G124(P) Is it time to enforce rigorous infection control guidelines for visitors attending the neonatal intensive care unit?

Abstract

Nosocomial infections remain a major issue in neonatal intensive care units (NICU). This is related to numerous factors including, impaired immunity, fragile skin, and invasive lines. The impact of healthcare workers on infection transmission has been well documented, however little work has looked at the risk posed by visitors who frequently handle infants on NICU. Aims The aim of our study was to assess the existing infection control guidelines and their enforcement for visitors attending tertiary level NICUs across England and to recommend a standard set of guidelines to reduce the risk of infection in infants on NICU. Methods Our study included 46 level 3 NICUs across England during November 2013–March 2014. A survey questionnaire was set and the sister in charge was contacted by telephone. Results Among 46 units, 46(100%) responded to the survey. 27(58.7%) provided infection control leaflets for visitors, all of those included hand washing. 15 of the 27(55.5%) had multilingual leaflets. 34(73.9%) used a cot-side nurse or receptionist to enforce infection control policies. 11(23.9%) had no restricted visiting times, only if accompanied by parents. 42(91.3%) allowed siblings, however 2 excluded winter, 1 disallowed siblings under 6, and 1 only in infectious outbreaks. 26 (56.5%) had a limited handling policy. All allowed kangaroo care, 28(60.9%) of which stipulated only when the baby was stable. 10(21.7%) allowed it any time. 1(2.2%) only permitted on extubation and if lines were taken out. 42(91.3%) prohibited wearing coats. 3(6.5%) had a bare below the elbow policy and 25 (54.3%) asked that jewellery was removed. None of the units asked visitors to remove plain bands. All stipulated hand washing, however 44(95.6%) stipulated hand gelling. 3(6.5%) stipulated the wearing of gowns, and 4 (8.6%) asked visitors to wear gloves, both of which were only necessary if the baby had an infection. Conclusion Our study results have thrown light on variations in infection control policies for visitors to NICUs across England. A set of infection control guidelines and methods for their enforcement are proposed.