Brar

Dear Gustaf, Thank you for posting this question. It's a complex topic that I wasn't able to address while travelling, so please excuse the delayed response. The complexity that often leads to debates in clinical practice arises from the interaction of several factors, some of which you have already touched upon in your question: the regulatory framework (e.g. the European Union medical device regulation [6], biocidal products regulation [7]). probe-disinfectant compatibility (many manufacturers do not consider 70% alcohol to be compatible). the general vulnerability of a neonatal intensive care unit's patient population (if cross-transmission occurs, it typically affects high-risk infants the most). the fact that point-of-care ultrasound (POCUS) has expanded bedside imaging faster than infection-control protocols and training have been able to keep up with (although guidelines exist, adherence is often poor [3]). cost and sustainability considerations. Additionally, there is no neonatology-specific ultrasound infection prevention and control (IPC) guideline. This topic is covered in documents on broader neonatal POCUS practice [2] and general IPC-in-ultrasound guidelines [1], but I am not aware of a single document that brings everything together for neonatal units. What follows therefore draws on these sources, neonatal outbreak literature [4, 5] and my own reasoning about the vulnerability of the neonatology cohort. In my opinion, ultrasound probe reprocessing in a NICU should adhere to a rather high standard. Patients in the NICU are a mixed-vulnerability cohort and when a probe moves between infants, it must be reprocessed to a standard that protects the most vulnerable infant it might touch next, while also accounting for transmission chains that would result from reprocessing failure. Reprocessing failures and colonisation events can easily propagate across the whole population, which probably is the dynamic you observed in the unit. The textbook answer to "What should that standard be?" is pretty straightforward: a CE-marked, EN-tested wipe with documented bactericidal, yeasticidal, fungicidal and full virucidal properties, used to reprocess the probe between patients. For ultrasound-guided invasive procedures (vascular access, drainage, puncture, line placement) or any contact with non-intact skin, mucosa, blood or body fluid, a sterile sheath plus sterile single-use gel should be used [1]. In practice, the textbook standard is rarely achievable consistently. Fully virucidal activity, probe compatibility, local availability, and a workable contact time at the cot side don't often coincide. A pragmatic baseline is therefore a wipe with bactericidal, yeasticidal, and at least limited virucidal activity, with a defined escalation pathway to a fully virucidal product when local epidemiology calls for it (e. g. a confirmed or suspected non-enveloped viral infection in an infant on the unit who shares equipment). The escalation pathway needs a clear trigger, a designated alternative product on the shelf, and someone authorised to make the call. Several other tensions also need to be acknowledged: Pre-cleaning is the real bottleneck. Gel residue and biological material neutralise most disinfectants. The formal standard is to clean the probe before disinfecting it, but this often collapses to a single combined step in practice. Cost is rarely the main consideration for the NICU. The cost–risk asymmetry runs the other way there. A more honest tension is that the IPC team is likely defending a uniform, hospital-wide standard for reasons of consistency, procurement, and auditing. Documentation burden, training, and staff rotation all make it difficult to maintain consistent technique. As I see it, the question facing a neonatology unit is not "which wipe is microbiologically optimal", but "what is the highest standard that the unit can consistently maintain, given probe compatibility, available products and workflow", and how to address the resulting gaps. Sterile sheaths plus sterile gel for ultrasound-guided invasive procedures, clean handling of non-sterile gel where it is used for routine examinations, and consistent pre-cleaning probably have a greater impact on actual infection rates than choosing between two reasonable wipe products. Regarding the three products in your situation, the 45% isopropyl alcohol with surfactants is acceptable if it is a CE-marked product with documented EN test claims for the relevant baseline spectrum (bactericidal, yeasticidal and limited virucidal). Check the data sheet if in doubt (but your IPC team probably has done this already). The Kiilto Pro Cleanisept Wipes are a standard quaternary ammonium compound (QAC) wipe with strong probe compatibility across all major ultrasound vendors, but they only provide bactericidal, yeasticidal and limited virucidal coverage. While combining them with 70% ethanol wipes to close the virucidal gap is a reasonable approach, ethanol probe-head compatibility varies widely (you have to check the manufacturer's instructions to find out), and using two products is more complicated than using a single, full-spectrum option. A more straightforward option would be to use a QAC wipe with documented fully virucidal activity — some manufacturers offer such a variant. One practical note on QAC wipes is that they leave a thin film with repeated use. Therefore, a final wipe with a clean, water-moistened, single-use cloth after the disinfection step is typically required to remove residue and protect neonatal skin. This matches what most manufacturer instructions specify, but it is an additional step with additional material requirements and is therefore often skipped. This, combined with their generally broader spectrum of activity, has recently led to the emergence of products containing oxygen-releasing agents (hydrogen peroxide and/or peracetic acid), which often also offer a pretty good material compatibility. Two issues that often dominate actual infection risk and may matter more than the choice of wipe are gel handling (use sterile single-use gel for invasive procedures and do not refill multi-dose bottles for routine examinations, handling non-sterile gel in accordance with the manufacturer's recommendations [4]) and use of a physical barrier during ultrasound-guided invasive procedures [1]. Regarding the discussion with your IPC-nurse, hospital-wide uniformity is a sensible default, but there's a reasonable case for a unit-level adjustment when the standard procedure wasn't designed with the NICU population in mind. A constructive framing might be: "Our population sits outside the typical adult intact-skin assumption; we'd benefit from a documented exception." Beyond the wipe question, there’s a structural matter worth raising: regular involvement of a neonatologist or senior neonatal nurse when the IPC team writes or revises protocols affecting the unit (this would address your longer-term concern about neonatal perspectives but the specific arrangement depends on how IPC is organised in your hospital). I hope this is helpful. Best wishes, Brar References Nyhsen CM, Humphreys H, Koerner RJ, et al. Infection prevention and control in ultrasound — best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights into Imaging. 2017;8(6):523–535. https://doi.org/10.1007/s13244-017-0580-3 Singh Y, Tissot C, Fraga MV, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Critical Care. 2020;24:65. https://doi.org/10.1186/s13054-020-2787-9 Carrico RM, Furmanek S, English C. Ultrasound probe use and reprocessing: Results from a national survey among U.S. infection preventionists. American Journal of Infection Control. 2018;46(8):913–920. https://doi.org/10.1016/j.ajic.2018.03.025 Burkholderia stabilis outbreak from contaminated nonsterile ultrasound gel. MMWR 2022. https://doi.org/10.15585/mmwr.mm7148a3 NICU enterovirus outbreak with systematic review. https://doi.org/10.3934/microbiol.2025009 European Union Medical Device Regulation 2017/745. http://data.europa.eu/eli/reg/2017/745/2026-01-01 Biocidal Products Regulation 528/2012. http://data.europa.eu/eli/reg/2012/528/2024-06-11

