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 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
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 Patient safety & hygiene)
A (Moderate quality) B (High quality)
Patient information sheet1
Parents are asked by healthcare professionals to instruct the own family and relatives to apply NICU hygiene guidelines. (see Patient safety & hygiene)
B (Moderate quality)
Parent feedback
For healthcare professionals
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
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
Training on cleaning on yearly basis is attended by all responsible staff.
B (High quality)
Training documentation
For neonatal unit
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
A schedule of cleaning procedures and their monitoring is continuously available. (3,15–17,25,26)
A (Moderate quality)
Audit report2
An experienced person responsible for environmental hygiene and monitoring is identified.
B (Moderate quality)
Audit report2
For hospital
Training on environmental hygiene policy and identification of poor practice is ensured. (3,7,16,17,24)
B (High quality)
Training documentation
Training of staff responsible for cleaning is ensured on yearly basis.
B (High quality)
Training documentation
The hygiene department supervises and maintains environmental hygiene.
B (Moderate quality)
Audit report2
For health service
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
1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
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.
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.
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.
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.
Pessoa-Silva CL, Dharan S, Hugonnet S, Touveneau S, Posfay-Barbe K, Pfister R, et al. Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol. 2004 Mar;25(3):192–7.
Kane E, Bretz G. Reduction in Coagulase-Negative Staphylococcus Infection Rates in the NICU Using Evidence-Based Research. Neonatal Netw J Neonatal Nurs. 2011 May 1;30(3):165–74.
Kampf G, Löffler H, Gastmeier P. Hand Hygiene for the Prevention of Nosocomial Infections. Dtsch Aerzteblatt Online [Internet]. 2009 Oct 2 [cited 2018 May 8]; Available from: https://www.aerzteblatt.de/10.3238/arztebl.2009.0649
Suchomel M, Kundi M, Pittet D, Rotter ML. Modified World Health Organization Hand Rub Formulations Comply with European Efficacy Requirements for Preoperative Surgical Hand Preparations. Infect Control Hosp Epidemiol. 2013 Mar;34(03):245–50.
Sen R, Keaney M, Trail A, Howard C, Chadwick P. Hand washing. Healthcare workers washed their hands on only a third occasion. BMJ. 1999;21(319(7208)):518.
Rotter ML. Arguments for alcoholic hand disinfection. J Hosp Infect. 2001 Aug;48 Suppl A:S4-8.
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.
Ng PC, Wong HL, Lyon DJ, So KW, Liu F, Lam RKY, et al. Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004 Jul;89(4):F336-340.
Widmer AF. Replace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis Off Publ Infect Dis Soc Am. 2000 Jul;31(1):136–43.
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
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.
Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections: A Technical Brief. Ann Intern Med. 2015 Oct 20;163(8):598.
Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, et al. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2004;
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.
Hansen S, Zingg W, Ahmad R, Kyratsis Y, Behnke M, Schwab F, et al. Organization of infection control in European hospitals. J Hosp Infect. 2015 Dec;91(4):338–45.
Schwab F, Zibell R, Piening B, Geffers C, Gastmeier P. Mortality Due to Bloodstream Infections and Necrotizing Enterocolitis in Very Low Birth Weight Infants: Pediatr Infect Dis J. 2015 Mar;34(3):235–40.
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.
Alexander VN, Northrup V, Bizzarro MJ. Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing Enterocolitis. J Pediatr. 2011 Sep;159(3):392–7.
Janota J, Šebková S, Višňovská M, Kudláčková J, Hamplová D, Zach J. Hand hygiene with alcohol hand rub and gloves reduces the incidence of late onset sepsis in preterm neonates. Acta Paediatr. 2014 Oct;103(10):1053–6.
Celenza JF, Zayack D, Buus-Frank ME, Horbar JD. Family Involvement in Quality Improvement: From Bedside Advocate to System Advisor. Clin Perinatol. 2017 Sep;44(3):553–66.
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet Lond Engl. 2000 Oct 14;356(9238):1307–12.
Bokulich NA, Mills DA, Underwood MA. Surface Microbes in the Neonatal Intensive Care Unit: Changes with Routine Cleaning and over Time. J Clin Microbiol. 2013 Aug 1;51(8):2617–24.
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.
