Download Infection Prevention for Newborns

Title:
Infection Prevention for Newborns in Neonatal Areas
NEONATAL CLINICAL
PRACTICE GUIDELINE
1.0
Approval Date:
June 2015
Approved by:
Neonatal Patient Care Teams, HSC & SBH
Child Health Standards Committee
Pages:
1 of 5
Supercedes:
HSC# 80.275.700
SBH #040
PURPOSE AND INTENT
1.1
To provide a process to reduce the risk of cross-contamination between patients in neonatal
areas.
Note: All recommendations are approximate guidelines only and practitioners must take in to account
individual patient characteristics and situation. Concerns regarding appropriate treatment must be
discussed with the attending neonatologist.
2.0
PRACTICE OUTCOME
2.1
3.0
Decrease the incidence of nosocomial infections in vulnerable newborns.
GUIDELINES
3.1
Follow Infection Control precautions as outlined in the WRHA Infection Prevention and Control
Manual
3.2
Adhere to the “4 Moments for Hand Hygiene”:
 Before initial patient / patient environment contact
 Before aseptic / clean procedures
 After body fluid exposure risk
 After patient / patient environment contact
3.3
Upon entering the Neonatal Intensive Care Unit at St. Boniface Hospital follow the instructions
found in Appendix A.
3.4
Instruct all visitors in appropriate hand hygiene and infection prevention measures.
3.5
Remove all rings watches and other jewelry on hands and wrists before performing hand hygiene
and handling of neonatal patients.
3.6
Keep natural nails clean with the nail not showing past the end of the finger, with any nail polish
fresh and in good condition and no artificial nails or nail enhancements.
3.7
Keep arms bare to the elbows during direct patient care.
3.8
Wear clean gloves for all handling of invasive devices such as peripheral IV’s, chest tubes etc
that are indwelling. Management of central lines is done according to the Neonatal Guideline
“Central Venous Access Device Management in Neonates”.
3.9
Discontinue invasive devices including chest tubes, drains and urinary catheters as early as
possible to diminish the infection risk.
3.10
Provide skin antisepsis prior to invasive procedures using the appropriate antiseptic options
outlined in Appendix A. Note: for umbilical catheter insertions prevent potential chemical burns
by using care to cleanse the umbilical cord only and not the abdominal skin. See “Umbilical
Catheters in Neonates” Clinical Practice Guideline for details on the procedure.
3.11
Cover gowns or another appropriate barrier must be worn if:
Title:
Infection Prevention for Newborns in Neonatal Areas
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An infant is on isolation technique
A staff member will be holding an infant in close contact and then will move on to hold a
second infant with close contact.
A patient care activity is likely to generate splashed or sprays of any body fluid.
For more details see the WRHA Infection Prevention and Control Manual
4.0
3.12
Gather all clean supplies with clean hands and assemble them on a clean surface.
3.13
Use medication bedside bins for medications only. Clean bins daily and when visibly soiled.
3.14
Use hospital approved disinfectant to clean contaminated surfaces and objects.
3.15
Clean surface with hospital approved disinfectant before and after infant feeding preparation.
3.16
Wipe patient bedside area at the start of every shift and as often as necessary. This includes
bedside table or cart, counter tops, monitor, ventilators, IV pump control pads and any computer
keyboard that are in the area.
3.17
Clean incubators / infant warmers according to a schedule and additionally as required. When
cleaning an incubator or warmer, remove and scrub all detachable parts. If the incubator has a
fan, clean and disinfect it according to the manufacturer’s instructions. Maintain the air filter as
recommended by the manufacturer. Replace mattresses when the surface covering is broken.
Clean and disinfect portholes, cuffs and sleeves frequently.
3.18
Staff members who have cold sores (herpetic lesions) do not work with newborns until the lesion
is crusted and dry.
3.19
Staff with significant hand lesions, dermatitis or presumed allergy to hospital products inform the
Manager of Patient Care and contact the Department of Occupational and Environmental Safety
& Health (OESH) to determine strategies for treatment.
3.20
Visitors who have been identified as having an infection can visit only after consultation with the
Infection Prevention and Control department and the attending Neonatologist.
3.21
Families who wish to bring toys in to the hospital are encouraged to bring in toys that are easily
cleaned. Plush toys are sent home with the family to be laundered weekly and when visibly
soiled or contaminated. Keep plush toys away from direct contact with patients who have
invasive lines.
REFERENCES
4.1
Anderson, C., Hart, J., Vemgal, P., Harrison, C., The Mercy Neonatal Nosocomial Infection
Working Group. (2005). Prospective evaluation of a multi-factorial prevention strategy on the
impact of nosocomial infection in very-low-birthweight infants. Journal of Hospital Infection 61,
162-167.
4.2
Centers for Disease Control and the Healthcare Infection Control Practices Advisory Committee
(2004) Guidelines for preventing health-care-associated pneumonia. Morbidity and Mortality
Weekly Report, 53(RR03); 1-36
4.3
Centers for Disease Control and Prevention (2002). Guideline for Hand Hygiene in Health-Care
Settings. Morbidity and Mortality Weekly Report, 51 (RR-16). Retrieved from www.cdc.gov
4.4
Centers for Disease Control and Prevention Healthcare Infection Control Practice Advisory
Committee (2003). Guidelines for environmental infection control in health care facilities.
Title:
Infection Prevention for Newborns in Neonatal Areas
Page:
3 of 5
Retrieved from www.cdc.gov
5.0
4.5
Manzoni, P., Rizzollo, S., Decembrino, L., Ruffinazzi, G., Rossi Ricci, A., Gallo, E., Stolfi, I.,
Mostert, M., Stronati, M., & Farina, D. (2011). Recent advances in prevention of sepsis in the
premature neonates in NICU. Early Human Development, doi:10.1016/j.
4.6
Polin, R.A. Denson, S.& Brady, M.T. & The Committee on Fetus and Newborn and Committee
on Infectious Diseases. (2012) Strategies for prevention of health care – associated infections in
the NICU. Pediatrics, 129(4). E1085-e1093.
4.7
Provincial Infectious Diseases Advisory Committee (2015). Best practices for infection prevention
and control in perinatology. Ontario Agency for Health Protection and Promotion accessed April
20, 2015 at
http://www.publichealthontario.ca/en/eRepository/IPC%20in%20Perinatology_ENGLISH_Final_2
012-05-25[1].pdf
4.8
Public Health Agency of Canada (2012) Routine practices and additional precautions for
preventing the transmission of infection in healthcare settings. Access April 20, 2015 from:
http://publications.gc.ca/collections/collection_2013/aspc-phac/HP40-83-2013-eng.pdf
PRIMARY AUTHORS
5.1
5.2
5.3
5.4
5.5
5.6
Doris Sawatzky-Dickson Clinical Nurse Specialist NICU HSC
Karen Olekson, Infection Control Practitioner HSC
Karen Bodnaryk Nurse Educator NICU HSC
Tanya Tichon, Nurse Educator NICU HSC
John Baier, Assistant Medical Director NICU HSC
Barbara Wheeler, Clinical Nurse Specialist NICU, SBH
Title:
Infection Prevention for Newborns in Neonatal Areas
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APPENDIX A
St. Boniface Hospital Neonatal Intensive Care Unit
Before entering a PATIENT CARE OR PATIENT EQUIPMENT PREP AREA (ie. pod, the Observation
Unit, Pharmacy, formula prep area, medication prep area, isolation anteroom or utility room:
 Remove lab coat or jacket
 Remove bracelets, watches or rings
 Scrub to the elbows with an approved antimicrobial soap for 1 minute
Upon re-entering on the same day:
 Wash well to the elbows for 15 seconds before handling any neonate’s equipment, after removing
gloves, and between handling babies. This includes parents of multiplies who are handling more
than one of them.
Before entering NON-PATIENT CARE AREAS (ie. Multipurpose room, Respiratory lab, area behind main
desk)
 Scrub as outlined above for 1 minute OR, use alcohol based hand rub/foam
 It is not necessary to remove jewelry if not entering a patient care or equipment prep area.
Title:
Infection Prevention for Newborns in Neonatal Areas
Page:
5 of 5
APPENDIX B
Skin and Device Antisepsis for Neonates
Procedure
Infants <29 weeks and less
than 3 weeks of age
2% chlorhexidine swab sticks or
prep pads (no alcohol)
Other infants
Invasive Procedures eg:

