Screening Training Manual. Section 3: Screening Team & Screening Environment

Transcription

1 Screening Training Manual Section 3: Screening Team & Screening Environment 3.1 Working with Newborns and Their Families 3.2 Work Attire and Presentation 3.3 Screening Safety Procedures 3.4 Infection Control in Well Baby and Neonatal Intensive Care Unit (NICU) 3.5 Roles and Responsibilities

2 3.1 Working with Newborns and Their Families Characteristics of Newborns Reflexes There are several reflexes that are characteristic of newborn infants: Rooting: The infant turns towards whichever cheek is stroked. Sucking: The infant sucks anything that comes near the mouth. Moro and Startle: The whole body reacts to a stimulus. This can be minimized if the infant is swaddled and moved slowly. Palmar Grasp: The infant grabs onto anything that is stroked across the palm of his hand. Vision The eyes of a newborn may not be focused. Fetal Position The infant prefers to be in a tucked position rather than having their body straight. Hiccoughs Hiccoughs are common in newborns. They are a nuisance, but are not painful for the infant. They will go away by themselves, or may disappear if the mother gives a few more sips of feeding (breast milk or formula). Feeding Feeding generally takes between 45 minutes and 1 hour or more. This includes the subsequent diaper change. The time requirement is unaffected by breastfeeding or formula. New mothers may require significantly more time, and at more frequent intervals. Responsiveness Responsiveness varies considerably in newborns. The infant may be sleepy, especially if jaundice is present, and he/she may be exhausted from the delivery process. Noisiness Breathing may be erratic and noisy due to mucous build-up, and the infant may be crying or grunting. Page 2 of 11

3 Characteristics of New Parents New parents, particularly new mothers, display certain common characteristics. These include: Exhaustion A feeling of being overwhelmed (lots of tears) Hormonal changes Inability to process much new information Loss of mobility Concern that the infant is being constantly poked and prodded, and trying to understand the new infant and wondering how to be a parent Communicating with New Parents Ask for parental permission before proceeding with the screening. The parent may want to be involved in preparing the infant for the procedure e.g. swaddling, positioning. Ask for permission to turn the infant, if the infant needs to be repositioned. Keep explanations simple. Remember, new parents are tired and there is much new information. English-as-a-Second Language (ESL) issues may be magnified and cause fear if screening is not explained simply. Parents need to have written material to which they can refer after the screening. If an infant is referred from the screening, the parent may have a difficult time understanding this. Parents sometimes ask questions that are difficult for a hearing screener to answer. In these cases, refer the parents to the audiologist. If an infant is referred and the parents appear upset, contact the nurse on duty or call an Audiologist for assistance. Always accept a parent s right to refuse the screening. Do not push. Offer to come back another time or day, or offer outpatient screening. Ask the nurse on duty for assistance, if necessary. If parents wish to decline screening altogether, explain the Screening Waiver Form (bring in interpreter if ESL) and have the parents sign it. Please see Appendix 12 - Scripts for instructions on explaining the results of screening to parents. Please see Appendix 13 Frequently Asked Questions for sample questions that parents frequently ask during the screening process. Page 3 of 11

4 3.2 Work Attire and Personal Presentation Clothing worn while providing direct patient care must be easily laundered. Sleeves must be short or able to be rolled up past the elbows. Hospital gowns are available and are worn if there is a possibility of soiling clothes. Long hair must be tied back away from the face. Do not wear rings, watches, bracelets or long necklaces, as they could scratch or come into contact with the infant. Closed footwear is mandatory: sandal and open-toed shoes are not acceptable. Footwear should provide good coverage/support, and have a non-skid sole and a low heel. Remember that you are on your feet most of the hospital shift. Fingernails should be kept short (to the end of the fingertips) to avoid scratching the infant, as well as to control infections. Artificial nails, wraps, tips, acrylics and gels are not to be worn. Numerous studies have shown that health care workers with nail enhancements have more bacteria on their nails both before, and even after, hand washing. Do not wear perfume or other scented products, as many patients are sensitive or allergic. 3.3 Screening Safety Measures General Safety Measures Hospital rooms have many hazards. Clear the hazards out of the way, and reposition the bassinets for comfortable and safe screening, if necessary. Ensure there is a clear path to the equipment. The infant s head needs firm support while being turned or lifted. Have the parent move the infant if he/she prefers. Swaddling helps to calm and protect the baby, by providing a feeling of security and limiting movement. The body motions involved in screening place the hearing screener at risk for a musculoskeletal injury. The key is to prevent an injury. Please be sure to: Take frequent breaks. Move equipment slowly and safely. Remove any obstacles to the cart and avoid manoeuvring the cart around obstacles; avoid manoeuvring the cart around sharp corners or in small spaces. Take the time to safely position yourself and the cart: avoid leaning over the cart, or twisting to either enter the data or screen the baby. Try to decrease the amount of pushing of the cart e.g. when searching for babies who are ready for screening, leave the cart against the wall in the hall and check out several babies. Only move the cart after you know where you are going. If you are experiencing pain, weakness or abnormal muscle fatigue, take a break from screening, and report to your supervisor. If you get injured while screening, stop your work and seek medical attention. Page 4 of 11

