Protocols for disinfection of medical devices and medical equipment in resource limited neonatal units
Dr. M Tauseef Omer
Assistant Professor of Neonatology
Cleaning
Definition: The physical removal of dust, secretions, blood, etc from objects and surfaces using water, detergents, or enzymatic cleaners.
Purpose: Reduces bioburden and prepares items for disinfection or sterilization.
Key Point: Cleaning must precede any disinfection or sterilization process because residual debris can interfere with germicidal efficacy.
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Disinfection
Definition: The process that eliminates many or all pathogenic microorganisms (except bacterial spores) on inanimate objects.
Levels:
High-level disinfection: Kills all microbes except large numbers of bacterial spores.
Intermediate-level: Inactivates Mycobacterium tuberculosis, most viruses, and fungi.
Low-level: Eliminates most vegetative bacteria, some fungi, and some viruses.
Agents: Chemical disinfectants mentioned below with concentration and time of contact.
Sterilization
Definition: The complete elimination or destruction of all forms of microbial life, including bacterial spores.
Methods:
Steam under pressure (autoclaving)
Ethylene oxide gas
Hydrogen peroxide
Use: Critical items that enter sterile tissue or the vascular system (e.g., surgical instruments, catheters)
Medical devices and medical equipment:
Incubator surfaces
Mattress covers
Radiant warmers
Temperature probes
SpO2 probes
Blood pressure apparatus and BP cuffs
Cardiac monitors
Glucometers
Laryngoscope blades and handles
Reusable breathing circuits of ventilators and nasal CPAP
Handles of doors
Anything that is reusable, is touched by healthcare providers or baby or attendants of baby.
Single use (only) items:
Endotracheal tube
Suction Catheters
Nasal cannulas
Breathing circuits
Umbilical venous catheters
IV cannulas
Syringes and needles
Lancets
Feeding tubes
ECG electrodes
Cord clamps
Specimen collection containers
General Principals of disinfection:
Cleaning must precede any disinfection or sterilization process because residual debris can interfere with germicidal efficacy.
Every device or equipment has cleaning, disinfection, and sterilization recommendations from manufacturer. These recommendations may include safe chemicals for disinfection or safe temperature ranges for sterilization and duration for both disinfection and sterilization.
For every disinfectant, use correct dilution, application method, and contact time. Contact time can vary depending on dilution (concentration) and manufacturer recommendations.
If the equipment is powered using electricity, power off the device, remove the plug from electric mains, and let the equipment cool down. Then, cleaning and surface disinfection must not affect the electronic circuity, no liquid should trickle inside the buttons. Once cleaning and surface disinfection has been done, let the device dry completely, then plug the device into mains and test run the device before connecting it to the patient.
For any device to be cleaned and disinfected, disassemble it to maximum parts. And dry completely after disinfection before assembling again.
Do not clean/disinfect single use items.
Prepare/dilute disinfectant in well-ventilated areas. Freshly prepared solution is mandatory.
Train staff adequately about personal safety from fumes/vapors of disinfectant.
Prepare check lists for disinfection of high dependency equipment. Maintain logs of disinfection.
Chemicals, concentrations, and contact time for disinfection:
For Floors:
Bleach (sodium hypochlorite) – For general floor areas with no spills of blood use 0.05% concentration while the areas with blood spills use 0.5% concentration.
To prepare 0.5 % of bleach, mix 75 mL (1/3 cup) of bleach in 4 Liters of water.
To Prepare 0.05% of bleach, mix 7.5 mL of bleach in 4 L of water
Tablet Presept 2.5g (sodium troclosene)
Mixing 1 tablet in 1.5 L of cold water gives 1000 ppm of presept which is used for general cleaning of NICU floors.
Places with blood spills will need to be cleaned with solution containing 4 tablets in 1L of cold water (5000 ppm). Always prepare the solution in a well ventilated space to avoid inhaling fumes.
For surfaces of incubators, warmers, ventilators, cardiac monitors:
Bleach 0.5%
Presept 1000 ppm (1 tablet of 2.5 grams in 1.5L of water)
Laryngoscope blades, respiratory tubings, instruments:
Glutaraldehyde 2.4% commercially available as cidex, soak for 8 to 20 minutes.
Triacid is an alternative, but less effective. May need soaking for upto hours.
Procedures:
NICU Cleaning Protocol for Silicone AMBU Bags & Face Masks
Wear personnel protective equipment, mark, gloves.
1. Disassembly
Separate all detachable parts: bag, valves, mask, reservoir, and connectors.
2. Pre-Cleaning
Rinse each part under cool running water to remove visible debris.
Use a soft brush and neutral pH detergent to scrub internal and external surfaces.
3. Cleaning
Immerse parts in warm water with detergent.
Gently agitate or manually clean for 5–10 minutes.
Rinse thoroughly with clean water to remove all detergent residue.
4. Disinfection
Chemical disinfection: Soak in a 2.4 % glutaraldehyde (Cidex) solution for the manufacturer-recommended time (usually 10–20 minutes).
Ensure full submersion and no air bubbles.
Rinse thoroughly with sterile or filtered water (3 times) to remove chemical residue.
OR
Thermal disinfection: If the item is autoclavable (check label), autoclave at 121°C for 15–20 minutes.
5. Drying
Air-dry on a clean, lint-free surface or hang in a drying cabinet.
Avoid wiping with clothes
6. Inspection & Storage
Check for cracks, discoloration, or valve malfunction.
Store in a clean, dry, closed container labeled “Ready for Use.”
Laryngoscopes
Laryngoscope blades are to be disinfected after each use.
Wear gloves, face mask, and gown.
Disassemble the laryngoscope, detach blade, and remove cells.
Clean the blades by thoroughly washing under running water, then use soap or detergent to remove all visible secretions and blood.
Next,
Dip in disinfectant solution (Cidex 2.4%) for 8 to 20 minutes. If multiple blades are being disinfected, then dip these separately.
Then,
Rinse with sterile distilled water or normal saline thoroughly to remove all disinfectant from the blades.
Let blades air dry.
Infusion pumps, syringe pumps, cardiac monitors, nebulizer machines
Turn off the electric supply.
Unplug from electric mains.
Let the device cool down.
Wear mask, gloves, gown.
Tablet Presept (2.5 gram) prepared to the dilution of 1:500 ppm by mixing ½ tablet in 1.5 Liter of water may be used as disinfectant solution.
Incubators and warmers
Turn off the electric supply.
Unplug from electric mains.
Let the device cool down.
Wear mask, gloves, gown.
The outer surface and inner surface of incubator may be wipes with 1:500 diluted presept tablet (prepared by mixing ½ tablet in 1.5L of water)
Remove mattress, and clean it.
Remove humidifier tray, discard water inside, clean the inner and outer surfaces of water container using soap and water to remove any visible dirt, and then soak in 1000 ppm of Presept for 8 to 20 minutes. (Mix 1 tablet 2.5 gram of presept tablet in 1.5L of water)
Suction machine
Wear mask, gloves, gown.
Clean the outer surface of machine with 1000 ppm of Presept tablet solution.
Remove tubing and dip in 1000 ppm solution of Presept tablet.
Empty the jars of suction machine and rinse with water and soap to remove all visible debris. Then clean them inside and outside with 1000ppm of presept tablet solution.
Remove tubings from solution, and let these air dry with the jars.
Assemble tubings and jars.
Check proper functioning of the suction machine and suction pressures.
Oxygen Flow meters
Disinfect when oxygen flow meter is not in use.
Remove it from the fitting.
Open the water container and discard water.
Clean the outer and inner surface of water jar with soap and water and let it air dry.
Clean the surface of flow meter and its knob with tablet Presept solution 1000ppm .
Assemble all once dry.
Do not use alcohol wipes or bleach for the risk of fire.
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