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Overview

Infants admitted to a neonatal intensive care unit are extremely vulnerable and thus at a high risk of being harmed by lapses in quality or safety. Hygiene is an additional major issue in the NICU, as pathogen contamination of surfaces in neonatal wards and hand carriage of pathogens are associated with nosocomial infections. Continuous improvement of patient safety and hygiene is therefore an important component of high-quality care and requires an appropriate system of specific procedures, including identification of gaps, and reporting of these to facilitate learning from safety, hygiene, and quality issues. To ensure the highest possible level of hygiene and safety, the development of care bundles for common healthcare procedures, including cleaning guidelines, is essential. (1,2) Safety hazards emanating from human beings like staff and parents should be minimised by personal and hand hygiene guidelines. (3,4) Finally, patient screening for resistant bacteria as part of infection prevention should be a strategy to avoid risks emanating from the patients themselves. (5,6)

With regards to medical equipment (e.g. monitors, cannulas) knowledge in their use, interpretation of values, as well as cleaning procedures, are respective patient safety measures. (7) To prevent medication errors and potential adverse drug events, correct drug calculation and prescription should be achieved by electronic support during drug prescription and preparation. (8,9) To ensure a high quality of care and improve care where gaps are present, monitoring and reporting of errors regarding safety issues in a blame-free error culture is crucial to facilitate awareness. (10) The ratio of appropriately trained nurses needs to be present has to be defined, taking into account the level of care infants in this unit need. (11,12)

The Topic Expert Group on Patient safety and hygiene practice develops standards related to the prevention of healthcare-associated infections and thus antibiotic resistance by dealing with a holistic concept for patient safety and hygiene practice.

Source

  1. Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR. 2003;52(No. RR-10):1–48.
  2. Simpson CD, Hawes J, James AG, Lee K-S. Use of bundled interventions, including a checklist to promote compliance with aseptic technique, to reduce catheter-related bloodstream infections in the intensive care unit. Paediatr Child Health. 2014 Apr;19(4):e20-23.
  3. Helder OK, Brug J, Looman CWN, van Goudoever JB, Kornelisse RF. The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an intervention study with before and after comparison. Int J Nurs Stud. 2010 Oct;47(10):1245–52.
  4. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010 Mar;31(3):283–94.
  5. Milstone AM, Song X, Coffin S, Elward A, Society for Healthcare Epidemiology of America’s Pediatric Special Interest Group. Identification and eradication of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit: results of a national survey. Infect Control Hosp Epidemiol. 2010 Jul;31(7):766–8.
  6. Popoola VO, Budd A, Wittig SM, Ross T, Aucott SW, Perl TM, et al. Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention. Infect Control Hosp Epidemiol. 2014 Apr;35(4):412–8.
  7. Mattox E. Medical devices and patient safety. Crit Care Nurse. 2012 Aug;32(4):60–8.
  8. Antonucci R, Porcella A. Preventing medication errors in neonatology: Is it a dream? World J Clin Pediatr. 2014 Aug 8;3(3):37–44.
  9. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001 Apr 25;285(16):2114–20.
  10. Haraden C, Staines A. The Journey to Improve Patient Safety across the Continuum: International Forum on Quality and Safety in Healthcare. In London; 2015.
  11. British Association of Perinatal Medicine (BAPM). Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their Medical Staffing. A Framework for Practice [Internet]. 2014. Available from: https://www.bapm.org/resources/optimal-arrangements-neonatal-intensive-care-units-uk-including-guidance-their-medical
  12. Gemeinsamer Bundesausschuss. Qualitätssicherungs-Richtlinie Früh- und Reifgeborene – QFR-RL [Internet]. 2018. Available from: https://www.g-ba.de/informationen/richtlinien/41/

Standards

Central venous catheter infection prevention

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Environmental hygiene in the NICU

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Hand hygiene

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Monitoring errors

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Nurse staffing in neonatal intensive care

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Patient safety and quality awareness in neonatal intensive care

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Patient screening for resistant bacteria

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Personal hygiene

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Prevention of medication errors in NICU patients

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Prevention of necrotising enterocolitis (NEC)

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Prevention of ventilator associated pneumonia

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Safe equipment use

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Vascular access

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