Problem Scenario
A new born Native American female infant was admitted to the neonatal intensive care unit the same day the mother had delivered the baby. Infant’s data indicated that she had low birth weight. As per records, the infant was a prematurely born baby and was admitted to the neonatal intensive care unit due to low birth weight. The infant’s gender, birth date, birth weight, sex, gestational age was included in the records.
The infant had not undergone any surgical procedures but was immediately put on the ventilator. At birth, the infant appeared to have a normal body temperature and slight variation in skin color. After a 3 day normal stay in the NICU, the nurse noticed fluid from the infant’s eye. Doctors diagnosed an eye infection. Hospital infections are the primary cause of infections among infants in NICUs (Caglar et al., 2010). Infants are prone to developing infections rather quickly due to their low birth weights and reduced immunity levels (Caglar et al., 2010).
According to the nurse’s observation, the infant had been handled by the mother for feeding. However, due to the inability to suck appropriately, the mother had requested an external feed to suffice the infant. Another nurse had provided the mother with a breast pump so that the mother could extract milk and feed the baby. When questioned, the mother informed that the nurse was very busy and had not washed her hands before supplying the pump.
The nurse had however washed and sterilized the pump before giving it to the mother. The hand hygiene protocol which necessitates washing the hands using disinfectant or scrubbing with an alcohol based scrub had clearly not been followed. According to the CDC (2002), it is imperative for hand-washing to be done in a hygienic manner. The mother also informed that she noticed not all nurses wash their hands in between treating and handling the babies. Research confirms that organisms which cause nosocomial infections in NICUs are most likely to be transferred by nurses, physicians or other hospital personnel (Lam et al., 2004).
Hand hygiene has been identified as a major factor in preventing nosocomial infections (Lam et al., 2004). The CDC (2002) clearly recommends guidelines and measure indicating the importance of washing hands before and after contact with every patient. Clearly, the infection due to the transmission of the virus could have been prevented or avoided with the use of appropriate hand wash techniques and procedures by the nurses.
Problem
Healthcare associated infections are a major cause of deaths of infants in neonatal intensive care units (NICUs) (Caglar, Yildiz & Savaser, 2010). Lam, Lee & Lau (2004) affirm that infants in NICUs are prone to high levels of healthcare associated infections. In their study of a NICU of a university teaching hospital in Thailand, Picheansathian, Pearson & Suchaxaya (2008) found that the intensive care units had the highest rates of infection to the tune of 6.4%. Infants in the NICU are weak due to low body weight and a weak immune system. NICU infants are also exposed to several hospital procedures and could have diseases from birth which makes them more susceptible to infections. Inadequate measures taken to prevent these infections could prove to be fatal for NICU infants who may not be able to fight these infections.
Lack of compliance to hand hygiene by healthcare professionals increases the risk of infections among NICU infants. Poor compliance to hand-hygiene practice if a major reason for the transmission of healthcare associated infection and pathogens (CDC/HICPAC, 2002). Research confirms that hand hygiene is the most effective and cheapest measure for preventing healthcare associated infection (Calgar et al., 2010; Lam et al., 2004).
Intervention
Washing of hands with an antiseptic soap and following up with a sanitizer is an effective way of reducing the risk of infections when treating infants from the neonatal intensive care units. Compliance to hand hygiene is the most appropriate way to prevent healthcare associated infections in NICUs. Thorough washing of hands before and after handling infants in the NICU will remove the pathogens and bacterial infections acquired during the treatment. Since the defense mechanisms of the infants in the NICU are immature, it is important to remove any nosocomial infections which may occur due to proximity to other patients (Lam et al., 2004).
Hand hygiene refers to cleaning the hands using soap and water or an antiseptic alcohol or iodine based hand rub to remove bacterial infections and pathogens (CDC/HICPAC, 2002). Using an alcohol based hand rub is preferred over washing with soap and water since it is quick and saves time. When using alcohol based solutions, it is important for healthcare workers to cover all parts of the hands and rub the solution until it dries; failure to do so will result in incomplete hand hygiene and incomplete removal of infectious bacteria and pathogens (Picheansathian et al., 2008).
Comparison Intervention
Healthcare workers who wash their hands with an antiseptic before and after handling an infant are less likely to pass on healthcare associated pathogens as compared to those who don’t wash their hands (CDC/HICPAC, 2002). Studies indicate that using an antiseptic to wash hands reduces healthcare infection rates as compared to washing hands with plain soap and water. Washing hands with plain soap fails to remove pathogens from the hands of the healthcare worker (CDC/HICPAC, 2002). On the contrary, it could increase the bacterial count on the skin, cause irritation and dryness and contaminate the skin due to previous use (CDC/HICPAC, 2002).
The use of alcohol based antiseptics is preferred over normal soap and water. Using an alcohol based scrub is more effective that using plain soap and water to reduce the risk of nosocomial infections in NICU infants. This is because alcohol based solutions are more effective antiseptics due to their chemical content of isopropanol, ethanol, n-propanol or a combination of any 2 of these compounds (CDC/HICPAC, 2002).
There is a clear indication that the higher frequency of hand washing both before and after contact with the patient is associated with reduced infections. Personnel could use an antiseptic hand wash or an alcohol based hand rub to clean their hands. Using an alcohol based hand rub is preferred when personnel are in a hurry or when their hands were not visibly soiled. Using an antiseptic hand wash removes visible soiling (Picheansathian et al., 2008).
Outcome
Hands are the primary means of transfer of bacterial infections and pathogens in hospital settings (Calgary et al., 2010; Lam et al., 2004; Picheansathian et al., 2008). Washing hands with an antiseptic or an alcohol rub is the ideal, most effective and cheapest way of preventing infections. Data and several studies point to the effectiveness of hand hygiene is preventing reducing infections and associated risks (CDC/HICPAC, 2002; Picheansathian et al., 2008). Appropriate adherence and compliance to hand hygiene will ensure the reduced rate of infection among NICU infants who have a weak immunity.
Time
Healthcare associated infection can occur at the time of admission or by coming into contact with healthcare personnel for treatment in the NICU. The infant could be exposed to risk of infection when placed in contact with other infants or while being handled by the mother or other relative.
PICOT Question Statement
In Neonatal intensive care unit infants (P) will the use of alcohol rubs and sanitizers (I) compared to soap and water (C), reduce the possibility of infection (O) during care and treatment in the neonatal intensive care unit of the hospital (T)?
References
Caglar, S., Yildiz, S., & Savaser, S. (2010). Observation results of handwashing by health-care workers in a neonatal intensive care unit. International Journal Of Nursing Practice, 16 (2), 132-137.
Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) (2002). Guideline for Hand Hygiene in Health-Care Settings. Web.
Lam, B., Lee, J., & Lau, Y. (2004). Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics, 114(5), e565-71.
Picheansathian, W., Pearson, A., & Suchaxaya, P. (2008). The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. International Journal Of Nursing Practice, 14(4), 315-321.