Addendum for Infection Prevention and Control within Neonatal Settings (NNU)
The purpose of this addendum is to provide additional guidance to chapters 1,2 and 3 for NNUs.
For COVID specific IPC guidance please refer to Appendix 21.
Clinicians must consider the possibility of infection associated with other respiratory pathogens spread by the droplet or airborne route. Therefore Transmission Based Precautions (TBPs) should not be automatically discontinued where COVID-19 has been excluded.
Any patient who has a coinfection with COVID-19 must not be cohorted with other COVID-19 patients.
4.1 Placement of neonates/assessment for infection risk
Undertake assessment for infection risk at the point of entry into the unit before placement of the neonate is decided. This assessment is the minimal microbiological testing required and any additional testing would be determined by the clinical presentation of the neonate. The potential for transmission of infection should be continuously reviewed throughout the stay/period and must be documented in the clinical notes.
Neonates who present as a cross infection risk include those who:
- have been transferred from another unit in Scotland with an ongoing incident/outbreak or
- were born outside Scotland
- have previously been positive with a Multidrug Resistant Organism (MDRO), or any alert organism or alert condition as found in Appendix 13.
From mothers who have:
- been hospitalised outside Scotland in the previous 12 months
- had no antenatal care
- been previously positive with a MDRO e.g. Meticillin Resistant Staphylococcus Aureus (MRSA) or Carbapenemase Producing Enterobacterales (CPE)
If a neonate is considered to be a cross infection risk then the clinical judgement of those involved in the management of the baby should assess the placement by prioritising the incubator/cot in a suitable area pending investigation i.e. place in a single room or cohort area/room with a wash hand basin.
Information/advice must be given to parents/carers of all neonates; particularly during outbreaks/incidents
4.2 Healthcare infection, incidents, outbreaks and data exceedance
In addition to the definitions in Chapter 3, in a neonatal unit investigation by IPCT is also required if:
- a single case of Pseudomonas aeruginosa is identified
- a single case of infection with an alert organism is identified
- two or more cases of colonisation with the same organism; linked in time and place are identified
Additionally, the local IPC team should consider the possibility of any onward transmission and potential for an incident/outbreak where there is:
- A single case of colonisation with an alert organism identified
Assigning a dedicated team to care for infected or colonised neonates may also be required. During outbreaks or incidents the ratio of staff to neonates may need to increase and it may be necessary to restrict admissions to the area. Prior to closing or restricting a neonatal unit, communication must be agreed across neonatal services and risk assessed.
Transfers to other units during incidents or outbreaks should be avoided, where possible; however this should take into consideration the clinical needs of neonates, and any practical or logistical issues for parents/carers.
4.3 Personal care of neonates
Due to the vulnerability of some neonates the use of tap water for personal care requires consideration and this is outlined in Guidance for neonatal units (NNUs) (levels 1, 2 & 3), adult and paediatric intensive care units (ICUs) in Scotland to minimise the risk of Pseudomonas aeruginosa infection from water. For example, an assessment should be made on the neonate’s condition and whether tap water can be used or if an alternative, such as sterile water, is considered more appropriate.
In addition incubators/cots should not be placed near any water source where spraying or splashing may occur.
Further information for neonatal IPC management of healthcare incidents and outbreaks can be found in the supporting literature review.
Quality improvement tools provide short practice points which when followed correctly can help reduce HAIs and improve patient safety.
These quality improvement tools are based on scientific literature reviews and practice recommendations from ARHAI Scotland.
Materials including posters are available for the following procedures/situations: