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Transcript
Maternal – Child
Health
1. Describe the role of infection prevention
and control in maternal child health.
2. Identify potential infection risks in this
setting.
3. Explain practices for prevention and
control of infection for these patients.
December 1, 2013
Learning objectives
2
• 60 minutes
December 1, 2013
Time involved
3
• Infection prevention and control strategies based on the
principle of combined care
• For neonates requiring intensive care, the newborn’s
environment must be clearly delineated, with spatial
separation between incubators
• Sharing of equipment and supplies must be preceded by
thorough cleaning and appropriate
disinfection/sterilisation
• Standard Precautions should be applied for all patient
care
• Prevention strategies include hand hygiene, patient
hygiene, environmental cleaning and immunisation
December 1, 2013
Key points
4
• The World Health Organization (WHO)
estimates that approximately 210
million women become pregnant each
year and that 529,000 die from
complications
• In the immediate post-partum period,
sepsis and haemorrhage are the
commonest causes of maternal death
• Severe infections cause more than onethird of neonatal deaths
December 1, 2013
Background
5
• Maternal infections
• Foetal gestational age at the time of the
infection
• Complications of delivery
December 1, 2013
Neonatal risk factors - 1
6
• Premature infants are at risk for infection due to:
• Absence of normal microbial flora
• Increases the risk of colonisation with pathogens
• Colonisation by gastrointestinal flora
December 1 2013
Neonatal risk factors - 2
• Risk differs between breast fed babies versus formula-fed
babies
• Abnormal colonisation that occurs most often in
newborns in neonatal intensive care units
• Fragile, underdeveloped organs that normally provide
a barrier to infectious pathogens
• Such as the skin and lining of the lung
• A poor immune (antibody) response
7
• Occur in the first 28 days of life
• May be spread:
• In utero
December 1, 2013
Neonatal infections
• By the transplacental route
• Intrapartum
• When in contact with the maternal genital tract, blood
or stool
• Postpartum
• When in contact with the mother, family and visitors,
other neonates in the nursery, health care workers, or
contaminated equipment
8
• For full term newborns - superficial infections of the
skin, eye and mucous membranes.
• Additional infections occur in intensive care
• Bacteraemia associated with central lines, pneumonia and
gastrointestinal infections
December 1, 2013
Infant infections
• Microorganisms associated with neonatal infections
• Staphylococcus aureus, coagulase negative staphylococci,
Group B streptococci, Escherichia coli and Candida
• Other pathogens often associated with
outbreaks in the nursery
• Klebsiella, Serratia, Enterobacter, Citrobacter and
Pseudomonas species
9
• Prolonged rupture of membranes (>24 hours)
• Obesity
• Interferes with wound healing
December 1, 2013
Maternal Risk Factors
• Diabetes mellitus
• Invasive tests and procedures
10
• Common infections include:
• Endometritis
• Infection of the lining and wall of the uterus (endometrium
and myometrium)
December 1, 2013
Maternal Infections
• Mastitis
• Inflammation and infection of the breast
• Caesarean surgical site infections
• Episiotomy site infections
• Infection at the site of incision of the perineum
• Sepsis
• Bloodstream infection which causes a systemic inflammatory
response
11
• Standard Precautions
• Hand Hygiene
• Protective barriers
• Cohorting
• Additional precautions
• Single rooms
• Cleaning
December 1, 2013
Prevention Strategies
12
• Basic hygienic precautions are recommended for
all patient encounters
December 1, 2013
Standard Precautions
13
• Use soap and running water or alcohol-based
hand rubs:
• before and after contact
December 1, 2013
Hand Hygiene
• with the mother
• with the neonate
• with their immediate environment
• before an aseptic procedure
• after handling blood and body fluids
• after removal of gloves
14
• Gloves worn for all contact with
mucous membranes, non-intact skin
and moist body substances
• Masks and/or protective eyewear or
face shields worn when body
substances are likely to splash skin or
mucous membrane
• Gowns and/or plastic aprons worn
when body substances are likely to
soil clothing or skin
• Gowns worn for holding infant to the
uniform
December 1, 2013
Protective barriers
15
Cohorting infants with the same infection
helps prevent spread of infections in the
nursery
December 1, 2013
Cohorting
16
• May be indicated for infants colonised or
infected with epidemiologically significant
microorganisms
• Suspected or confirmed infections should be
handled according to guidelines developed by
the Infection Control Team
December 1, 2013
Additional Precautions
17
• Priority given to mothers who soil articles in the
environment with body substances and those
colonised or infected with epidemiologically
significant microorganisms
• Infants and/or mothers with diagnosed or
suspected infections transmitted by the airborne
route must be placed in a single room with
negative pressure and the door closed
December 1, 2013
Single Rooms
18
• For labour and delivery suites, post delivery,
remove soiled linens using gloved hands
• The delivery table/bed and the immediate
patient environment should be cleaned after
each use
• Use non-toxic disinfectants for cleaning neonatal
equipment and incubators
December 1, 2013
Cleaning
• Avoid phenolic disinfectants
19
• Parent/infant contact encouraged
• Except for the occasional case when there is a
risk of transmitting infection
• Labouring mothers may shower or bath
• Post partum, instruct patient on daily
perineal care after toileting
• Reviewing good hygienic policies with
parents is vital to protect both mother and
infant from acquiring or spreading
infections
December 1, 2013
General Infection prevention
and control - 1
20
• Prenatal assessment – to identify risk factors for
maternal/ newborn infection and allow prevention
strategies
• Screen women for Group B streptococcus at 35-37
weeks gestation
• Screen for human immunodeficiency virus and
Hepatitis B
December 1, 2013
General Infection prevention
and control - 2
• HIV positive mothers should refrain from breastfeeding unless
alternatives are not available.
• Antepartum
• Screen mothers upon admission for symptoms of infection
such as new onset of fever and other respiratory symptoms
• New onset of cough, rash, or diarrhoea
• If the patient responds “yes” to the any of these conditions,
initiate the appropriate additional precautions and spatial
separation from other patients (> 2 metres)
21
• Breast milk is protective as it provides specific
IgA antibody and helps establish normal flora
in the neonate
• Provide post-partum hygiene for the mother
and infant immunisations as required
• For facilities with little room and
overcrowding, consider kangaroo mother care
December 1, 2013
General Infection prevention
and control - 3
• This includes skin to skin positioning of the baby on
the mother’s chest
22
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
AIDS
Standard
Precautions
Standard
Precautions
VRE/MRSA:
Contact
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
Permitted
No
Permitted
Permitted
Permitted
Permitted
Antibiotic Resistant Mother uses
Organisms - Infant Standard
Precautions
Candida Standard
Mother
Precautions
VRE/MRSA:
Contact
Precautions
Standard
Precautions
Permitted
Permitted
Permitted
Permitted
Candida - Infant
Standard
Precautions
Permitted
Permitted
Amnionitis
Antibiotic
Resistant
Organisms Mother
Standard
Precautions
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
23
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Chickenpox
Airborne
precautions
Infant room in
with mother
Permitted
Permitted
Mother ill – healthy
term infant
Chickenpox
Airborne
precautions
Mother ill – Infant
in NICU
Mother may not
visit the NICU
Infant in NICU –
chickenpox or
contact
Only parents &
visitors who are
immune may
visit.
Standard
Not Permitted
Precautions until
day 10. As of day
10 to and including
day 28 start
Airborne
Precautions
Airborne
Permitted if
precautions
woman is immune.
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Permitted (as
expressed breast
milk)
Permitted
24
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Chlamydia
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Healthy Term
Infant:
Permitted
Mother
Chlamydia Newborn
Conjunctivitis
and/or pneumonia
Conjunctivitis Bacterial
Standard
Precautions
Contact
Precautions.
Conjunctivitis No sharing of
Adenovirus Mother
towels, face
cloths, pillows,
linens



December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Room in
Extreme care with
hand hygiene
No sharing of
towels, linens
25
Infant in NICU:
Mother NOT to go
to NICU
Permitted as
expressed breast
milk.
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Conjunctivitis
Standard
Precautions
As above
Standard
Precautions
As above
Contact
Precautions.
No sharing of
patient care items.
Standard
Permitted
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Healthy Term
Infant: Permitted
with Standard
Precautions.
