Private NICU rooms...A Stinky Subject

[BabyLady, BSN, RN]

I work at a hospital that has private NICU rooms.

As you know, some of these families are in rooms for sometimes 2, 3, 4 months. I have noticed that some of these rooms get so infiltrated with odors (from families bringing in food, bedding that they bring from home and that never gets washed, etc) that they can smell up an entire floor...that can't be good and makes it look like we are not keeping the place clean.

Does any other NICU's have policies where famlies may be required to change rooms every so many weeks so that the room they have been staying in gets a floor to ceiling scrubbing?

Our hospital has no such policy and some of these rooms smell so bad that it's hard to even walk in without feeling like you have to hold your breath.

I understand that it's just how they are going to live at home, but while these babies are in the hospital, I feel like we owe it to them to give them their best shot at a clean environment before they go home to what is to be, less than sanitary conditions.

Any opinions?

[ittybabyRN, RN]

That sounds crazy...they don't get cleaned at all???

We have an absolutely no food or drink policy, breastfeeding mothers may have water but that is it, and we try to enforce it because apparently in the old NICU (this one just opened in May) we had a bug problem. Families are able to eat off the unit in the family waiting area or the caf. As far as bedding...we only have one recliner in the room and only one family member is allowed to sleep the night at the bedside (unless things aren't going well), the other parent may sleep in the family waiting area inside the unit, I haven't really seen anyone bringing in their own bedding, the occasional blanket but most use pillows and blankets we provide...and thus launder. Bedding for the baby is kept in the babies cabinet in the room, parents are to bring home dirty clothes/bedding to wash and bring back. We move babies around a lot but typically the chronics tend to stay in their own room for a long time, we've had babies in the same room for 6-8 months and I can't recall not being able to go in because the room smelled, our janitors also clean the floors in the rooms and most of the nurses give their work areas a thorough "purple wipe" rub down at the start and end of their shift

[ghillbert, MSN, NP]

Why don't you just ask them to leave for "rest period" or something and have the room cleaned? The rooms should be getting cleaned anyhow. If they stink, tell them to wash their bedding etc.

[BabyLady, BSN, RN]

The rooms in our unit actually have beds and food is not only permitted, it is actually served 3 times a day by the hospital for a "caregiver tray".

Yes, housekeeping cleans the rooms daily, the floors, etc...however, when you have families that have things piled everywhere as if they have "moved in", you cannot get a thorough cleaning...things start to smell.

I didn't know if this was happening other places or just with our unit.

[SteveNNP, MSN, NP]

This is exactly why I dread ever going to an all-private room NICU. How are caregivers supposed to provide care when a parent is there 24/7, sleeping at your feet? We've had a few parents camp out in one of our private rooms and had to temporarily "evict" them to get the room clean. There was so much garbage and dirty underwear in that room it was repulsive.

[BabyLady, BSN, RN]

This is exactly why I dread ever going to an all-private room NICU. How are caregivers supposed to provide care when a parent is there 24/7, sleeping at your feet? We've had a few parents camp out in one of our private rooms and had to temporarily "evict" them to get the room clean. There was so much garbage and dirty underwear in that room it was repulsive.

We work over them. When I need to assess, I walk in, turn on the lights and do what I need to do...my first priority is to the baby, if it wakes up the mother or father, then oh well.

If the situation is emergent, we tell parents to leave the room.

[ittybabyRN, RN]

Interesting...I have never worked anywhere else but I like our private rooms, we don't seem to have any of those issues...no beds in the room tho and limits on numbers of visitors/sleepers so I'm sure that helps, maybe your caregiver meals could be changed into vouchers from the caf and you could eliminate food?

[jwendt]

EKnicuRN,

I would be interested in any policies that your hospital has. We are going to private rooms on May 1, and these are some of our concerns also. We will have a no food or drinks policy for the parents in the rooms. We have the cafeteria and a family waiting room area for that kind of thing.

Any help form anyone about how to nip these issues early on would be greatly appreciated.

Thanks, Jody

[ittybabyRN, RN]

Jody,

I don't know if we have definitive written policies, and I'm not back at work until Friday to check, in the meantime I can give you some general info

1. No food/drink at all (breastfeeding mothers may have water)

2. We have recliners in the rooms for parents, only one parent at the bedside overnight though the other may stay in the in unit family quiet room

3. The room is set up so that when you walk in the nurses area is right when you walk in...nurse server cart with supplies, computer, cabinets w/diapers/bottles etc. The baby is in the crib/isolette up against the center of the wall, the wall has all their oxygen/suction/monitor etc. parent area is in the opposite corner of the room, if they want to recline the chair to sleep they are well of of the way of us needing to get to the baby. And regardless of if they are sleeping I will still turn all the lights on when I need to see the baby and if there is an x-ray coming I will wake the parents up and either make sure they leave or cover them with the lead apron

4. I have yet to see any issues with parents stuff gathering in the rooms, generally if they have stuff they tend to keep it neat and out of the way & usually they don't have much, we don't encourage parents leaving a lot of stuff because babies do occasionally get moved around and we wouldnt want to leave anything behind, we also have lots of cabinets on the parents side if they want to store blankets/clothes etc

5. Parents are allowed to be present in emergency situations as long as they dont get in the way, if a baby is coding we try to make sure someone is designated to be with the parents whether social worker, nurse or PSA, if they are getting to emotional (screaming/rolling on the floor) then the person designated to them will escort them to a nearby consult room

Hope that helps, if I find a written policy I will let you know but I'm not sure what exists (I am relatively new to the unit)

[nicunursenikki]

We are all private room and parents literally move in. We have mini fridges in each room for breastmilk, but parents are allowed to also store their food in their as well. We have a bed and a recliner for sleeping. There are private full bathrooms in each room. The rooms get stinky! Parents bring bouncer chairs, swings, radios, ect in the rooms.

I would LOVE a policy stating what is expected of parents when they stay. We do have signs posted saying a light will be on, doors will remain open, but some nurses let it go and close doors, lights off, ect. A few months ago we had a babe on a vent and because the RN didn't want to wake the parents she had all lights off, well instead of bumping the FiO2, she bumped up the PEEP, nothing happened to the babe, but the email that went out from the manager regarding this was to remember to bring in a flash light to adjust vent settings if lights are of... ***!? was my reaction to that. We are an ICU not a Hilton.

[ittybabyRN, RN]

We do not have bathrooms for the parents in the rooms either, there are visitor bathrooms on the unit but not in rooms. Parents make bring bouncy chairs for bigger babies that its appropriate for, we have fridges/freezers in the room for breastmilk but nothing else, they are cleared out daily and extra breastmilk that will not be used for that shift is moved to our large deep freezer

[iyqyqr]

We just moved into our new all private room NICU the end of last year. We have a couch along one wall that converts to a twin bed and a recliner in each room, so both parents can stay all night, if they choose, with their baby. There are drawers beneath the couch for pillows/bedding; theirs or what we supply from our linen cart. The fridge in each room is for breastmilk only. We have bathrooms for parents on the floor and they can go to a parent respite area on another floor for showers. Statistics show that only about 10% of parents regularly stay all night and that has been about the case for us. A curtain on casters closes off the parent area from the part of the room the baby is in. Another curtain closes off the entire room for more privacy and each room also has a sliding glass door that can be fully closed. Our monitors are wired to pagers to alert us to desats/bradys, but even with that the curtain must be open enough to allow us to visualize the baby's monitor from outside the room. My goal is to practice 'family-centered care' so I am respectful of the parent's need for rest. I know from personal experience how stressful and exhausting it can be to have a child hospitalized and be there with them 24/7. I work 7p-7a so I do my baths/bed changes and stocking early in my shift. I respond ASAP to my feeding pumps alarms and other alarms and sometimes, with mom's who are recently post C-section and learning to breastfeed, I feel I am swamped doing mother-baby care. Our usual assigments are 3 pts to one nurse, unless the baby is extra critical, then it will be 2:1. There is definitely more customer service required, but sometimes this is balanced out by parents who actively particpate in most of the care. We do have parents who do cares during the day, and opt to sleep through the night and then we wish they would just go home, if they live locally, and get a good night's rest. It is hard to not feel like their personal babysitter.

We have not had odors related to family, but sometimes when the door is closed and the baby is on Neosure or some special formula, the odors from those diapers in the closed room take your breath away. Our wastebaskets are emptied on days.

On a real busy night with kids that desat often and 1-2 families who stay all night, I feel I have 5 patients; my three babies, the pager that needs constant silencing and messages cleared, and the parents and their needs. It can be overwhelming, but it is not the norm day in and out. Best of luck in your new units.