QUESTIONS AND ANSWERS SECTION

TOPIC: INFECTION CONTROL MEASURES

b) NEONATOLOGY

QUESTIONS AND ANSWERS SECTION

TOPIC: INFECTION CONTROL MEASURES
b) NEONATOLOGY

1. I want to know what care should be provided to the NB of an HIV-

positive mother. Do you bathe him right away? With what? thank you
Newborns of mothers with HIV should be bathed like any other newborn. This is
one of the reasons RNs bathe. Biosafety when in contact with body excretions. RNs
are normally bathed with glycerin soap.

2. In the NICU, for seven units of which have two respirators, how many
nurses should there be?
In neonatal intensive care units, the recommendation is one nurse for two patients,
and depending on the complexity of the patients, it may be necessary to have one
nurse per patient. (1,2)
It should be sufficient to allow adequate care of children and to ensure that they
have the necessary time to wash their hands before and after contact with each
patient.
The importance of having highly trained personnel for the management of high-risk
children should be taken into account as an important measure to avoid both
infectious and other complications.
Bibliography
1. American Academy of pediatrics an American College of Obstetricians and Gynecologists.
Inpatient Perinatal Care Services. In: Hault JC, Merenstein GB. Guidelines for Perinatal Care.
4th ed. 1997:13-50.
2. Bureau of Communicable Disease Epidemiology, Health Protection Branch and Health
Services Directorate. Infection Control Guidelines for Perinatal Care. Ottawa, Canada. 1998.

3. How often are the guide and syringe changed in gastroclysis feeding in
the NICU area?
A summary is attached and it is suggested to expand on this topic in CODEINEP,
INFECTION CONTROL, UPDATE ON INFECTION CONTROL TOPICS, INFECTION
CONTROL IN PEDIATRICS AND NEONATOLOGY.
BREASTMILK
• When breast milk is administered by continuous infusion at room temperature, it
creates a risk of bacterial growth in the syringe or container and in the tubing.
• The syringe and tubing should be changed every 12 hours at most.
• The nasogastric tube should be changed every 7 days.
TRADE FORMULAS
• Administration of continuous closed system feeding should never exceed 8 hours
of infusion.
• The nasogastric feeding administration set should be changed every 24 hours.
Bibliography
• American Academy of pediatrics an American College of Obstetricians and Gynecologists.
Infection Control. In: Guidelines for Perinatal Care. 4th ed. 1997:251-277.
• Moore DL. Nosocomial Infections in Newborn Nurseries and Neonatal Intensive Care Units
in: Mayhall CG. Hospital Epidemiology and Infection Control 2nd ed.1999:665-690.
• Chapman IA. Prevention of Nosocomial Infections in the Neonatal Intensive Care Unit.
Current Opinion in Pediatrics. 2002, 14: 157-164.
• Martin MA. Nosocomial Infections Related to Patient Care Support Services in: Wenzel RP.
Prevention and Control of Nosocomial Infections. 3rd ed. 1997: 647-688.

4. How much should the separation from one incubator to another in a

NICU be?

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 QUESTIONS AND ANSWERS SECTION
TOPIC: INFECTION CONTROL MEASURES
b) NEONATOLOGY
The design of the unit should consider the need to have sufficient space for
patient care and necessary equipment as well as an appropriate number of
accessible handwashing sinks.
There are recommendations from the AAP (American Association of Pediatrics) in
collaboration with ACOG (American College of Obstetricians and Gynecologists, (1)
which establish that a space of 150 square feet (140 m2) is required for neonatal
intensive care units. per infant and at least 6 feet (1.8 meters) between incubators.
There should be a sink for every 3 or 4 patients. Other sources (2,3) suggest a pool
for every 2 patients, located in such a way that the staff does not need to take
more than 8 steps to reach it.
Ventilation should offer positive pressure, with air intake from the ceiling and
exhaust near the floor to eliminate dust; and have filters with an efficiency of at
least 90%(1,3)
The AAC-ACOG recommends a minimum of 6 air changes per hour, while others
(4,3) recommend 10 to 15 air changes per hour.
The unit must have at least one room for isolation of patients with airborne
diseases, with negative pressure. (1)
Bibliography:
1. American Academy of pediatrics an American College of Obstetricians and Gynecologists.
Inpatient Perinatal Care Services. In: Hault JC, Merenstein GB. Guidelines for Perinatal Care.
4th ed. 1997:13-50.
2. Bureau of Communicable Disease Epidemiology, Health Protection Branch and Health
Services Directorate. Infection Control Guidelines for Perinatal Care. Ottawa, Canada. 1998.
3. American Academy of pediatrics an American College of Obstetricians and Gynecologists.
Infection Control. In: Guidelines for Perinatal Care. 4th ed. 1997:251-277.
4. Moore DL. Nosocomial Infections in Newborn Nurseries and Neonatal Intensive Care Units
in: Mayhall CG. Hospital Epidemiology and Infection Control 2nd ed.1999:665-690.