Infant in NICU: Not
permitted until
asymptomatic for
48 hours.
Healthy Term
Infant: Permitted
Adenovirus Infant
Cytomegalovirus
Mother
Cytomegalovirus Infant
Diarrhoea
Mother
Bacterial
(suspected or
confirmed)
Single room with
toilet
Mother/Infant
Contact
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Breast Feeding
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Permitted
Infant in NICU:
Permitted as
expressed breast
milk.
26
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Diarrhoea
Mother
Antibiotic
associated/C.
difficile
Diarrhoea
Mother
Contact
precautions
Single room with
toilet
Standard
Precautions
Permitted
Permitted
Contact
precautions
Single room with
toilet
Healthy Term
Infant: Permitted
with Standard
Precautions
Healthy Term
Infant: Permitted
Viral (e.g.,
norovirus)
Contact
precautions
Single room with
toilet
Infant in NICU:
Woman is not
permitted in the
NICU until
asymptomatic for
48 hours
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed breast
milk.
27
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Diarrhoea
Standard
Precautions
Contact
precautions
Permitted
Permitted
Standard
Precautions
Contact
precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Infant
Bacterial
(suspected or
confirmed
Diarrhoea
Infant
Viral (e.g.
norovirus)
Endometritis
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
28
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Enterovirus
Contact
precautions
Single room
Contact
precautions Single
room
Healthy Term
Infant: Permitted
with Standard
Precautions.
Healthy Term
Infant: Permitted
Mother
Enterovirus
Infant
Standard
Precautions
Contact
precautions
Infant in NICU:
Woman is not
permitted in the
NICU until
asymptomatic.
Permitted
Ensure immediate
disposal of diapers
into leak proof bag
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed breast
milk.
Permitted
29
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Gonococcal
Infections
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Mother-Untreated
or <24 hours of
treatment
Gonococcal
Infections - Infant
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Conjunctivitis,
scalp abscess,
sepsis
Hepatitis – Mother,
Type A
Hepatitis – Mother,
Type B (HbsAg+)
Standard
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
After prophylaxis
of infant
Permitted
After prophylaxis
of infant
Permitted
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
30
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Hepatitis –Mother,
Type C
Herpes simplex –
Mother, Genital –
delivered by
Caesarean section
Herpes simplex –
Mother, Genital –
vaginal delivery
Herpes simplex –
Mother, Oral or
mucocutaneous
(i.e., cold sore)
Standard
Precautions
Standard
Precautions
Standard
Precautions
See Infant –
Asymptomatic
Permitted
Permitted
Permitted – see
Comments
Permitted
Standard
Precautions
See Infant –
Asymptomatic
Permitted
Permitted
Standard
Precautions
See Infant Asymptomatic
Permitted.
Permitted if there
are no herpetic
lesions on the
breast.
Total rooming-in
preferred.
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
31
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Herpes simplex –
Mother , Whitlow
Standard
Precautions
See Infant –
Asymptomatic
Direct/hands-on
contact is NOT
permitted.
Herpes simplex –
Infant ,
Asymptomatic
Standard
Precautions
Contact
precautions. For
duration of
incubation period
(up to 4 weeks)
Contact
precautions
Permitted
May pump and
discard milk until
lesions are gone or
may nurse if the
woman does not
touch her infant
(i.e. someone else
holds and
positions infant).
Permitted
Herpes simplex Standard
Permitted
Infant,
Precautions
Symptomatic
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
32
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast
Feeding
Herpes
zoster(shingles) Mother – localized
Standard
Precautions in
single room.
Standard Precautions
Permitted. Total
rooming-in
preferred. Mother
may not go to
nursery until
lesions are
crusted.
Permitted. Total
rooming-in
preferred. Mother
may not go to
nursery until
lesions are
crusted.
Permitted if
lesions are not
on breast.
Only immune
staff may care for
patient.
Herpes
zoster(shingles)
Airborne
precautions
Mother –
disseminated
Immune staff only
Term Infant Roomingin: Standard
Precautions
Infant in NICU:
Airborne precautions
from day 10 from 1st
exposure to day 21 of
last exposure (or day
28 if infant has been
given VarIG).
Infant in NICU:
Woman may NOT
go to the NICU
until lesions are
crusted.
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Permitted if
lesions are not
on breast.
Infant in NICU:
Provide
expressed
milk.
33
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Influenza
Droplet &Contact
Precautions
Standard
Precautions
Healthy Term
Infant: Permitted.
Woman must wear
a surgical mask
when within 2
metres of infant.
Healthy Term
Infant: Permitted
Mother
Single room
preferred
Influenza - Infant
Standard
Precautions
Droplet &Contact
Precautions
Listeria
Standard
Precautions
Standard
Precautions
Mother
Infant in NICU:
Woman is not
permitted to go to
NICU.
Permitted
Permitted
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed breast
milk.
Permitted
Permitted
34
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/In Breast Feeding
fant
Contact
Listeria
Standard Precautions
Standard Precautions
Permitted
Infant
Measles (Rubeola)
Airborne Precautions
Standard Precautions
Room in
Permitted if
with woman rooming in with
woman. May
provide expressed
breast milk if not
rooming in.
Woman not Permitted as
permitted in expressed breast
NICU until 4 milk only until
days after
woman no longer
the
infectious
appearance
of the rash.

Immune staff only
Only immune family
and visitors
permitted
Mother ill – Term
healthy infant

Measles (Rubeola)
Airborne Precautions

Immune staff only

Only immune
family and visitors
permitted
Mother ill – infant
in NICU
From 8 days from 1st
exposure to 12 days
from last exposure
Airborne Precautions


Immune staff only
Only immune family
and visitors
permitted
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
35
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Measles (Rubeola)
Standard
Precautions
Airborne
Precautions
Woman immune –
permitted to see
infant
Permitted
Infant ill or
exposed
(i.e. exposed in
NICU)
Meningitis
Neissera
meningitidis/
Haemophilus
influenzae


Immune staff
only
Only immune
family and
visitors
permitted
Woman
susceptible –
woman not
permitted to see
infant
Droplet
precautions until
24 hrs. after
appropriate
antimicrobial
therapy
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Woman
susceptible –
Permitted as
expressed breast
milk only until
infant no longer
infectious
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
36
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Inf
ant Contact
Breast Feeding
Mumps
Droplet/Contact
precaution
Standard Precautions
Term Infant:
Permitted
Term Infant:
Permitted
Droplet/Contact
precautions starting
from 10 days from
first exposure to 26
days from last
exposure.
Woman
immune –
permitted to
see infant
Woman immune –
Permitted
Mother


Mumps
Infant in NICU
Exposed or ill
Immune Staff
only
Only immune
family and
visitors permitted
Standard
Precautions



Woman
Single room
susceptible –
Immune Staff only
woman not
Only immune family
permitted to
and visitors
see infant
permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Woman
susceptible –
Permitted as
expressed breast
37
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Pediculosis
Head Lice
Contact
Standard
Precautions
Precautions
Precautions
remain in place
until after woman
has been
appropriately
treated.
Mother/Infant
Contact
Breast Feeding
Healthy Term
Infant:
Permitted
Healthy Term
Infant: Permitted
Infant in NICU:
Permitted once
woman has been
appropriately
treated
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed breast
milk until woman
has been
appropriately
treated.
38
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Pertussis
Mother
Droplet
Precautions
Single room
Standard Precautions Healthy Term Infant:
Permitted. Reinforce hand
hygiene and wear a
surgical mask when within
2 metres of infant.
Pertussis
Infant
Precautions
remain in place
until 5 days of
appropriate
antibiotic
treatment has
been completed.
Standard
Precautions
Contact Precautions
Consider cohorting
Precautions remain
in place until 5 days
of appropriate
antibiotic treatment
has been completed.
Mother/Infant Contact Breast
Feeding
Infant in NICU: Not
permitted in NICU until 5
days of appropriate
antibiotic treatment has
been completed.
Permitted
Healthy Term
Infant:
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed
breast milk.
Permitted
39
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Respiratory Virus
Infections
Droplet/Contact
Precautions
Standard
Precautions
Mother ill
Single room
Healthy Term
Infant: Permitted.
