Infection control guidelines in LD/NSY/PP

[CoppertopRNC, BSN]

I was looking for some information about practice guidelines concerning infection control in the L&D, Newborn Nursery and Mother/Baby settings. We have a policy that has been in place for at least 18 years and renewed from time to time but no real changes have ever been made. Our policy states that a 3 minute scrub will be done at the beginning of every shift in each area. Also, of course, good handwashing using either soap or alcohol foam after each contact. Our policy also includes wearing cover gowns when feeding or holding infants in the nursery. We are also practicing universal precautions with all patients which involves wearing gloves with any contact we have. We are not allowed to wear jewelry( with the exception of a plain wedding band) or watches, our hair must be neatly tied back. Each infant is given its own stethascope(for use in the hospital) and thermometer(to take home.)and disposal b.p cuff. Is this pretty much the routine in your institutions as well? I have been trying to look for evidence based practice (articles ect) but have not had any luck......Please let me know what you all are doing.......

[nurseynightnight]

Can I just say Wow!! Your policies sound great!! I will say our nurses/hospital is much more relaxed. We hold babies and feed them in our scrubs, we use the same stethoscopes on all of the babies (clean with alcohol), and use a thermometer with disposable covers. And our nurses are not required to wear their hair back. I recently cut my hair (down to the middle of my back) and very rarely pulled it back.

I hate to admit this but most of our nurses don't wear gloves while changing diapers/doing baths. I wear gloves with the first bath but then don't after that. I am sure our infection control nurse would have a COW if she knew this.

One time one of our nurses was changing a diaper on a baby. The soon to be foster parent was standing there (she is a child care provider) and said "why do I have to wear gloves while changing diapers at the daycare but you don't?" The nurse didn't know what to say. She knew she had been "caught" doing something she wasn't supposed to be doing.

[prmenrs, RN]

Those actually look darn good to me. The only thing I would change is the cover gown bit. Not necessary, even for the parents, and it's very expensive. And, it's not "evidence-based".

If you really want to update it, call your hospital's Infection Control Practitioner and ask him/her to take a look @ it with you.

Do some homework on the APIC website (http://www.apic.org) and on NANN and AANN before you meet w/the ICP.

[birdgardner]

IMO, infection control gets shot to hell when you have two bleeding pp women sharing a room and bath.

[crissrn27, RN]

When I did nursery, we didn't wear gloves to change wet diapers (some didn't for poop), we didn't do cover gowns after first bath. We did do 3 min scrub, but now I do L and D and we don't do a scrub. Definitely didn't do gloves with all contact, I doubt that is evidenced based, except with infants on precautions. Do you mean you don't hold them, give a bottle, paci, etc, without gloves on?

We used one steth for everyone, and a therm. with disposbable covers. You could wear hair up or down, no jewlery except wedding band.

The not wearing gloves for wet diapers came from an informal study one of the nurses did on how much money it saved not to wear gloves for wets.

[queenjean]

We are to do a two minute scrub at the beginning of every shift. Each infant has it's own stethoscope that is attached to its bassinette. We use a thermometer with disposable tips. I do not use gloves to feed the babies, nor to insert a paci. I will of course wear gloves if I stick my finger in an infant's mouth for whatever reason. We are supposed to tie our hair back, but I see many nurses wearing it down. Mine's short, so doesn't matter.

I never wear any jewelery, but once again, it appears that most nurses do. I don't want it to get dirty, or damaged by the alcohol rub. Also, when I was a patient a long time ago, a nurse gave me one he** of a scratch with the solitaire on her wedding ring. Enough where I had to get a tetorifice shot and it wouldn't stop bleeding without some pressure and a dressing. Not enough to get stitches or anything. But I was mad enough when it happened to me--I'd be mother-bear enraged if a nurse did it to my infant.

We are supposed to use gloves when we touch the infant prior to it's first bath and when we change diapers. I wear gloves for the first bath (if I can't just get the parents to do the bath), and I must admit I rarely use gloves to change a diaper. Urine is sterile, and frankly, the mec should be, too, don't you think?

I don't know; I'd like a little input and guidance on that last one. Does everyone wear gloves to change healthy newborn diapers? I do an alcohol rub before each contact, and a handwash after each diaper change. My orientation was a bit hit and miss, and in watching the other nurses, I see some wear gloves and some don't. We do, however, tell the parents they do not have to wear gloves--so I wonder why we should?

Thanks for the input, J.

[Elvish, BSN, DNP, RN, NP]

We scrub 3 min at the beginning of each shift. Wash hands before and after everything.

We use nursery-dedicated stethoscopes, but not one for each baby. We clean them c alcohol before & after use.

Thermometers are shared, with disposable covers.

Cover gowns & gloves during first bath.

I personally wear gloves when changing poopy but not wet diapers. Urine is (in theory, at least) considered sterile. (Plus, I can't count how many times I've been peed on by some little stinker of a boy and well, it's just considered an occupational hazard.:))

We wash hands between contact with babies.

One nurse I work with never wears gloves, not for anything.

[Elvish, BSN, DNP, RN, NP]

We do, however, tell the parents they do not have to wear gloves--so I wonder why we should?

I think the theory is that while the parents are only changing their baby's diaper, you are likely changing multiple babies' diapers. So the risk for cross-contamination is a lot higher. I'd wear gloves for poopy diapers cause while the babe's gut is sterile at birth, once they open their mouth and/or eat, their GI tract is exposed to the world & all its pathogens. So, like Forrest says, you never know what you're gonna get. Urine is a bit more of a closed system, unless of course, you're changing the diaper of a little boy who's decided that you're a fine target....

That's my thinking, anyway. Somebody please feel free to correct me.

[prmenrs, RN]

"....unless of course, you're changing the diaper of a little boy who's decided that you're a fine target...."

Or, perhaps, the kid in the next crib....Show-offs!

[queenjean]

I'm going to expose my ignorance here....but isn't mec sterile, too? At least the first several? For some reason (and I can't even place a source) I was under the impression that it is. Any input?

[Elvish, BSN, DNP, RN, NP]

Mec is sterile at first because the gut is sterile at birth....but once baby eats, the GI tract loses sterility. I get what you're saying, QJ.

Breastfed babies tend to have far fewer pathogens in their gut than bottle babies because of all the lovely breastmilk antibodies.

I'd rather get mec on me than blood any day (if I HAD to choose), but I still wear gloves for poopy diapers. I'm sure someone can add something to this.

[crissrn27, RN]

I will be honest and say that, in a pinch, I have changed poopy diapers without gloves, but that isn't the norm for me. I would never change an adult without gloves (poop, or pee!), but the yuck factor isn't as high with a baby. Mostly, if I am in a Moms room with no gloves, and they want me to change baby, I don't bother to go back for any. OK, don't fuss at me too much:chair:

I know several that do the no gloves, ever, thing. Not even on a fresh baby covered with blood. I am a bit paranoid about gloves, gowns, etc, until the first bath. All the moms gunk, ya know.