Manual of Newborn Critical Care Medicine Dipak K Guha, Rashmi Guha, RD Srivastava
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1Basic Focus on Newborn Care

Newborn Critical Care Nursery (NCCN) or Newborn Intensive Care Unit (NICU) General Policies1

Summary of Policy
It is the policy of the Neonatal Care Units that appropriate infection control measures are utilized to reduce the risk of infection in patients, staff and visitors. There is a hospital program for control of infections in place.
  1. Prior to employment all nursing personnel hired for the Neonatal Care Units will complete a pre-placement physical by Hospital Health Service.
  2. Any staff member with a known contagious illness is not permitted into the Neonatal Care Unit.
  1. Before first entry into the nursery in any 24 hour period, a full surgical scrub up to the elbows for a minimum of 3 minutes must be performed with appropriate antimicrobial scrub
  2. Hands must be washed between each infant contact.
  3. All jewelery must be removed prior to handwashing.
Standard Precautions are Utilized in the Care of All Patients
Appropriate personal protective equipment, gowns, gloves, masks, protective eyewear, etc. are available in all patient care areas.
Nursery Attire
  1. Standard uniforms or scrub suits are acceptable.
  2. All persons entering the nursery must remove outer coats and / or jackets, roll their sleeves, to the elbow and perform a three-minute scrub.
  3. All non-nursery personnel must wear a gown if removing a baby from the isolette.
  1. The same absolute criteria for exclusion from the nursery for illness apply to family or visitors as to staff. The medical staff will be responsible for determining those to be excluded.
  2. Siblings and grandparents
    1. Mother/father fills out a health screen and returns it to the neonatal nurse for health check up.
    2. Siblings and grandparents must be symptom-free of any infectious disease. If there is any question, the attending neonatologist must be consulted.
    3. Siblings will be allowed to enter the NCCN/NICU or Intermediate Nursery in instance of special need.
Infant Care
  1. Skin
    1. All infants will receive an initial bath with sterile water to remove blood from the face and head and meconium from the perianal area as soon as after admission as his condition permits and his temperature is stable.
    2. All infants will receive daily care with water. Lotion not containing hexachlorophene may be used if desired.
    3. A doctor's order shall be required if use of hexachlorophene is deemed necessary.
  2. Cord Care
    1. The umbilical cord should be clamped with a sterile, disposable cord clamp.
    2. The cord cutter should be returned to the cleaning area for cleaning before being used on the next infant or disposable blade if available should be preferred.
    3. Stump should be observed daily for signs of inflammation.
    4. Daily care to include the application of triple dye or betadine lotion to the cord surrounding skin.
  3. Eye Care
    1. Each infant receives daily eye care. Using sterile water and a clean wash cloths wipe each eye starting at the inner canthus and wipe outward.
    2. Drainage should be reported immediately to the physician and documented.
  4. Surveillance
    Screening culture will be performed as deemed necessary at the direction of the Committee for Prevention and control of Infection only.
Care of Infants and Equipment in Isolation Nursery
  1. Infants should be placed in an Isolette incubator to reduce risk of cross infection. If there is only one patient who is recovering and is not a danger to caretakers, he may be placed in a crib for stimulation if this is appropriate.
  2. Strict handwashing should be practiced between infants
  3. Facilities should be available in the isolation unit for the disposal of linen and other contaminated articles.
  4. Resuscitation equipment and monitors should be available.
  5. When isolation is discontinued, the unit and all its furnishings and equipment should be disinfected.
  6. The Isolette should be cleaned with an appropriate detergent disinfectant.
Cleaning Nursery Unit and Equipment
Disinfectant—detergent products approved for use by Infection Control, the Medical Director of the Nursery and Environmental Services will be used. The disinfectant should be safe for patients, and unnecessary exposure to the disinfectant must be avoided. Manufacturer's recommendations will be adhered to.
Environmental Cleaning
  1. Daily damp dusting and cleaning and floor care should be done in each nursery.
  2. On a periodic basis, general cleaning will be done, including floor stripping and cleaning.
  3. Housekeeping personnel not assigned to the nursery exclusively should wear clean gown when entering the nursery complex.
Isolettes and Bassinets
  1. Isolette should be changed and cleaned every one week and between each occupancy. Bassinets should be cleaned between occupancy.
  2. Water of any type must not be added to the reservoirs. Humidly will be added by the use of outside cascades of humidifiers controlled and cared for by Department of Respiratory Therapy if available.
Other Equipment
  1. The transport isolette should be thoroughly cleaned at the completion of the transport.
  2. Each infant is to have his/her own stethoscope.
  3. Small equipment that can be easily cleaned should be cleaned between each assignment to an infant; a quaternary detergent should be used for this purpose.
  4. Other equipment, including equipment from an isolated patient, should be gas autoclaved using the standard procedure.
  5. Thermometers and other necessary articles should be kept on the shelf of the infant's isolette or crib. There should be no common use of such articles.
Outbreak Control
  1. The plan will be put into effect when two or more patients residing in the same nursery display signs and symptoms and have positive Gram stains or culture for Staph or other contagious organisms as diagnosed by the neonatologist or designee.
  2. A plan and its review will be the work of collaborative effort by the Director of Nurseries, the Nursing Coordinator, the Infectious Disease Nurse and the Infection Control Committee and will be congruent with the control measures of the Obstetrical and Delivery Room suites all or part of this group will formulate a plan of action based on the specifics of each individual situation, i.e. specific organism, site, mode of transmission and recommended control.
  3. The plan will include:
    1. Persons to be notified.
    2. Culture and treatment regimen.
    3. Cohortation of patients and staff procedure.
    4. Procedure for notification of pediatricians and parents of discharged exposed infants.
    5. Recommendations if epidemic appears resistant to implemented control measures.
  4. The infection control practitioner will maintain a record of:
    1. Suspected cases.
    2. Exposed cases.
    3. All measure implemented.
    4. Summary and recommendations made by decision-making meetings held during the epidemic of infections event.
    5. Staff members cultured and their results when applicable.
    6. Results of implementation.
  5. A copy of this record will be kept in the office of infection control committee.
The NCCN staff aims to promote bonding between family and infant while minimizing the risk of infections and maximizing the security and wellbeing of all infants in the Critical Care Nursery.
  1. Parents are welcome in the NCCN anytime 24 hours a day, 7 days a week. When discussing certain sensitive cases, the parents of other infants in the NCCN may be asked to step out briefly so that we can protect the confidentiality of the affected patient and his or her family.
  2. Due to the demands of shift changes, nurse will not be available to assist parents or answer questions and phone calls during these times, shift changes are scheduled at 7.00–7.45 a.m. and p.m. or any other shift changing times.
  3. All visitors must be accompanied by a parent or legal guardian.
  4. Only two visitors are allowed at a bedside at one time.
  5. Children under 12 years of age (other than the siblings of the patient) are not permitted to visit the NCCN.
  6. All visitors must be free of any signs or symptoms of infection. If there is a question regarding possible infection or exposure, the visitor should speak with the nurse caring for the infant before entering the NCCN.
  7. Information regarding an infant's condition will only be given to parents or legal guardians.
  • Hospital resources—Unauthorized use of telephones, copiers, faxes machines and computer is prohibited within the nursery. The computer and telephone in the staff lounge is available for personal use during breaks.
  • Personal business—Employees may not conduct personal business during work hours or use Hospital resources for personal business.
  • Food and drink—Staff are not permitted to have food or drink within the nursery. All food must be stored and consumed in the staff lounge. Drinks may be kept in the coffee machine in the hall in front of NCCN. All food and drink must be labeled and dated. Staff are expected to clean up after eating.
  • Family lounge—The family lounge is for the benefit of families. It should not be used by the staff. Specifically, staff member are not permitted to watch TV or use the computer or telephone in the family support area.
  • Professional dress—Staff members providing direct care are expected to wear scrubs (exceptions are Attending physicians and nurse assigned to the delivery room. All other staff is expected to dress in professional attire consistent with the Hospital dress code.