INFECTION CONTROL IN NURSERY Goal: To prevent the spread of infection in neonatal nursery To contain an outbreak of infection Policy: To maintain

ain infection control measures aimed to prevent morbidity and mortality.

EACH INFANT IS A POTENTAIL SOURCE AND RECIPENT OF MICRO ORANISMS. Physical Design of Neo-Natal Nursery: The nursery design should have adequate space for necessary equipment Traffic through the other services should not pass through the unit ! square feet per neonate appro"imately three feet bet#een bassinets is currently recommended .

$or infant #ho require e"tensive nursing care %!-&! square feet #orking space #ith at least four feet bet#een incubators or bassinets and five feet #ide aisles. $or Neonatal intensive care units '!-(!! square feet per infant #ith at least si" feet bet#een incubators or bassinets and eight feet bet#een aisles Hand was in! Facili"i#s There should be at least one elbo# operated hand #ashing sink for every )-& basinettes *ach single room shall be provided #ith an elbo# operated stand alone sink +and #ashing posters #ith clear #ashing instructions should be provided above all sinks +and #ashing sinks should be scoured and cleaned daily using a detergent. $#n"ila"ion: Positive pressure airflo# from a ceiling entry to a floor return pulling dust do#n#ards and out is recommended $ilters #ith efficiency of at least ,!-(!!- must be used .inimum of (!-(% air charges per hour

 /ccess to at least one isolation room #ith negative air pressure discharging air vented to the outside to accommodate ne#borns #ith airborne infections S"a%%in! No&'s: /dequate staff is mandatory to allo# for hand #ashing bet#een patients0contact Normal nursery staffing ratio is: one professional nurse to every &-' infants 1ntermediate care nursery staffing ratio is: one professional nurse for ever 2- patients N134- one professional nurse for every (-2 patients Dedicated assistance is needed to mentor and support lodger mothers not to e"pose their babies to cross-infection S"anda&d In%#c"ion Con"&ol P&#ca("ions )Uni*#&sal+ , "o -# o-s#&*#d. Isola"ion Roo's: /ppropriately designed isolation rooms should be available in all hospitals #ith a nursery / suitable area should be designated for hand scrubbing in preparation for procedures that require aseptic technique /dequate space of ( .,) square metres 5(%! square feet6 should be available e"cluding the entry #ork area 1deally single multi-bedded corners are appropriate 7entilation in isolation rooms to have negative pressure #ith our (!!- e"hausted to the outside / hands free emergency communication system is required #ithin the isolation room to minimi8e in and out movement 3hoice and placement of #indo#s an blinds should allo# for care of operation and cleaning /ll babies #ith 9epticaemia should be isolated :abies transferred from other hospitals or admitted from home must have s#abs taken and sent for culture Transfers must be nursed in an isolation unit Hand .as in! 4se antiseptic soap to thoroughly #ash and rinse hands before entering the Nursery 4se paper to#el to dry hands and dispose of in a plastic lined functional pedal bin.

P&o"#c"i*# A""i&#: / short sleeved go#n should be #orn over special clothing designated for nursery by the health care personnel and lodger mothers- this go#n to be e"clusively for one named neonate and hand hygiene strictly practiced before moving on to others. Pa"i#n" Ca&# E/(i0'#n" 3leaning and disinfection: important to follo# the manufacturer0s instructions; s#abs for culture should be taken from ventilators of the infected babies< neonates. Terminal disinfection of equipment done using soap and #ater and hypochlorite solution 7entilator tubing used in babies #ith negative bacilli to be discarded as medical #aste 7entilators used for infected babies to be left standing for ,&hours after terminal disinfection before re-use 1ncubators and bassinets should have the detachable parts removed and scrubbed meticulously 1ncubator fans; #here applicable should be cleaned and disinfected /ir filters in the incubator should be maintained as recommended by the manufacturer =aterproofed mattresses replaced #hen #aterproof covering is broken Porthole cuffs are easily and often heavily contaminated; therefore need for daily cleaning #ith detergent and daily cleaning #ith disinfectant :abies admitted in the nursery for prolonged periods; need to be transferred into cleaned and disinfected incubators after seven days and the used incubator be e"posed to thorough cleaning and disinfection In*asi*# D#*ic#: .eticulous attention should be given to aseptic and maintenance of cannulae and to aseptic techniques of fluid administration Parental nutrition fluids ordered direct from supplying company and no decanting at the facility level 5even in the pharmacy6 to prevent cross infections. 9ingle dose medication vials are recommended for in>ections. $or handling of intravenous lines; this to be done according to relevant policy 1nfection 3ontrol guidelines should be observed #ith the : endotracheal tubes

