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Two-step or one-step - are all methods for neonatal incubator decontamination equal?

S Watkin1, H Dunn2, D Ready3

  • 1Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK.

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|August 4, 2024
PubMed
Summary

Two-step decontamination effectively removed microbial markers from neonatal incubator surfaces, unlike one-step wiping. However, markers persisted on mattresses, highlighting the need for improved decontamination strategies in neonatal intensive care units (NICUs).

Keywords:
Built environmentDecontaminationEnvironmental contaminationInfection prevention and controlNeonatal infectionsStaphylococcus capitis

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Area of Science:

  • Infection Prevention and Control
  • Microbiology
  • Biomedical Engineering

Background:

  • Healthcare-associated pathogens pose risks in neonatal intensive care units (NICUs).
  • Effective incubator decontamination is crucial for infection control.
  • Submersion decontamination is recommended but not always feasible, leading to the use of wipe decontamination.

Purpose of the Study:

  • To compare the efficacy of a two-step (enzymatic detergent submersion + hypochlorite wipe) versus a one-step (quaternary ammonium compound wipe) decontamination procedure.
  • To assess the removal of microbial surrogate markers from neonatal incubator surfaces.
  • To identify potential microbial persistence on incubator components after terminal decontamination.

Main Methods:

  • Three cauliflower-mosaic-virus-derived microbial surrogate markers were inoculated onto incubator surfaces (fan, mattress seam, door clips).
  • Two decontamination methods were applied: one-step (quaternary ammonium compound wipes) and two-step (enzymatic detergent submersion followed by hypochlorite wipes).
  • Quantitative PCR (qPCR) was used to detect marker presence at 28 sites post-decontamination.

Main Results:

  • Two-step decontamination resulted in 11% positive sites, while one-step decontamination left 43% of sites positive for microbial markers.
  • Microbial markers transferred to other surfaces during one-step decontamination, particularly from door clips.
  • Markers inoculated on incubator mattresses persisted after both one-step and two-step decontamination procedures.

Conclusions:

  • One-step decontamination alone is insufficient for complete microbial marker removal from neonatal incubator surfaces.
  • Two-step decontamination is more effective, particularly for submergible components, but not for mattresses.
  • Microbial persistence on incubator surfaces, especially mattresses, underscores the importance of optimizing terminal decontamination protocols in NICUs.