Infection control in NICU. pptx

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 A ssociated B lood S tream 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

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.. Early BF / use of colostrums/minimal entral nutrition Immunomodulators Antifungal prophylaxis

31. INFECTION CONTROL STEP 8 INFECTION CONTROL PROTOCOLS

32. Contd..

33. INFECTION CONTROL COMMITTEE Yearly programme of activity for surveillance & prevention Epidemiological surveillance data and identify areas for intervention Ensure appropriate staff training in infection control and safety 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 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 F ormaldehyde, 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 C etrimide 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 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 7 th 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

55. DISPOSAL OF WASTE AND SOILED LINEN

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