Reinforce hand
hygiene and wear
a surgical mask
when within 2
metres of infant
Healthy Term
Infant: Infant
rooming-in:
Permitted
Respiratory Virus
Infections Infant ill
Infant in NICU –
chickenpox or
contact
Standard
Precautions
Droplet /Contact
Precautions
Only parents &
visitors who are
immune may
visit.
Airborne
precautions
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted as
expressed breast
Infant in NICU: Not milk.
permitted in NICU.
Permitted
Permitted
Permitted if
Permitted
woman is immune.
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
40
Infection/
Organism
Maternal
Precautions
Rubella
Droplet
Droplet
precautions
precautions
Immune staff only Immune staff only
Mother
Rubella
Standard
Precautions
Newborn
Precautions
Droplet
Precautions
Mother/Infant
Contact
Breast Feeding
Healthy Term
Infant: Permitted
Healthy Term
Infant: Permitted
Infant in NICU:
Woman cannot go
into the NICU until
7 days after the
onset of the rash.
Infant in NICU:
Expressed breast
milk as the woman
cannot go into the
NICU until 7 days
after the onset of
the rash.
Permitted
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant (Congenital)
41
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Scabies
Contact
Precautions
Standard
Precautions
Healthy Term
Infant:
Permitted once
woman has been
appropriately
treated.
Healthy Term
Infant:
Permitted once
woman has been
appropriately
treated or may
provide expressed
breast milk.
Precautions
remain in place
until after woman
has been
appropriately
treated.
Infant in NICU:
Permitted once
woman has been
appropriately
treated.
Staphylococcus
Standard
Standard
Permitted
aureus - Mother
Precautions
Precautions
Mastitis
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infant in NICU:
Permitted once
woman has been
appropriately
treated or may
provide expressed
breast milk.
Permitted (see
Comments)
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
42
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Staphylococcus
aureus - Mother,
Breast Abscess
Standard
Precautions
Standard
Precautions
Permitted
Healthy Term
Infant:
Permitted
Staphylococcus
aureus – Mother,
Minor Wound
Infection
(contained) or Toxic
Shock Syndrome
Staphylococcus
aureus - Mother,
Major Wound (not
contained)
Standard
Precautions
Standard
Precautions
Permitted if
draining lesion is
adequately
contained
Contact
Precautions
Standard
Precautions
Permitted if
draining can be
adequately
contained
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Infant in NICU:
Permitted on the
unaffected breast
Permitted
Permitted
43
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Staphylococcus
aureus
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Infant pneumonia
Staphylococcus
aureus
Standard
Precautions
Standard
Precautions
Including gloves
and gowns for
contact with
infant.
Standard
Precautions
Permitted
Permitted
Permitted
Permitted
Infant skin lesions
(localized or
scalded skin)
Staphylococcus
epidermidis and
other coagulase
negative
staphylococcal
infections
Standard
Precautions
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
44
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant Breast Feeding
Contact
Streptococcal
Disease Group A Mother, Minor
Wound Infection
(contained)
Streptococcal
Disease Group A Mother, Major
wound infection or
endometritis
Streptococcal
Disease
Group A Mother, Invasive
Disease
Single room
until 24 hours
after effective
treatment.
Standard
Precautions
Permitted
Permitted
Single room
until 24 hours
after effective
treatment.
Standard
Precautions
Permitted
Permitted
Single room
until 24 hours
after effective
treatment.
Standard
Precautions
Permitted after
24 hours of
effective
treatment.
Permitted after 24
hours of effective
treatment.
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
45
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infa
nt Contact
Streptococcal
Disease
Group A Mother,
Pharyngitis (strep
throat)
Streptococcal
Disease
Group A (GAS) Infant
Droplet Precautions.
Single room .
Precautions remain in
place until 24 hours
after effective
treatment
Standard Precautions
Standard
Precautions
Permitted after Permitted after 24
24 hours of
hours of effective
effective
treatment.
treatment
Contact
Precautions
Streptococcal
Disease
Group A (GAS)
Streptococcal
Disease
Group B (GBS) Mother,
Colonization
Standard Precautions
Precautions
remain in place
until 24 hrs. after
effective
treatment.
