PC2107: Disinfection in Resource-limited Settings: Lessons from a Mixed-methods Kenyan Experience

Background: The majority of neonatal deaths occur in low-and middle-income countries (LMIC) and are most commonly due to perinatal events, prematurity, and/or infection. Neonatal resuscitation equipment in LMIC settings is difficult to sustain and disinfect. Disinfection of reusable neonatal resuscitation equipment to prevent infection may prevent neonatal mortality/morbidity. Helping Babies Breathe (HBB), a neonatal resuscitation education program designed for LMIC settings, has been shown to reduce mortality/morbidity secondary to perinatal events. HBB endorses the PATH guidelines for the disinfection (reprocessing) of reusable neonatal resuscitation equipment but these guidelines have not been well studied in the field.

Methods: Based on a needs assessment and front-line staff interviews, we sought to implement a steam-based high-level disinfection (HLD) program in the labor/delivery ward of a rural Kenyan referral hospital (Table 1). To evaluate the program’s success, we tested the bacterial burden of neonatal resuscitation equipment using baseline chlorine-based disinfection and steam-based HLD. We used exit interviews to collect qualitative feedback about the new HLD program and its potential sustainability.

Results: Significant bacterial burden was identified after equipment clinical use and after chlorine-based disinfection, suggesting suboptimal disinfection (Table 2). Steam-based HLD found lower bioburden on equipment, but staff cited challenges with steam and preferred to instead optimize chlorine-based chemical HLD (Table 2). Specifically, staff felt chlorine-based HLD is easier to optimize and sustain. Optimal chlorine-based HLD was non-inferior to steam-based HLD (Table 2). We implemented chlorine-based HLD using quality improvement methods.

Conclusion: HLD of critical neonatal resuscitation equipment in LMIC settings is a complex issue. Bacterial burden testing proved optimal chlorine-based HLD was non-inferior to steaming. We used local resource availability, method effectiveness, and staff input on feasibility, sustainability and preferences to guide the choice of HLD method for this site.