We actually discussed this among us on Thursday and decided to use this very location (discussions in the NeoIPC club) for this. It may be a bit less visible that a forum at first but this is an open club and everybody can join, so spreading the discussions across multiple locations probably wouldn't help a lot. With that in mind, please go ahead and ask, and we'll find out if we know the answer. Maybe start a new discussion (ore even one per topic) so that interesting things don't get buried at the bottom of a long thread.

Hi @Stefan Johansson, @Valentina Canepa manages the NeoIPC communications, so she's the person to coordinate the announcement with. I think, many of us still need to warm up and find out what's possible before we can really tell what our plans here are but in my opinion this is not a prerequisite for an announcement of our collaboration. In any case, it sounds as if @Chiara Minotti may have further plans that I don't know about.

Dear all, thanks to @Tuuli Metsvaht's introduction in today's NeoIPC Surveillance webinar I have just learnt that this space already exists. Thanks also to @Stefan Johansson, @piatkat, @Annika, @Valentina Canepa and @Chiara Minotti for making this happen! I hope that this will be a nice space where we can exchange ideas and experience regarding infection prevention and control in neonatology I'm happy to contribute my experience regarding surveillance here and hope for support and feedback regarding the NeoIPC Surveillance Toolkit. If you have any questions in that regard, please go ahead and ask. Best wishes, Brar

We are using https://www.embryotox.de/

You can download the webinar's slide set at https://neoipc.org/wp-content/uploads/2023/11/NeoIPC-CPN-Webinar_Surveillance_20231123.pdf and the recording of the webminar is now available on YouTube

How is the state of infection prevention and control in your NICU? Do you have all the data you need to continuously have an eye on the trends of hospital-acquired infection rates and antibiotic consumtion? Do you have a reliable external bechmark to compare these numbers against? If yes, you are probably part of a successful surveillance network and probably want to find out what is going on elsewhere 😉. If no, you maybe want to start performing surveillance of nosocomial infection and maybe even become part of a bigger surveilance network. In any case, you may want to join the Webinar on surveillance of hospital-acquired infections in the NICU that is hosted by the NeoIPC Clinical Practice Network and will happen tommorow 23rd of November at 16:00 CET. If you are interested, please register here.