 In Ward 4N, a mother may be issued with 1-2 nipple shields as required, labelled with permanent marker as per document: QActivity_45N11_Best Practice Guideline_4N.doc After use, the shield is washed and stored as above, with daily thermo-disinfection in Miele dishwasher. When the mother no longer requires the nipple shield it should be discarded, or she may be discharged with the shield. Provide the mother with the LGH Patient Pamphlet Nipple Shield use during Breastfeeding.

Infant dummies / pacifiers

Ward 4O: Dummy use is discouraged, with nil hospital issue (refer to BFHI documents and LGH Breastfeeding Policy). Ward 4N: Pacifier use can form part of clinical care for specific babies. Pacifiers are treated as single patient use. If clinical judgement requires an infant to have a pacifier, 1-2 pacifiers are issued according to purpose of either non nutritive sucking or respiratory therapy adjunct. Pacifiers will be meticulously cleaned with detergent wipe, mechanical action and hot water after each episode of use, capped and stored dry in the patients drawer. In addition, all pacifiers are to be thermally disinfected in the Miele daily during length of stay. Pacifiers and covering caps can be securely placed in the teat rack (see diagram page 7). At discharge, pacifiers are either discarded or sent home with baby at parents request. Ward 4K Most parents should provide own dummy for their infant, discuss normal care of dummy and ensure reasonable care and cleaning is observed. An appropriately named dummy should be disinfected daily in the steam steriliser as with feeding equipment.

Specialised infant feeding equipment

Medela Special Needs Feeder, Pigeon Cleft Pal Teat, Chu Chu teat should be cleaned and disinfected as per product recommendation. Refer to document QActivity_45N11_Best Practice Guideline_4N.doc

Rationale/Evidence Base
There is no clear consensus in the literature regarding methods of disinfection and sterilisation of infant feeding equipment.
Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

6 of 9

Infant feeding equipment in the hospital setting is classed as semi-critical under the Spaulding classification (1968). Semi critical items have contact with intact non sterile mucosa or non intact skin and therefore requires re processing in accordance with AS/NZS 4187 -2003 (CHRISP 2010). Breastmilk is a body fluid and may contain infectious agents. Powdered artificial formula is not a sterile product and may contain pathogens acquired during manufacturing that can cause serious illness. Both breastmilk and artificial formula can be contaminated by incorrectly disinfected feeding equipment (see reference list re basis for evidence).

Outcomes
Nil infant in-patient infections directly related to improper care and disinfection of infant feeding equipment.

Responsibilities/Delegations
Responsible for ensuring this procedure is enforced: Nurse Unit Managers 4N, 4K and 4O/B; Lactation Consultants. Staff members responsible for carrying out the actions that fulfil the procedures directions: ALL STAFF

Audit and Compliance

Any infant in-patient infections directly attributable to improper care and disinfection of infant feeding equipment should be reported via EIMS. Staff education will be linked to Artificial Infant Milk: Safe Preparation, Storage & Handling Policy requirements. The Miele Compact Thermo-Disinfector G7735 CD quality print-outs will provide visual monitoring of required standard AS/NZS 4187:2003 (see above). Print-outs will be retained for suggested period of 3 years in case review required. Failure to comply with this policy without providing a good reason for doing so, may lead to disciplinary action

Related Documents/Useful Resources

Artificial Infant Milk: Safe preparation, storage & handling protocol Breastfeeding LGH Policy 2012 Breastmilk: Safe Management WACSClinProc7. 3 AS/NZS Australian Standards AS4187 2003 Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities. Baby Friendly Health Initiative (BFHI) 10 Steps to Successful Breastfeeding, UNICEF & World Health Organisation, administered by Australian College of Midwives in Australia http://www.bfhi.org.au/

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

7 of 9

Management of Infant Feeding Equipment in 4N 2012 and associated quality improvement activities 2012. QActivity_45N11_Best Practice Guideline_4N.doc

