Disinfection of neonatal resuscitation equipment in low‐resource settings: The importance, the reality, and considerations for the future

Anne M. White, Dominic Mutai, David Cheruiyot, Amy R.L. Rule, Joel E. Mortensen, Joshua K. Schaffzin, Beena D. Kamath‐rayne

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under‐five mortality. The vast majority of these deaths are in resource‐limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID‐19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low‐resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, high-lighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best‐practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low‐resource areas. The guidelines follow the gold‐standard principle of high‐level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is im-portant, why this is challenging in low‐resource settings, and suggestions for solutions to move forward.

Original languageEnglish (US)
Article number7065
JournalInternational journal of environmental research and public health
Issue number13
StatePublished - Jul 1 2021

Bibliographical note

Funding Information:
This work is funded by a Cincinnati Children’s Hospital Place Outcomes Award as well as a Laerdal Foundation grant.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Disinfection
  • Global child health
  • Neonatal infection
  • Neonatal mortality
  • Reprocessing


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