Disinfection of incubators used in Neonatal Intensive Care Units: an integrative review

Brito, Eva Anny Wélly de Souza; Martins, Mariana Cavalcante; Guedes, Nirla Gomes; Oriá, Mônica Oliveira Batista; Castro, Régia Christina Moura Barbosa; Sousa, Weslley Monteiro Amora; Silva, Leonardo Alexandrino da; Carneiro, Thais Aquino

doi:10.37689/acta-ape/2022AR0033977

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Review Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AR0033977 copy

Disinfection of incubators used in Neonatal Intensive Care Units: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the scientific evidence of incubator disinfection practices used in Neonatal Intensive Care Units.

Methods

This is an integrative literature review, conducted from June to July 2020, in the LILACS, SciELO, CINAHL, Scopus, Web of Science and MEDLINE databases. The findings were organized according to the PRISMA flowchart and discussed according to pertinent literature.

Results

Of the 780 articles found, only five met the inclusion criteria. The sanitizers used were: didecyldimethylammonium chloride, PHMB and vaporized hydrogen peroxide (VHP); didecyldimethylammonium chloride; N-(3-aminopropyl)-N-dodecylpropane-1,3-diamine; didecyldimethylammonium chloride and steam cleaning; water with detergent for cleaning in the bucket and bleach (200 mg/L) and 2.5% Umonium38® disinfectant. There is a diversity of options for disinfection of incubators, with variation of methods and frequency of cleaning. The sanitants used were effective, pointing to reduction of microbial load.

Conclusion

A variety of procedures and products were observed that can be used for cleaning and disinfection of incubators. Disinfection procedures favored the reduction of surface contamination. However, the presence of microorganisms, even if reduced, alerts about the risk to patient safety.

Incubators; Infant, newborn; Intensive care units, neonatal; Disinfection; Cross infection

Authors, year, country	Products used	Disinfection frequency	Result
Li et al. 2017. China. (A1)	Cloths soaked with disinfectant (substance not informed), after cleaning the environment with bleach.	Daily	HAI reduction
Fattorini et al. 2018. Italy. (A2)	Umonium38^® Neutralis disinfectant.	<6 days of hospitalization: Upon discharge/transfer >7 days of hospitalization: weekly	Colony Forming Unit reduction
Chiguer et al.; 2019; Morocco (A3)	Disposable wipes moistened with PHMB-associated didecyldimethylammonium chloride, followed by the use of hydrogen peroxide.	One-off intervention	Colony Forming Unit reduction
Cadot et al., 2019. France. (A4)	Didecyldimethylammonium chloride (1), associated with Surfanios^® (2), in addition to steam cleaning (2).	Daily (1) and weekly (2)	Contamination reduction
Ory et al., 2019. France. (A5)	Water vapor disinfection (Sanivap SV2900).	Not specified	S. capitis case incidence reduction

Study	Objectives	Hygiene/material (steps followed)	Results/conclusions	Levels of evidence
A1	Assess the scope of the impact of relocating the ward to a new facility and changing environmental cleanup practices to reduce MRSA^a on inanimate surfaces and HAI incident rate over the five-year period.	1. Change of reusable cotton cloths for all surfaces of the unit, including the NB’s spaces, once a day to use individual cloths soaked with disinfectant substance, after cleaning the environment with bleach (200mg/L) twice a day. P.S.: Disinfectant substance not specified.	There was a significant reduction in HAI incidence after the intervention (P<0.001); however, there was an increase in the incidence of infections related to PICC^b (P=0.019).	VI
A2	Assess the effectiveness of a protocol for disinfecting neonatal incubators in a clinical environment for different microorganisms potentially involved in the spread of HAI.	1. Cleaning protocol, consisting of five phases: a) machine is disconnected and removed from the energy source; b) removal of removable parts; c) disinfection of removable parts; d) disinfection of fixed parts; e) assembly of removable parts. 2. Every seven days, the NB was transferred to a new incubator. 3. Umonium38^® Neutralis^c disinfectant was used with manufacturer’s recommendation of 2.5% and contact time for 10 minutes.	Decrease of at least 91.2% of CFU^d, presenting lower rates of bacterial growth in the samples referring to the internal surfaces after disinfection.	VI
A3	Assess the effectiveness of enhanced cleaning process to reduce bacterial contamination in the NICU environment.	1^st day: standard cleaning routine of the unit with didecyldimethylammonium chloride in reusable plain cloths. 2^nd day: disinfection routine implementation with disposable wipes moistened with didecyldimethylammonium chloride associated with PHMB^e. 3^rd day: use of VHP^f for the entire wing.	There was a statistically significant decrease in CFU^d, after applying the changes only from moment 1 to 2 (P<0.0001), decreasing from 24 CFU to 2. From moment 2 to 3, there was a drop from 2 to 0 CFU^d.	VI
A4	Present the investigation process and hygiene practices adopted with a focus on the incubator to control an outbreak of K. pneumoniae producing beta-lactamase.	1^st moment: assessment of standard precautionary practices, contact and disinfection. 2^nd moment: Surfanios^®h, after steam cleaning (daily cleaning of the incubator with Anios DE^® 7.85 II^g; weekly, the NBs are transferred from the incubator, being disinfected with Surfanios^®h, and steam cleaning [SV 4000A, Sanivap, France] of the incubator and the mattress), was added to pre-established protocol. 3^rd moment: exchange of all mattresses due to cracks (reassessment after 1 month). Steam cleaning for the acrylic of the incubators and chemicals for the mattresses. 4^th moment: reassessment after seven months.	After applying the interventions, there was a reduction in the level of contamination of incubators, decreasing from 35.6% to 4.9% and mattresses from 61.2% to 9.8% of positive samples.	VI
A5	Assess the impact of infection control interventions to reduce the number of cases of S. capitis NRCS-A during a five-year period in a NICU.	1. Replacement of disinfection with molecular detergents for disinfection with water vapor (Sanivap SV2900ⁱ). 2. Protocol followed four periods: P1) steam cleaner pre-purchase; P2) cleaner use; P3) machinery malfunction; P4) cleaner repair and reuse.	The incidence of cases of infection by S. capitis, during the periods of use (P2 and P4), was lower than those of non-use (P1 and P3), with a statistically significant difference (P<0.001), with zero infections in P4.	VI

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[1] Corresponding author: Mariana Cavalcante Martins E-mail: marianaenfermagem@hotmail.com