Hand Hygiene in NICU

Dr Manan Parikh
Bacteria that cause hospital-acquired
infections most commonly transmitted via
HCWs hands
Studies have shown that washing hands
between patients reduces spread of bacteria
in health care
HCW handwashing compliance rate 40%

Improving Hand Hygiene Practice
Why?
Minor Action _ Major Outcome
Simple tasks can contaminate hands:
Taking a patients vital signs
Touching the patients clothing or linens
Touching equipment and furniture nearby

Hand Hygiene
is the SINGLE
most important practice
to prevent
nosocomial infections

Benefits of Hand Hygiene
Reduced number of deaths
Reduced number of infections:
Decreased antibiotic usage
Decreased patient length of stay
Decreased use of resources
Definitions
Hand Hygiene
a general term that applies to either handwashing,
antiseptic hand wash, antiseptic hand rub or
surgical hand antisepsis.
Handwashing
washing hands with plain soap and water.
Antiseptic Hand Wash
washing hands with water and soap or other
detergents containing an antiseptic agent.
Alcohol-based Hand Rub
the alcohol-containing preparation applied to the
hands to reduce the number of viable
microorganisms.



When To Perform Hand Hygiene?
High Risk for Contamination Activities

Low Risk for Contamination Activities
Immediately before and after patient contact
Immediately before and after a procedure
Before and after touching any
devices/equipment directly connected to the
patient e.g.
IV Lines, Umbilical Lines, PICC Lines, Central Lines
External Ventricular Drains
Urinary Catheters
Ventilation Equipment
High Risk for Contamination
Moving from contaminated to a clean body site
After contact with body fluids
After coming from washroom
After taking food

High Risk for Contamination
Low Risk for Contamination
After contact with equipment
e.g. patients charts, monitors
After removing gloves
After contact with own nose/mouth/hair

BEFORE Hand Wash
Nails should be kept short / No Nail Polish
Artificial nails should not be worn
Remove your footwear, take NICU slippers
Remove all your ornaments (rings, bracelet, bangles etc),
wristwatch before entering NICU
Roll over your sleeves up to elbow
Wear ICU Gown, Apron (even if you are not touching the
baby)
Use antiseptic solution for Hand rub (even if you are not
touching the baby)
Wear face mask, if you have common cold, cough, URTI

How to do Hand Wash?
Alcohol at EVERY bed helps
increase compliance
0
5
10
15
20
25
30
35
40
45
50
P
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C
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Baseline 1 Dispenser per
4 Beds
1 Dispenser for
Every Bed
Biscoff WE et al 1998: Abstract K132
Ensure that hands have no visible
contamination
Apply product to palm of one hand
and rub hands together covering all
surfaces and fingers
Allow to air dry
The process takes about 15 seconds


How to do Hand Rub ?
Continue rubbing hands together until
alcohol is dry (should take 10-15 sec).

After using an alcohol based product,
you will feel a build up on your hands.
To remove this, wash your hands with
soap and water as often as necessary.

A few tips when using the hand rub
Before & After
EVERY ACT
related to
patient care
When to follow Hand Hygiene?
Before Entering NICU
When Hands are Visibly Soiled
Before examining the Patient
Before Touching the Patient
In between 2 Patients
Before VF Insertion
Before Procedure
Before - After IV Injections
After Waste Disposal
Before After touching Infusion Pump
Before After touching Monitor
Before After touching Trolley
Before After Nappy Change
After Handling Body Fluids / Secretions
After Touching Files / Papers
After removing gloves
After touching the Mobile
WHO should follow Hand Hygiene?
Consultants
Outside consultants visiting NICU
(Superspecialist, Radiologist, Neurologist, Physiotherapist etc)
In-House Paediatrician
Resident Doctors
Nurses
Health care assistant
Support staff
X-ray Technician
Lab Assistant
Mothers / Relatives / Visitors
Cleaning Staff
Hospital Management Staff
Maintenance people of different NICU instruments
WHO SO EVER ENTERS THE NICU ---- MUST FOLLOW HAND HYGIENE
Nurses Role
Follow the Hand Hygiene Guidelines
For every patient
For every act
In every shift
Observe others. If somebody is not
following Hand Hygiene Even if
CONSULTANTS You have right to tell them
to follow Hand Hygiene Guidelines
Single Step to Prevent Infection
Hand washing
Hand washing
Hand washing
Hand washing
Hand washing
Hand washing

Questions ?