Routine decontamination method

Clear local protocols and procedures for cleaning and maintaining birthing pools are required¹. There are no national guidelines at present. For plumbed pools, Coombs et al (1994) suggest:

• opening the taps for five minutes each day to drain off static water in the dead leg
• allowing the water to flow for two minutes before filling the pool
• cleaning and drying the pool thoroughly after each use².

Always follow the manufacturer’s instructions for cleaning and maintaining the birthing pool. During labour, keep the pool water as clean as possible. Use a sieve to remove any maternal faeces, meconium or blood clots. After each patient use, remove any debris using the sieve and discard this as clinical waste. If used, discard the disposable pool liner after each use. Thoroughly clean the pool and any accessories with detergent and warm water, and then wash the pool with a chlorine releasing agent paying particular attention to the pool outlet. Then, rinse the pool with clean water and dry it thoroughly. Do not leave any water standing in the pool. Some manufacturers supply disposable filling and emptying hoses. Discard disposable hoses after each use. Clean and disinfect any reusable detachable hoses by sending to the Sterile Services Department.

Additional recommendations

A risk assessment may be necessary to determine whether it is appropriate for women with complicated pregnancies or those infected with blood borne viruses to use the birthing pool. Regular microbiological surveillance of the birthing pool may be necessary³. Postnatal surveillance of mothers and babies may help to determine infection rates⁴. Always follow the manufacturer’s instructions and adhere to local procedures and policies. Seek advice from your Infection Control Team if in doubt.

Routine decontamination method

The Public Health Laboratory Service (www.hpa.org.uk) provides comprehensive guidance on the use and decontamination of hydrotherapy pools⁵. All staff involved in the pool’s operation must adhere to these guidelines, local policies and procedures, and the manufacturer’s instructions. Decontamination involves filtering, draining and cleaning the hydrotherapy pool regularly as part of a routine, and maintaining disinfectant levels within the pool water. Microbiological surveillance is also required.

Staff should ensure that before entering the pool, patients have a clean face and teeth, and that the patient has emptied their bladder. Following contamination of the pool water with body fluids, the pool must not be used until it has been appropriately decontaminated and declared microbiologically safe (following testing of water samples according to your local policy).

Additional recommendations

You will need to exclude patients who are incontinent, have an infection, and those with open wounds from using the pool. Always follow the manufacturer’s instructions and adhere to local procedures and policies. Seek advice from your Infection Control Team if in doubt.

Routine decontamination method

You may rent or purchase therapeutic beds (e.g. air-fluidised beds, mattresses or overlays in which warm air circulates through fine ceramic beads covered by a permeable sheet) for pressure relief and pressure ulcer management. Make sure you adhere to the manufacturer’s infection control policy, which they recommend or operate. You will need to send beds to a dedicated decontamination centre for thorough disinfection. If so, take care to follow the centre's procedures for returning beds.

Additional recommendations

Always follow the manufacturer’s instructions and adhere to local procedures and policies. Seek advice from your Infection Control Team if in doubt.

Routine decontamination method

Hot wax therapy is a method used in physiotherapy to apply heat to the body. This usually employs a thermostatically controlled heating vessel which heats a paraffin wax with a low melting point to approximately 40 to 44°C. The heated wax may be transferred to a secondary vessel (bowl) and from there to the patient’s skin. In some cases, the patient immerses the appropriate limb into the bowl and lifts it out so that wax solidifies on the skin. The waxed body part may then be wrapped in a plastic bag or covering.

Make sure the patient cleans and dries their hands (or the body part to be treated) prior to insertion in the wax. Use a clean spatula or vessel to remove wax from the heating vessel each time. Do not place contaminated items into the wax in the heating vessel. Use a clean bowl and spatula for each patient.

Discard any remaining wax in the secondary vessel. Paraffin wax is flammable and must be disposed of according to local policy. Discard any single-use equipment and the plastic wrapping used to cover the patient’s body part, and clean the bowl and spatula after each use, in accordance with local policy.

Clean splashes or spillages of wax immediately after treatment. Do not sieve and reuse hot wax. Ensure that you switch off the heating vessel after use and that you clean and maintain it according to the manufacturer’s instructions.

Additional recommendations

Patients with open wounds on the part of the body to be treated are not suitable for wax therapy. Always follow the manufacturer’s instructions and adhere to local procedures and policies. Seek advice from your Infection Control Team if in doubt.

Routine decontamination method

Whirlpool baths are not suitable for clinical or community multi-patient settings as outbreaks of legionnaire’s disease have been associated with them⁸.

Whirlpool baths should not be used with soapy water as this can foam and leave residue in the pipes, encouraging bacterial growth. After every use, the whirlpool bath should be wiped clean. Jets should be regularly removed and cleaned using a solution of 10-50mg per litre of chlorine. The bath should also be cleaned thoroughly at the same time. The bath should be filled with cold water and dosed at 20 parts per million of chlorine for at least 2.5 hours to disinfect the system. The system should then be drained, refilled and drained again. This cleaning schedule should be done on a weekly basis in the home setting and daily in a commercial setting, such as a hotel. A whirlpool cleaning agent is recommended but extreme care should be taken to ensure that it is suitable for contact with human skin. If in doubt, seek expert advice.