This document outlines infection control protocol in the neonatal intensive care unit (NICU). It discusses 8 key steps: 1) Preventing entry of microbes into the NICU, 2) Preventing proliferation of microbes in the NICU, 3) Preventing infection spread between babies, 4) Preventing entry of microbes into infants, 5) Guidelines for breast milk/formula, 6) Kangaroo mother care and early discharge, 7) Decreasing infant susceptibility, and 8) The role of infection control committees and protocols. The document provides detailed guidelines and procedures to implement these 8 steps to effectively control infections in the NICU.
Important points in the organization of a NICU. The Aims and Objectives, Main components of NICU eg., physical facilities, personnel, equipment, laboratory facilities, procedure manual, transport of sick child and levels or grades of neonatal care.
Important points in the organization of a NICU. The Aims and Objectives, Main components of NICU eg., physical facilities, personnel, equipment, laboratory facilities, procedure manual, transport of sick child and levels or grades of neonatal care.
Immediate care involves: Drying the baby with warm towels or cloths, while being placed on the mother's abdomen or in her arms. This mother-child skin-to-skin contact is important to maintain the baby's temperature, encourage bonding and expose the baby to the mother's skin bacteria
This slides contain detailed description of radiant warmer used in hospital setting, various modes , alarms, do's and don't of radiant warmer and nursing care management for the baby under radiant warmer
Kangaroo mother care is generally given to low birth weight babies. it is very essential for baby's health. there are many benefits of KMC as it provides warmth to he child, helps in breast feeding and helps in maintaining good attachment. please read this and get knowledge. this information will help young mothers more. stay tuned.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
Immediate care involves: Drying the baby with warm towels or cloths, while being placed on the mother's abdomen or in her arms. This mother-child skin-to-skin contact is important to maintain the baby's temperature, encourage bonding and expose the baby to the mother's skin bacteria
This slides contain detailed description of radiant warmer used in hospital setting, various modes , alarms, do's and don't of radiant warmer and nursing care management for the baby under radiant warmer
Kangaroo mother care is generally given to low birth weight babies. it is very essential for baby's health. there are many benefits of KMC as it provides warmth to he child, helps in breast feeding and helps in maintaining good attachment. please read this and get knowledge. this information will help young mothers more. stay tuned.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
Guidelines on Disposal of Dead Bodies of Cattle and other Domestic Animals during Natural Disasters /Calamities (Heavy Rains-Floods-Tsunamis-Earthquakes) as well as Outbreaks of Zoonotic Diseases
INFECTION CONTROL NURSING - Agents of Nosocomial Infection - Modes of Transmi...Enoch Snowden