5 Please see Appendix 17 A, B and C Ergonomics Brochures (MSIP, Stretching and Bubble Zone) for more information on risk factors and good body mechanics. Emergency Codes There are a series of standard emergency codes (see below). In the event of an emergency code in the hospital, screening personnel who work in the hospital must follow the instructions of the nurses, hospital staff, or public announcement systems. Code Blue Red Whhi iit tee Yellow Black Grey Green Brown Orange Meaning Cardiac Arrest Fire VVi iiool lleennccee/ /AAggggr reessssi iioonn Missing Patient/Resident or Abduction of Infant Bomb Threat Shutdown (Air Handling Systems)/Air Exclusion (Closing Windows) Evacuation Hazardous Spills Disaster 3.4 Infection Control in Well Baby and Neonatal Intensive Care Unit (NICU) Infection Control is the conscious management of the environment for the purposes of minimizing or eliminating the potential spread of disease (Bankaitis and Kemp, 2003). As a program the BCEHP supports best practices in infection control procedures. Measures are in place to protect both the baby and the hearing screener. If these measures are not followed properly, the baby can acquire an infection directly from the hearing screener or indirectly from other sources through improperly cleaned equipment. The following techniques should prove helpful in providing a healthy environment for babies and screening personnel. Health Authority facilities will have their own specific infection control procedures, so it will be important to consult with your facility s risk manager (infection control person) to obtain specific procedures required for your hospital. If there are discrepancies between your Health Authority and BCEHP procedures, it is important that you follow the more stringent of the two. To enter the Well Baby Unit or the NICU the screener must: Be free of transmissible infectious diseases such as conjunctivitis, active cold/cough, and dermatitis. In other words, if you are sick please stay at home. Be vaccinated against Rubella, if the staff member is susceptible; plus, Ensure any Herpes lesions (cold sores) are dry and scabbed, and are covered whenever possible. Page 5 of 11

6 Infection Control Common Precautions Standard Precautions also known as Routine or Universal Precautions Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection. Standard precautions are specific to the task being performed, not the individual s diagnosis. Protective attire is applied before patient contact when it is anticipated that there may be contact with: Blood Body fluids, secretions and excretions, with or without visible blood Non-intact skin Mucous membranes Wear gloves when direct contact with moist body substance and/or contaminated objects is expected. Wear gowns when there is risk that clothing may be soiled by moist body substances. Wear masks and protective eyewear when splattering of body fluid into the mouth, nose or eyes is anticipated. Transmission-based Precautions In addition to the standard precautions, patients with specific infectious conditions may require transmission-based precautions. These include: Airborne Precautions Droplet Precautions Contact Precautions Strict Precautions In an acute care setting, a patient requiring isolation precautions is identified with an Isolation sign placed on the wall outside the room or over the bed. Precautions listed on the sign are to be adhered to by all persons entering the room/bed space. Please Note: When an isolation sign is present, check with the baby s nurse for what precautions should be followed, before entering the room or touching the baby. MRSA (Methicillin Resistant Staphylococcus Aureus) is a bacterial infection that is resistant to antibiotics. Within the hospital environment, spread of MRSA is a significant concern. MRSA-positive babies may be encountered in hospital or in the clinic. Additional special precautions are required. Check with the baby s nurse to determine when screening should be attempted. Please See Appendix 25 MRSA Precautions for an example of precautions used at BC Children s Hospital. Page 6 of 11

7 Respiratory Etiquette Many respiratory illnesses, including serious ones, are spread by coughing and sneezing; however, some can also spread by direct contact e.g. after someone s hands become contaminated by droplets from coughing and sneezing. These illnesses spread most easily where people are in close contact. To ensure these respiratory illnesses are not spread: Stay home when you are sick. Cover your nose and mouth with a tissue when you cough or sneeze; if you don t have a tissue, sneeze or cough into your sleeve. Wash your hands frequently, especially after coughing or sneezing. If soap and water are not available, use a waterless antiseptic hand cleanser. Infection Control Procedures Hand Washing Hands must be washed thoroughly with facility-approved soap immediately upon arrival in a patient care area, as well as: Before and after each patient contact After contact with a source that is likely to be contaminated with blood or any excretions or secretions Before and after screening each baby and after recording on data sheets When hands are visibly soiled Before and after handling or eating food After removal of gloves For personal hygiene (after using the toilet, blowing your nose or smoking) General Hand Washing Procedure Remove all rings, bracelets, and watch and put in a safe place. Ensure sleeves are above elbows. Stand with clothing clear of the sink and regulate water to warm. Clean under fingernails, when visibly dirty or if nails are long. Wet hands and arms and apply soap from dispenser. Rub hands together for at least 30 seconds, washing between fingers, around nails, the backs of the hands, and wrists, including arms, up to the elbows, using the time it takes to sing Happy Birthday twice. Rinse hands and arms under running water, with fingers extended downwards. Use paper towel to thoroughly dry hands. Turn off water with paper towel. Discard paper towel into open, plastic-lined receptacle or one with a footoperated cover. Page 7 of 11

