RECOMMENDED ANTISEPTICS FOR KILLING BACTERIAL GROWTH IN NEONATAL BLUE BULB SYRINGES: ADDRESSING A CLINICAL ISSUE Linda A Hanson, MBA, AB, Honors BSN Student and Pamela V. O’Neal, PhD, RN University of Alabama in Huntsville College of Nursing

INTRODUCTION RESULTS PRACTICE IMPLICATIONS Blue Bulb Syringes (BBSs) Disinfection of E. coli V050-A1 in Mueller-Hinton broth, 22C, with different • Blue Bulb Syringes have the • Used to remove oral and nasal secretions from newborns antiseptics at multiples of the Minimum Inhibitory Concentration (MIC) potential to cause disease in a Triclosan newborn or young child if reused l-Lactic • Provided to parents at hospital discharge 1 • Three antiseptics identified which • Can be purchased by parents for home use during times of are more effective than the current acid respiratory illness 0 recommendation at killing bacterial • Multi-use device growth in a BBS Chlorhexidine • Current recommendation for cleaning: rinsing in warm, -1 • Identified antiseptics are

) gluconate

soapy water 0 inexpensive and widely available

/N t 1 -2 and can be used in underdeveloped • Previous research identified bacterial growth in a BBS areas of the world • No research studies have identified the efficacy of cleaning (N Log -3 • Effective killing of bacteria in a has methods for killing bacteria growing in secretions inside the potential to break the chain of ? Povidone- BBS -4 infection at the mode of iodine • Three inexpensive, widely-available antiseptics are effective transmission

in killing bacterial growth within a BBS -5 • l-lactic acid is FDA approved, 0 5 10 15 20 25 30 has a rapid kill rate, and is Hydrogen METHODS Time (min) widely available Peroxide Why Escherichia coli? Negative Control Triclosan 5*MIC Photos: E.coli, retrieved from http://www.npr.org/tags/136926984/e- coli. Blue bulb, retrieved from https://www.indy-pen-dance.com/Bulb- • Most common bacteria (approximately 10%) found in BBS used in vaginal deliveries1 Hydrogen Peroxide 5*MIC Povidone-Iodine 4*MIC Syringes.html l-Lactic Acid 4*MIC Chlorhexidine Gluconate 5*MIC • Leading cause of neonatal sepsis in newborns2,3 SELECTED REFERENCES Antiseptic Cost • Leading cause of Early Onset Neonatal Bacterial Meningitis (EONBM)4 Application of REFERENCES Antiseptic with 8 oz. FDA Approved Pros Cons Use sterile water 1. O’Neal, P. V., Adams, E. D., Hanson, L. A., Damron, N. E., Alexander, M. B., Zhang, X., Leahy, J. G. Experimental study (2017). Microbial profile and characterization of blue bulb manual suction devices used to promote Triclosan $0.58 Currently Commonly Ineffective in Not airway clearance in newborns in intrapartum and postpartum units. American Journal of Infection approved, but found in killing E. coli in recommended; Control. In press. Intervention banned household under 30 research 2. Bizzarro, M. J., Shabanova, V., Baltimore, R. S., Dembry, L., Ehrenkranz, R. A., & Gallagher, P. G. Application of a specific concentration of selected antiseptic beginning in products minutes supports FDA (2015). Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci. Journal Of 2019 ban Negative control experiment showed that intervention is necessary Pediatrics, 166(5), 1193-1199. doi:10.1016/j.jpeds.2015.02.009 Hydrogen $0.21 Yes Inexpensive 4 minutes to kill Home use, since to achieve bactericidal state 3. Kerur, B. J., Bhat, B. V., Harish, B. N., Habeebullah, S., & Kumar, C. U. (2006). Maternal Genital Peroxide 99% of E. coli it require 10 Bacteria and Surface Colonization in Early Neonatal Sepsis, Indian Journal of Pediatrics, 73(1), 29- Experiments run in triplicate to ensure integrity of results minute soak 32. Povidone-iodine $0.26 Not for mucosal Killed 99% of E. Not currently Countries which 4. May, M., Daley, A., Donath, S., & Isaacs, D. (2005). Early onset neonatal meningitis in Australia and Null hypothesis contact coli in 27 FDA approved permit mucosal New Zealand, 1992-2002. Archives Of Disease In Childhood -- Fetal & Neonatal Edition, 90(4), Intervention would have no impact on bacterial colony count seconds for mucosal contact F324-7. contact l-Lactic acid $3.66 Yes Killed 99% pf E. Most expensive Home use, Criteria for selection of antiseptic included being inexpensive and widely available: ACKNOWLEDGEMENTS coli in 26 option followed by rinse Triclosan: active ingredient in Equate® antibacterial dish detergent seconds with clean water Sigma Theta Tau International, Beta Phi Chapter, UAH Hydrogen Peroxide: Equate® hydrogen peroxide and drip dry Research and Creative Experience for Undergraduates, UAH Povidone-Iodine: active ingredient in Equate® antiseptic and Betadine, used in some Chlorhexidine $3.15 Yes Killed 99% of Surgical scrub Hospital or Laboratory assistants: Tanuj Alapati, Lana Harwell, Alex Moore countries as mouthwash for VAP prevention gluconate E.coli in 25 strength (4%) home use, must The CLEAR Project Team l-Lactic Acid: active ingredient in Palmolive® antibacterial dish detergent seconds causes be mouthwash ® ARDs/death in strength (0.12%) Marsha Adams, PhD, RN, CNE, ANEF, FAAN, Dean, College of Nursing Chlorhexidine Gluconate: active ingredient in Peridex mouthwash rats