Infection control Nursing - Agents of Nosocomial Infection - Modes of Transmission - Infection Control Principles -GENERAL MEASURES TO REDUCE INFECTIONS - INFECTION CONTROL GUIDELINES/ POLICIES
Video presentation - https://www.youtube.com/watch?v=45CjKnJaIC0
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Infection control protocol in nicu BY DR.PRITESH B PATEL
1. INFECTION CONTROL PROTOCOL IN
NICU
DR.PRITESH PATEL
MBBS, MD(PEDIA), FELLOWSHIP IN
NEONATOLOGY (FIAP), PGPN(BOSTON)
2. INTRODUCTION
• NEWBORN CARE – VITAL SECTORS TO BE LOOKED TO
REDUCE NEONATAL MORTALITY AND MORBIDITY
• DIFFICULT TO TREAT BUT EASIER TO PREVENT
• APPROACH TOWARDS THE PREVENTION IS MULTI-
DISCIPLINARY (Neonatologist,Nursing staff, Engineers etc)
• EFFECTIVE INFECTION CONTROL – ONCE JOURNEY OF
MICROBE FROM ENVIRONMENT TO SUSCIPTIBLE INFANT IS
UNDERSTOOD
3. INTRODUCTION
• MICROBES ENTER THE NICU VIA VISITORS AND HEALTH
CARE WORKERS(HCW)
• SPREAD TO NEONATE VIA CONTAMINATED
EQUIPMENTS AND HANDS OF HCWS
• ONCE BABIES ARE COLONIZED , ORGANISMS ENTER
THROUGH
– UMBILICAL CORD,
– SKIN (During IV access, Parentral fluids, Enteral
fluids, Intubation, Suctioning ET)
4. INFECTION CONTROL STEPS
PREVENT ENTRY OF MICROBES INTO THE NICU
PREVENT PROLIFERATION OF MICROBES IN THE
NICU
PREVENTING INFECTON SPREAD FROM
PROLIFERATION SITES TO BABY AND FROM ONE
BABY TO OTHER
PREVENT ENTRY OF MICROBES INTO THE
INFANTS
5. INFECTION CONTROL STEPS
BREAST MILK/BREAST FEEDING AND
CORRECT PREPARATION OF FORMULA MILK
KANGAROO MOTHER CARE/ EARLY
DISCHARGE
DECREASING SUSCEPTIBILITY OF THE BABY
TO INFECTIONS
INFECTION CONTROL PROTOCOLS
7. STEP 1. PREVENT ENTRY OF MICROBES INTO THE NICU
A. CLEAN IMMEDIATE ENVIRONMENT
ORGANISMS FROM LR/ RESUSCITATION ROOM/MATERANAL
VAGINAL FLORA CAN COLONISED NEBORN SKIN
PREVENTED BY FOLLOWING 6 C’s
1) CLEAN PERINEUM
2) CLEAN DELIVERY SURFACE
3) CLEAN CORD
4) CUTTING INSTRMENTS
5) CLEAN CORD CARE
6) ENSURING NOTHING UNCLEAN
EQUIPMENTS CLEANED AND REGULARLY AUTOCLAVED
8. B. STANDARDIZE THE NICU DESIGN
1) LOCATION OF NICU
DISTINCTED AREA WITH CONTROLLED ACCESS
EACH INFANT SPACE MIN 120 SQ FT FLOOR SPACE
MINIMUM 4 FT BETWEEN TWO INFANTS
2) AIRBORNE INFECTION ISOLATION ROOM
SHOULD BE AVAILABLE
HANDS FREE HAND WASHING STATION
AREA FOR GOWNING AND STORAGE OF CLEAN MATERIAL
VENTILATION WITH NEGATIVE PRESSURE WITH EXAUST
RELATIVE HUMIDITY 30-60% (>60% promote growth of micro-
organisms)
9. 3) HAND WASHING STATION
INFANT BED SHOULD BE WITHIN 20 FEET FROM HAND WASHING
SINK
WASHING SINK SOULD BE LARGE ENOUGH TO CONTROL
SPLASHING
PICTORIAL HAND WASHING INSTRUCTUION
NON ABSORBENT WALL MATERIAL (To prevent growth mould)
SPACE FOR SOAP AND TOWEL DISPENSERS
ELBOW OR FOOT OPERATED TAPS
10.
11. C. HAND HYGIENE
CDC RECOMMENDS HAND WASHING BEFORE AND AFTER CONTACT
WITH EVERY PATIENT FOR 20 SECS AND 40-60 SECS BEFORE
ENTERING NICU
STEP BY STEP HAND WASHING
REMOVE ALL ACCESSORIES
TURN ON WATER, WET HANDS, APPLY ANTIMICROBIAL SOAP
RUBBING PALM TO PALM AND DORSUM OF PALM
RUBBING FINGER INTERLACED AND BACK OF FINGER
RUBBING THUMB ROTATIONALLY
RUBBING WRIST AND THEN FOREARM
TURN OFF WATER, WIEP HANDS, DISCARD PAPER
EACH ACTION REQUIRED MINIMUM 5 SECONDS
12.
