Disinfection guidelines for the NICU Neonatal Intensive Care Units

1. ASEPSIS & DISINFECTION
IN
THE NEONATAL ICU

2. Little Manushi was born at just 28 weeks - was just 8.6 inches long and her skin was
paper-thin, had a 0.5% chance of survival.
Manushi is believed to the smallest surviving baby in Asia.
NICU: A MAGICAL PLACE!

3. A newborn baby admitted in the NICU almost exclusively acquires all skin & mucosal
microbial colonization from the NICU environment and the mother
Risk factors like prematurity, feeding difficulties ,underdeveloped skin barrier &
immune function, broad spectrum antibiotic cover & presence of devices place the
neonate at an exaggerated susceptibility to serious infections
Many of the infections acquired in the NICU are caused by MDR organisms which are
very challenging to treat, hence it is essential to focus on prevention of these
infections
Neonatal sepsis the most important cause of preventable death in the NICU
WHY ASEPSIS & DISINFECTION

4. HIGH-RISK SURFACES

7. BREAKING THE CHAIN OF INFECTION

8. SOME BASICS OF ASEPSIS FOR THE NICU
1. Avoid overcrowding
2. Optimal nursing ratio for number of admitted babies
3. Soap Elbow or foot operated taps
4. Use of disposables wherever possible
5. Strict policies for asepsis and adequate training of all NICU staff &
housekeeping teams for the same with documented protocols
6. Regulated entry only for parents in the NICU with appropriate aseptic
measures
7. No entry in the NICU for any parent or personnel with any signs of active
infection
8. Rational antibiotic policy with active microbiological correlation

9. NURSERY & BASSINET ENVIRONMENT
Nursery:
The temperature should be maintained between 28-30° C preferably with
controlled air-conditioning with adequate air-changes and not too much direct
sunlight
Bassinet:
Separate spirit and swab containers, stethoscope, tape measure and thermometer
for each baby
Separate gown for mothers & for nurse for each baby
Do not keep fomites e.g. files, X-ray films, pens etc. on the baby cot
Change antiseptic solution in and sterile water in oxygen humidification chambers
everyday

10. Rinsing hands with alcohol is NOT A SUBSTITUTE for proper hand washing
HANDWASH is the single MOST IMPORTANT, SIMPLEST & CHEAPEST means of
preventing nosocomial infections in the NICU
Alcohol-based hand antiseptics are not effective on hands that are visibly dirty or
contaminated with organic materials. Hands that are visibly dirty or contaminated
with organic material must be washed with soap and water, even if hand
antiseptics are to be used as an adjunct measure.
Hand hygiene with alcohol hand rub for 20-30 seconds can be used before and
after touching babies, before any clean/aseptic procedure, after body fluid
exposure risk and after touching baby surroundings. Application of alcohol-based
hand rubs is preferred over hand washing for all routine contact.
HANDWASH & HANDRUB

11. The term “patient contact” is not restricted to direct contact with a patient.
It includes the following:
1. Performing any kind of non-invasive procedure
2. Recording any patient parameter
3. Touching baby's clothes/linen
4. Handling baby's incubator/warmer/devices attached to baby
5. Handling baby's probes/BP cuff Handling baby's IV tubing/syringes
6. Handling baby's milk tubing/syringes
POINTS OF PATIENT CONTACT

12. STEPS OF HANDWASH

13. STEPS OF HANDRUB

14. SURFACE DISINFECTION IN THE NICU

15. SURFACE DISINFECTION IN THE NICU

16. DISINFECTANTS FOR USE IN THE NICU

17. RECOMMENDED ROUTINES IN THE NICU
Terminal disinfection is done after transferring out, discharge or death of a baby. Preferably
all items of the baby to be kept in the incubator and fumigated with 40% formalin (grossly
infected baby).
In other cases, thorough routine cleaning will suffice

18. SURVEILLANCE IN THE NICU
Surveillance is the monitoring of infections in the unit by conducting periodic surveys
in order to identify unusual pattern of flora and infections It also includes monitoring
of antibiotic use and resistance, whereby positive culture are reviewed every 4-6
months based on which antibiotic policy of the unit is revised, if necessary
How frequently should surveillance be carried out? What all should be cultured?
1. Room air - weekly Surfaces (viz. laminar flow, warmer, incubator, trolleys) - twice
weekly
2. Equipment (viz. laryngoscopes, AMBU bags, mask, stethoscopes, oxygen hoods,
B.P. cuffs) - twice weekly
3. Liquids (viz. water in humidifier bottles) - every two week
4. Blood / CSF culture whenever indicated Pus cultures whenever present
5. Personnel: hands, nasal throat swabs as required

19. REFERENCES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719657/
https://pubmed.ncbi.nlm.nih.gov/23372757/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156200/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847238/
https://www.ajicjournal.org/article/S0196-6553(00)90655-2/fulltext
https://www.newbornwhocc.org/Dec2014_pdf/Prvention-of-infection-house-keeping-in-
facilty-2014.pdf
https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf