NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

Abstract

Background: Contamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings.Methods: A quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention (NeoCLEAN) for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate (ATP) bioluminescence assays and fluorescent ultraviolet (UV) markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020). Results: Environmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1=49%, P2=66%, P3=69%; p=0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (<200 relative light units) increased over time (P1=40%, P2=54%, P3=65%; p=0.002), as did the UV marker removal rate (P1=23%, P2=71%, P3=74%; p<0.001).Conclusion: Routine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.

Impact of a multi-strain probiotic administration on peri-rectal colonization with drug-resistant Gram-negative bacteria in preterm neonates

“…The most frequently cultured Gram-negative (GN) pathogens from neonatal BSI include Klebsiella pneumoniae, Escherichia coli, Enterobacter spp., Serratia marcescens, Acinetobacter baumannii and Pseudomonas aeruginosa (7)(8)(9). Factors contributing to neonatal colonization and/or infection with GN pathogens include poor compliance with hand hygiene, equipment and environmental cleaning recommendations, overcrowding, low nurse to patient ratios, overuse of broad spectrum antibiotics and delay in introducing breastmilk (10)(11)(12). A recent study in the neonatal wards at Tygerberg Hospital, South Africa showed that the highest aerobic colony counts were seen in moist surfaces, e.g., sinks, milk kitchen surfaces, humidifiers, and suction tubing.…”

“…A recent study in the neonatal wards at Tygerberg Hospital, South Africa showed that the highest aerobic colony counts were seen in moist surfaces, e.g., sinks, milk kitchen surfaces, humidifiers, and suction tubing. The organisms cultured were mainly Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii (11). Due to their prematurity and absence of a suckling reflex, preterm neonates are mainly fed via a feeding tube.…”