Central or umblilical lines

Lumbar punctures

Suprapubic Taps
Urinary Catheterization
2% chlorhexidine swab sticks
(no alcohol)
2.0% chlorhexidine with 70%
alcohol swab sticks or prep
packs.
Povidone-iodine – pour small
amount from bottle or use prep
packs
Peripheral Intravenous
2% chlorhexidine prep packs
(no alcohol)
Povidone-iodine – pour small
amount from bottle or use prep
packs
(Chlorhexidine is not
recommended for mucous
membranes)
0.5% chlorhexidine with 70%
alcohol prep pad
Access to Central Lines
70% alcohol prep packs
(Alcohol has the best results for
antisepsis on objects, while
chlorhexidine is superior on
skin)
2% chlorhexidine swab sticks
(no alcohol)
70% alcohol prep packs
(Alcohol has the best results for
antisepsis on objects, while
chlorhexidine is superior on
skin)
2% chlorhexidine swab sticks
with 70% alcohol
2% chlorhexidine prep packs
(no alcohol)
70% alcohol prep pad
Or chlorhexidine with 70%
alcohol prep pad.
Blood Culture
Central Line Site Care
Heel sticks
2% chlorhexidine with 70%
alcohol prep pad
If sensitivity or allergy to chlorhexidine has been demonstrated 10% povidone-iodine can be used
for subsequent procedures.