13. D. USE OF ALCOHOL BASE HAND RUB (ABHR)
USED AS HAND HYEGIENE AGENTS(2-3 ML) IF HANDS ARE NOT
VISIBLY DIRTY OR CONTAMINATED
PROVEN MORE EFFECTIVE THAN STANDARD HAND WASHING
USED IN BETWEEN PATIENT EXMINATION
NOT USEFUL AFTER TOUCHING INFECTED PATIENT OR HANDS ARE
SOILED
E. VISITOR’S POLICY / MOBILE RESTRICTION
MICROBES ENTER THROUGH PERSON, SO RETRICT ENTRY IS MUST
INFECTED PERSON(RESPI / GIT) AND CHILDREN SHOULD NOT ALLOW
INFECTED AND OUT BORN BABIES MANAGED IN ISOLATION ROOM
NICU SHOULD BE A CELL PHONE FREE ZONE
14.
15. F. GOWNING TO REDUCED NOSOCOMIAL INFECTION
NO REDUCTION OF INFECTION
FOCUS ON ADEQUET HAND WASHING BY ALL
G. JEWELARY AND FINGER NAILS POLICY
NOT WEAR ARTEFICIAL FINGERNAILS WHEN HAVING DIRECT CONTACT
NATURAL NAILS SHOULD KEPT SHORT (0.5CM / ¼ INCH LONG)
16. STEP 2. PREVENT PROLIFERATION OF MICROBES IN THE
NICU
GOOD HOUSEKEEPING ROUTINES HELPFUL IN PREVENTING AND
CURTAILING SPREAD OF INFECTION
AVOID WET AREA INSIDE NICU
DRY AND CLEAN UNLIKELY TO HARBOUR MICROBES
DAILY ROUTINE IN NICU
INCUBATORS, WARMERS, SYRINGE PUMP,
INFUSION PUMP, PHOTOTHERAPY UNITS,
MATTRESS,PULSE OXIMETER, MULTIPARA
MONITOR, HOOD, VENILATOR, CPAP, TELEPHONE
DRY DUSTING, CLEAN USING
MOIST WIPE
SUCTION BOTTLES, HUMIDIFIER CHAMBER, WATER
IN BUBBLE CPAP
CHANGED WITH DISTILLED
WATER
VENTILATOR FILTERS CLEAN DAILY AND DUST OFF
17. DAILY ROUTINE IN NICU
BAG AND MASK IMMERSE IN 2% CIDEX FOR 6 TO 8 HOURS
AFTER DISMANTLING AND CLEANING
WITH RUNNING WATER
INCUBATOR, WARMER CLEAN WITH BACILLOCID IF NOT
OCCUPIED BY INFANT
LARYNGOSCOPE, MASK, MEASURE TAPE,
TEMP AND SPO2 PROBE, TORCHS WIPE WITH SPIRIT
WALLS, FLOORS, WASH BASINS
CLEAN WITH PHENOL/ LYSOL/ 2%
BACILOCID IN EACH SHIFT
DUST BINS, BUCKETS, WASTE EMPTY IN EACH SHIFT CLEAN WITH SOAP
AND WATER
18. WEEKLY ROUTINE IN NICU
VENTILATOR AND CPAP MACHINE CHANGE NEW CIRCUIT
PROCEDURE SETS AUTOCLAVE AFTER EVERY USE
WINDOW AIR CONDITIONERS SURFACE AND FILTERS WITH SOAP AND
WATER
REFRIGERATORS SOARTED AND CLEANED
SEPARATE FRIDGE DOOR FOR MILK AND
LAB SAMPLES
WEIGHING SCALE, STETHOSCOPE, BP
CUFF, LARYNGOSCOPE
CLEANED AND WIPE WITH SPIRIT AFTER
EVERY USE
FEEDING UTENSIL BOILED FOR 15 MIN AFTER CLEANING
19.
20.
