- –Breast pump milk collection kits should not be reused by different mothers unless they have been sterilized in a sterile services department between these different users.
- –When used by the same mother, a detergent wash followed by thorough rinsing and drying after each use gives acceptable decontamination for most circumstances, as long as it is performed correctly.
- –Additional decontamination precautions to washing, rinsing and drying may be used if indicated by local risk assessments and on advice from the departmental clinicians and infection prevention and control teams. The microbiological quality of the rinse water is an important consideration, particularly for infants on neonatal units.
- –If bottle brushes or breast/nipple shields are used, they should be for use by one mother only. Decontamination should be by the processes used for breast pump milk collection kits.
- –Dummies (soothers, pacifiers or comforters) needed for non-nutritive sucking by infants on neonatal units should be for single infant use. Manufacturers should provide these dummies ready to use and individually packaged. They must be discarded at least every 24h or immediately if soiled with anything other than the baby’s saliva. No attempt should be made to decontaminate the dummies, either before or during use.
Aims and target groups
- –Decontamination is any process that renders an item safe and fit for reuse; it will always involve cleaning and may involve disinfection and/or sterilization.
- –Sterilization is rendering an item free from micro-organisms with a very high level of quality assurance.
- –Disinfection is a process resulting in a reduction in the number of infectious agents to a level considered safe.
- –Cleaning is a process that entails physical removal of micro-organisms and anything else that is not part of an item.
Decontamination methods available for Working Group consideration
- –Single use only, where new disposable sterile equipment is provided for every use.
- –Washing in warm water with detergent, rinsing thoroughly, drying and storing the equipment dry.
- –Washing and rinsing followed by an additional decontamination method.
- •Production of atmospheric pressure steam by heating tap water either in a freestanding electrical unit, or inside bags or lidded bowls placed in a microwave oven.
- •Immersion in hypochlorite-based chemical disinfectants. There are two main sources of hypochlorite: liquid sodium hypochlorite or solid (tableted) sodium dichloroisocyanurate (NaDCC). See further comments on this method below under ‘Chemical disinfection’.
Sources of information used in development of The Guidance
Surveys of current decontamination practices in UK hospitals
Summary of the findings of surveys on decontamination practices
Decontamination of breast pump milk collection kits
|Survey date and number of units taking part||Immersion in hypochlorite-based disinfectant after each use||Atmospheric pressure steam after each use||Detergent wash, rinse and dry after each use||Discard after each use||Sterilize in a sterile services department after each use||Other, including dish- washing machines|
|2002/3 (71 units)||61% (43 units)||27% (19 units)||0% (0 units)||7% (5 units)||0.7% (1 unit)||4% (3 units)|
|2006 (25 units)||56% (14 units)||16% (4 units)||4% (1 unit )||8% (2 units)||16% (4 units)||0% (0 units)|
|35% (9 units)||19% (5 units)||41% (11 units)||8% (2 units)||4% (1 unit)||4% (1 unit)|
Decontamination of bottle brushes
Decontamination of dummies
Comment on the survey results
Decontamination of breast pump milk collection kits
Routine decontamination for kits for reuse by the same mother
Additional decontamination methods
Decontamination of related articles
Bottle brushes and breast/nipple shields
Dummies (pacifiers, comforters or soothers) for infants on neonatal units
Conflict of interest
Appendix. Decontamination recommendations from a Joint Working Group of the Healthcare Infection Society and the Infection Prevention Society
Section A. Decontamination of breast pump milk collection kits
- 1.General considerations
- 2.Guidance for routine cleaning of kits for reuse by one mother
- 3.Additional decontamination methods
- 4.Comments on hypochlorite-based chemical disinfection of kits for reuse by one mother
Section B. Decontamination of related items
- 1.Bottle brushes
- 2.Breast/nipple shields
- 3.Dummies (pacifiers, comforters or soothers) used on neonatal units (NNUs)
- I.All points listed below apply in both home and hospital, apart from those points that specifically refer to one or other situation.
- II.In the home, clean kitchen roll may be used as an alternative to the paper towels used in hospital.
Section A. Decontamination of breast pump milk collection kits
1. General considerations
- 1.1.Kits should be discarded when no longer needed for use by the mother. They should not be passed on to another mother (unless they can be sterilized in an SSD).
- 1.2.Microbiological quality of the water:
- –All places where mothers express their milk should have good microbiological quality water.
- –For well infants in the home, potable (drinking quality) water should be used for rinsing the kits.
- –In NNUs, the rinse water should be from outlets complying with Department of Health, Health Technical Memorandum 04-01.8If the rinse water is not of an appropriately high microbiological quality, the use of sterile water for rinsing is advised.
