Local stakeholders at a tertiary referral hospital in rural Kenya identified neonatal sepsis as a significant problem at their facility and decided that disinfection of neonatal resuscitation equipment was the first step in addressing this issue.

Adaptations were made in the ward to implement a steam-based high-level disinfection (HLD) process, which damaged single-use equipment, so this process was not sustainable at the hospital.

Pivoting to an optimized chemical HLD based on staff preference and availability of local resources and supply chain realities proved to be a sustainable method of reprocessing. There was no significant difference observed in bacterial counts following the optimized high-level disinfection compared to steam-based high-level disinfection, and both processes were improved compared to the baseline method.

Implementation of proper disinfection processes must be tailored to local settings and preferences and consider the availability of resources, including clean water, personnel, and space, as well as adequate training and system-wide support for implementation.

The majority of neonatal deaths occur in low- and middle-income countries, most often due to perinatal events, prematurity, and/or infection. Reprocessing of neonatal resuscitation equipment is vital for ensuring the availability of clean equipment and preventing transmission of infection to a newborn. Staff at Tenwek Hospital, a tertiary referral hospital in rural Kenya, identified reprocessing medical equipment as a gap in improving neonatal care. We sought to implement steam-based high-level disinfection (HLD) for reprocessing neonatal resuscitation equipment in the labor and delivery ward of Tenwek Hospital.

Before implementation, a needs assessment was conducted to identify existing facilitators and barriers to reprocessing through semistructured interviews with key stakeholders at the hospital (N=12) and identify gaps in the hospital’s existing reprocessing procedures. A chemical, chlorine-based method of disinfection was used for neonatal resuscitation equipment in the ward. We conducted baseline bacterial burden of neonatal resuscitation equipment before clinical use, after clinical use, and after reprocessing. There was not a significant decrease in bacterial burden after reprocessing.

After implementing a new steam-based HLD process, we conducted bacterial burden testing, which showed a reduction. However, staff preferences and implementation challenges compelled us to modify our original plan and instead implement optimized chemical HLD using chlorine. Although testing showed improved bacterial burden from baseline, in our small number of samples, bacterial burden testing after implementing the optimized chemical HLD process did not differ significantly compared to steam-based HLD.

Optimal chemical HLD was felt to be feasible and sustainable in the local setting. Reprocessing methods should be designed for unique challenges in low-resource settings.

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