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.
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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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
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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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.
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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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.
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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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/
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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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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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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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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http://www.publish.csiro.au/journals/hihttp://www.reproline.jhu.edu/english/4morerh/4ip/ip_manual/01_Introduction.pdfhttp://emedicine.medscape.com/article/1835675-overviewhttp://www.publish.csiro.au/journals/hihttp://www.reproline.jhu.edu/english/4morerh/4ip/ip_manual/01_Introduction.pdfhttp://emedicine.medscape.com/article/1835675-overview