Detail infection control NICU policy

1. INFECTION
CONTROL
POLICY IN NICU
GUIDE: MAJ KIRTI MAAN
PRESENTED BY: N/CDT TANVEER
KAUR

2. WHY NEONATES?
 Low birth weight
 Prematurity
 Congenital malformations
 Prolonged hospital stay
 Frequent invasive procedures
 Decrease immunity
 Inadequate nursing staff/over crowding
 Lapses in handwashing

3. COMMON INFECTIONS
 Central Line Associated Blood Stream
Infection(CLABSI)
 Pneumonia
 Neonatal sepsis
 Device associated
infections

4. STATISTICAL DATA

5. INDIA STATISTICS

6. ASEPSIS
 Asepsis is a state of being free from disease –
causing microbes such as bacteria, viruses,
fungi and parasites.

7. PARTS OF ASEPSIS
 Practices that prevent entry of microbes into
the nursery environment
 Practices that prevent proliferation of microbes
in nursery
 Practices that prevent spread of microbes
between babies
 Practices that protect newborn from
developing infections
 Practices that enable better asepsis and
administration

8. INFECTION CONTROL STEP
1
 PREVENT ENTRY OF MICROBES INTO THE
NICU

9. CLEAN IMMEDIATE
ENVIRONMENT
6 C’s
 Clean perineum
 Clean delivery surface
 Clean cord
 Cutting instrument
 Clean cord care
 Nothing unclean is introduced to vagina

10. STANDARDIZE THE NICU
DESIGN
LOCATION
 Space-120 sq ft excluding the handwashing
area and corridors
 Two infants separated by min 4 ft

11. Contd..
AIRBORNE INFECTION ISOLATION
ROOM
At entrance-
 Hand washing area
 Gowning and storage of clean material

12. Contd..
HANDWASHING
 Before first entry into the nursery, full surgical
scrub upto elbows for a min of 2- 3 min with
appropriate antimicrobial scrub
 Washed between each infant contact (15-20
sec)
 Jewellery must be removed

13. Contd..

14. VISITORS
 Same as non –nursery staff
 Visitors fills out a health screen
 Must be symptom free

15. NURSERY ATTIRE
 Standards uniform or scrubs
 Persons entering must remove outer coats and
jackets and perform scrub
 Non –nursery personnel must wear a gown

16. Contd..
PERSONNEL
 Prior to employment,nurses will complete a
pre-placement physical by Hospital Health
Service
 Any staff member with a known contagious
illness is not permitted in NICU

17. INFECTION CONTROL STEP
2
 PREVENT PROLIFERATION OF MICROBES
IN THE NICU

18. HOUSEKEEPING ROUTINES
 Avoid dry dusting and sweeping instead use
vacuum cleaners
 Wet mopping with soap and water (3% phenol)
- 3 times/day

19. DAILY
Incubators, warmers, syringe
pump, infusion pumps,
phototherapy units, Mattress, Pulse
oximeter, multichannel monitors,
Oxygen hood, Ventilator, CPAP
machine, Telephone
Dry dusting, clean using a moist
wipe
Suction bottles, Humidifier
chamber, water in Bubble CPAP
Change with distilled water
Ventilator filters Clean daily and dust off
Bag and mask
Immerse in 2% cidex for 6 to 8
hours after dismantling and
cleaning with running water.

20. DAILY
Incubators / Radiant warmers
Clean with 2% Bacillocid if not
occupied by an infant.
Laryngoscopes, masks,
stethoscopes, measuring tapes,
Thermometer, BP cuff, temperature
and Spo2 probes, Torches
Wipe with spirit
Walls, floor, Wash basins
Clean with polysan or phenol or
Lysol or 2% bacillocid or 0.5%
chlorine (for walls only) in each shift
Dust bins, buckets, waste
Empty during each shift and clean
with soap and water

21. WEEKLY
Ventilator and CPAP circuits Change with a new circuit
Procedure sets
Autoclave after every use and keep
ready the sets
Window Air-conditioners
Surfaces and filters with soap and
water
Refrigerators
Sorted and cleaned separate fridge
for milk and lab samples
Thermometer, weighing scale, stethoscopes, BP cuff,
laryngoscopes should be cleaned and wiped with spirit after
every use. Feeding utensils/ paladai should be boiled for 15
minutes after cleaning after each use.

