Infection Control in The Neonatal Care Unit

Dr Mohd Maghayreh PRTH

Introduction
 Infection control is an important part of every

component of care of a newborn baby.  Newborn babies are more susceptible to infection because of their immature immune system; thus, the consequences of failing to follow infection control principles when handling neonates are particularly devastating .

Introduction (cont.)
 The most important factors contributing to  nosocomial infection are:  Noncompliance to the infection control policy, especially the

hand-washing procedure.
 Invasive procedures which interrupt normal body barriers such

as intubation, catheterization, and the placement of various intravascular lines.

Introduction (cont.)
 Overcrowding and understaffing in the

neonatal care units.  Immaturity of the immune system, especially in preterm neonates.  Antibiotics abuse.

General Principles of Infection Control in NICU
 Appropriate physical setup of the NICU

environment.  Provide routine care for the newborn baby.  Consider every person (including members of staff) as potentially infectious.  Wash hands or use alcohol-based hand scrub.

General Principles of Infection Control in NICU (cont.)
 Overcrowding and understaffing in the

neonatal care units.
 Immaturity of the immune system, especially

in preterm neonates.
 Antibiotics abuse.

General Principles of Infection Control in NICU
 Appropriate physical setup of the NICU

environment.  Provide routine care for the newborn baby.  Consider every person (including members of staff) as potentially infectious.  Wash hands or use alcohol-based hand scrub.

General Principles of Infection Control in NICU (cont.)
    

Wear protective clothing and gloves. Sterilize or disinfect instruments and equipment. Routinely clean the NICU and dispose of waste. Isolate the infectious baby. Surveillance for nosocomial infection.

 Physical Setup of The NICU Environment  The nursery should be isolated from the street environment with no windows open to the outside.  All nursery entrances should have elbow or foot operated sinks, soap dispensers and disposable towels to allow for hand-washing before entering the nursery.  Avoid overcrowding in the nursery.  The NICU should be adequately ventilated and the ventilation air should be filtered efficiently.

    

Wear protective clothing and gloves. Sterilize or disinfect instruments and equipment. Routinely clean the NICU and dispose of waste. Isolate the infectious baby. Surveillance for nosocomial infection.

Neonates

 Neonates should be bathed 3 times/week using baby    

soap. Electrodes should be changed every third day. The umbilical stump should be treated with alcohol every shift. Prophylactic eye drops should be given to all neonates on the first day of life. A neonate admitted from the community should remain in a designated area of the nursery and be under contact precautions for 72 hours.

Staff Health
 Healthcare workers should be immune to rubella,

measles, and chicken pox.  Healthcare workers should receive yearly influenza vaccinations.  Ideally, individuals with respiratory, cutaneous, mucocutaneous, or gastrointestinal infections should not have direct contact with neonates.  The number of different individuals handling the baby should be limited.

Hand Washing
 Medical and hospital personnel must follow careful

hand washing techniques to minimize transmission of diseases.  Instruct the mother to wash her hands before and after handling the baby.  Personnel should remove rings, watches, and bracelets before washing their hands and entering the neonatal nursery.  Fingernails should be trimmed short and no false fingernails or nail polish should be permitted.

Hand Washing (cont.)
Antiseptic preparations (e.g. chlorhexidine 4% or Betadine) should be used for scrubbing :

   

Before entering the nursery. Before providing care for neonates . Before performing invasive procedures. After providing care for neonates.

Hand Washing (cont.)
 Before handling neonates for the first time,

personnel should scrub their hands and arms to a point above the elbow thoroughly with an antiseptic soap. rinsed thoroughly and dried with paper towels.

 After vigorous washing, the hands should be

Hand Washing (cont.)
 A 10-second wash without a brush, but with

soap and vigorous rubbing, followed by thorough rinsing under a stream of water, is required before and after handling each neonate and after touching objects or surfaces likely to be contaminated with virulent micro-organisms or hospital pathogens.

