Cronobacter Support
03-04-2009, 01:21 PM
PIF is not a sterile product and may be contaminated with pathogens that can cause serious illness. Correct preparation and handling reduces the risk of illness.
Where available, commercially sterile ready-to-feed liquid infant formula should be used for infants at greatest risk. Sterile liquid infant formula does not contain pathogenic microorganisms and so does not pose a risk of infection. However, its use may not always be an option, and the use of PIF may be required.
PIF is not a sterile product and may contain harmful bacteria. Reconstituted PIF provides an ideal environment for the growth of these pathogens. Even if present in powdered formula at very low levels, inappropriate preparation and handling of reconstituted PIF provides ideal conditions for these pathogens to multiply, which greatly increases the risk of infection. However, the risk of illness can be reduced if PIF is prepared safely and handled correctly.
Care settings include hospitals and day-care centres such as crèches. Hospitals, especially intensive care units, that provide care for vulnerable infants are at greatest risk of E. sakazakii infection, as discussed earlier.
Hospitals and day-care centres may also be required to prepare large batches of PIF in advance, for later use. This practice may increase the risk of E. sakazakii infection if not carried out correctly.
Because PIF is not a sterile product, there is an innate risk of infection with bacteria such as E. sakazakii. The recommendations below outline best practice for the preparation, storage and handling of PIF in care settings in order to reduce the risk of infection with E. sakazakii. These recommendations are also appropriate for reducing the risk of infection with Salmonella.
2.1 Recommendations
2.1.1 Use of infant formula
1. Infant formula should be selected based on the medical needs of the infant.
2. Where available, use commercially sterile liquid infant formula for infants at greatest risk.
2.1.2 General requirements
1. Each institution should establish written guidelines for the preparation and handling of PIF.
2. The implementation of guidelines should be monitored.
3. Personnel preparing PIF should be fully trained according to the guidelines and trained in hygiene requirements for food preparation.
4. There should be full traceability of PIF prepared in care settings.
5. There should be a clean dedicated area for preparation and storage of PIF. Additional guidance on the layout of the preparation room should be communicated at country level.
2.1.3 Cleaning and sterilization of feeding and preparation equipment
It is very important that all equipment used for feeding infants and for preparing feeds has been thoroughly cleaned and sterilized before use.
1. Hands should always be washed thoroughly with soap and water before cleaning and sterilizing feeding and preparation equipment (as described below). In care settings, a dedicated hand-washing sink is recommended.
2. Cleaning: wash feeding and preparation equipment (e.g. cups, bottles, teats and spoons) thoroughly in hot soapy water. Where feeding bottles are used, clean bottle and teat brushes should be used to scrub inside and outside of bottles and teats to ensure that all remaining feed is removed.
3. After washing feeding and preparation equipment, rinse thoroughly in safe water.
4. Sterilizing: if using a commercial sterilizer, follow manufacturer's instructions. Feeding and preparation equipment can also be sterilized by boiling:a. fill a large pan with water and completely submerge all washed feeding and preparation equipment,ensuring that there are no trapped air bubbles;
b. cover the pan with a lid and bring to a rolling boil, making sure the pan does not boil dry; and
c. keep the pan covered until the feeding and preparation equipment is needed.
5. Hands should be washed thoroughly with soap and water before removing feeding and preparation equipment from a sterilizer or pan. The use of sterilized forceps for handling sterilized feeding and preparation equipment is recommended.
6. To prevent recontamination, it is best to remove feeding and preparation equipment just before it is required for use. If equipment is removed from the sterilizer and not used immediately, it should be covered and stored in a clean place. Feeding bottles can be fully assembled to prevent the inside of the sterilized bottle and the inside and outside of the teat from becoming contaminated.