22. WASTE DISPOSAL
Black drums (waste disposal by
dumping
Left-over food, vegetables, waste
paper, packing material, empty bags
etc
Yellow drums (disposed by
incineration)
Infected non plastic waste- human
secreta, blood and body fluids.
Blue drums (made noninfectious by
autoclaving and disposed by
shredding)
Infected plastic waste like IV sets,
ET tubes, catheters, urobags etc

23. INFECTION CONTROL STEP
3
 PREVENTING INFECTION SPREAD FROM
PROLIFERATION SITES TO BABY AND
FROM ONE BABY TO OTHER

24. CONTD..
 Nurse to patient ratio
 Use disposables
 Laminar flow system for drugs , fluids and
TPN preparation

25. INFECTION CONTROL STEP
4
 PREVENT ENTRY OF MICROBES INTO THE
INFANT

26. INFANT CARE
Cord care Skin
care
Eye care
Precautio
ns during
procedure
s

27. INFECTION CONTROL STEP
5
 BREASTMILK/BREASTFEEDING AND
FORMULA MILK

28. INFECTION CONTROL STEP
6
 KANGAROO MOTHER CARE / EARLY
DISCHARGE

29. INFECTION CONTROL STEP
7
 DECREASING SUSCEPTIBILITY OF THE
BABY TO INFECTIONS

30. Cont..
a. Early BF / use of colostrums/minimal entral
nutrition
b. Immunomodulators
c. Antifungal prophylaxis

31. INFECTION CONTROL STEP 8
 INFECTION CONTROL PROTOCOLS

32. Contd..
Infection control
committee
Role of hospital
management
Antibiotic usage and
microbial resistance

33. INFECTION CONTROL
COMMITTEE
1. Yearly programme of activity for surveillance
& prevention
2. Epidemiological surveillance data and identify
areas for intervention
3. Ensure appropriate staff training in infection
control and safety
4. Provide inputs into investigation of epidemics

34. CARE OF INFANTS AND
EQUIPMENTS
 Infants placed in isolated incubator to prevent
cross infection
 Strict handwashing
 Proper disposal of linen and other
contaminated articles
 Proper disinfection

35. STANDARD PRECAUTIONS IN
NICU
HANDWASHING

36. Contd..
 GLOVES

37. Contd..
 MASK ,EYE PROYTECTION,FACE SHIELD

38. Contd..
 GOWNS

39. Contd..
 PATIENT CARE EQUIPMENT

40. UNIVERSAL PRECAUTIONS

41. CONTACT PRECAUTIONS

42. DISINFECTIONS AND
GERMICIDES
1. BACILLOCID 100 g-
 Formaldehyde, glutaraldehyde, alkylurea
derivative, benzalkonium chlorides
 Use 2% solution (200 ml in 10 L water) for
cleaning surface and spraying
 30 mts for good efficacy
 Avoid contact with concentrated
solution
 5 ml=1 sqm

43. KORSOLEX 100 g
 Formaldehyde, glutaraldehyde, polymethylol
urea formaldehyde
 I :9 to get 10% solution
 20 min for sterilization
 4 hrs for disinfection
 Active for 14 days

44. CIDEX
 Glutaraldehyde and activator
 same as korsolex

45. SAVLON
 Cetrimide solution, chlorhexidine gluconate,
isopropylalcohol
 1:100 for equipments , furniture
 1:30 for wounds and catheters

46. STERILLIUM
 2 propanolol, 1- propanolol , ethyl dimethyl
 2-3 ml for 30 sec for disinfection

47. BETADINE
 Povidine, iodine
 Skin preparation, on wounds
 Leave for 3 min

48. FORMALIN
 Formaldehyde aqueous solution
 Fumigation-routine (30 ml of 4% in 90 ml of
water)
 Intensive(90 ml of 4% in 90 ml)
 OTICARE-30 min , room closed for 6 hrs

49. DISINFECTION OF
EQUIPMENT
1. RESUSCITATION EQUIPMENT-
 Bags and masks-cidex
 Silicon bags and masks-autoclaving
 Laryngoscope-70% isopropyl alcohol
 Alcohol should not be used for cleaning as it
causes opacification

50. Contd..
2.OPEN CARE SYSTEMS AND COTS
 Cleaned everyday with 3% phenol or 5% lysol
 Mattresses plastic cover should be intact to
clean with antiseptic solution
 Blankets for autoclaving
 Laminar air flow for drugs , fluids ,TPN

51. Contd..
3.INCUBATORS
 Thoroughly disinfected every 7th day
 After discharge or death -50 ml formalin in 50
ml water
 Canopy and mattress should be cleaned with
soap and water
 Humidification unit –disinfected with cidex for
10 min

52. Contd..
4.RUBBER AND PLASTIC TUBING
 Ventilator tubings-single use
 Infant face masks-70% isopropyl alcohol

53. Contd..
6.FEEDING UTENSILS
 Bottles and teats- wash with soap and water
after feeds and then boiled or autoclaved
 Spoons and paladays –bolied for 15 min
before use

54. Contd..
7. PROCEDURES
Hand washing
Sterile gloves
Masks
Gown
Other standard precautions

55. DISPOSAL OF WASTE AND
SOILED LINEN
Foot operated bins
Plastic bags as
hamper
Mopping of dustbins
with 3% phenol

56. SURVEILLANCE
 Monitoring of infections in unit by conducting
periodic surveys in order to identify unusual
pattern of flora and infections

57. ROLE OF NURSE