Disinfection in the Neonatal Intensive Care Unit

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

5. BREAKING THE CHAIN OF INFECTION

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

7. 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

8. 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

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

10. STEPS OF HANDWASH

11. STEPS OF HANDRUB

12. SURFACE DISINFECTION IN THE NICU

13. SURFACE DISINFECTION IN THE NICU

14. DISINFECTANTS FOR USE IN THE NICU

15. 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

16. 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? 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 Blood / CSF culture whenever indicated Pus cultures whenever present Personnel: hands, nasal throat swabs as required

17. 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 https://www.nabh.co/Images/PDF/HIC_Guidebook.pdf