infant feeding equipment

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Tasmanian Health Organisation - NorthWOMENS AND CHILDRENS SERVICES LAUNCESTON GENERAL

HOSPITAL

SDMS Id No.: SDMS Id No.297-001

WACS Policy No: 7.5-12

Infant Feeding Equipment: Care andDisinfection

SDMS Id Number

Document No.

Effective from

Functional Sub Group

Application:

P2010/0297-001

WAC Policy 7.5-2012

25 July, 2012

Womens and Childrens Services - Lactation

Nurses, Midwives and Hospital Aides, WACS, LGHSummary:

Replaces Doc No.

Version No.

Author Area

Contact

Applies to

Policy Type

Review Date

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

Preparedby

Jill Hanson &Dianne Haworth

Clinical NurseConsultant: Lactation

63488934

7 June 2012

Through Sue McBeathCo-Director, Nursing &Midwifery, WACS

63488976

21 August 2012

Through Amanda DennisCo-Director, Medical,WACS

63488972

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 DESTROYPRINTED COPIES. The electronic version of this Procedure is the approved and current versionand is located on the departments intranet. Any printed version is uncontrolled and therefore not current.

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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.


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Implementation/Policy in Operation

1 Disinfection methods:

a) 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 environmentsin 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 beused 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


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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 waterinto 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 notguaranteed.

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.

2 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.

3 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 thepatient, labelled with the date of disinfection.


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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.

4 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.

5 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.

6 Nipple Shields

Nipple shields are for single patient-use only.

In Ward 4O and 4K, after use the shield should be rinsed, wiped with detergent-

based wipes, rinsed again, dried with paper towel and stored in zip-lock bag.Note: PLEASE DESTROYPRINTED COPIES. The electronic version of this Procedure is the approved and current versionand is located on the departments intranet. Any printed version is uncontrolled and therefore not current.

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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.

7 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.

8 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.


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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 standardAS/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/


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http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0395-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0300-001http://www.bfhi.org.au/http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0395-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0299-001http://pssbpr-trim02/PandP/showdoc.aspx?recnum=P2010/0300-001http://www.bfhi.org.au/


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Management of Infant Feeding Equipment in 4N 2012 and associated quality

improvement activities 2012. QActivity_45N11_Best Practice Guideline_4N.doc

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