Personal hygiene

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Authors

Lausten-Thomsen U, Helder O, Tissières P, Mader S, Thiele N, Ares S

Click on the image to read the standard in brief.

Target group

Infants, parents, families, and healthcare professionals

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

High personal hygiene standard is ensured to reduce the risk of nosocomial infections.

Rationale

Personal carriage of pathogens places infants at risk for nosocomial infections. The risk is increased because of immature host defences and frequent invasive procedures, which in turn increases the risk of mortality, morbidity, and prolonged hospital stay. (1–4) Apart from hand carried contamination (5,6), several other potential sources for personally carried pathogens among healthcare professionals, parents and families have been identified, including clothing/textiles (7,8), personal jewellery (9,10), artificial fingernails (11), personal electronic devices (10,12), and contagious diseases, e.g. human respiratory syncytial virus. (13) Implementation of standardised hygiene protocols reduces the bacterial burden in the NICU environment, and subsequently the risk of sepsis. (14) (see Patient safety & hygiene practices)

Benefits

Short-term benefits

Long-term benefits

Components of the Standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

  1. Parents and family are informed and instructed by healthcare professionals about personal hygiene, personal clothing, and use of electronic personal devices to reduce the risk of nosocomial infections.

B (Moderate quality)

Patient information sheet1, training documentation

  1. Parents are asked to instruct the own family and relatives to apply NICU hygiene guidelines.

B (Moderate quality)

Parent feedback

  1. Fingernails are kept clean and short and artificial nails are not used. (11)

A (Moderate quality)

Guideline

  1. Strict adherence to local infections control politics (such as proper hand hygiene) practices are followed when electronic devices are handled. (10,12) (see Patient safety & hygiene practices)

A (Moderate quality)

Guideline

For healthcare professionals

  1. Healthcare professionals are informed and instructed about personal hygiene, personal clothing, and use of electronic personal devices to reduce the risk of nosocomial infections.

B (Moderate quality)

Guideline

  1. A unit guideline on personal hygiene is adhered to by all healthcare professionals.

B (Moderate quality)

Guideline

  1. Healthcare professionals are encouraged to identify poor practice.

B (Moderate quality)

Audit report2, training documentation

  1. Fingernails are kept clean and short and artificial nails are not used. (11)

A (Moderate quality)

Guideline

  1. Strict adherence to local infections control politics (such as proper hand hygiene) practices are followed when electronic devices are handled. (10,12) (see Patient safety & hygiene practices)

A (Moderate quality)

Guideline

  1. Single use of non-sterile gloves, gown, and mask is ensured:
    • in case of infectious diseases
    • non-sterile gloves are worn when in contact with blood, mucous membranes, non-intact skin or other potentially infectious materials. Gloves are worn and changed according to the WHO “5 moments of handy hygiene”. (15) (see Patient safety & hygiene practices)

B (Moderate quality)

Guideline

For neonatal unit

  1. A unit guideline on personal hygiene, uniforms, jewellery and use of personal electronic devices is available and regularly updated. (9,10)

A (Moderate quality)
B (High quality)

Guideline

  1. Local uniform regulations are applied (indoor washable shoes, short sleeved uniform changed daily and when soiled, hair short or kept away from the patient). (8,16)

A (Moderate quality)
B (Moderate quality)

Guideline

For hospital

  1. The NICU is incorporated alongside each individual hospital’s infection control guidelines and the products they choose to use.

A (Moderate quality)
B (Moderate quality)

Guideline

  1. Access to showers in the NICU is ensured for parents, family, and staff. (see NICU design)

B (Moderate quality)

Guideline

For health service

  1. A national guideline on personal hygiene including hand hygiene, washing and shower facilities, uniforms is available and regularly updated. (see Patient safety & hygiene practices)

B (Moderate 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

  • Focus future interventions on newborn infants ≤1000 g birth weight, in whom infection rates are higher. (17)

A (Moderate quality)

  • Report compliance to personal hygiene guideline.

B (Moderate quality)

For hospital

  • Audit adherence to protocol regularly including a combination of staff education, promotion hand hygiene, and performance monitoring with regular feedback in order to promote/maintain a high level of hygiene.

A (Low quality)
B (Low quality)

For health service

N/A

Getting started

Initial steps

For parents and family

  • Parents and family are informed and instructed by healthcare professionals about personal hygiene, personal clothing, and use of electronic personal devices to reduce the risk of nosocomial infections.