2.1.4 Preparing a feed using PIF
It is best to prepare feeds fresh each time and to feed immediately. Hospitals and other care settings will be required to prepare feeds for many infants. Ideally, each feed should be prepared in an individual feeding cup or bottle. However, in certain circumstances, feeds are mixed in larger containers, and then transferred into individual feeding cups or bottles. This practice poses a risk because PIF is more susceptible to contamination in large, open containers. Also, large volumes of feed take much longer to cool, leaving the potential for growth of harmful bacteria. The recommendations below outline the safest practice for preparing feed in individual containers or in batches for immediate consumption:
1. Clean and disinfect a surface on which to prepare the feed.
2. Wash hands with soap and water, and dry using a clean cloth or a single-use napkin.
3. Boil a sufficient volume of safe water. If using an automatic kettle, wait until the kettle switches off; otherwise make sure that the water comes to a rolling boil. Note: bottled water is not sterile and must be boiled before use. Microwave ovens should never be used in the preparation of PIF as uneven heating may result in 'hot spots' that can scald the infant's mouth.
4. Taking care to avoid scalds, pour the appropriate amount of boiled water, which has been allowed to cool slightly, but not below 70 °C, into a cleaned and sterilized feeding cup or bottle. The temperature of the water should be checked using a sterile thermometer. a. If making a batch in a larger container: the container should have been cleaned and sterilized. It should be no larger than 1 litre, be made from food-grade material and be suitable for pouring hot liquids.
5. To the water, add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make infants ill. a. If using feeding bottles: assemble the cleaned and sterilized parts of the bottle according to the manufacturer's instructions. Shake or swirl gently until the contents are mixed thoroughly, taking care to avoid scalds.
b. If using feeding cups: mix thoroughly by stirring with a cleaned and sterilized spoon, taking care to avoid scalds.
c. If preparing a batch in a larger container: stir formula using a cleaned and sterilized spoon to ensure even mixing. Immediately pour into individual feeding cups or bottles, taking care to avoid scalds.
6. Cool feeds quickly to feeding temperature by holding under a running tap, or placing in a container of cold water or iced water. Ensure that the level of the cooling water is below the top of the feeding cup or the lid of the bottle.
7. Dry the outside of the feeding cup or bottle with a clean or disposable cloth and label with appropriate information, such as type of formula, infant's name or ID, time and date prepared, and preparer's name.
8. Because very hot water has been used to prepare the feed, it is essential that the feeding temperature is checked before feeding in order to avoid scalding the infant's mouth. If necessary, continue cooling as outlined in step 6 above.
9. Discard any feed that has not been consumed within two hours.
2.1.5 Preparing feeds in advance for later use
It is best to make PIF fresh for each feed and to consume immediately, as reconstituted PIF provides ideal conditions for the growth of harmful bacteria. For practical reasons, feeds may need to be prepared in advance. In care or institutional settings, feeds may have to be prepared in batches and stored until required. The steps below outline the safest practice for preparing feeds in advance and storing for later use. If refrigeration is not available, feeds should be prepared fresh and consumed immediately. They should not be prepared in advance for later use.
1. Follow steps 1 to 7 in Section 2.1.4. If using feeding cups, a batch of formula should be prepared in a clean, sterilized jar or container that is no larger than 1 litre and has a lid. The prepared PIF can be refrigerated in the lidded container and dispensed into cups as needed.
2. Place cooled feeds in a dedicated refrigerator. The temperature of the refrigerator should be no higher than 5 °C and should be monitored daily.
3. Feeds can be stored in the refrigerator for up to 24 hours.
It is not recommended that batches of formula are cooled and stored in large volumes as large volumes can promote inadequate cooling and hence lead to the growth of harmful bacteria.
2.1.6 Re-warming stored feeds
1. Remove feeds from the refrigerator just before they are needed.
2. Re-warm for no more than 15 minutes.
3. To ensure that the feed heats evenly, periodically shake or swirl the feed in its covered container. Note: microwave ovens should never be used for re-warming feeds as uneven heating may result in 'hot spots' that
may scald the infant's mouth.