5. I request standards for collecting urine cultures for Neonatology. Thank

you

Urine Cultures in Neonates

Suprapubic bladder puncture and bladder catheterization are the most accurate
methods for performing urine cultures in children under two years of age.
Fundamentally in these children they are safe methods since at that age the
bladder is an abdominal organ and can be easily punctured.

Suprapubic puncture
It must be taken by the doctor
1. Make sure the bladder is full
2. Practice surgical disinfection of the area to be punctured.
3. Take the sample aseptically and place it in a sterile urine culture bottle.
4. Refrigerate immediately. Indicate in the analysis order that the sample was
taken by suprapubic puncture.

Urine obtained through urinary catheter

1. Follow the nursing instructions for changing the urinary catheter.
2. After placing the new catheter, the initial portion of urine is discarded and the
middle portion is collected in a sterile bottle.
3. Refrigerate and send immediately to the Laboratory. Indicate in the analysis
order: Urine by catheterization

6. Hello, my question is to ask for some type of recommendation on which

enzymatic detergent can be used to clean incubators in neonatology.
Currently we use for cleaning materials the
Adox Dm3 detergent but we do not use it in the neo. Thank you so much.
Silvia Neirot, Enf. Viedma Hospital, Río Negro, Argentina.

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 QUESTIONS AND ANSWERS SECTION
TOPIC: INFECTION CONTROL MEASURES
b) NEONATOLOGY
The recommendation for cleaning the incubators in use is found on the CODEINEP
website, in the INFECTION CONTROL, INFECTION PREVENTION section: in the
topic: ENVIRONMENT AND SURFACE CLEANING. This recommendation describes
the use of an enzymatic detergent. The Adox dm3 product is a multi-enzymatic
detergent and therefore could be used (this can also be used for cleaning
instruments and endoscopes).
Regarding cleaning the incubator once the patient has been discharged, it must be
cleaned and disinfected, with products such as: detergent and chlorine, or some
disinfectant cleaner (one step only). It is recommended not to use phenolic
derivatives because the appearance of hyperbilirubinemia in newborns has been
observed. Because they are absorbed by porous materials, their residues can cause
tissue irritation even when rinsed. To learn this topic well, we suggest taking the
distance course that begins on September 10: SURFACE CLEANING AND WASTE
COLLECTION IN THE FIELD OF HEALTH.

7. I would need you to suggest the appropriate product to use for bathing
patients in the Neonatology Service and at the RN reception. What do you
think of the use of chlorhexidine? Thank you so much. Lic. Sonia Tomé.
Hospital 4 de Junio "Dr. Ramón Carrillo”. Presidency R. S. Peña-Chaco,
Argentina.

Bathing in preterm newborns has many potentially beneficial effects, but it is not a
harmless procedure, as was believed for many years. However, there is little
evidence and diversity of criteria in relation to the frequency, duration, type of
bathing and the use of cleaning agents.
The first bath of the newborn has multiple purposes, removing blood and potentially
infectious fluids, reducing microbial colonization, allowing correct observation of the
newborn's skin, in addition to aesthetic issues. In the case of preterm newborns,
the initial bath in the delivery room is a postponed routine, because there are
priority resuscitation and stabilization routines and that performed before 2-4 hours
of life produces alterations in thermoregulation and in vital signs.
For the first bath, in newborns under 32 weeks, warm sterile water is
recommended, if clinical conditions allow it.
Routine bathing aims to remove dirt and microorganisms, but can damage neonatal
skin due to the fragility of the epidermis and allow greater colonization of bacteria
from the acquired environment.
Most authors affirm that all soaps are irritating and emphasize that their frequent
use is harmful, since they remove the lipid film from the surface of the skin.
Physiologically, the pH of the skin is neutral at birth, and becomes acidic during the
first week of life, with pH values between 5.0 to 5.5. This “acid mantle” decreases
bacterial colonization and promotes moisture retention in the skin barrier.
Frequent bathing of preterm newborns can modify the “acid mantle” and raise the
pH of the skin. The mechanisms involved in colonization of the skin of premature
newborns in a NICU are not fully known.
Colonization of the skin of a newborn in a NICU is a consequence of multiple
factors, including routine bathing.
There is no difference between bathing with water or bathing with mild soap of
neutral pH and water on the microbial flora of the skin of premature newborns.
The use of routine antiseptics such as chlorhexidine is not recommended in term
and preterm children, since although they reduce colonization, their action is short,
and they cause skin irritation and dryness. It is recommended to use liquid or bar
soaps that have a neutral Ph, so that this practice does not alter the Ph of the skin.
You can alternate baths with warm water only, with baths with soap.