8 Special Hand Washing Procedure (for NICU) Follow the steps for General Hand Washing Procedure, except that: The initial scrub upon entering the NICU should be for 1 minute. Subsequent (e.g. after screening) hand washes should be for 30 seconds. After setting up equipment and recording data at bedside, clean hands again prior to touching baby. If hands become visibly soiled, repeat a 1 minute scrub. Waterless Hand Scrub Procedure (Waterless/Alcohol-Based Cleanser) Remove rings, bracelets, and watch. Ensure sleeves are above elbows. Dispense hand-scrub agent into palm of hand. Spread solution over hands, taking care to cover all surfaces of hands (front, back, between fingers and nail beds), wrists and forearms. Rub hands together vigorously until dry. If solution dries before all surfaces have been covered, apply more solution. WARNING!! There is a fire risk when using alcohol-based sanitizers, particularly in oxygen-enriched environments. When using this product ensure that your hands are completely dry (the cleanser is fully evaporated) before you touch any equipment, bed linens or patients. Please See Appendix 24 Hand Sanitizer Alert. Gloves In the Well Baby and the NICU, gloves are required, for the circumstances outlined below, when performing newborn hearing screening. Before donning gloves, jewellery must be removed and hands washed with a hospital-approved soap. If a puncture of the glove occurs, remove the gloves and wash the hands. Wear gloves when: Open sores are present on the hands. Staff with infected open lesions or extensive dermatitis must consult with a supervisor or charge nurse. Coming in contact with blood or body secretions and excretions. Coming in contact with mucous membranes. Coming in contact with non-intact skin. Gloves must be changed or removed and hand hygiene done, once each task is completed. To remove gloves, peel from the wrist turning the gloves inside out as they come off. Discard all gloves in the appropriate waste container and wash hands. Gloves are not worn while traveling between departments/units. Page 8 of 11

9 Gowns Long-sleeved gowns are worn to protect the skin and prevent soiling of the screener s own clothing. They are worn when babies are under standard precautions as well as when they are in isolation. Wash hands before putting on a gown. They are worn with the opening at the back and tied at the neck and back to ensure protection. When removing, fold the gown from the inside to prevent contamination of clothing and place in a linen hamper. Wash hands again after the gown is removed. Clean Equipment and Work Surfaces Establish a daily cleaning routine that includes anything that will come in direct contact with the baby or the screening materials, such as any carts or tables. Use cleaning materials recommended by the facility. Use a clean AccuScreen probe tip (blue or green) for every baby. Clean probe tips at the end of the day (Follow the procedure in Appendix 23). Use only individual disposable baby supplies, and discard in an approved receptacle after the screening of each baby. Wipe the probe, cables, electrode leads and the screening equipment with alcohol or disinfectant wipes between babies. WARNING!! Chemical interaction can occur if combining different cleaning wipes. Use of CaviWipes following Virox is a particular problem. Please see Appendix 25 - OHSAH Alert - CaviWipes Page 9 of 11

10 3.5 Roles and Responsibilities Successful screening requires a team approach. The team consists of family members, screening personnel, Audiologists, Regional Co-ordinators, hospital nurses, hospital unit clerks, and public health nurses. The general roles are outlined below. Individual screening sites and health authorities may adjust these slightly to fit local needs. The Regional Co-ordinator is responsible to ensure all roles are fulfilled and personnel are clear on their responsibilities. Regional Co-ordinator The Regional Co-ordinator is responsible for: Developing, managing and evaluating the local program Providing ongoing support for screening personnel Ensuring audiological follow-up of all referred infants Screening Personnel The Screening personnel are responsible for: Identifying infants who need to be screened Completing hearing screening on infants, using specialized equipment in the hospital and community screening sites Identifying infants who have been missed for future follow-up at the community screening sites Providing follow-up screening at the community sites for infants who missed the screening or who were referred Communicating screening results to families, service providers, hospital staff and other screening personnel Collecting data, recording it on the BCEHP Screening Worksheet and entering screening results into the database Generating and delivering screening reports for hospital chart records Maintaining, monitoring, tracking and reporting the equipment and supply inventory Hospital Nurse The hospital nurse facilitates the hearing screening by informing screening personnel if a baby is ready for screening, directing enquiries to the screening personnel, and providing information on late onset risk factors. Hospital Unit Clerk The hospital unit clerk provides specific clerical support to the screening personnel, including the patient lists, and accepting the hospital documentation on screening (BCEHP Screening Report ). Page 10 of 11

11 Public Health Nurse The public health nurse assists by providing information about the screening program, when required, and by encouraging compliance of families which do not attend scheduled follow-up appointments. Midwife/Doula The midwife/doula is responsible for communicating birth information in a timely fashion to ensure accurate screening lists, providing accurate information, and encouraging families to attend screening appointments. Page 11 of 11