21. WASTE DISPOSAL
BLACK DRUMS
(DISPOSAL BY DUMPING) {disposed off by
routine municipal council committee
machinery}
LEFT OVER FOOD, VEG, WASTE PAPER,
PACKINGS , EMPTY BAGS
YELLOW DRUMS
(DISPOSAL BY INCINERATON)
INFECTED NON PLASTIC, HUMAN
SECRETA, BLOOD AND BODY FLUIDS
BLUE DRUMS
(NON INFECTIOUS BY AUTOCLAVE AND
DISPOSED BY SHEDDING)
INFECTED PLASTIC WASTE (IV SETS, ET
TUBE, CATHETER, UTOBAGS)
22. STEP 3. PREVENTING INFECTON SPREAD FROM
PROLIFERATION SITES TO BABY AND FROM
ONE BABY TO OTHER
• MOST IMORTANT STEP
A. NURSE TO PATIENT RATIO
1:1 IF BABY HAS MULTI DRUG RESISTENT MICROBES
1:2 SUSCEPTIBLE OR BABIES HAVE SIMILAR ORGANISM
1:3 ADEQUATE ANTIBIOTICS COVER
B. LAMINAR FLOW SYSTEM FOR DRUGS, FLUIDS AND TPN
PREPARATION
DECREASE LOCAL COMPLICATIONS AND SEPSIS
23. C. USE DISPOSABLES
BABY KIT – STETHOSCOPE, MEASURE TAPE, THERMOMETER, TORCH
IN STERILE CONTAINER AT EACH BED
SEPARATE SYRINGE FOR EACH MEDICINE, FOR EACH BABY
FRESH SUCTION CATHETER FOR ET/ORAL SUCTION
SEPARATE GLOVES, ANTIBIOTICS VIALS, DISPOSABLE RESPIRATORY
CIRCUIT
DON’T KEEP FOMITES (FILE, PEN, X RAY) ON BABY COT
FLUSHING OF CATHETER -STOCK SOLUTION (HEPARINISED) SHOULD
NOT USED
EPIDEMIC OF ENTEROBACTER CLOACE WITH USE OF MULTI DOSE
ANTIBIOTICS VIAL
24. STEP 4. PREVENT ENTRY OF MICROBES INTO THE
INFANTS
A. CORD CARE
CORD INFECTION PREVENTED BY CLEAN CORD CARE AND REDUCING
HARMFUL CORD APPLICATIONS
WHO RECOMMENDS DRY CORD CARE AND USE OF SOAP AND
WATER SOLUTION TO CLEAN IF SOILED
B. SKIN CARE
SKIN INJURY PREVENTED BY APPLYING LESS ADHESIVE TAPE, USING
TEGADERM BETWEEN SKIN AND ADHESIVE
PRECAUTION DURING ADHESIVE REMOVAL
USE SKIN FRIENDLY DUROPORE INSTEED OF DYNAPLAST/MICROPORE
25. C. PRECAUTIONS DURING PROCEDURES
ASEPTIC PRECAUTION TAKEN DURING ALL PROCEDURES
HAND SCRUB PRIOR TO EACH PROCEDURE
SKIN CLEANED WITH SPIRIT-BETADINE-SPIRIT
DISPOSABLE GLOVES WORN
AFTER IV CANNULA INSERTION FIXED WITH TRANSPARENT TAPE
CANNULATION SITE MONITORED DAILY FOR THOMBOPHLEBITIS
CATHETER (IF INSERTED IN EMERGENCY) REMOVED ONCE PATIENT
CONDITION STABILISED
26. D. PRECAUTIONS DURING CVC/PICC UMBILICAL CATHETER/
HANDLING OF CATHETER
TRAINING AND EDUCATION OF HCW
HAND HYGIENE / WEAR GLOVES
POVIDONE IODINE ON SKIN FOR ATLEAST 2 MIN
STERILE GAUGE/ STERILE TRANSPARENT , SEMI PERMEABLE DRESSING
TO COVER CATHETER SITE
MONITOR CATHETER SITE VISIBLY OR PALPATION
REPLACE CATHETER SITE DRESSING IF DRESSING DAMP, LOOSENES,
SOILED
REMOVE CATHETER IF NO LONGER ESSENTIAL / COMPLICATIONS
