SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY

Transcription

1 PS1006 SARASOTA MEMORIAL HOSPITAL DEPARTMENT POLICY TITLE: INFECTION CONTROL DEPARTMENT POLICY FOR NEONATAL INTENSIVE Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE: POLICY TYPE: Director, Women s and Children s Services (neonatal) 12/17/ /17 DEPARTMENTAL INTERDEPARTMENTAL DEPARTMENTS PROVIDING NURSING CARE 1 of 13 PURPOSE: POLICY STATEMENT: EXCEPTIONS: DEFINITIONS: To prevent and control the risk of infection to neonates in the neonatal intensive care units. Neonates, especially those in the neonatal intensive care units are at risk for infection because of their low birth weight and the use of invasive procedures. This policy addresses measures for preventing and controlling the risk of infection within the neonatal intensive care units. NONE Neonatal Intensive Care Units areas providing intensive care or intermediate care to neonates. Normal Flora non-pathogenic microorganisms that colonize the skin, mucus membranes and gastrointestinal tract early in life. Colonization the multiplication of microorganisms in a host without tissue invasion or injury. Infection the multiplication of microorganisms in the tissues of a host; infections can be symptomatic or asymptomatic. Contamination the presence of microorganisms on or in inanimate objects or transiently transported on body surfaces such as hands. Infectious Disease an infection producing signs or symptoms. Communicable Disease an infectious disease that can be transmitted from one individual to another. Isolation the physical separation of an infected patient from

2 2 of 13 other patients. Antiseptic a product with antimicrobial activity designed for use on the skin and other body surfaces. Disinfectant a product with antimicrobial activity designed for use on inanimate objects and surfaces. High-level Disinfectant a product that removes all vegetative bacteria and viruses but not necessarily bacterial spores. NNIS National Nosocomial Infection Surveillance (NNIS) Definitions and database established by the Centers for Disease Control and Prevention (CDC) allowing benchmarking of infection rates. PROCEDURE: A. Dress Code: 1. Staff will wear their own, clean scrub attire when in the neonatal areas. 2. Staff will limit jewelry to one plain ring on one hand. Bracelets or other jewelry are prohibited. Watches must be cleaned and not come in contact with patient. 3. Staff is not permitted to have artificial nails. B. Hand Hygiene: 1. All visitors will perform an initial one (1) minute hand hygiene using hospital grade soap when they enter the NICU. 2. Visitors with artificial nails should use a scrub brush and extra caution washing their hands. 3. Staff and cuddler volunteers who handle infants will perform an initial three (3)) minute scrub to the elbows using hospital grade soap at the beginning of each shift. 4. Hand hygiene will be performed according to policy 00.IFC.67 Hand Hygiene.

3 3 of 13 C. Personnel Practices: 1. Gloves will be worn when handling newborns until after the first bath and hand hygiene must be performed immediately after gloves are removed. After that, policies addressing standard precautions, special precautions and hand hygiene will be followed. 2. Personnel and cuddler volunteers will not eat or drink in the neonatal areas except in designated areas. 3. Personnel and cuddler volunteers will dispose of drinks only in the sink in the soiled utility room or staff lounges not in the NICU scrub sinks or the sinks in patient rooms. 4. Employees and cuddlers with signs or symptoms of illness, fever, respiratory symptoms, cutaneous or mucocutaneous lesions, diarrhea, and/or rash are to report to the clinical manager, and/or Employee Health Services prior to the start of their shift for evaluation and authorization to work. 5. Employees and cuddlers will be prohibited from working until 24 hours after symptoms have resolved for any of the following conditions: a. Airborne infections b. Herpetic hand lesions c. Exposure to varicella, measles, rubella or mumps during the incubation phase if non-immune 6. All persons in the NICU should be instructed to sneeze or cough into their sleeves and wash or alcohol foam hands after. D. Prevention of Transmission of Infection from the Mother to the Newborn: 1. Mother s with a fever of > F with unknown origin may not visit the NICU until afebrile for 24 hrs. 2. Mother s with known origin of fever, such as Chorioamnionitis may visit. 3. Mother s should perform hand hygiene before touching their baby and after changing diapers. 4. Mothers with communicable diseases or infections should perform hand hygiene before handling their infants and take measures to prevent contact between the infant and potentially contaminated clothing, bedclothes tissues and environmental surfaces.

