frequency of linen changes in the NICU

[iyqyqr]

With all the concerns about infection and VAP I've been surprised to find that only one of the NICU's I've worked in as a traveler had a policy on how often the warmer, isolette, and open crib linens were changed. They changed bedding to the nest every day and did a full bed change to the mattress every other day, no matter how ill the infant was. I'm considering setting up a research study and culturing beds to see at what point the germ levels increase. Has any hospital scientifically done this research? What is your unit's policy on linen changes and even baths? Do you document this on the chart or on the bed with a sticky? Please let me know and I promise to post my data after I do my study.

:balloons:

[SteveNNP, MSN, NP]

We have no such policy. Our bed linens get changed on night shift when the acuity of the child allows it, linens are soiled, and when we have the baby out to bathe... Are you planning on culturing linens, or isolettes as well? If so, that may decrease the validity of your study, as it is a completely different issue.

[BittyBabyGrower, MSN, RN]

We do baths, linen changes and weights twice weekly on infants less than 34 weeks. We do change linens if they are yucky in between. We also change our isolettes weekly, on bath day for those kids less than 34 weeks. Bigger kids get bathed as needed and their weights are ordered by the attendings. On our sicker kids, ones oscill, on a VIA, multiple drips, and the such, they are left alone and we will only change linen/bed if absolutely necessary. We also do not allow stuffed animals of any sort in the beds, or in the nursery for that matter...there are studies where they cultured those and ewwwww....the things that grew on them, yuck! We instituted this all with a VAP and Bacterimia rollout and with new developmental care protocols. We also start weaning the humidity when we can as that is a set up for infection, such as fungus.

Steve, use IHI.org site for info on this kind of stuff....great site!

[NICU Mama]

I've worked in three different NICU's in three different states, and none one had a policy on changing linen. Two of the three had policies on changing the isolettes (every 14 days or sooner if soiled and needed). As far as changing the linen, I know of some nurses who don't do it even when soiled. This grosses me out. They will just cover the area. :angryfire I see most nurses change linen at night when weights are obtained. I'm not sure how many go down to the mattress, though. I usually change all the way down to the mattress at this time even if it doesn't look soiled because I don't know when it was last done. This way I know my babies are in very clean beds. The only time I don't do it is when the baby is so critically ill that it would stress and decompensate the baby.

[hikernurse]

Linen down to the mattress gets changed 3X a week and when soiled. Some sweaty little guys get changed each shift. Isolettes are changed out weekly. Our techs stay on top of cleaning cribs, etc. so if their beds are looking grimy at all (or "tape-y", amazing how that sticky stuff stays on) the nurse will just switch out their beds and linens. The nurses (most of them, anyway) are good at staying on top of that.

We do have lots of cute linens, so that's kind of an incentive .

[prmenrs, RN]

Can you find ONE well-researched article that connects dirty linen to VAP or any other infection? I would seriously doubt it. There is way more evidence that poor mouth care is associated w/VAP.

When I did Infection Control, I would give lectures. THE most frequent question from ER nurses was how often to change the cubicle curtains. My answer: When they are dirty. If you can see blood, sputum, vomitus..., change them. Not because the curtains cause infections, but because the next pt expects to have a clean and odorless environment.

Linen changes should be dictated by the clinical condition of the infant. If s/he practically crashes when you touch them, don't change the linen.

JMO

[BittyBabyGrower, MSN, RN]

prmnrs is right. If you are looking at VAP, mouth care is number one. Other things that are instituted are HOB up 30 degrees, not breaking into the circuit unless necessary (ie aerosols or emergency bagging). A closed circuit is a big one....that is why everyone should be using closed suction systems and separate oral and ET suction setups (separate tubing and containers). We instituted the linen changes with the baths/weights so that we aren't breaking into the circuit except for twice a week. Circuit changes are also done on weight nights.

In all our research for our bundles, linens did not show up.

[preemieRNkate, RN]

We don't have a policy about linen changes. I typically do it when I weigh the baby at night (which is done after midnight), or in between as needed. If I pick up a baby in a messy bed, I try to do it before the parents come in. Our patient satisfaction surveys show that these are the thing parents notice. We change isolettes weekly.

[littleneoRN]

We are supposed to change our isolettes every 14 days and as needed. We are not always very strict about that timeline though---I wish we were better because inevitably there are drops of milk in cracks and other lovely things. Parents can't always judge the quality of our medical care, so they make judgements on what they can see. If their baby's clothes, linens, bed, bedside, etc. are dirty, they see this as an indicator that we might be lax in other areas.

We change our linens as needed, so typically a minimum of once every 1-2 days. All of our kids get daily weights on nights, and I try to change my linens with weights. Baths are every four days or as needed, a little more often for some of your bigger, messy eaters.

We have a policy that staff must have bare arms to the elbows because research shows that germs stay alive and travel well on cloth (such as sleeves). I would imagine you could extend that to suggest that germs stay alive in bed linens for a fair period of time, but how well they grow/multiply and the risk to the infant being that bed linen does not travel would be something you couldn't extend from those studies.

[RainDreamer, BSN, RN]

We have no specific policy regarding how often we change linens. We change linens whenever they need it. And yes we document in the computer if we do a linen change and if was was a "partial" or "complete" linen change.

Most stable babies get a complete linen change every couple days though. But some babies feel the need to bleed and/or poop on their linens and want them changed every round!

All beds/isolettes/cribs get changed out every 14 days if the baby is stable enough.

[Sweeper933]

We change all linens every night when we weigh the babies. I am always surprised (and annoyed) when I come in to find that the day shift just turned over the burp cloth after the baby puked all over it. I mean come on... how hard is it to just swap out the burp cloth! Of course, if the baby is very critical, linen changing gets a bit spottier...

[RainDreamer, BSN, RN]

We change all linens every night when we weigh the babies.

We usually do that too. Sometimes the day nurses change it though if they need to be changed, so it just depends on how it looks or how long ago it was changed. But I'm anal about stuff like that ..... even if the blankets don't match or I don't like how the roll looks or if the bed just looks sloppy, then my babies get new beds.

I am always surprised (and annoyed) when I come in to find that the day shift just turned over the burp cloth after the baby puked all over it. I mean come on... how hard is it to just swap out the burp cloth!

I hate when people do that!! One time I even had a nurse tell me in report that the baby threw up. I go in to do my round and she hadn't even changed the linen!! That irks me to no end because 1.) that's disgusting, how would you like laying in dried throw up? and 2.) would you like your baby to be laying in that?