Infection control overkill?

[BabyLady, BSN, RN]

My NICU has banned the practice of wearing simple wedding rings...even though we already have the practice in place of wearing gloves anytime we practice infant care as well as a 3-minute hand scrub when you enter the unit. Touch an infant = wearing gloves.

Personally, I find this offensive and there was no outbreak of anything recent that led to this practice...every time we have had anything to spread, it has always been traced back to lack of handwashing/glove wearing practice.

Does anyone else find this overkill? I am so infuriated I am almost tempted to refuse to remove mine...based on the fact that other people from other units, ie. techs, physicians, physical therapists, etc...still wear theirs when working with our patient population.

[prmenrs, RN]

Ask. Email the Infection Control team/nurse, whatever, and ask if you can see a copy what literature or study they are basing the policy on. Do it such a way that your questions are intended to gain knowledge, not challenge. You are trying to understand where they are coming from. Maybe there was an outbreak in another facility due to rings.

If you have an education coordinator, s/he might be able to facilitate communication between your staff and the policy makers.

Should you be required to do this, safety pin your ring thru your scrub to your bra strap so that you can't lose it.

Best wishes. Nothing's worse than edicts from "above" being issued w/o rationales!

[walkingrock, ADN]

I would love to hear more on this...I agree with "prmenrs"approach. Don't want to have your infection control people getting defensive before you can even get started in your quest. There must be something they are basing this change on....

[hikernurse]

My NICU has a nothing below the elbow policy. As weird as it feels to not wear my wedding rings, I also miss wearing my watch . The policy is extended to anyone working with our babies--phlebotomists, doctors, PT, etc. Even parents are expected to comply.

In addition, doctors wearing lab coats (usually consults from outside our unit) have to leave them outside the patient care areas.

I think a lot of NICUs do this, but it would be interesting to see what the percentage actually is :).

[llg, PhD, RN]

The NICU at my hospital also has a "nothing below the elbow" policy. No rings of any kind. However, they don't wear gloves for every contact -- only those that pose special risk.

I think the removal of rings is far more important than the 100% gloving. I don't have citations handy, but there have been studies for years showing that bugs grow under, on, and around rings.

[hikernurse]

The NICU at my hospital also has a "nothing below the elbow" policy. No rings of any kind. However, they don't wear gloves for every contact -- only those that pose special risk.

We also don't wear gloves for every contact. I can't imagine being in the hospital for several months--your whole life--and not ever being touched skin to skin. While we encourage kangaroo care, some of our parents are unable to visit often and their babies would miss out on some human touch. I would think that would cause some developmental problems.

[sjc80]

We also don't wear gloves for every contact. I can't imagine being in the hospital for several months--your whole life--and not ever being touched skin to skin. While we encourage kangaroo care, some of our parents are unable to visit often and their babies would miss out on some human touch. I would think that would cause some developmental problems.

I agree. Our unit policy is "bare below the elbows", which is strictly enforced for ANYONE touching the babies, as well has CONSTANT hand washing. Our infection rate is superb, so it obviously works for us.

It seems wrong to put on gloves just to turn a baby or something when good hand hygiene is just as good. Baby's need skin to skin contact and like you said, often parents aren't around......

[prmenrs, RN]

I bought a "lapel watch" cuz I didn't like how I couldn't wash my hands w/o worrying about getting my wrist wet. Some places have clocks everywhere, but just my luck to be standing in the wrong dang spot to see it.

Here are some examples of "alternative" watches: Amazon.com: lapel watch

[NicuGal, MSN, RN]

We too are a nothing below the elbow group. Everyone that enters the unit, including parents, must comply. Our ID department had us put a fluorescent cream on after we did a three minute scrub in and after we used hand sanitizer, lit us up with a black light and you would not believe how many of us still lit up around our watches and rings! It was pretty gross. Rings kind of rank up there with fake nails if you think about it. They can harbor bacteria. And we had a lot of opposition, but you have to think...what if that was your kid laying there????

It isn't overkill. This coupled with our central line bundles and VAP bundles, we have had 1 VAP and 1 CVL line infection in over a year. 0 on umbilical lines and we have also seen a huge decrease in the number of hospital acquired MRSA (we culture all of our babies upon admission, so we know if they have it from birth).

Also, I really hate when people glove for every little thing, unless the kid is isolated for a reason. Talk about overkill!

[littleneoRN]

We are 100% gloved for all contact, nothing below the elbow, including sleeves, rings, and watches. Our infection rate has drastically improved since we made those changes. I think the rings and watches off are very important for above mentioned reasons.

[NebraskaRN]

the nicu i worked at ny had a policy to glove for any patient and equipment contact but did not enforce the policy for jewelry here in fl you can where a simple wedding band but must scrub in at the start of the shift and practice good hand hygiene before and after patient contact. i agree that the bundles for ivs is a good idea and is proven to work, also i agree that babies need skin contact. i am undecided on the wedding ring, i agree bacteria is hard to remove around rings but i dont like not wearing my wedding ring i feel naked...lol i am planning on buying a simple wedding band to wear at work.

[TiffyRN, BSN, PhD]

I quit wearing my wedding ring to work for a couple of reasons.

First, before we moved to gelling a lot, my skin would stay wet under my ring and the skin would be all wrinkly like fingers soaked in a pool or tub for a long time. That can't be good for infection control. When we moved to gelling, the only adverse effect I had was my skin would peel; only right at my ring.

Secondly, my ring has deep engraved letters around the outside and I see all those crevices as hiding spots for bacteria. Not work the risk.

My husband works the same area and feels the same way about wedding rings and work. So basically, neither one of us wears our rings regularly. I know a lot of people think it's odd we are often without our wedding rings but it works for us.