4 4 of Abscesses, draining wounds, and cutaneous herpetic lesions should be covered with a clean, dry dressing and clothing prior to handling the infant. 6. Mothers with active, untreated tuberculosis should don a general surgical mask prior to entering the NICU. The mask should remain on throughout the visit. 7. Mothers with disseminated shingles, chickenpox or influenza will be prohibited from entering the NICU without prior authorization from the Neonatologists and/or Infectious Disease consult. 8. If mother s MRSA screen is positive with present hospital admission, staff will perform contact precautions throughout the infants hospital stay. Parents and visitors do not need to gown & glove when visiting. They will be educated on good hand hygiene when entering and leaving the infant s room. Hand hygiene should also be repeated if parents touch their nose or face. If mom is still a patient at SMH, she will change her patient gown before leaving her room on MBU and perform hand hygiene. Once in the NICU mom will change patient gown again & perform hand hygiene when she leaves the NICU to go back to MBU. Extra patient gowns should be kept in yellow isolation caddy. Any family member with positive MRSA screen may be asked to perform contact precautions based on the severity of infant s condition. This will be determined on an individual basis by the neonatologist. A. Staff entering the room to answer a monitor or pump alarm without patient contact is required to wear gloves and do hand hygiene upon removal of gloves. B. Isolation gown and gloves will be worn for any patient contact or environmental contact such as stocking cart or patient drawers. C. No contact precautions are needed for mothers with a history of MRSA but a negative MRSA screen for this admission. 9. The infant of a MRSA positive mom will be screened one time upon admission as well as infants transferred in from an outlying facility or any infants that are readmitted to the NICU. No precautions are needed if mom has a history of MRSA but a negative screen on this admission. 10. If a mother has a current outbreak of HSV at the time of delivery, contact isolation has to be done by every person entering the room. Mom may breastfeed after

5 5 of 13 good hand hygiene education has occurred. Wearing gloves is optional during breastfeeding. Emphasis should be placed on the need for breast-feeding mothers to check their breasts for lesions. Parents with oral herpes should wear a face mask and avoid kissing their infants whiles lesions are open and draining. E. Breastfeeding: 1. Mothers who are positive with HIV or Human T- lymphotorpic virus HTLV-1 and HTLV-2 infection should not breastfeed. 2. Mothers who have Herpes simplex virus or syphilis lesions is present on the nipple should not breastfeed from the affected side until the lesion(s) have completely healed. Mothers should express milk from the affected side to maintain milk supply. If the milk touches the sore or if parts of the breast pump touch the milk also touch the sore, that milk must be discarded. 3. It is important that mothers who have influenza provide their breast milk for their babies so that their babies receive the antibodies their mom is producing in response to their illness. Mom should provide expressed breast milk until she can directly breast feed. Breastfeeding can resume usually after 24 hours of flu therapy. 4. Mothers with active, untreated tuberculosis may express milk for their baby while they are separated. Direct breastfeeding can safely continue when the mother, infant or both are receiving anti-tb therapy and are considered no longer infectious-usually about 2 weeks. F. Prevention of Transmission of Infection from Visitors to the Neonate: 1. Visitors with signs of infection will not be allowed to visit the NICU. 2. Siblings will be screened utilizing the visitor s screening tool, See policy Family Care Time and Visitors in the NICU ( ).

6 6 of A completed immunization form will need to be provided before any sibling under the age of 12 has access to the NICU. 4. Upon arrival to the unit, visitors are to check-in with the NICU staff for instructions on proper hand hygiene and infection control issues. 5. All visitors will perform hand hygiene before touching the baby and after handling cell phones G. Patient Care Practices: 1. Newborns, well border babies and well babies will not be admitted to the NICU. 2. Infants born outside the hospital may be admitted to the NICU up to 14 days after birth at the discretion of the NICU physician. Infants transferred from other units/facilities may be placed in the NICU if agreed upon by the admitting physician and the department director or designee. Admission care will include eye care with Erythromycin ophthalmic ointment per physician s order, unless eyes are fused, and vitamin K injection. 3. Micro preemies will be bathed with sterile water only. 4. Peripheral IV Tubing changes with be done with aseptic technique and all tubing insertion sites will be cleaned vigorously for 15 seconds. See Policy # Central lines IV tubing changes will be done with sterile technique according to nursing procedure # nur16 Insertion, monitoring and discontinuation of an umbilical catheter. 6. VAP Bundle to be used with ventilated infants to prevent ventilator associated pneumonia. 7. Peripheral blood cultures will be done with sterile technique. 8. Circumcision care will be done with each diaper change and will include cleaning the area as needed and wrapping in Vaseline gauze. 9. Disposable diapers will be used and disposed of in containers with foot pedal lids. 10. Head of the bed is determined clean and the foot of the bed is determined dirty. 11. Each infant will have a chuck-it bucket in the dirty area or below the crib, where soiled diapers and cloths can be placed before disposing of them. Parents will be

