infection-free NICU

[Julie Basilio]

I just wonder...is an infection - free unit (NICU) possible? Any insight!

[neonatal_nurse]

I think even the OR- the supposedly most sterile area in the hospital has some bacteria of some sort around even if they do weekly/daily cleaning. It's a hospital, Julie, that's why there is such a thing as nosocomial infection. Especially when your hospital is like centuries old like mine.

As for keeping the NICU infection free in the most possible way, this is always an issue for our unit, as there is no such thing as a completely isolated unit without ever coming in contact with people from the outside. We're a team, a baby can't heal by itself, just like no man is an island. So I guess the usual infection prevention measures- handwashing, gloving, double gloving, proper disposal of wastes-- these stuff we already know. But, hell still there are still those not following these simple rules. For my unit, we do weekly cleaning of the whole unit, and regular cultures of our facilities. They even tested our hands when there was an outbreak at some point. Bottomline: We could do everything to prevent it, but if not everyone's cooperating, well you can already guess the result.

[Julie Basilio]

So i got your point...infection will always be around us. We can though prevent infection if we have 1 strong team to fight it. For short, we need a 100 percent compliance from the whole team. Thanks a lot!

[NeoNurseTX, RN]

And then there are still parents, siblings, etc etc.

[BittyBabyGrower, MSN, RN]

You will never have no infections, but you can really make a decline by using bundles for VAP and line sepsis. We also swab all kids upon admission for MRSA so we can determine if it is acquired from mom or hospital. We are very conscious about keeping our beds and bedspaces clean and we have purell at every bedside and outside every pod. We audit handwashing and line placement for sterility. We have a been without an umbilical line sepsis for over 1 year and 7 months for central lines, and 11 months for a VAP :) Last MRSA we had was a mom acquired one :)

[TiffyRN, BSN, PhD]

We have a been without an umbilical line sepsis for over 1 year and 7 months for central lines, and 11 months for a VAP :) Last MRSA we had was a mom acquired one :)

That is so excellent. I have heard of some hospitals (all units, adult and pediatric) being free of CLABSI (central line acquired blood stream infection?) for years. I believe I saw it in one of my nursing magazines last year. Lord knows we all want to be free of infections. I believe it's an admirable goal, and one that most units could do better. Some infections obviously cannot be helped as the infants are born infected.

[Tina1639]

What measures does your unit use to recognize and prevent VAP? In my previous unit with adults we had to go through a checklist daily of signs to look for on every vent patient, but in the NICU I'm in now, we don't have anything in place and I wondered if it was similar to adults.

[dawnebeth]

What measures does your unit use to recognize and prevent VAP? In my previous unit with adults we had to go through a checklist daily of signs to look for on every vent patient, but in the NICU I'm in now, we don't have anything in place and I wondered if it was similar to adults.

Last year or the one before, our unit came out with a checklist to prevent VAP and one of the main ones that has worked really, really well was using designated suction tubing for the ET and another for the mouth and nose. We have them marked specifically and they are not interchangeable (as we used to do). Also, change the in line suction each night, as well as the mouth suction device (used to be an olive tip, now it's called a BBG where we work--booger be gone!)

[Bortaz, MSN, RN]

Our NICU has recently had a rash of Serratia marcescens infections, mostly in trachs, so there's been a major push to re-educate on the importance of hand washing and gloving. Especially when moving from baby to baby. We cohorted all the infected kids into our currently-unused intermediate nursery area, as well.

[Tina1639]

one of the main ones that has worked really, really well was using designated suction tubing for the ET and another for the mouth and nose.

We did that in the adult unit and I thought it strange that our NICU doesn't do that. When I asked, nobody had heard to do that. I was always taught that the suction setup for ETT suctioning was a sterile closed system and it wasn't to be disconnected at all because that introduces germs to the setup. I'm going to ask if we can implement that because I've always thought it odd that we open their airway line up constantly by taking the suction tubing off to connect it to the nose/mouth sucker. Thanks.

And what all is in your checklist? The adults one, if I can remember it all, was checking for: increased secretions, fever, increased WBC, worsening chest xray and last date of sputum specimen. And if you answered yes to 2 or more (I think) AND it had been more than 3 days since last specimen, another specimen had to be done.

[dawnebeth]

Because I had a primary (who just left) who wasn't intubated for the last month that she was here, I cannot accurately tell you the check list, but some of it was keep the head of the bed elevated, suction with the dedicated suction catheters and wipe down the bedside each shift. We're also doing our line changes as sterilely as possible, especially priming the tubing when we change the TPN/Hyperal.

[EmilyPeruana]

you dont want my answer...we've been the overly nicu unit lately b/c our census has been low and the hospital has been bursting at the seams everywhere else...we have private room and are divided into "pods" and have given up a pod for acute care overflow...and another isolated pod for rsv...what's the world coming to