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Interventions implemented to remediate mold identified in Neonatal Intensive Care Unit (NICU) incubators, 2022 to
Lacey Kovar1, Courtney McPherson2, Jennifer Ware2
1Infection Prevention Covenant Children's Hospital, Lubbock, TX.
Background:
Neonatal Intensive Care Units utilize incubators to sustain core temperatures associated with transepidermal water loss. High relative humidity in incubators provides an environment for fungi to grow. In August 2022, mold was identified growing in 11 (85%) Neonatal Intensive Care Unit incubators.
Methods:
A team assembled to address mold in incubators. The environment was addressed as a possible source of contamination by consulting an environmental specialist. The air handler, ducts, and environment were terminally cleaned. Specimens were collected from the contaminated incubators and the manufacturer reviewed cleaning practices. Experimental trials were conducted using the incubators to replicate mold growth after interventions.
Results:
The environmental consultant approved when the space could be reoccupied. Incubators introduced to the clean environment did not grow mold. Various fungi or yeast were identified in the contaminated incubators. Opportunities to improve cleaning and replacement of parts were identified by the manufacturer. September 2022 to February 2023, 7 experimental trials were completed after cleaning the incubators. Four (36%) of the 11 contaminated incubators were placed back in use due to no fungal growth. No patient illnesses occurred.
Conclusions:
The interventions implemented stopped ongoing contamination of incubators and use of previously contaminated incubators.
Insights
Mold contamination in Neonatal Intensive Care Unit incubators was addressed through environmental cleaning and manufacturer collaboration. Interventions successfully eliminated fungal growth, allowing previously contaminated incubators to be safely reused without patient impact.
Area of Science:
- Neonatal care
- Infection control
- Environmental hygiene
Background:
- Neonatal Intensive Care Units (NICUs) use incubators to regulate infant temperature, but high humidity can promote fungal growth.
- In August 2022, mold was detected in 85% of NICU incubators, posing a significant infection risk.
- Transepidermal water loss management in incubators creates a conducive environment for microbial proliferation.
Purpose of the Study:
- To investigate and eliminate mold contamination in NICU incubators.
- To identify the source of fungal contamination within the NICU environment.
- To validate the effectiveness of cleaning and intervention strategies.
Main Methods:
- Consultation with an environmental specialist to assess and remediate the NICU environment, including air handlers and ducts.
- Terminal cleaning of the NICU environment and affected incubators.
- Specimen collection from contaminated incubators and review of manufacturer cleaning protocols.
- Conducting experimental trials to assess mold recurrence post-intervention.
Main Results:
- Post-cleaning, incubators placed in the remediated environment showed no recurrence of mold growth.
- Various fungi and yeast were identified in the initially contaminated incubators.
- Manufacturer identified areas for improvement in incubator cleaning and parts replacement.
- Following interventions, 36% of previously contaminated incubators were safely returned to service with no observed fungal growth.
Conclusions:
- Implemented environmental and equipment interventions effectively halted incubator mold contamination.
- Previously contaminated incubators could be safely reintroduced into clinical use after successful remediation.
- No patient illnesses were associated with the incubator mold contamination events.
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