Hand Washing (cont.)
 Hand washing is necessary even when

gloves have been worn in direct contact with the infant.  Hand washing should immediately follow the removal of gloves, and should occur before touching another infant.  Alcohol-based hand scrubs kill bacteria satisfactorily when applied to clean hands and with sufficient contact .

Hand Washing (cont.)
 They can be used in areas where no sinks

are available or during emergencies, but they are not sufficient in cleaning physically soiled hands because transient organisms are not removed. procedure for infection control.

 Hand washing is the single most important

Protective Clothes and Gloves
 Sterile long sleeved gowns must be worn by

all personnel who have direct contact with the sterile field during surgical and invasive procedures in the neonatal unit.
 Gloves should be worn when handling the

neonate until blood and amniotic fluid have been removed from the skin.

General Housekeeping and Waste Disposal
 Clean the NICU in the following order: patient areas,

accessory areas, and then adjacent halls.  Clean from the top to the bottom (i.e. starting with walls and windows coverings), so that the dirt that falls during cleaning is removed.  Wet-mop floors with a disinfectant and detergent solution.  Do not sweep floors or use cleaning methods that increase the dust.

Protective Clothes and Gloves
 Sterile long sleeved gowns must be worn by

all personnel who have direct contact with the sterile field during surgical and invasive procedures in the neonatal unit.
 Gloves should be worn when handling the

neonate until blood and amniotic fluid have been removed from the skin.

Protective Clothes and Gloves
 When a neonate is held outside the bassinet

by nursing staff, a gown should be worn over the clothing and either discarded after use or maintained for use exclusively in the care of that neonate.
 Caps, masks, and sterile gloves should be

used during surgical and invasive procedures

General Housekeeping and Waste Disposal (cont.)
 Cabinet counters, work surfaces, and similar

horizontal areas should be cleaned once a day and between patient use with a disinfectant/detergent. physical removal of dirt and contaminating microorganisms.

 Friction cleaning is important to ensure

General Housekeeping and Waste Disposal
 Clean the NICU in the following order: patient areas,

accessory areas, and then adjacent halls.  Clean from the top to the bottom (i.e. starting with walls and windows coverings), so that the dirt that falls during cleaning is removed.  Wet-mop floors with a disinfectant and detergent solution.  Do not sweep floors or use cleaning methods that increase the dust.

General Housekeeping and Waste Disposal (cont.)
 Cabinet counters, work surfaces, and similar

horizontal areas should be cleaned once a day and between patient use with a disinfectant/detergent. physical removal of dirt and contaminating microorganisms.

 Friction cleaning is important to ensure

General Housekeeping and Waste Disposal
 Clean the NICU in the following order: patient areas,

accessory areas, and then adjacent halls.  Clean from the top to the bottom (i.e. starting with walls and windows coverings), so that the dirt that falls during cleaning is removed.  Wet-mop floors with a disinfectant and detergent solution.  Do not sweep floors or use cleaning methods that increase the dust.

General Housekeeping and Waste Disposal (cont.)
 Cabinet counters, work surfaces, and similar

horizontal areas should be cleaned once a day and between patient use with a disinfectant/detergent. physical removal of dirt and contaminating microorganisms.

 Friction cleaning is important to ensure

General Housekeeping and Waste Disposal (cont.)
 Clean up spills of blood or bodily fluids

immediately using disinfectant solution.  Walls, windows, storage shelves, and similar non-critical surfaces should be scrubbed periodically with a disinfectant /detergent solution as part of the general housekeeping program.

General Housekeeping and Waste Disposal (cont.)
 Sinks should be scrubbed clean at least daily with a

detergent.  Separate contaminated waste (e.g. items soiled by blood, pus, and other bodily fluids) from noncontaminated waste.  Use a puncture-proof container for contaminated sharps, and destroy the container when it is twothirds full.  The chemicals trichlorocarbanilide and sodium salt of pentachlorophenol should not be used in hospital laundering because they may be harmful.

Cleaning and Disinfecting Patient Care Equipment
Respiratory equipment  Change the breathing circuits of the ventilator or CPAP every 3 days.  Wash the resuscitation bag, mask, and head box with soap and water and wipe the exposed surfaces with a gauze pad soaked in disinfectant solution.