(CLABSI, THROMBOSIS)
CAHNGE TUBE AND BOTTLE EVERY 24 HOURS
UAC NOT BE LEFT IN PLACE >5 DAYS
UVC REMOVED AS SOON AS POSSIBLE BUT USED UPTO 14 DAYS
27. E. PRECAUTIONS DURING ENDOTRACHEAL INTUBATION
AND SUCTION
WEAR FACE MASK, SCRUB HANDS, WEAR GOWN AND GLOVES
ET TUBE STAY IN PACK UNTILL POINT OF USE
DON’T TOUCH TRACHEAL TIP
WEAR STERILE GLOVES FOR SUCTION
FIRST TRACHEAL SUCTION THEN MOUTH
DISCARD SUCTION CATHETER AFTER SINGLE USE
TAKE HELP OF NURSE FOR INSTILLING SALINE OR DISCONNECTING
VENTILATOR
28. STEP 5. BREAST MILK/BREAST FEEDING AND CORRECT
PREPARATION OF FORMULA MILK
SUPPORT BREASTFEEDING AND PROMOTE ITS BENEFITS TO INFANTS
ENCOURAGE USE OF COLOSTRUMS, TOPHIC FEEDS WITH EBM AND NNS
MOTHER’S ENTRY INTO NICU AND PUMPING OF MILK TO ENSURE
ADEQUATE MILK FOR INFANT
FOR FORMULA FEED WATER TEMPEARURE -70 C AT TIME OF
RECONSTITUTION AND DECREASE HOLDING AND FEEDING TIME TO
REDUCE RISK OF CONTAMINATION
IF PREPARE IN ADVANCE , REFRIGERATED TO BELOW 50 C BUT NOT MORE
THEN 24 HOURS.
REWARMING DONE IMMEDIATELY BEFORE FEEDING
FEED SHOULD NOT BE LEFT WARMING FOR MORE THAN 15 MIN.
29. STEP 6. KANGAROO MOTHER CARE/ EARLY
DISCHARGE
KMC WAS ASSOCIATED WITH SIGNIFICANT REDUCTION IN
SEVERE INFECTION/ SEPSIS AT FOLLOW UP,
NOSOCOMIAL INFECTION / SEPSIS AT DISCHARGE OR AT 40 WEEKS OF
CORRECTED GESTATIONAL AGE
(Cochrane meta-analysis)
30. STEP 7. DECREASING SUSCEPTIBILITY OF THE BABY TO
INFECTIONS
A. EARLY BREAST FEEDING / USE OF COLOSTRUMS / MINIMAL
ENTERAL NUTRITION
OWN MOTHER MILK/ COLOSTRUM- LOWER INCIDENCE AND
SEVERITY OF NOSOCOMIAL INFECTION /LOS
TROPHIC FEEDING IMPROVED MILK TOLERANCE, GREATER POST
NATAL GROWTH, REDUCED SYSTEMIC SEPSIS AND SHORTEN
HOSPITAL STAY
B. IMMUNOMODULATORS
NO ROLE OF IVIG AND GM-CSF FOR PREVENTION OF SEPSIS
ROLE OF PROBIOTICS IS PROMISING
(But Right choice, Right dose and Right patient is still under review)
C. ANTIFUNGAL PROPHYLAXIS
RECOMMENDED FOR ELBW
31. STEP 8. INFECTION CONTROL PROTOCOLS
A. ROLE OF HOSPITAL MANAGEMENT
ESTABLISHED MULTI DISCIPLINARY INFECTION CONTROL COMMITTEE
WHO CAN USE APPROPIATE RESOURCES AND METHODS TO
MONITOR AND PREVENT INFECTION, ENSURE EDUCATION AND
TRAINING
THE PHYSICIAN, MICROBILOGIST, NURSING MANAGER, RESIDENT
AND HOUSE KEEPING STAFF PLAY THEIR ROLE IN INFECTION
SURVIELLANCE AND PREVENTION OF INFECTION OUTBREAKS
B. INFECTION CONTROL COMMITTEE
HOSPITAL SHOULD HAVE COMMITTEE WITH GOAL TO REVIEW
YEARLY PROGRAMME OF ACTIVITY FOR SURVILLANCE AND
PREVENTION
EPIDEMIOLOGICAL SURVEILLANCE