urinary catheters

Lin#n Handlin! =ash linen in correct temperature to disinfect it; that is , ?3 for infected linen *nsure that linen handling policy is adhered to; to prevent cross-infection *nough clean linen must be made available 3lean linen should be transported in covered carts or laundry bags to the nursery area Ne# garments to be first laundered prior the use of neonates Soil#d Lin#n: 9oiled linen should be discarded into leak proof yello# bags; taken to the laundry t#ice daily 9oiled diapers and medical #aste should be collected hourly after every feeding round

Nappy changes should be done #earing disposable rubber gloves to prevent heavy contamination and transient coloni8ation of the hands

Pa"i#n" Ca&# /septic techniques is to be maintained using sterile cotton balls in sterile #arm #ater for the skin and !;%- chlorheridine in @!- alcohol for the umbilical cords

Ey# Ca&# 9terile cotton #ool used and aseptic techniques manufactured $or topical prophyla"es use of single dose treatment packs advisable /void eye contamination #ith drips catheters after suctioning the nasopharyn" or endotraecheal tube In%an" F##din! +and hygiene emphasi8ed and aseptic techniques maintained during preparation and handling processes Nurses to take responsibility and ensure that all feeds are handled #ithout contamination 1f a breast pump is used; pump components to be #ashed in soapy #ater; rinsed off and sterili8ed after use =here medicine measures are used for feeding; #ash in soapy #ater; rinse; then double bagged and send for autoclaving

 =here disposable syringes are used for feeding; use once and discard 3ontinuous infusion tube feeding set up under aseptic precautions #ith sterile gadgets used per each feeding episode. H#al" Ed(ca"ion "o Lod!#& Mo" #&s Aodger mothers are from diverse cultures and communities and need to be treated #ith understanding; respect and patience Aodger mothers should be taught the importance of good personal hygiene and hand #ashing practices 1mportance of #earing a clean go#n and disposable plastic apron emphasi8ed Taught the importance of preventing baby contact #ith potential contaminated facecloths; to#els; bedclothes; tissue and other $isi"o&s 7isitors should be treated on a individual basis 7ie# babies through the vie#ing bo" 1f mandatory to enter the unit; hand hygiene and protective clothing should be used as for all staff members and lodger mothers O("-&#a1 Con"&ol The infection control committee should define the status referred to as an outbreak #hen there is a significant change from the baseline infection rate at a certain site or #ith a particular microbe .icrobiological intervention measures should be taken to identify involved micro-organisms *mphasis on compliance to infection control practices should be the main focus 3ontinuous 9urveillance and appropriate reports for#arded to the hospital infection control; management; 3D3 and District Bffice for prompt outbreak response measures E'0loy## H#al" Personnel allocated to #ork in nursery should be immune to rubella; measles; polio and chicken po" 9taff to be offered yearly +:7 and influen8a 7/331N* Protective apparel should be readily available for appropriate use; #here blood splashes and body fluids spillages are anticipated Cesuscitation equipment should be adequate to eliminate cross-infection 1nfection safety to be practiced to prevent needle stick in>uries

I'0l#'#n"a"ion2 Moni"o&in! and E*al(a"ion o% " is Policy 1t is the responsibility of the hospital manager; the nurse manager; the head of department and the nursery personnel 5both day and night6 the infection control manager and the matron in charge of the nursery to ensure that effective support; implementation; monitoring and evaluation systems are in place. 1t is the responsibility of all nursery staff to support and mentor the lodger mothers and to comply #ith the policy.