- 1.3.In hospital, washing the kits should take place in a designated area approved by the IPCT and local department clinicians.
- 1.4.All decontamination methods should comply with the manufacturer’s instructions, as long as these instructions are in accordance with locally agreed infection control policies.
- 1.5.For kits for reuse by one mother:
- –Each mother should have her own breast pump collection kit or two kits for dual pumping where both breasts are expressed at the same time.
- –Kits should not be shared with other mothers.
- –After every use, the kits need to be decontaminated as detailed below (see Section A.2.3).
- –Decontaminating the kits is usually carried out by the mother. Mothers should be given clear instructions by the relevant member of staff, using written and illustrated guidance.
- –Staff should check that the mothers understand the importance of completely disassembling the breast pump milk collection kits, then thoroughly washing, rinsing and completely drying the individual parts (including the small and more intricate pieces).
- –Mothers should be aware that any part of the kit that remains wet could be a source of infection for the infant.
- –Initial supervision of the decontamination process is recommended.
2. Guidance for routine cleaning of the kits for reuse by one mother
- 2.1.Before first use
- 2.1.1.In hospital, the kits should ideally be sterile. Where kits for hospital use are not sterile, they should be new and individually packaged by the manufacturer. They should be decontaminated according to the manufacturer’s instructions; at minimum, they should be detergent washed, rinsed and dried as detailed below.
- NB. Some hospitals use only sterile kits which are then discarded after use and a sterile replacement provided (see Section A.3.3.1).
- 2.1.2.In the home, kits should be new, individually packaged and sealed by the manufacturer. If they are not marked as sterile, they should be decontaminated according to the manufacturer's instructions; at minimum, they should be detergent washed, rinsed and dried as detailed below.
- 2.2.Before each use
- 2.2.1.Before assembling the kit for use, wash hands, rinse thoroughly and dry with a paper towel.
- 2.3.After each use
- 2.3.1.Clean kits as soon as possible after use to avoid milk residues sticking to surfaces.
- 2.3.2.Do not immerse the tubing between the collection kit and the pump in water. This tubing should remain dry during use. If it is splashed or dropped on the floor, the outside should be wiped over and dried with paper towels. If there is moisture within the tubing, it should be replaced.
- 2.3.3.Dismantle the kit completely.
- 2.3.4.Wash all parts of the kit using a clean bowl reserved for this purpose. Initially remove milk residues from the kit with water, drain and then use warm water and liquid detergent (one or two drops of detergent is sufficient).
- 2.3.5.Rinse each part of the kit thoroughly with running water to remove detergent and any debris. Place the parts of the kit on paper towels on a clean dry surface.
- 2.3.6.Allow to air dry completely or dry all parts with paper towels. As far as possible, hollow parts should be inverted to allow draining. Do not use reusable cloth towels such as tea towels; these can have significant levels of bacterial contamination. Paper towels or kitchen roll should be stored in clean conditions, especially once opened.
- 2.3.7.The bowl used for washing the kits should also be washed, rinsed and dried after each use and stored dry.
- 2.3.8.The cleaned, disassembled kit should be stored dry in a clean, dry container covered with fresh paper towels to allow for complete drying of any undetected or inaccessible wet areas.
- 2.3.9.The storage container should be for the use of one mother only. It should be washed, rinsed and dried once a day.
- 2.3.10.If the storage container is sufficiently large, it could also be used as the washing bowl for these kits. This would save space and ensure that all components are kept together.
- 2.3.11.In hospital, the storage container should be marked with the mother's name and hospital number to avoid any mix up with kits belonging to other mothers. Care should be taken that these details are not washed off.
- 2.3.12.Bottle brushes can be a source of contamination. Details on bottle brush use and decontamination are given at the end of this document (see Section B.1).
- 2.4.Dishwashing machines
- 2.4.1.As recommended by some manufacturers, the top shelf should be used on a 65–75°C cycle.
- 2.4.2.The kit should be fully dismantled. As far as possible, hollow items should be loaded inverted to allow drainage. A perforated container which holds the smaller dismantled parts and allows water to circulate around them is needed.
- 2.4.3.The washed kit should be removed from the dishwashing machine with clean hands, water should be shaken off all parts of the kit and they should be allowed to dry on paper towels/kitchen roll. Further drying with paper towels may be necessary. The kit should be stored dismantled in a clean, dry container covered with paper towels as in 2.3.8.
- 2.4.4.In the home, the kit can be part of a normal dishwasher load and does not need to be washed separately. If the dishwashing machine is only used once a day, other decontamination procedures (usually wash, rinse and dry) will be needed at other times.
