Cleaning ENFit in the Neonatal Intensive Care Unit

 

An ENFit implementation makes clinicians suddenly aware of the importance of cleaning enteral products. The ENFit design change – male/female reversal and a locking system – makes the hub on the syringe larger, and the “moat” area around the tubing larger also.

Although education takes place in the beginning of an ENFit transition, a buildup of dried milk may not be noticed until several days later. Then it’s a frustrating surprise! Most hospitals don’t address cleaning protocols before the implementation because they don’t realize it will be more of an issue – enteral tube cleaning – than it was with conventional enteral products.

I have some suggestions on how to talk about and implement policy for cleaning ENFit. I use the acronym ECE to remember three solutions for teaching and discussion.

ECE: Education, Cleaning, Endorsements

• Education – Prevention is the best cure. Prevention is not filling to the tip of an ENFit syringe to avoid having milk spill out into the “moat” areas of the hub. It is also helpful to keep the syringe tip pointed upwards while attaching the extension set. Nurses may not be used to doing this and it may take practice change education to reinforce.
• Cleaning Protocols – ENFit means hospitals may need to look at new cleaning protocols and enforce them. The above syringe filling and tubing attachment practice helps prevent excess spill, but existing and new cleaning protocols can help keep the hub clean. Ideally, hospitals should have cleaning protocols in place before moving to ENFit and reinforce them after implementation.
• Endorsements – ENFit is supported by 15 regulating agencies and medical organizations according to the GEDSA website. Many children’s hospitals have already successfully adopted ENFit, and many other units in hospitals as well. The goal is to improve safety by reducing the risk of misconnections.

You can use existing methods when cleaning the ENFit hub, such as a Q-tip or a small moist gauze pad. Some hospitals also use toothbrushes.

I realize that the ENFit design may seem difficult to clean, and perfect solutions are not available yet. It’s important to remember that hospitals already have a cleaning protocol for feeding tubes, and that ENFit can benefit from that. Keeping Q-tips, gauze, sterile water, and toothbrushes at the bedside should help. It’s not necessary to purchase specialty brushes to clean ENFit.

A final note is to remember to not over-prime (otherwise milk may get into the hub or near the tips of the ENFit products). If a nurse leaves a small space of air before capping, the milk can’t get into the moat or the cap.

Prevention is the best cure as they say. By combining existing protocols and adopting best ENFit practices, your NICU can successfully adopt ENFit into practice.

 

Looking for more on this topic? Read ENFit Solutions for Pharmacy and NICU/Pediatric Clinicians