4. Check feeding temperature in order to avoid scalding the infant's mouth.
5. Discard any re-warmed feed that has not been consumed within two hours.
Where available, commercially sterile ready-to-feed liquid infant formula should be used for infants at greatest risk. Sterile liquid infant formula does not contain pathogenic microorganisms and so does not pose a risk of infection. However, its use may not always be an option, and the use of PIF may be required.
PIF is not a sterile product and may contain harmful bacteria. Reconstituted PIF provides an ideal environment for the growth of these pathogens. Even if present in powdered formula at very low levels, inappropriate preparation and handling of reconstituted PIF provides ideal conditions for these pathogens to multiply, which greatly increases the risk of infection. However, the risk of illness can be reduced if PIF is prepared safely and handled correctly.
Care settings include hospitals and day-care centres such as crèches. Hospitals, especially intensive care units, that provide care for vulnerable infants are at greatest risk of E. sakazakii infection, as discussed earlier.
Hospitals and day-care centres may also be required to prepare large batches of PIF in advance, for later use. This practice may increase the risk of E. sakazakii infection if not carried out correctly.
Because PIF is not a sterile product, there is an innate risk of infection with bacteria such as E. sakazakii. The recommendations below outline best practice for the preparation, storage and handling of PIF in care settings in order to reduce the risk of infection with E. sakazakii. These recommendations are also appropriate for reducing the risk of infection with Salmonella.
2.1 Recommendations
2.1.1 Use of infant formula
1. Infant formula should be selected based on the medical needs of the infant.
2. Where available, use commercially sterile liquid infant formula for infants at greatest risk.
2.1.2 General requirements
1. Each institution should establish written guidelines for the preparation and handling of PIF.
2. The implementation of guidelines should be monitored.
3. Personnel preparing PIF should be fully trained according to the guidelines and trained in hygiene requirements for food preparation.
4. There should be full traceability of PIF prepared in care settings.
5. There should be a clean dedicated area for preparation and storage of PIF. Additional guidance on the layout of the preparation room should be communicated at country level.
2.1.3 Cleaning and sterilization of feeding and preparation equipment
It is very important that all equipment used for feeding infants and for preparing feeds has been thoroughly cleaned and sterilized before use.
1. Hands should always be washed thoroughly with soap and water before cleaning and sterilizing feeding and preparation equipment (as described below). In care settings, a dedicated hand-washing sink is recommended.
2. Cleaning: wash feeding and preparation equipment (e.g. cups, bottles, teats and spoons) thoroughly in hot soapy water. Where feeding bottles are used, clean bottle and teat brushes should be used to scrub inside and outside of bottles and teats to ensure that all remaining feed is removed.
3. After washing feeding and preparation equipment, rinse thoroughly in safe water.
4. Sterilizing: if using a commercial sterilizer, follow manufacturer's instructions. Feeding and preparation equipment can also be sterilized by boiling:a. fill a large pan with water and completely submerge all washed feeding and preparation equipment,ensuring that there are no trapped air bubbles;
b. cover the pan with a lid and bring to a rolling boil, making sure the pan does not boil dry; and
c. keep the pan covered until the feeding and preparation equipment is needed.
5. Hands should be washed thoroughly with soap and water before removing feeding and preparation equipment from a sterilizer or pan. The use of sterilized forceps for handling sterilized feeding and preparation equipment is recommended.
6. To prevent recontamination, it is best to remove feeding and preparation equipment just before it is required for use. If equipment is removed from the sterilizer and not used immediately, it should be covered and stored in a clean place. Feeding bottles can be fully assembled to prevent the inside of the sterilized bottle and the inside and outside of the teat from becoming contaminated.