APPROPIATE STAFF TRAINING IN INFECTION CONTROL AND SAFETY
PROVIDE INPUT INTO INVESTIGATION OF EPIDEMICS
32. C. ANTIBIOTIC USAGE AND MICROBIAL RESISTANCE
HOSPITAL MUST HAVE ANTIBIOTICS POLICY DEPEND UPON LOCAL
CONDITIONS
PROPHYLACTIC ANTIBIOICS NOT BE STARTED IN BIRTH ASPHYXIA,
NNHB, CS DELIVERY, EXCHANGE TRANSFUSION
BLOOD CULTURE OBTAINED BEFORE STARTING ANTIBIOTICS
IF BLOOD CULTURE STERILE AFTER 48-72 HOURS OF INCUBATION,
SAFE TO STOP ANTIBIOTICS
RESTRICT USE OF EMPIRICAL BROAD SPECTRUM ANTIBIOTICS
CRP SHOULD NOT BE A GUIDE FOR ANTIBIOITC THERAPY
SHORTEN DURATION OF ANTIBIOTICS WHENEVER POSSIBLE
ANTIBIOTICS STEWARDSHIP IS MULTISYSTEM TEAM APPROACH
LIMITING INAPPROPIATE USE OF ANTIBIOTICS AND WHILE
CHOOSING SELECTION, DOSE DURATION AND ROUTE WITH MOST
APPROPIATE DRUG
TREAT INFECTION , NOT COLONIZATION OR CONTAMINATION
33. • WHAT DO UNIVERSAL PRECAUTIONS MEAN?
ALWAYS WEAR STERILE GLOVES FOR HEEL STABS, PHLEBOTOMY
AND INSERTION OF VASCULAR CATHETERS
WEAR GLOVES WHILE HANDLING ANY KIND OF BODY FLUIDS
DO NOT RECAP USED NEEDLES BY HAND
DO NOT REMOVE USED NEEDLES FROM DISPOSABLE SYRINGES BY
HAND
DO NOT BEND, BREAK, OR OTHERWISE MANIPULATE USED
NEEDLES BY HAND
DESTROY NEEDLES USING THE NEEDLE DESTROYER PROVIDED IN
EVERY WARD
DISPOSE SCALPEL BLADES AND OTHER SHARP ITEMS IN PUNCTURE-
RESISTANT CONTAINERS FOR DISPOSAL.
34. TAKE HOME MESSAGES
1) MORBIDITY AND MORTALITY REDUCED BY INSTITUTING STRICT INFECTION CONTROL
PROTOCOL
2) PREVENTION OF ENTRY OF MICROBE IN NICU BY CLEAN ENVIRONMENT, HAND HYGIENE,
CONDUCTIVE INFRASTRUCTURE
3) CURTAILING PROLIFERATION OF MICROBE BY DAILY AND WEEKLY MAINTAINANCE OF
EQUIPMENTS LIKE (Incubatores, Warmer, Syringe pump, Ventilator filter, Circuits, Bag and
Mask)
4) EFFICIENT BIO-MEDICAL WASTE DISPOSAL IS VERY IMPORTANT
5) CORD CARE, SKIN CARE, PRECAUTIONS DURING PROCEDURES (Vene puncture, Intubation,
UAC/UVC insertion) ARE IMPORTANT
6) EARLY BREAST FEEDING, USE OF COLOSTRUM ,EARLY DISCHARGE PLAY AN IMPORTANT
ROLE
7) HOSPITAL MANAGEMENT AND ROBUST INFECTION CONTROL COMMITTEE PLAY MAJOR
ROLE IN PREVENTION OF INFECTION
Editor's Notes
INFECTION CONTROL PROTOCOL IN NICU SUITABLE FOR A PERIPHERAL NEWBORN CARE UNIT BY PATRO P, KOTHARI N , JAIN P. MGM MEDICAL COLLAGE AND HOSPITAL 2015 NAVI MUMBAI
WE ARE LOSING MANY BABIES BECAUSE OF SEPSIS
INFECTION IS A GREAT AREA OF CONCERN ESPECIALLY FOR PRETERM BABIES
EVERY HOSPITAL SHOULD ESTABLISH ITS OWN DETAILED POLICIES TO PREVENT INFECTION OF NEWBORN IN THE BABY CARE AREA.