For healthcare professionals

  • Healthcare professionals are informed and instructed about personal hygiene, personal clothing, and use of electronic personal devices to reduce the risk of nosocomial infections.
  • Monitor nosocomial infection rates.

For neonatal unit

  • Develop and implement a unit guideline on personal hygiene.
  • Develop information material on personal hygiene for parents and family.
  • Promote adherence to hand hygiene protocols to prevent healthcare-associated infections.
  • Measure compliance on regular base.
  • Educate healthcare personnel about the importance of hand hygiene for infection prevention, reminders, and adherence surveillance with feedback of results to frontline providers in hand hygiene adherence programmes.
  • Develop inter-professional awareness by educating all healthcare professionals and family on preventing personal carried contamination/transmission of nosocomial agents: include medical, nursing, laboratory, and maintenance personnel, students, volunteer staff, visitors, and families.

For hospital

  • Promote adherence to hand hygiene to prevent healthcare-associated infections.

For health service

  • Develop and implement a national guideline on personal hygiene.

  1. The Canadian Neonatal Network, Aziz K, McMillan DD, Andrews W, Pendray M, Qiu Z, et al. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr [Internet]. 2005 Dec [cited 2018 May 17];5(1). Available from: http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-5-22
  2. Donovan E, Sparling K, Lake M, Narendran V, Schibler K, Haberman B, et al. The Investment Case for Preventing NICU-Associated Infections. Am J Perinatol. 2012 Jul 26;30(03):179–84.
  3. Rogers E, Alderdice F, McCall E, Jenkins J, Craig S. Reducing nosocomial infections in neonatal intensive care. J Matern Fetal Neonatal Med. 2010 Sep;23(9):1039–46.
  4. Kilbride HW, Wirtschafter DD, Powers RJ, Sheehan MB. Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics. 2003 Apr;111(4 Pt 2):e519-533.
  5. Pessoa-Silva CL, Hugonnet S, Pfister R, Touveneau S, Dharan S, Posfay-Barbe K, et al. Reduction of Health Care Associated Infection Risk in Neonates by Successful Hand Hygiene Promotion. PEDIATRICS. 2007 Aug 1;120(2):e382–90.
  6. Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ. 2015 Jul 28;h3728.
  7. Pittet D. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach. Emerg Infect Dis. 2001 Apr;7(2):234–40.
  8. Mitchell A, Spencer M, Edmiston C. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. J Hosp Infect. 2015 Aug;90(4):285–92.
  9. Hoffman PN, Cooke EM, McCarville MR, Emmerson AM. Micro-organisms isolated from skin under wedding rings worn by hospital staff. Br Med J Clin Res Ed. 1985 Jan 19;290(6463):206–7.
  10. Saxena S, Singh T, Agarwal H, Mehta G, Dutta R. Bacterial colonization of rings and cell phones carried by health-care providers: are these mobile bacterial zoos in the hospital? Trop Doct. 2011 Apr;41(2):116–8.
  11. McNeil SA, Foster CL, Hedderwick SA, Kauffman CA. Effect of Hand Cleansing with Antimicrobial Soap or Alcohol-Based Gel on Microbial Colonization of Artificial Fingernails Worn by Health Care Workers. Clin Infect Dis. 2001 Feb 1;32(3):367–72.
  12. Ulger F, Dilek A, Esen S, Sunbul M, Leblebicioglu H. Are healthcare workers’ mobile phones a potential source of nosocomial infections? Review of the literature. J Infect Dev Ctries. 2015 Oct 29;9(10):1046.
  13. Heerens AT, Marshall DD, Bose CL. Nosocomial Respiratory Syncytial Virus: A Threat in the Modern Neonatal Intensive Care Unit. J Perinatol. 2002 Jun;22(4):306–7.
  14. Rohde A, Hammerl JA, Appel B, Dieckmann R, Al Dahouk S. FISHing for bacteria in food – A promising tool for the reliable detection of pathogenic bacteria? Food Microbiol. 2015 Apr;46:395–407.
  15. World Health Organization (WHO). Five moments for hand hygiene [Internet]. 2006. Available from: http://www.who.int/gpsc/tools/Five_moments/en/
  16. Bearman G, Bryant K, Leekha S, Mayer J, Munoz-Price LS, Murthy R, et al. Healthcare Personnel Attire in Non-Operating-Room Settings. Infect Control Hosp Epidemiol. 2014 Feb;35(02):107–21.
  17. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-Onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network. PEDIATRICS. 2002 Aug 1;110(2):285–91.

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Lausten-Thomsen U, Helder O et al., European Standards of Care for Newborn Health: Personal hygiene. 2018.

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