MARY JEAN N. FAJARDO

PAST PRESIDENT and ADVISER

A medical specialty concerned with the care and treatment of mother

and infant immediately prior to, during, and following birth.

HOST RISK FACTORS FOR INFECTION IN

NEW BORNS:

Low birth weight

Acuity (insight) of underlying illness

Immature immune system

Permeable skin

Vertical transmission, known as mother-to-child transmission, is the

transmission of an infection during pregnancy or parturition (child

bearing).

Congenital Infections – infection of the newborn that is acquired in

utero and is present at birth.

Infections Acquired During Parturition :

• Newborns may be colonized or infected by microorganisms acquired

during the delivery

• Microorgs found in the maternal birth canal may result in infection of

the newborn based on the pathogenecity of the microorgs and the

susceptibility of the newborn.

Risk factors for HAI acquisition includes:

• Exposure to invasive devices

• Exposure to broad-spectrum antibiotics

• Over-crowding

• Poor staffing ratios

Routine Practices in Perinatology

Routine practices – refers to the infection prevention & control

practices that are to be used with all patients during all care, to

prevent and control transmission of microorganism in all health care

settings.

Basic Elements:

• Risk assessment

• Hand Hygiene

• Environmental controls

• Administrative controls

• Personal protective equipment (PPE)

Risk Assessment - is applied before every interaction with the mother

or newborn, throughout the continuum of care (antenatal, care at birth,

postnatal and newborn care).

Based on the result of risk assessment:

• Interventions and barriers may be put into place to reduce one’s risk

of acquiring or transmitting infection

• Hand Hygiene and the FIVE MOMENTS are always required, the

risk assessment may indicate that extra barriers be put into place.

Examples:

• exposure of hands WEAR GLOVES

• exposure of clothing or forearms WEAR A GOWN

• exposure to mucous membranes of the eyes, nose, mouth

WEAR A MASK OR EYE PROTECTION

• exposure to contaminated equipment or surfaces

WEAR GLOVES and POSSIBLY GOWN

HAND HYGIENE – single most important and effective Infection

Prevention and Control measure to prevent the spread of Health

Care Associated Infections (HCAI).

Effective Hand Hygiene is reflected by the Five Moments:

1. BEFORE initial contact with each patient or their environment

2. BEFORE performing an aseptic procedure

3. AFTER care involving body fluid exposure risk

4. AFTER contact with the patient

5. After contact with patient surroundings

For purposes of Hand Hygiene, three distinctive

environments in the NICU:

NICU Environment

Clean hands at initial entry

IMMEDIATE CARE ENVIRONMENT

Clean hands on each entry into the space and on

leaving the space

NEONATE ENVIRONMENT

Clean hands at each entry to the space

Personnel Protective Equipment (PPE)

-worn to prevent transmission of microorganisms from patient-to-

patient, from patient-to-staff and from staff-to-patient, by placing a

barrier between the potential source of infection and one’s own

mucous membranes, airways, skin and clothing.

- Gloves, Gowns, Facial protection, Eye protection, Mask (N95

respirator as needed)

Environmental Cleaning

- Integral to the safety of mothers, newborns, staff and visitors.

• Frequency of cleaning (cleaning and disinfection) – routine and

consistent

Products that leave no toxic residues should be selected for

cleaning and disinfecting newborn areas and equipment.

Provincial Infectious Diseases Advisory

Committee (PIDAC) Recommendations on

Cleaning:

• Clean labour and birthing rooms after each patient AND additionally

as required

• Clean well baby observation areas at least daily AND additionally as

required

• Clean mother’s room at least once daily AND additionally as

required

• Clean NICU at least twice per day AND additiionally as required

• Clean isolettes/warmers according to a schedule AND additionally

as required

• Terminally clean NICU isolettes/warmers and environment on

discharge of the newborn

• Terminally transport equipment after each newborn transport

Frequent audits of practice should be included as part of the

organization’s resposibility for maintaining a clean

environment.

Milk Preparation Areas

• Should be separate and not used for other purposes

• These areas may become contaminated and must be cleaned

daily and between the preparations of milk from different mothers

• Refrigerators and freezers used for breast milk should have a

regular cleaning schedule and must not be used for preparing or

storing other items such as food, specimens or medications.

Birthing Pools, Tubs and Tanks

• Remove parts in contact with contaminated water for cleaning and

disinfection

• Drain equipment after each use

• Thoroughly clean all surfaces and removable parts of the

equipment

• Disinfect surfaces and removable parts with a chemical germicide

and disinfection method recommended by the equipment

manufacturer

LINEN

• Newborn care items should be cleanable or disposable

• Items that are laundered in-house must be laundered according to

established standards and best practices

Clean Linens:

• Transported, sorted and stored in a manner that prevents

contamination

• Handled only by staff with clean hands

• Stored out of the path of normal traffic in a clean, dry area

• Stored in a manner that allows stock rotation

WASTE

• Segregated at a point where it was generated into either a plastic bag or

a rigid container with a lid

• Double-bagging of waste should only be necessary if the first bag

become stretched or damaged, or when waste has spilled on the exterior

• Waste bag are closed when three quarters full and tied in a manner that

prevents contents from escaping

• Soiled diapers are disposed immediately into a covered receptacle

EQUIPMENT REPROCESSING

• Reusable Medical Equipment must be cleanable and be able to be

disinfected or sterilized.

READMISSION or TRANSFER of

MOTHERS/NEWBORNS

• Transfer in-Mothers from other hospitals should be screened for

antibiotic-resistant organisms (ARO)

• Transfer Out-Mothers:

Receiving facilities should be notified about any known infection,

colonization or exposure.

• Transfer In-Newborns:

Receiving sites should screen newborns that are transferred in for

the presence of ARO and consider putting the newborn on additional

precautions until results are known, depend on the assessed level of

risk

Transfer Out- Newborns:

• When an exposure/cluster/outbreak has been identified in a nursery,

hospitals should promptly notify receiving unitsof newborns that

were transfered and that may have been exposed.

FAMILIES and VISITORS

• Visitation policies should be flexible but safe

• Parents should be encouraged to spend as much time with their

newborns

• Family members and others should not visit with S/S that are

possible infectious in etiology:

> fever

> cough or influenza-like symptoms

> runny nose

> vomiting or diarrhea

> rash

> conjunctivitis