7 7 of 13 educated on clean versus dirty. 12. No stuffed animals in cribs. 13. If an infant must be taken from the NICU area to another department, a closed isolette, transporter or transport crib will be used during transport. If infant is on contact precautions, do not wear gloves or gowns when transporting infant. Clean the area of crib that will be touched for transport with a disinfectant wipe prior to leaving the patients room. Staff may use clean hands when transporting infants on contact precautions. Once to destination staff must wear proper PPE for any patient interaction. Staff must continue to use proper hand hygiene. 14. Supplies such as topical preparations used on the skin, cord, or eyes will be provided for single-patient use and will not be shared between neonates. H. Equipment and Supplies: 1. When formula is used, sterile commercial formula in ready-to-feed bottles will be used. Bottles will be used within 4 hours of opening. 2. Aseptic technique will be used to set up naso-gastric feeding administration systems. Administration sets used for continuous feeds will be changed every 24 hours. Syringes used for bolus feeding will be changed every 4 hours. 3. Reusable instruments, materials and equipment that require sterilization will be processed according to manufacturer s instruction. Stored materials will be examined before use for integrity, dating and stock rotation. 4. Evaporative humidifiers in incubators will be used only if central humidification provides insufficient humidity. If used, the water reservoir will be drained, cleaned and refilled with sterile water every week, per manufacturer studies. 5. Sterile water will be used in nebulizers and humidifiers. 6. Disposable equipment will be used whenever possible and will be discarded after patient use. 7. Stethoscopes will be cleaned with alcohol prep pad or antiseptic wipes between use. A stethoscope will be designated for each infant. 8. Nursery nurses will disinfect all equipment at the

8 8 of 13 infant s bedside with an EPA registered hospital disinfectant spray or wipe or cleaner every 7 days and as necessary. 9. Giraffe omnibeds and isolettes will be changed and cleaned according to manufacturer s recommendation. 10. Isolette/giraffe filters will be changed every 3 months, or after any patient with signs of infection, isolation and after oxygen use. 11. Biomedical waste receptacles will have lids and will remain covered when not depositing trash. 12. Unit entrance sinks will be hand-free operation and will be activated by either a foot pedal or motion sensor. 13. No aerators in faucets. 14. Separate areas will be used for storage of clean and soiled equipment. 15. Respiratory Care Services and anesthesia equipment used in neonatal areas will be maintained by the standards of those departments. I. Environmental Controls: 1. The NICU will be located in a low-traffic area with restricted access. 2. The design will provide adequate space for appropriate care of the infant and necessary equipment. 3. Environmental Services will clean the area daily with a hospital approved disinfectant. Refer to policy 00.IFC.62 Infection Control for Environmental Surfaces 4. Every shift the nurse will clean the patient area with an EPA-registered hospital disinfectant wipe J. Laundry & Linen: Contracted hospital laundered linen used on newborns will be washed separately from other linen and stacked in cupboards in NICU. Clean linen will be kept covered during transport to NICU and during storage to prevent dust contamination. Linen supply will be ordered daily to avoid excess stock. Soiled linen will be placed in covered hampers; it will be

9 9 of 13 handled as little as possible to avoid hand contamination and aerosolization of microorganisms. Soiled linen will be picked up twice per shift by Environmental Services. K. Specialty NICU Linen and Clothing 1. The NICU washer and dryer will be used for specialty infant laundry at the discretion of the staff. 2. All soiled linen and clothing will be placed in a leak proof clear plastic belongings bag located in each NICU room. 3. Linen and clothing will not be sorted or pre-rinsed in the NICU patient care rooms. 4. Linen and clothing soiled with blood or body fluids will be bagged and transported in leak proof clear patient belonging bag to a soiled utility room where the hopper is located. 5. The soiled linen and clothing will be rinsed in the hopper by personnel wearing gloves and goggles and then placed in a dirty linen hamper. (If splashing potential wear gown) 6. Prior to placing dirty NICU laundry in the NICU washer, clean the 3 washer lint trays once a day. 7. Specialty NICU linen/clothing will be loaded in the NICU washer directly from the clear plastic patient belongings bag using gloves worn by personnel. The clear bags will be discarded in a designated garbage can. 8. The NICU laundry areas will have hands free hand washing sinks, gloves and foam for personnel utilization. After loading washing machine, NICU personnel will wash hands in provided sink with soap rubbing vigorously. 9. Washing machine dials will be set appropriately. Linens and clothing will be washed in water at least 165 degrees Fahrenheit. Water temperature will be monitored by the Central Energy Plant (CEP) at SMH. 10. Prior to placing washed NICU laundry in the NICU dryer, clean the lint tray of the dryer with EVERY load.

