Aspesis in NICU

Introduction

• Neonates are highly susceptible to healthcare-associated infections (HAI).
• This susceptibility is due to their immature immune systems and the frequent need for invasive devices.
• Strict asepsis in the Neonatal Intensive Care Unit (NICU) is critical to prevent morbidity and mortality.
• Infection prevention and control requires standardized protocols across the unit.

General Infection Control Practices

Hand Hygiene

• Hand washing is the most effective method for controlling hospital infections.
• Adhere strictly to the five moments of hand hygiene.
• These moments are: before touching a patient, before aseptic procedures, after body fluid exposure, after touching a patient, and after touching patient surroundings.
• Use alcohol-based hand rubs placed at every bedside.
• Follow the bare below elbow technique.
• Wear half-sleeved clothes.
• Remove white coats, jewelry, rings, and bangles.
• Keep fingernails short and clean.
• Avoid using nail polish.

NICU Entry Protocols

• Restrict entry to prevent overcrowding.
• Ensure hand washing and gowning for everyone before entering the NICU.
• Maintain separate footwear for use inside the unit.
• Ensure doctors and nurses wear special NICU attire.
• Prohibit individuals with active infections from entering the NICU.

Asepsis During Neonatal Procedures

Skin Antisepsis

• Use 2% chlorhexidine for skin asepsis in babies weighing more than 1500 g.
• Use lower concentrations of chlorhexidine (0.1%) in extreme preterm infants.
• Avoid povidone-iodine due to the rare risk of systemic absorption causing hypothyroidism.

Maximal Barrier Precautions

• Follow maximal barrier precautions during invasive procedures.
• These procedures include central line insertion, endotracheal intubation, and intercostal drain insertion.
• Wear sterile gowns, gloves, masks, and caps.
• Use a sterile drape to create a sterile field.
• Dedicate specific devices like stethoscopes, measuring tapes, and thermometers to each baby.
• This prevents cross-infection between neonates.

Medication and Intravenous Fluid Safety

• Prepare intravenous (IV) fluids in a separate designated area.
• Use a laminar flow hood whenever possible.
• Cleanse vials properly before withdrawing any medication.
• Use single-use vials, needles, and syringes.
• Do not store IV fluid packs once they are punctured or opened.
• Dispose of all sharp objects appropriately in designated bins.

Environmental Control and Housekeeping

Air Quality and Surfaces

• Maintain a warm, draught-free environment with temperatures between 26-28°C.
• Ensure a minimum of six air exchanges per hour.
• At least two of these should be fresh air exchanges.
• Clean walls and floors with a surface detergent like 3% phenol or 5% Lysol at least once a day.
• Perform wet mopping at least three times daily.
• Avoid dry sweeping and dusting to prevent the airborne spread of pathogens.

Decontamination of Equipment

• Clean, disinfect, and sterilize reusable medical equipment based on evidence-based protocols.

Bundled Care Approaches

• Implement care bundles to achieve a greater reduction in HAI.
• Use the Central Line-Associated Bloodstream Infection (CLABSI) bundle.
• This includes proper hand hygiene, maximal sterile barrier precautions, and choosing optimal insertion sites.
• Perform daily assessments of catheter need.
• Maintain closed line systems for infusions and blood draws.
• Scrub the hub for at least 15 seconds before initiating infusions to minimize contamination.
• Implement Ventilator-Associated Pneumonia (VAP) bundles.
• This involves limiting circuit breaks, practicing standardized endotracheal care, and training staff.

Surveillance and Outbreak Prevention

• Perform periodic culturing of surface swabs from NICU equipment and patient environments.
• Do not routinely perform body surface surveillance cultures on neonates.
• Implement these cultures only during an active outbreak to identify colonized infants or healthcare workers.