References
Adair, S 2003 Pacifier Use in Children: a review of the Literature, Paediatric Dentistry, vol. 25, Iss. 5, pp.449-458. Centre For Healthcare Related Infection Surveillance And Prevention, (CHRISP) 2010, QLD, Cleaning and reprocessing of infant feeding equipment in Hospitals Comina, E, Marion, K, Renaud, F, Dore, J, Bergeron, E & Freney, J 2006, Pacifiers: a Microbial Reservoir, abstract accessed online 30/12/2011 Da Silveira, L, Charone, S, Maia, L, Soares, R & Portela, M 2009 Biofilm formation by Candida Species on Silicon Surfaces and Latex Pacifier Nipples: An in vivo study, Journal Of Paediatric Dentistry, vol. 33, No. 3, pp. 235-240. Department of Health, WA, Operational circular 2004 Reprocessing of Infant Feeding Equipment in Health care Facilities. Gilks J, Gould D, Price E 2007 Decontaminating breast pump collection kits for use on a Neonatal Unit. Review of current practice and the literature, in Journal of Neonatal Nursing, 13: 191-198. Management of Feeding Equipment 2009 Procedure Southern Health Victoria. May J 2003 Tables of the antimicrobial factors and microbiological contaminants relevant to human milk banking, http://www.latrobe.edu/microbiology/ National Health and Medical Research Council (NHMRC) 2003 Food for Health: Dietary Guidelines for Children and Adolescents in Australia Incorporating the Infant Feeding Guidelines for Health Workers. Commonwealth. AGPS. National Health and Medical Research Council (NHMRC) 2011 Infant Feeding Guidelines, Draft, section 8.3.3 Sterilisation methods. NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010, accessed online http://www.nhmrc.gov.au/node/30290 NSW Department of Health 2006 Breastfeeding in NSW: Promotion, Protection and Support Policy Directive PD2006_012. Further details are available in the NSW DOH Safety Advocate, July 2004. (http://www.health.nsw.gov.au/pubs/s/pdf/safety_ad_7.pdf). NSW Department of Health 2003 Incident Management Policy PD 2006_030. NSW Department of Health 2006 Breastmilk Safe Management PD2006_088. Online: http://www.health.nsw.gov.au/policies/PD/2010/PD2010_019.html PD2005_311 HIV, hepatitis B and hepatitis C - Management of Healthcare workers potentially exposed provides direction on the management of potential exposure to infectious pathogens. Pittard W, Geddes K, Brown S, Mintz S & Hulsey T 1991 Bacterial contamination of human milk: container type and method of expression, Am J Perinatology, 8 (1): 25-27.
Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

8 of 9

Price, E, Awadel-Kariem, F, Hateley, P, Harvey, J, Gilks, J & Kempley, S 2006, Possible Hazards of Hypochlorite disinfection for Feeding Equipmentcfor Premature Infants, Journal of Hospital Infection, vol. 64, pp.90-92. Robson A & Anderson K 1964 Thrush in infants: the disadvantages of teat sterilization by sodium hypochloride, Med J Aust, April: 519-521. Riordan J & Auerbach K (2004) Breastfeeding and human lactation, 3rd Edition, USA. Safe Preparation, Storage And Handling Of Powdered Infant formula WHO Guidelines 2007 Scott C, Bradford J & Gillespie E (2010) Achieving best practice in the management of infant-feeding equipment, in Research, published by CSIRO www.publish.csiro.au/journals/hi Spaulding 1968 Introduction to Infection Prevention. http://www.reproline.jhu.edu/english/4morerh/4ip/ip_manual/01_Introduction.pdf Tully M 2000 Recommendations for handling of mothers own milk, J Hum Lact, 16 (2) : 149-151. Wagner, C 2010, Human Milk and lactation, accessed online 1/2/2012 http://emedicine.medscape.com/article/1835675-overview Warner, B. & Sapsford, A. 2004 Misappropriated Human Milk: Fantasy, fear and fact regarding infectious risk, Newborn and Infant Nursing Reviews , 4:1. 56-61. Widger, J, OConnell, N and Stack, T 2009 Breast milk causing neonatal sepsis and Death, Clin Microbiol Infect, 2010 16: 17961798

Note: PLEASE DESTROY PRINTED COPIES. The electronic version of this Procedure is the approved and current version and is located on the departments intranet. Any printed version is uncontrolled and therefore not current. Page

9 of 9