THE NEWBORN IS FREE FROM HARMFUL ORGANISMS FOR INITIAL FEW HOURS AFTER BIRTH. HCWS WORKING IN THE HOSPITAL TEND TO TRANSMIT ORGANISMS DURING ROUTINE PROCEDURES, THUS LEADING TO COLONIZATION OF ORGANISMS ON SURROUNDING SKIN OF THE ABDOMEN, THE PERINEUM, GROINS AND RESPIRATORY TRACT.
THE NURSERY TEMPERATURE SHOULD BE MAINTAINED BETWEEN 28-30° C
ENSURE 24 HOURS WATER AND ELECTRICITY SUPPLY WITH ADEQUATE LIGHTING AND VENTILATION.
ONCE YOU HAVE WASHED YOUR HANDS, DO NOT TOUCH ANYTHING
RINSING HANDS WITH ALCOHOL IS NOT A SUBSTITUTE FOR PROPER HAND WASHING
ONLY PARENTS OF THE BABIES SHOULD BE ALLOWED ENTRY INTO THE NURSERY AND MOTHERS ARE WELCOME ANY TIME, THEY CAN COME EVERY 2 TO 3 HOURS TO THE BABY CARE AREA, PARENTS SHOULD BE INFORMED EVERY MORNING AND EVENING ABOUT THE CONDITION OF THE BABY. THEY SHOULD BE TRAINED AND SUPERVISED ABOUT THE ASEPSIS ROUTINES OF THE UNIT. MOTHER SHOULD BE INVOLVED FULLY IN THE CARE OF HER BABY. SHE SHOULD COME IN AND LOOK AT HER BABY. IF BABY IS STABLE, SHE CAN LIFT HER BABY, KEEP HIM IN HER LAP, GIVE BREAST FEEDS, OR GIVE KATORI SPOON FEED. SHE CAN HELP IN CHANGING NAPKIN
HOW TO MAKE AN ALCOHOL HANDRUB LOCALLY AT LOW COST
BECAUSE ALCOHOL USED BY ITSELF DRIES THE SKIN AND CAN MAKE IT CRACK, MIX ALCOHOL AS FOLLOWS WITH AN INGREDIENT TO MOISTURIZE THE SKIN
- 100 ML OF 60-90% ALCOHOL
2 ML OF GLYCERIN, PROPYLENE GLYCOL, OR SORBITOL
AFTER USING THIS METHOD 5-10 TIMES, YOU WILL NEED TO REMOVE THE BUILD-UP OF MOISTURIZER (SUCH AS GLYCERIN) FROM YOUR SKIN.WASH THIS OFF WITH SOAP AND WATER.
CHANGE ANTISEPTIC SOLUTION IN SUCTION BOTTLES AND STERILE WATER IN OXYGEN HUMIDIFICATION CHAMBERS EVERYDAY AND STERILIZE THE BOTTLES/CHAMBERS DAILY BY DIPPING IN 2% GLUTERALDEHYDE FOR 4 TO 6 HOURS
TO BREAK JOURNEY OF MICROBES, AMPLE DISPOSABLE ARE NEEDED
PROPER DISPOSAL OF HOSPITAL WASTE IS IMPORTANT TO KEEP THE ENVIRONMENT CLEAN. THE WASTE SHOULD BE DISPOSED OFF IN A PROPER WAY. ALL HEALTH PROFESSIONALS SHOULD BE WELL CONVERSANT WITH THEIR LOCAL HOSPITAL POLICIES FOR WASTE DISPOSAL WHICH MAY VARY FROM PLACE TO PLACE
RECRUIT OPTIMAL NUMBER OF NURSES FOR CARE OF MORE BABIES
PRIMARY NURSE IS ONE WHO RECEIVES THE BABY IN THE NURSERY. SHE SHOULD BE ASSIGNED THAT BABY IN EACH SHIFT, WHENEVER SHE IS ON DUTY. SHE SHOULD DISCUSS WITH THE PARENTS THE CONDITION OF THE BABY FROM THE TIME OF THE ADMISSION TILL DISCHARGE. PARENTS WILL ALSO HAVE MORE CONFIDENCE ON THAT NURSE.