Standard
Precautions
Breast Feeding
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Standard
Precautions
Infant
Permitted
Permitted
46
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Streptococcal
Disease
Group B (GBS) –
Mother,
Endometritis
Streptococcal
Disease
Group B (GBS) Infant
Colonization
Streptococcal
Disease
Group B (GBS) Infant Sepsis or
Meningitis
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
47
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Syphilis Mother,
Mucocutaneous
Contact
Precautions
Standard
Precautions
Permitted after 24
hours effective
treatment.
Permitted after 24
hours effective
treatment.
Contact
Precautions
Until 24 hours
effective
treatment
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Permitted
Permitted
Permitted
Permitted
Syphilis Infant,
Congenital
Toxoplasmosis
Mother
Toxoplasmosis
Infant
Until 24 hours
effective
treatment
Standard
Precautions
Standard
Precautions
Standard
Precautions
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
48
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Tuberculosis Standard
Standard
Permitted
Mother,
Precautions
Precautions
Positive Skin test –
asymptomatic
Tuberculosis Standard
Standard
Permitted
Mother,
Precautions
Precautions
Pulmonary or
laryngeal on
effective treatment
Tuberculosis Airborne
Standard
Not permitted
Mother,
Precautions
Precautions
until woman is no
Pulmonary or
longer infectious
laryngeal – newly
diagnosed, on
inadequate
treatment or
noncompliant
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Breast Feeding
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
Permitted
Mother may
provide expressed
breast milk.
49
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Tuberculosis
Standard
Precautions
Standard
Precautions
Permitted
Standard
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
Permitted
Permitted unless
the
extrapulmonary TB
is causing a breast
abscess. Not
permitted until TB
abscess is treated.
Permitted
Permitted
Permitted
Mother
Extrapulmonary
Urinary Tract
Infection
West Nile Virus
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
50
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
Infection/
Organism
Maternal
Precautions
Newborn
Precautions
Mother/Infant
Contact
Breast Feeding
Wound Infections Mother,
Minor or Limited
Wound Infections Mother,
Major
Wound Infections Infant
Yeast
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Standard
Precautions
Standard
Precautions
Standard
Precautions
Standard
Precautions
Permitted
Permitted
Permitted
Permitted
December 1, 2013
Maternal/Child Infectious
Diseases and IPC Management
51
Adapted from Sunnybrook Health Sciences Centre, Toronto, On. 2010
• Committee on Infectious Diseases. (2012). The Red Book
29th Edition. Elk Grove Village, Illinois: American
Academy of Pediatrics.
• Guidelines for the Prevention of Invasive Group A
Streptococcal Disease, CCDR 2006; V32S2.
http://www.phac-aspc.gc.ca/publicat/ccdrrmtc/06pdf/32s2_e.pdf
• World Health Organization (WHO): Practical Guidelines
for Infection Control in health Care settings, 2003.
http://whqlibdoc.who.int/wpro/2003/a82694.pdf
December 1, 2013
References - 1
52
• World Health Organization, Geneva, 2010. Packages of
Interventions for Family Planning, Safe Abortion Care,
Maternal, Newborn and Child Health.
http://whqlibdoc.who.int/hq/2010/WHO_FCH_10.06_en
g.pdf
• APIC. (2009). In APIC Text Infection Control and
Epidemiology, 3rd Edition (Chapters 37, 38, 39).
Washington: Association of Professionals for Infection
Prevention and Control and Epidemiology
• World Health Organization (WHO): Recommendations
for Routine Immunization 2010.
http://www.who.int/immunization/policy/immunization
_tables/en/index.html
December 1, 2013
References - 2
53
1.
2.
There are specific precautions required when mothers or
infants have communicable diseases. The issues centre around
breast feeding and needed precautions. T/F?
Maternal infection risks are
a)
b)
c)
d)
3.
Prolonged rupture of membranes (>24 hours)
Diabetes mellitus
Invasive tests and procedures
All of the above
December 1, 2013
Quiz
Infection prevention strategies specific to maternal child health
include all except:
a)
b)
c)
d)
Single rooms
Cohorting
Type of carpet in patient rooms
Screening for streptococcus
54
• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
December 1, 2013
International Federation of
Infection Control
55