Hand washing?

Specialties NICU

Published

Was looking at some NICU videos on youtube and came across this Australian set of videos on one of their NICUs in Victoria. It was great...except for the fact that the nurse was taking care of this 24 weeker WITHOUT GLOVES!

Now, I'm still a brand new nurse, only 4 months out, on orientation at a level 3 (although I guess some people call it a level 4). And I worked in school on a level 3 with nothing more complex than vents. So my exposure to the NICU culture isn't that much. In my months of working, though, I would be absolutely horrified at the thought of not wearing gloves. In fact, at my facility, we gown up as well, "protective isolation" for kiddos under a kilo.

But maybe this is the norm in some other facilities. I've recently learned that some level IIs don't even put their infants on monitors. Man, if my kiddos weren't on monitors, I would be so nervous and probably wouldn't leave their bedsides, because you never know when that supposed healthy/turning-the-corner kid crumps.

So...I don't know. Do you guys always wear gloves and wash/gel before/after you touch your patients? Or am I just naiive?

We wore gloves for everything for ages. Then it came up that this was not EBP and we stopped and just went with Universal Precautions. Have not seen a change in our infection rate.

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Specializes in NICU.
I'm ready for an up to date policy abou the line changes...sooooo ready because everyone says different things with it.

You'll learn things much more quickly when you move to nights and get visited by a lovely line team member for fluid changes. Basically though...dayshift changes clears like UAC fluids, and nightshift changes anything that goes with TPN. If you have a central line, line team comes and gets sterile to change the fluids, do CVC dressing changes (PCVL is transport), and draw labs if ordered. Anytime you need to break into a central line (like to add a medline to your UVC) call line team except when you give meds and start blood products. Yes, we can start our own blood...still doesn't make sense WHY but whatever. And anything going through PIV's is changed by you. Sorry to hijack the thread....

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You'll learn things much more quickly when you move to nights and get visited by a lovely line team member for fluid changes. ....

Line Team??? :confused: I wish!! :chuckle

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Staff nurses change all of our own fluids in my unit too, I've never heard of a line team. Day shift changes most fluids (and tubing if due) around 1700-1800, and night shift is responsible for hanging new lipids in the morning.

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Specializes in Neonatal ICU (Cardiothoracic).
You'll learn things much more quickly when you move to nights and get visited by a lovely line team member for fluid changes. Basically though...dayshift changes clears like UAC fluids, and nightshift changes anything that goes with TPN. If you have a central line, line team comes and gets sterile to change the fluids, do CVC dressing changes (PCVL is transport), and draw labs if ordered. Anytime you need to break into a central line (like to add a medline to your UVC) call line team except when you give meds and start blood products. Yes, we can start our own blood...still doesn't make sense WHY but whatever. And anything going through PIV's is changed by you. Sorry to hijack the thread....

Holy crap. A line team? Where do you work? I'd like to know how your manager was able to get the FTEs for that one!

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Specializes in NICU, PICU, educator.

How old were the videos you watched?

We only glove if on isolation, for body fluids, for accessing lines, for pouring MBM. It isn't necessary to use gloves for every single little thing. No gowns either.

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Specializes in NICU Level III.
You'll learn things much more quickly when you move to nights and get visited by a lovely line team member for fluid changes. Basically though...dayshift changes clears like UAC fluids, and nightshift changes anything that goes with TPN. If you have a central line, line team comes and gets sterile to change the fluids, do CVC dressing changes (PCVL is transport), and draw labs if ordered. Anytime you need to break into a central line (like to add a medline to your UVC) call line team except when you give meds and start blood products. Yes, we can start our own blood...still doesn't make sense WHY but whatever. And anything going through PIV's is changed by you. Sorry to hijack the thread....

I've been doing line changes with them since my first day. Different people have different opinions about things...one person got written up for spiking a UAC fluid...instead of calling line team to do it ... but then I've had LT members tell me it's okay to spike if you don't have to change out the whole line. I do have a sorta policy but my preceptor points things out on there that have changed since. Ahh well. Yeah, I don't get why it's okay to hep flush a UVC port but not okay to put a line on it.

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Specializes in NICU Level III.
Holy crap. A line team? Where do you work? I'd like to know how your manager was able to get the FTEs for that one!

It's one person a shift on a HUGE unit. They get pulled into staffing sometimes, too, but the BSIs have gone down DRASTICALLY since. They do the sterile part of the line change and connect the tubing to the baby and the bedside nurse checks fluids before they get there, opens everything sterile, purges fluids and connects them to the pumps.

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Specializes in NICU.
It's one person a shift on a HUGE unit. They get pulled into staffing sometimes, too, but the BSIs have gone down DRASTICALLY since. They do the sterile part of the line change and connect the tubing to the baby and the bedside nurse checks fluids before they get there, opens everything sterile, purges fluids and connects them to the pumps.

Wow. I'd have to say it's not a job I'd be interested in, LOL, but I bet it does decrease infection rates.

We always wash/alcohol gel before and after patient contact and wear gloves with micropreemies. Otherwise, unless the baby is on precautions or I think there is a reasonable risk of bodily fluid exposure, I don't wear gloves for a lot of care. I always do when I suction or do anything with an OG (but I just think they're gross), but I think it's sad to think that for the first several months of life a baby is only touched with gloves on. My hands are clean and our infection rate is low, so I try to give some "human touch" to my babies when I can. I do have several kids of my own, so the thought of a little baby urine doesn't really throw me over the edge :p.

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Specializes in NICU.

We wear gloves for all patients. If I change gloves while caring for the same baby (like after changing the diaper, but before feeding), I use the hand sanitizer we have and put new gloves on. I always wash with soap and water in between babies though. And all of our babies are on monitors until they go home. We even send some babies home on monitors.

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Specializes in ICN.

I work in a level 3/level 4 ICN, and we do not wear gloves simply because the baby is a micro preemie. In fact, I've never considered size to be a cause to wear gloves. Gloves are worn with isolation and dealing with blood, that sort of thing.

We wash our hands constantly, so much so that I have had contact dermatitis, eczema since I started there (lots of clobetasol ointment for me). However, changing soaps, washing initially for one minute instead of five and the alcohol based gels have helped greatly in skin protection. We are supposed to wash our hands after every single time we touch anything--the monitor, our pens, the blood glucose machine, whatever and before we touch any baby.

One of our NPs does a lot of skin studies and has written many articles on skin care on micropreemies so that we rarely have skin fungal sepsis anymore and far less skin breakdown on those tiny babies.

Dawn

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