2.1.4 Preparing a feed using PIF
It is best to prepare feeds fresh each time and to feed immediately. Hospitals and other care settings will be required to prepare feeds for many infants. Ideally, each feed should be prepared in an individual feeding cup or bottle. However, in certain circumstances, feeds are mixed in larger containers, and then transferred into individual feeding cups or bottles. This practice poses a risk because PIF is more susceptible to contamination in large, open containers. Also, large volumes of feed take much longer to cool, leaving the potential for growth of harmful bacteria. The recommendations below outline the safest practice for preparing feed in individual containers or in batches for immediate consumption:
1. Clean and disinfect a surface on which to prepare the feed.
2. Wash hands with soap and water, and dry using a clean cloth or a single-use napkin.
3. Boil a sufficient volume of safe water. If using an automatic kettle, wait until the kettle switches off; otherwise make sure that the water comes to a rolling boil. Note: bottled water is not sterile and must be boiled before use. Microwave ovens should never be used in the preparation of PIF as uneven heating may result in 'hot spots' that can scald the infant's mouth.
4. Taking care to avoid scalds, pour the appropriate amount of boiled water, which has been allowed to cool slightly, but not below 70 °C, into a cleaned and sterilized feeding cup or bottle. The temperature of the water should be checked using a sterile thermometer. a. If making a batch in a larger container: the container should have been cleaned and sterilized. It should be no larger than 1 litre, be made from food-grade material and be suitable for pouring hot liquids.
5. To the water, add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make infants ill. a. If using feeding bottles: assemble the cleaned and sterilized parts of the bottle according to the manufacturer's instructions. Shake or swirl gently until the contents are mixed thoroughly, taking care to avoid scalds.
b. If using feeding cups: mix thoroughly by stirring with a cleaned and sterilized spoon, taking care to avoid scalds.
c. If preparing a batch in a larger container: stir formula using a cleaned and sterilized spoon to ensure even mixing. Immediately pour into individual feeding cups or bottles, taking care to avoid scalds.
6. Cool feeds quickly to feeding temperature by holding under a running tap, or placing in a container of cold water or iced water. Ensure that the level of the cooling water is below the top of the feeding cup or the lid of the bottle.
7. Dry the outside of the feeding cup or bottle with a clean or disposable cloth and label with appropriate information, such as type of formula, infant's name or ID, time and date prepared, and preparer's name.
8. Because very hot water has been used to prepare the feed, it is essential that the feeding temperature is checked before feeding in order to avoid scalding the infant's mouth. If necessary, continue cooling as outlined in step 6 above.
9. Discard any feed that has not been consumed within two hours.
2.1.5 Preparing feeds in advance for later use
It is best to make PIF fresh for each feed and to consume immediately, as reconstituted PIF provides ideal conditions for the growth of harmful bacteria. For practical reasons, feeds may need to be prepared in advance. In care or institutional settings, feeds may have to be prepared in batches and stored until required. The steps below outline the safest practice for preparing feeds in advance and storing for later use. If refrigeration is not available, feeds should be prepared fresh and consumed immediately. They should not be prepared in advance for later use.
1. Follow steps 1 to 7 in Section 2.1.4. If using feeding cups, a batch of formula should be prepared in a clean, sterilized jar or container that is no larger than 1 litre and has a lid. The prepared PIF can be refrigerated in the lidded container and dispensed into cups as needed.
2. Place cooled feeds in a dedicated refrigerator. The temperature of the refrigerator should be no higher than 5 °C and should be monitored daily.
3. Feeds can be stored in the refrigerator for up to 24 hours.
It is not recommended that batches of formula are cooled and stored in large volumes as large volumes can promote inadequate cooling and hence lead to the growth of harmful bacteria.
2.1.6 Re-warming stored feeds
1. Remove feeds from the refrigerator just before they are needed.
2. Re-warm for no more than 15 minutes.
3. To ensure that the feed heats evenly, periodically shake or swirl the feed in its covered container. Note: microwave ovens should never be used for re-warming feeds as uneven heating may result in 'hot spots' that
may scald the infant's mouth.
4. Check feeding temperature in order to avoid scalding the infant's mouth.
5. Discard any re-warmed feed that has not been consumed within two hours.