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Environmental hygiene in the NICU

Authors

Janota J, Tissières P. Helder O, Thiele N, Ares S

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

High standards of environmental hygiene and cleaning are ensured to reduce the occurrence of infection and complications.

Rationale

Neonatal late-onset sepsis is one of the most significant causes of morbidity and mortality mainly among very preterm infants. (1–12) Pathogen contamination of surfaces is a major source of pathogen contamination in neonatal wards. Personal materials such as mobile phones, jewellery are potential sources of contamination. (see TEG Patient safety & hygiene practice) Subsequent hand carriage of pathogens is associated with nosocomial infections.

The implementation of policies covering environmental hygiene, incubator cleaning, cleaning of devices (e.g. monitors and probes) has been shown to decrease the risks of spreading bacteria. The widespread use of disposable (single use) devices and materials may further improve the hygiene standards and decrease the occurrence of microbial contamination. (1,3,10,13–18)

Benefits

Short-term benefits

  • Reduced number of infections (2,3,6,11,19)
  • Reduced length of NICU stay (20)
  • Reduced healthcare costs (3,7,20)

Long-term benefits

  • Earlier discharge and reduced stress for families (20)
  • Reduced exposure to antibiotics (11,21,22)
  • Improved neurodevelopmental outcome (3,19,21)
  • Reduced healthcare costs (20)

 

Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family    
1. Parents and family are informed by healthcare professionals about the hygiene and personal items policy, why it is required and what is involved (e.g. jewellery, mobile phone). (3,7,23) (see TEG Patient safety & hygiene) A (Moderate quality)
B (High quality)
Patient information sheet
       
2. Parents are asked by healthcare professionals to instruct the own family and relatives to apply NICU hygiene guidelines. (see TEG Patient safety & hygiene) B (Moderate quality) Parent feedback
       
For healthcare professionals    
3. A unit guideline for hygiene including specified methods and schedules for cleaning of surface and equipment is adhered to by all staff. B (High quality) Guideline
       
4. Training on environmental hygiene policy and identification of poor practice is attended by all staff. (3,7) A (Moderate quality)
B (High quality)
Training documentation
       
5. Training on cleaning on yearly basis is attended by all responsible staff. B (High quality) Training documentation
       
For neonatal unit    
6. A unit guideline for hygiene including specified methods and schedules for cleaning of surface and equipment is available and regularly updated. (3,14–18,24–26) A (Moderate quality)
B (High quality)
Guideline
       
7. A schedule of cleaning procedures and their monitoring is continuously available. (3,15–17,25,26) A (Moderate quality) Audit report
       
8. An experienced person responsible for environmental hygiene and monitoring is identified. B (Moderate quality) Audit report
       
For hospital    
9. Training on environmental hygiene policy and identification of poor practice is ensured. (3,7,16,17,24) B (High quality) Training documentation
       
10. Training of staff responsible for cleaning is ensured on yearly basis. B (High quality) Training documentation
       
11. The hygiene department supervises and maintains environmental hygiene. B (Moderate quality) Audit report
       
For health service    
12. A national guideline for hygiene including specified methods and schedules for cleaning of surface and equipment is available and regularly updated. B (High quality) Guideline
       

Where to go

Further development Grading of evidence
For parents and family  
N/A  
For healthcare professionals  
N/A  
For neonatal unit  
  • Provide a limited number of dedicated persons for the cleaning of the unit.
B (Moderate quality)
For hospital  
  • Provide a limited number of dedicated persons for the cleaning of the unit.
B (Moderate quality)
For health service  
N/A  
   

Getting started

Initial steps
For parents and family
  • Parents and family are verbally informed by healthcare professionals about the hygiene and personal items policy, why it is required and what is involved (e.g. jewellery, mobile phone).
For healthcare professionals
  • Attend training on environmental hygiene policy and identification of poor practice.
For neonatal unit
  • Develop and implement a unit guideline for environmental hygiene including instructions and schedules for the cleaning of specific items of equipment.
  • Develop information material on hygiene and personal items policy for parents and family.
  • Monitor nosocomial infection rates.
For hospital
  • Support healthcare professionals to participate in training on environmental hygiene policy and identification of poor practice.
For health service
  • Develop and implement a national guideline for hygiene including specified methods and schedules for cleaning of surface and equipment.
  • Develop hygiene education programmes for healthcare professionals.
 

Sources

  1. Boghossian NS, Page GP, Bell EF, Stoll BJ, Murray JC, Cotten CM, et al. Late-Onset Sepsis in Very Low Birth Weight Infants from Singleton and Multiple-Gestation Births. J Pediatr. 2013 Jun;162(6):1120-1124.e1.
  2. Cohen B, Saiman L, Cimiotti J, Larson E. Factors associated with hand hygiene practices in two neonatal intensive care units. Pediatr Infect Dis J. 2003 Jun;22(6):494–9.
  3. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 2002 Oct 25;51(RR-16):1–45, quiz CE1-4.
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  10. Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK, et al. Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J. 2009 Dec;28(12):1052–6.
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  13. Renfrew MJ, McLoughlin M, McFadden A. Cleaning and sterilisation of infant feeding equipment: a systematic review. Public Health Nutr [Internet]. 2008 Nov [cited 2018 May 8];11(11). Available from: http://www.journals.cambridge.org/abstract_S1368980008001791
  14. White RD, Smith JA, Shepley MM, Committee to Establish Recommended Standards for Newborn ICU Design. Recommended standards for newborn ICU design, eighth edition. J Perinatol. 2013 Apr;33(S1):S2–16.
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  20. Harris BD, Hanson C, Christy C, Adams T, Banks A, Willis TS, et al. Strict Hand Hygiene And Other Practices Shortened Stays And Cut Costs And Mortality In A Pediatric Intensive Care Unit. Health Aff (Millwood). 2011 Sep 1;30(9):1751–61.
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  26. Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013 May;41(5):S12–9.

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Janota J, Tissières P et al, European Standards of Care for Newborn Health: Environmental hygiene in the NICU. 2018.

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