title: Neonatal resuscitation equipment: A hidden risk for our babies?
abstract: OBJECTIVE
  Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk.
  
  
  METHODS
  A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention.
  
  
  RESULTS
  Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01).
  
  
  CONCLUSIONS
  Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities.
authors.affiliation: Neonatal Department, University College Hospital, London, UK.
authors.forename: Lucinda C
authors.initials: LC
authors.lastname: Winckworth
authors.affiliation: Centre for IH&D, UCL Institute of Child Health, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: McLaren
authors.affiliation: Department of Medicine, St Richards Hospital, Chichester, UK.
authors.forename: Arvin
authors.initials: A
authors.lastname: Lingeswaran
authors.affiliation: Microbiology Department, The Whittington Hospital, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelsey
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D004781:Environmental Exposure; D004866:Equipment Contamination; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D012151:Resuscitation / Q000295:instrumentation*; D006113:United Kingdom / Q000453:epidemiology
keywords: environmental exposure; equipment contamination; fomite; neonate; resuscitation