Cronobacter Support
03-06-2009, 09:48 AM
3.1 Recommendations
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.
PIF is not a sterile product and can pose a risk to infants, particularly if it is prepared and handled inappropriately. Reconstituted PIF provides an ideal environment for the growth of harmful bacteria. Even if present in powdered formula at very low levels, inappropriate preparation and handling of feeds provides ideal conditions for the growth of harmful bacteria, which greatly increases the risk of infection. However, the risk can be reduced if feeds are prepared and handled correctly.
The recommendations below outline the best practice for the safe preparation, storage and handling of PIF in the home in order to reduce the risk of infection with E. sakazakii. These recommendations are also appropriate for reducing the risk of infection with Salmonella.
It is recommended healthcare professionals ensure that parents and caregivers are instructed in the safe preparation, storage and handling of PIF.
3.1.1 Cleaning and sterilizing 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).
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 the feeding and preparation equipment, rinse thoroughly in safe water.
4. Sterilizing: if using a commercial home sterilizer (e.g. electric or microwave steam sterilizer, or chemical 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 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 kitchen tongs 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 to be used. 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.
3.1.2 Preparing a feed using powdered infant formula
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. The steps below outline the safest way to prepare individual feeds of PIF in bottles or in feeding cups 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. Microwaves 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 that has been allowed to cool to no less than 70 °C, into a cleaned and sterilized feeding cup or bottle. To achieve this temperature, the water should be left for no more than 30 minutes after boiling.
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 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.
6. Immediately after preparation, quickly cool feeds to feeding temperature by holding the bottle or feeding cup under running tap water, or by placing in a container of cold 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.
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.
9. Discard any feed that has not been consumed within two hours.
3.1.3 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, however, feeds may need to be prepared in advance. The steps below outline the safest way to prepare and store feeds for later use. If refrigeration is not available, feeds should be prepared fresh and consumed immediately rather than prepared in advance for later use.
1. Follow steps 1 to 7 of Section 3.1.2. If using feeding cups, a batch of formula should be prepared in a clean, sterile jar that is no larger than 1 litre, with a lid. The prepared PIF can be refrigerated and dispensed into cups as needed.
2. Place cooled feeds in a refrigerator. The temperature of the refrigerator should be no higher than 5 °C.
3. Feeds can be stored in the refrigerator for up to 24 hours.
3.1.4 Re-warming stored feeds
1. Remove stored feed from the refrigerator just before it is needed.
2. Re-warm for no more than 15 minutes. To ensure that the feed heats evenly, periodically shake the covered jar or container.
3. Microwave ovens should never be used to re-warm a feed as uneven heating may result in 'hot spots' that can 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.
3.1.5 Transporting feeds
Because of the potential for growth of harmful bacteria during transport, feeds should first be cooled to no more than 5 °C in a refrigerator and then transported.
1. Prepare the feed and place in the refrigerator, as outlined in Section 3.1.3.
2. Ensure feed is cold before transporting.
3. Do not remove feed from the refrigerator until immediately before transporting.
4. Transport feed in a cool bag with ice packs.
5. Feeds transported in a cool bag should be used within two hours as cool bags do not always keep foods adequately chilled.
6. Re-warm at the destination, as in Section 3.1.4.
7. If you reach the destination within two hours, feeds transported in a cool bag can be placed in a refrigerator and held for up to 24 hours from the time of preparation.
8. Alternatively, if you are going out for the day, individual portions of PIF can be transported in washed and sterilized containers. At the destination, hot water no less than 70 °C can be used to prepare the feed, using washed and sterilized feeding and preparation equipment.
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.
PIF is not a sterile product and can pose a risk to infants, particularly if it is prepared and handled inappropriately. Reconstituted PIF provides an ideal environment for the growth of harmful bacteria. Even if present in powdered formula at very low levels, inappropriate preparation and handling of feeds provides ideal conditions for the growth of harmful bacteria, which greatly increases the risk of infection. However, the risk can be reduced if feeds are prepared and handled correctly.
The recommendations below outline the best practice for the safe preparation, storage and handling of PIF in the home in order to reduce the risk of infection with E. sakazakii. These recommendations are also appropriate for reducing the risk of infection with Salmonella.
It is recommended healthcare professionals ensure that parents and caregivers are instructed in the safe preparation, storage and handling of PIF.
3.1.1 Cleaning and sterilizing 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).
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 the feeding and preparation equipment, rinse thoroughly in safe water.
4. Sterilizing: if using a commercial home sterilizer (e.g. electric or microwave steam sterilizer, or chemical 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 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 kitchen tongs 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 to be used. 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.
3.1.2 Preparing a feed using powdered infant formula
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. The steps below outline the safest way to prepare individual feeds of PIF in bottles or in feeding cups 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. Microwaves 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 that has been allowed to cool to no less than 70 °C, into a cleaned and sterilized feeding cup or bottle. To achieve this temperature, the water should be left for no more than 30 minutes after boiling.
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 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.
6. Immediately after preparation, quickly cool feeds to feeding temperature by holding the bottle or feeding cup under running tap water, or by placing in a container of cold 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.
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.
9. Discard any feed that has not been consumed within two hours.
3.1.3 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, however, feeds may need to be prepared in advance. The steps below outline the safest way to prepare and store feeds for later use. If refrigeration is not available, feeds should be prepared fresh and consumed immediately rather than prepared in advance for later use.
1. Follow steps 1 to 7 of Section 3.1.2. If using feeding cups, a batch of formula should be prepared in a clean, sterile jar that is no larger than 1 litre, with a lid. The prepared PIF can be refrigerated and dispensed into cups as needed.
2. Place cooled feeds in a refrigerator. The temperature of the refrigerator should be no higher than 5 °C.
3. Feeds can be stored in the refrigerator for up to 24 hours.
3.1.4 Re-warming stored feeds
1. Remove stored feed from the refrigerator just before it is needed.
2. Re-warm for no more than 15 minutes. To ensure that the feed heats evenly, periodically shake the covered jar or container.
3. Microwave ovens should never be used to re-warm a feed as uneven heating may result in 'hot spots' that can 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.
3.1.5 Transporting feeds
Because of the potential for growth of harmful bacteria during transport, feeds should first be cooled to no more than 5 °C in a refrigerator and then transported.
1. Prepare the feed and place in the refrigerator, as outlined in Section 3.1.3.
2. Ensure feed is cold before transporting.
3. Do not remove feed from the refrigerator until immediately before transporting.
4. Transport feed in a cool bag with ice packs.
5. Feeds transported in a cool bag should be used within two hours as cool bags do not always keep foods adequately chilled.
6. Re-warm at the destination, as in Section 3.1.4.
7. If you reach the destination within two hours, feeds transported in a cool bag can be placed in a refrigerator and held for up to 24 hours from the time of preparation.
8. Alternatively, if you are going out for the day, individual portions of PIF can be transported in washed and sterilized containers. At the destination, hot water no less than 70 °C can be used to prepare the feed, using washed and sterilized feeding and preparation equipment.