ONCE MICROBES COLONIZE THE SKIN AND UMBILICAL CORD, THEY ENTER THE CIRCULATION IF THERE IS ANY BREACH IN ASPETIC PRECAUTIONS. HENCE PROPER HYGIENE DURING THE PROCEDURES IS CRUCIAL
-CONFINE TO SMALLEST POSSIBLE AREA OF SKIN FOR VENEPUNCTURE
THERE SHOULD BE SEPARATE IV FLUID BOTTLE FOR EACH BABY AND LABEL THE BOTTLE WITH DATE AND TIME OF OPENING. OPEN THE TOP SURFACE OF THE BOTTLE , KEEPING THE SEAL INTACT. USE SEPARATE IV LINE FOR GIVING ANTIBIOTICS (DO NOT OPEN THE IV FLUID LINE FOR GIVING INJECTIONS)
DO NOT USE A SINGLE DEXTROSE/SALINE BOTTLE FOR >24 HOURS
ANTIBIOTIC VIALS TO BE CHANGED AFTER 24 HRS. E.G. INJECTIONS AMPICILLIN AND CEFOTAXIME
PREVENTION OF NOSOCOMIAL INFECTION IS THE PRIME RESPONSIBILITY OF ALL INDIVIDUALS SO MUST WORK COOPERATIVE WITH EACH OTHER TO REDUCE RISK OF INFECTION
UNDER UNIVERSAL PRECAUTIONS ALL PATIENTS ARE CONSIDERED BE POSSIBLE CARRIERS OF BLOOD-BORNE PATHOGENS
ANTIMICROBIAL RESISTANCE EMERGED AS MAJOR PUBLIC HEALTH ISSUE ALL OVER WORLD SPECIALLY DEVELPONING COUNTRY. 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.
HOWFREQUENTLY SHOULD SURVEILLANCE BE CARRIED OUT? WHAT ALL SHOULD BE CULTURED?
ROOM AIR - WEEKLY
SURFACES (VIZ. LAMINAR FLOW, WARMER, INCUBATOR, TROLLEYS) - TWICE WEEKLY
EQUIPMENT (VIZ. LARYNGOSCOPES, AMBU BAGS, MASK, STETHOSCOPES, OXYGEN HOODS, B.P. CUFFS) - TWICE WEEKLY
LIQUIDS (VIZ. WATER IN HUMIDIFIER BOTTLES) - EVERY TWO WEEK
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)/20% ECOSHIELD. OTHERWISE ONE CAN JUST DO ROUTINE CLEANING THOROUGHLY.
UNIVERSAL PRECAUTIONS ARE TYPICALLY PRACTICED IN ANY ENVIRONMENT WHERE WORKERS ARE EXPOSED TO BODILY FLUIDS, SUCH AS BLOOD AND BODY FLUIDS CONTAINING VISIBLE BLOOD AND TISSUES AND CSF,SYNOVIAL FLUID, PLEURAL FLUID, PERITONEAL FLUID, PERICARDIAL FLUID, AND AMNIOTIC FLUID.
UNIVERSAL PRECAUTIONS DO NOT APPLY TO FECES, NASAL SECRETIONS, SPUTUM, SWEAT, TEARS, URINE, AND VOMITS UNLESS THEY CONTAIN VISIBLE BLOOD. THE RISK OF TRANSMISSION OF HIV AND HBV FROM THESE FLUIDS AND MATERIALS IS EXTREMELY LOW OR NONEXISTENT.