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 QUESTIONS AND ANSWERS SECTION
TOPIC: INFECTION CONTROL MEASURES
b) NEONATOLOGY
In newborns under 32 weeks, only warm water is recommended during the first
week of life, and in patients with broken skin, sterile water is recommended for this
procedure. It is not advisable to rub the skin, but rather clean it with cotton swabs.
The benefits of daily bathing are not well documented.
The frequency of bathing in the neonatal period should be based on the individual
needs of each newborn and taking into account the values and beliefs of the family.

Source: Neonatal Nursing Magazine. Year 002. Number 010. September 2010.
www.fundasamin.org.ar

8. Good afternoon. I would like to be informed if the maids in the

Neonatology sector have to have a sector in said place to wash floor cloths,
racks, etc. Or should they have it outside of Neonatology? Atte Sara
Robles, NICU nurse at Hospital Fernández, Bs. As., Argentina

At the national and provincial level there is legislation that regulates the
characteristics that a neonatology sector must have.
In 2012, the Guidelines for the Organization and Operation of Neonatal Care
Services were tested at the national level. RESOLUTION 641/2012. This does not
mention anything regarding the building structure you are asking us about.
While in the Province of Buenos Aires DECREE 3280/90 is still in force: Regulations
of existing welfare and recreation establishments in the Province. Articles related to
neonatology services are transcribed:

Article 44: Neonatal Intensive Care Unit: It is the hospitalization unit for the care
of patients up to one month of age at admission, who are in a current or imminent
critical state of life, with the possibility of partial or total recovery and who require,
for their survival, comprehensive medical and nursing care services, on a
permanent and constant basis, in addition to equipment and instruments that
ensure adequate control and treatment of the patient.
Article 46: They will be located in a semi-restricted circulation area and will have a
surface area of no less than 2.8 square meters per hospitalization space. The area
corresponding to the annexed environments for exclusive use will not be counted in
this surface area: room and doctor's bathroom on duty, locker room, etc.
a) Its physical environment will have: isolation room with capacity for 25% of the
inmates.
b) Air-conditioned environment that allows the temperature to be maintained
between 20 and 24 degrees Celsius, diffuse and individual lighting in each incubator
or crib, two electricity outlets for each hospitalization space.
c) Central nursing station with direct visualization of the patient.

d) One sink for every four seats or fraction.

e) The floors, walls and enclosures must allow the highest degree of airtightness or
coverage, they will have sanitary baseboards and ceilings and will be arranged in
such a way as to avoid the accumulation of dust and waste and facilitate their
permanent sanitization.
f) Place for deposit of care material and equipment.
g) Perimeter or individual shelf.
h) It will have the following annexed environments for exclusive use: room and

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 QUESTIONS AND ANSWERS SECTION
TOPIC: INFECTION CONTROL MEASURES
b) NEONATOLOGY
bathroom for the doctor on duty, kitchenette and accumulation area for dirty or
contaminated material.

When dirty areas or areas for contaminated material are mentioned, we may be
talking about: a sector where nursing washes material to send to be sterilized, or
the place where the maid stores and washes her cleaning materials. Therefore, the
maid must have a place designated for this purpose within the service, obviously
not within the hospitalization area (place with children, cribs and incubators), but in
a place attached, but close to the work area. That is, an area more belonging to the
service, such as the nursing room or nursing or medical room. .

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