General Housekeeping and Waste Disposal
 Clean the NICU in the following order: patient areas,

accessory areas, and then adjacent halls.  Clean from the top to the bottom (i.e. starting with walls and windows coverings), so that the dirt that falls during cleaning is removed.  Wet-mop floors with a disinfectant and detergent solution.  Do not sweep floors or use cleaning methods that increase the dust.

Protective Clothes and Gloves
 When a neonate is held outside the bassinet

by nursing staff, a gown should be worn over the clothing and either discarded after use or maintained for use exclusively in the care of that neonate.
 Caps, masks, and sterile gloves should be

used during surgical and invasive procedures

 Cleaning and Disinfecting Patient Care

Equipment Respiratory equipment  Change the breathing circuits of the ventilator or CPAP every 3 days.  Wash the resuscitation bag, mask, and head box with soap and water and wipe the exposed surfaces with a gauze pad soaked in disinfectant solution.

 Cleaning and Disinfecting Patient Care Equipment (cont.)

Suction equipment
 Change the suction apparatus water daily.  Change the suction tubes after use by each infant.

Incubators, open care units, and bassinets
 When the incubators, open care units, or bassinets

are being cleaned and disinfected, all detachable parts should be removed and scrubbed meticulously.

Incubators, Open Care Units, and Bassinets
 The air filter should be maintained as

recommended by the manufacturer.  Mattresses should be replaced when the surface covering is broken because such a break precludes effective disinfection or sterilization.  Portholes and porthole cuffs and sleeves are easily contaminated. Cuffs should be replaced on a regular schedule or cleaned and disinfected frequently.

Incubators, Open Care Units, and Bassinets (cont.)
 The incubator should be changed for proper

cleaning with 10% hypochlorite:

Every 5 days for infants < 1,000 gm  Every week for infants > 1, 000 gm
 A label with the date the incubator was

changed should be attached to the incubator.

Incubators, Open Care Units, and Bassinets (cont.)
 There should be a designated clean area to disinfect

incubators.  Linen inside the incubator should be changed once a day and/or if contaminated.  The incubator should be wiped with sterile water once a day and/or when contaminated.  Incubators not in use should be thoroughly dried by running the incubator hot without water in the reservoir for 24 hours after disinfection.

Feeding and Nutrition Equipment
 Proper sterilization of feeding bottles.  Use of sterile water for formula preparation.  Feeding tubes changed every 2-3 days.  Hand washing before and after food

preparation.

Intravenous Lines
 Meticulous attention should be given to aseptic

   

insertion and maintenance of the cannula, and to aseptic techniques of fluid administration. Replace IV fluids daily. Evaluate dressings daily. Change dressings if soiled or wet. Assess all insertion sites daily. Culture sites that appear infected (i.e., redness, swelling, or heat at site).

Intravenous Lines (cont.)
 Change the solutes and syringes of syringe pumps

daily.  Replace tubing used to administer blood, blood products, or lipid emulsions within 24 hours of initiating the infusion.  Intravenous tubing, stopcocks, and flush syringes should be changed on a regular basis and no less frequently than every 72 hours.  Open bottles must be discarded no later than 24 hours after the seal has been broken.

Isolate Infectious Baby
 An isolation room or area should be

available .  Keep the door closed.  When entering the room with the baby:
 

Wear a clean gown. Wear clean examination gloves if contact with infectious materials is anticipated.

Isolate Infectious Baby (cont.)
 Before leaving the room:
 

Remove the gown and gloves. Wash hands with a disinfectant or alcoholbased hand scrub.

 The nurse caring for the baby should have

as few other assignments as possible

Surveillance for Nosocomial Infection
 Routine surveillance of the incidence of

acquired infections in the nursery should be mandatory.  During outbreaks:
• Perform cultures by swabbing for bacteria on likely surface areas. • Perform blood cultures of infected neonates. • Identify bacterial isolates. • Bacterial cultures from the nursery personnel, equipment and environment are necessary.

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