Infection control concern in NICU

[Armywife08]

A few weeks ago I started working in a NICU that just opened up last month. The hospital I work at has a mandatory float policy (if you are told to float you must float, or face disciplinary action up to and including termination). I was floated recently to an ortho med/surg unit. My biggest concern was that I had isolation patients. This made me very concerned about pathogens being brought back into the NICU. It is not that big of a stretch to think that those kind of pathogens could end up on a nurses badge, shoes, ect. Then that same nurse go to work in the NICU the next day carrying those same pathogens in. Just think what would happen if a nurse was pulled to adult ICU with a patient with acinetobacter and got it on their shoes from the patient's room. The next day they work back in the NICU and are walking around spreading the acinetobacter on the floor. Then a syringe falls on the floor (still in the unopened wrapper) and a staff member puts it back where it fell from. Later that day it gets used for a blood draw, the nurse unaware that acinetobater got on the gloves from opening the syringe I, exposing an already immune-comprised premature baby to acinetobacter. I have brought this forward to my manager, but she seems to put staffing other departments as a priority over infection control. My manager stated that we may turn into a closed unit at some point but was not sure. If anyone knows of where I could find any research/literature to bring to her it would be very helpful. I would also be interested to know what the policies are at other hospitals in regards to floating NICU staff. The previous hospital I worked at the NNP's about through a fit over infection control when they were considering using are staff for float to med/surg. The NNP's won, but I do not what they brought forward when they went to management. I do not think that the NNP's or neo's in my NICU are aware that this is happening, as they voiced concern to the NICU nurses about our staff floating even to postpartum.

[smilingbig]

I just wanted to point out a few things....

Acinetobacter are bacteria that are naturally occurring in soil and water; so unfortunately, there is a great chance that just about every staff member at your facility is carrying that around on their shoes. Which leads me to my next point...

A staff member that picks up ANYTHING off the floor and places it ANYWHERE without thoroughly cleaning it has just created an infection control issue. I've come across many hospital staff members in my career that fail to understand that if it is on the floor or touches the floor it is dirty.

Also, standard precautions and isolation precautions are implemented to prevent the spread of organisms. If hand hygiene, standard & isolation precautions are being adhered to this will prevent the spread of organisms.

So the hypothetical situation that you have described is centered around a staff member that wouldn't adhere to simple infection control principles which I am sure are part of your institution's policy (somewhere). Management is going to assume that all nurses are going to adhere to these policies no matter their location.

I do completely agree with you that it would be best to have a closed unit. I was not able to find any literature that supported the points that you made. You may want to contact the previous hospital you worked at to see if they have references that you can provide your manager. I did find an article that correlates increased HAIs to units that have poor staffing and utilize float nurses often. (http://cid.oxfordjournals.org/content/47/7/937.full.pdf+html) I don't know if that will be helpful.

I don't know what state you live in, but you may want to look at your nursing practice act. If it has been awhile since you have cared for that type of patient population, it may not be safe for you to do so because your knowledge and skill set is now more focused on the NICU population. In Texas, our NPA doesn't not address staffing directly, but does state that as a nurse I am required to only accept an assignment that is within my education/training/experience. See below...

http://www.bon.texas.gov/practice/faq-floating.html

So, you may have an argument there. Good luck in trying to make changes to your unit!

[NicuGal, MSN, RN]

You posted a similar thread in the NICU forum.

Where I work you can't come back to the unit after floating and receiving isolated patients. If you absolutely have to do so you must shower and change scrubs.

As for the shoe thing...unless you are changing your shoes every time you leave the unit, kind of a moot point. Going to the cafeteria, etc you are walking on all kinds of stuff.

Talk to your ID department to set up guidelines if they haven't done so yet.

[meanmaryjean, DNP, RN]

OP was discussing floating one day and returning to the NICU the next. I don't see the problem.

And I am NOT being snarky- but rather making an observation. (I worked NICU for many years, so don't flame me) I have NEVER met a group of nurses who put up a bigger stink about floating than NICU nurses. I work in PICU- we float to NICU all the time but they will NOT come to our side (even to take care of kids who just arrived from NICU for surgery).

It is OK to say "I don't want to float". Few of us enjoy it. But to try and make up a scenario where lives are endangered because you float one day and work your unit the next is pretty far-fetched.

Again, my opinion only- but I have been there/ done that/ got the scrub top.

[NicuGal, MSN, RN]

Our unit floats to all maternal and child units. And to generalize that "we" put up a stink is not fair. We float and accept it because when we need floats we count on them. Of course I am not going to take some horrendous trauma and I am going to try to avoid isolation if I know I am going back to the unit because I have to shower, and honestly, who wants to do that!

Our directors have set guidelines for us to follow. No age appropriate kids, no float. But if you are following isolation protocol and going home to shower no problem.