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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