- 2.4.5.In hospital, dishwashing machines are not often used for decontaminating these kits. If used in hospital units, dishwashing machines should be dedicated to washing the kits. They should not be used for crockery and cutlery as well. A method of identifying individual pieces of equipment from specific mothers will be needed. The use of such a unit-based dishwashing machine for this purpose should be approved for individual mothers by the local IPCT.
3. Additional decontamination methods
- 3.1.Depending on local risk assessments, additional decontamination methods may be used for certain infants on NNUs who are at high risk of infection, as determined by the departmental clinicians. They may also be indicated in situations where there is potential lack of compliance by the parents or carers with basic decontamination procedures.
- 3.2.Although the infant is in hospital, the mother may be expressing her milk at home as well as in hospital. The quality of the milk expressed at home is of equal importance to that of the milk expressed in hospital. The departmental clinicians and IPCT should advise on decontamination of kits in both places and the following options should be considered.
- 3.3.Options for additional decontamination
- 3.3.1.Use of sterile kits – these are either decontaminated and then autoclaved between use or purchased sterile and discarded after being used once.
- 3.3.2.For kits for reuse by one mother – an infant bottle disinfector that uses atmospheric pressure steam (freestanding electrical units, or microwavable bowls or bags) may be used.
4. Comments on hypochlorite-based chemical disinfection of kits for reuse by one mother
- 4.1.Chemical methods have lower quality assurance for disinfection than heat methods. Where disinfection is needed for susceptible infants, the Working Group recommend that heat disinfection is the method of choice and chemical disinfection should only be used if the local IPCT has given approval of the method and quality assurance of its use.
- 4.2.Dilute (i.e. in-use) hypochlorite is unstable and should be made up fresh every day, taking care to measure liquids accurately.
- 4.3.Hypochlorites are highly susceptible to inactivation by organic matter; all items to be disinfected must be scrupulously clean. They should have been detergent washed and rinsed before immersion.
- 4.4.All items to be disinfected must be completely immersed for the period recommended by the manufacturer, and be free of trapped air that would prevent contact between hypochlorite and all surfaces. Each mother should have her own allocated immersion tank which should be washed, rinsed and dried daily.
- 4.5.After disinfection, kits should be rinsed and dried. Especially for susceptible infants mentioned above, sterile water where available or cooled boiled water as recommended by some manufacturers should be used for rinsing (see comments under ‘Chemical disinfection’ in the main article).
Section B. Decontamination of related items
1. Bottle brushes
- 1.1.If a bottle brush is used, it should be new for each mother and should not be shared with other mothers. It should only be used for cleaning the breast pump collection kit and any associated bottles.
- 1.2.In hospital, if bottle brushes are used, they should be suitably identified as belonging to that mother.
- 1.3.Bottle brushes should be detergent washed, rinsed in running water and thoroughly dried (ideally by squeezing in a clean dry paper towel) after every use and stored dry.
- 1.4.If bottle brushes are processed in a dishwashing machine or by an atmospheric pressure steam method (the latter after washing and rinsing), they should be thoroughly dried afterwards.
- 1.5.Bottle brushes should not be decontaminated with hypochlorite-based disinfectants if they contain metals; hypochlorite can be corrosive. If the brushes do not contain metals, they can be washed and immersed in hypochlorite, rinsed with good microbiological quality water (see Section A.1.2). They should be dried thoroughly.
- 1.6.There is a risk of bacterial contamination if brushes are left wet.
- 1.7.Brushes should be discarded when no longer needed by the mother and not passed on to other mothers.
2. Breast/nipple shields
- 2.1.If used, these should be decontaminated by the same methods as are used for breast pump milk collection kits, usually detergent wash, rinse, dry and store dry.
- 2.2.They should be used by one mother alone and discarded when no longer required by that mother.
3. Dummies (pacifiers, comforters or soothers) used on neonatal units (NNUs)
- 3.1.Dummies may be needed for certain infants on NNUs for non-nutritive sucking. They should always be single-infant use.
- 3.2.Manufacturers should provide the dummies ready to use and securely individually packaged.
- 3.3.There should be no attempt at decontaminating the dummies either before use or during use.
- 3.4.They should be discarded every 24h. When not in use during this time period, they should be stored in a clean container covered with fresh paper towels. The container should be washed, rinsed and dried every day. If soiled or contaminated with anything other than the infant’s saliva, the dummies should be discarded immediately (see further discussion in the accompanying text about the difficulty of decontaminating these dummies for use by infants on NNUs.)
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☆This paper is published simultaneously in The Journal of Hospital Infection and Journal of Infection Prevention. http://dx.doi.org/10.1177/1757177415613566. The Editors of the Journals have agreed that joint publication of the article is justified to ensure dissemination of the guidance to all relevant healthcare professionals.