10 10 of Clean laundered specialty NICU linen/clothing will be folded on a separate clean countertop to avoid contamination with soiled linen/clothing. 12. Clean linen/clothing will be transported by personnel and stored in covered cabinets to ensure its cleanliness. 13. SMH NICU personnel assigned to laundry duties will have a signed off checklist for competency skills during their NICU orientation. Review of policy # will be included in the Position Description of Cuddlers. L. Contact, Droplet & Airborne Isolation in the NICU Refer to policy 00.IFC.22 Isolation of Patients Using Contact, Droplet and/or Airborne Precautions: Infants requiring airborne precautions will be transferred to the isolation room with negative pressure capabilities. The asymptomatic infant of a mother with peripartum varicella or measles requires airborne isolation and will be transferred to an appropriate facility. Forced-air incubators will not be substituted for negative pressure rooms because they discharge unfiltered air into the nursery. Infants requiring droplet precautions will be admitted into a private room with a sign that identifies the type of isolation and special precautions required. Infants requiring contact precautions will be admitted into a private room with a sign that identifies the type of isolation and special precautions required. Special precautions will extend to the infant, include the outside of the isolette or incubator, and to the patient care supplies, equipment and work area immediately around the infant on contact precautions. Personal Protective Equipment (PPE) will be worn according to the level of precaution required and ordered by physician. Surveillance: a. All infants will be observed for signs of infection:

11 11 of 13 lethargy, poor feeding, temperature instability, hypo-perfusion, glucose intolerance, acidosis, coagulopathy, thrombocytopenia, leukopenia, leukocytosis, dyspnea, apnea, cyanosis, jaundice hepatomegaly, abdominal distention, irritability or diarrhea. b. Any suspected sign of infection will be reported to the physician. c. Infection Prevention & Control, in cooperation with NICU staff will conduct targeted surveillance of the following nosocomial infection rates: Bloodstream Infections per 1000 Central Venous Line days; Birth weight less than 1000 grams (per NHSN definition) Bloodstream Infections per 1000 Central Venous Line days; Birth weight grams (per NHSN definition) RESPONSIBILITY: REFERENCES: It is the responsibility of the director of Women s and Children s Services to ensure that staff is aware of and adhere to this policy. American Academy of Pediatrics. Serious Illnesses and Breastfeeding Retreived September 11, 2014 from stages/baby/breastfeeding/pages/serious-illnesses-and- Breasfeeding.aspx Merenstein, G. (2011). 22. In Merenstein & Gardner's handbook of neonatal intensive care (7th ed., p. 563). St. Louis, Mo.: Mosby Elsevier. Centers for Disease Control and Prevention. Breastfeeding: diseases and conditions Retrieved September 11, 2014 from Centers for Disease Control and Prevention. Laundry: washing infected material Retrieved August 30, 2013 from Centers for Disease Control and Prevention. Guidelines for environmental infection control in healthcare facilities 2003.

12 12 of 13 Retrieved August 30, 2013 from Mendicino, Nancy et al.. Neonates. APIC Text of Infection Control and Epidemiology, Association for Professionals in Infection Control and Epidemiology. 4th edition Chapter Kenner, Carole, Judy Wright Lott and Ann Applewhite Flandermeyer, Comprehensive Neonatal Nursing. A Physiological Perspective. 2 nd Edition. Chapter 27. Page 509. Lawrence, R.A., & Lawrence, R.M. (2011). Breastfeeding: A Guide for the Medical Profession. 7 th ed., Elsevier Mosby: MO Sarasota Memorial Health Care System Corporate Policy 00.IFC.22, Isolation of Patients Using Contact, Droplet and/or Airborne Precautions. Sarasota Memorial Health Care System Corporate Policy 00.IFC.62, Infection Control for Environmental Services. Sarasota Memorial Health Care System Corporate Policy 00.IFC.67, Hand Hygiene Sarasota Memorial Hospital Policy 01.IFC.21, Linen AUTHOR(S): Heather Graber, BSN, RNC-NIC Clinical Manager, NICU REVIEWING AUTHOR(S): Heike S. Bucken RNC-NIC, CLC NICU Clinical Coordinator Dr. R. Schilling OD, West Coast Neonatology Mary O Connor, MSN, RNC, IBCLC

13 13 of 13 APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Signature: Date 11/13/17 Title: Pam Beitlich, Director, Women s and Children s Signature: Title: Signature: Title: Signature: Title: Committee/Sections (if applicable): Clinical Practice Council 11/2/17 Vice President/Administrative Director (if applicable): Signature: Name and Title: Signature: 11/15/17 Name and Title: Connie Andersen, VP/ Chief Nursing Officer