Nicu Checklist Bundles Infection Control 1

8/19/2019 Nicu Checklist Bundles Infection Control 1

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DISCLAIMER

These handouts are compiled from various

sources to assist health care professionals.

It should not be regarded as complete and

coud vary in dierent units.


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India has witnessed rapid growth of facility-based care for sick neonates in recent years. The goal is to save

newborn lives and provide quality care. The special care and intensive care newborn units are home to premature

and sick newborn infants. These vunerabe babies need nurturing with utmost hoisc care and safe praccesthat minimize the probability of harm. Health care providers need to stay updated with current evidence in

literature. Working together as a team, physicians and nurses can follow standard evidence-based protocols to

improve care. In a neonata unit, a team of physicians, nurses and other heathcare sta carry out a number of

compex mu-step heathcare procedures.

From aviaon sector to operaon theatres, checkists have proved usefu in decreasing errors at key steps in a

high-stress environment. Checklists and bundles when applied to neonatal units can help in avoiding break in

asepsis during various care procedures and decrease the risk of acquision of heath-care associated infecon.

Recent study from Karnataka by Word Heath Organisaon reported that introducon of simpe checkist improves

pracces of heath workers during chidbirth. This safety checkist is being tested in 100 centres in North India for

mothers and babies.

Andhra Pradesh neonatologists under the able leadership of Fernandez Hospital team have taken a lead in this

direcon by conceptuaizing safe pracces checkist and bunde approaches using evidence based pracces

for reducing catheter-reated bood stream infecons, venator-associated pneumonia and other heathcare

associated (nosocomia) infecons. Evidence from deveoped countries supports the use of checkists in avoiding

medicaon errors and nosocomia infecons.

Chaenge is now to create instuons and network within each state where best unit pracces can be repicated

and documented. Proven intervenons are reavey inexpensive and easy to perform but the unfortunate disparity

between knowedge and pracce has constuted a major barrier to improving outcomes. Such innovave ideas

wi have far reaching eects in improving quaity of care in heathcare deivery in the region, reduce economic

burden and also serve as model for other disciplines of Medicine.

Dr. Ashok Deorari, FAMS FNNF

Professor, Department of Pediatrics

AIIMS, New Dehi

f oreword


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Quaity of care is a new paradigm in Neonatoogy. Team concept, standardizaon of care and buiding up processes

are the keys to quaity care. In an eort to improve quaity of care, we at Fernandez Hospita coated a checkists,

bundes and infecon contro pracces with ___________. This is a reference manua and not a standard

p reface


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INDEX

CHECKLISTS 7

ADMISSION CHECKlIST 9

CHECKLIST FOR DISCHARGE OF HEALTHY NEWBORN 10

DISCHARGE FROM NICU 11

TRANSPORT CHECKLIST 12

CHECKLIST FOR PREPARATION OF FORMULA FEED

Denominators for neonatal intensive Care Unit (niCU) 16

level 3 DailY form 17

level 2 DailY form 18

CHECKLIST – SETTING UP NICU (8 – 16 BEDS) 19

CHECKLIST FOR SURGERY 22

CENTRAL LINE INSERTION CHECKLIST 23

SURFACTANT ADMINISTRATION 24

CHECKLIST FOR INTUBATION 26

Peritoneal Dialysis 27

Checklist – Exchange Transfusion 29

Exchange Transfusion Monitoring Form 31

Checklist for Umbilical Line 32

Checklist for Peripherally Inserted Central Venous Line 33

Checkist for Intravenous Cannuaon 35

Infecon Contro Audit Checkist 37

Lumbar Puncture Checklist 39

Asepc Non-touch Technique Audit Checkist 40

Requirements for Venated Beds 41

Infecon Contro Pracces 43

Hand Hygiene 44

Handrub Procedure 45

Handwash Procedure 46

Housekeeping Procedures in the NICU 47

Bundes 54

Venator Associated Pneumonia (VAP) Bunde 55

Centra line Associated Bood Stream Infecon (ClABSI) Bunde 56

Nutrion Bunde 57

Prevenon of Hypothermia in ElBW and VlBW Infants 58


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YES NO

THINGS TO BE CHECKED IN AN ANTICIPATED ADMISSION

Warmer on Manual Mode

Crib made ready

Standby Venator / CPAP with New Circuit and Humidier

ON ARRIVAL

Baby Name Tagged

Sucon if Required

Oxygen by Hood/ Prongs

Nasa Prongs

Temperature Probe Aached

Warmer Mode Shied to Servo

Puse Oximeter Probe Aached

IV Cannula Inserted and Dated

GRBS on Arriva Checked

Necessary Invesgaons Coected

UVC / UAC / PICC lines

NIBP

X-ray Chest and Abdomen

IV Fluids Started

Feeding Tube Inserted

Urine Coecng Bags

Inj. Vitamin K- given

Time of First Dose of Anbioc aer Arriva Noted

Weight, Length, OFC Checked and Documented

Any Injuries, Previous Cannua Extravasaons Noted and Documented

ADMISSION FORMALITIES AND COUNSELLING DONE

Need of Admission

Expected Compicaons

Duraon of NICU Stay

Financial Counselling

Expained about Daiy Vising Hours, Time of Daiy Counseing

Explained regarding Feeding Plan and Expression of Milk and Storage of Milk

Visitors Cards Issued

Wrien Informed Consent taken Regarding Inia Support, Invasive Procedures

Baby shown to Aendants aer Inia Stabiisaon

Admission Sip, Medicaon Sip given to Aendants

ADMISSION CHECKLIST


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Day of Life

Weight at Discharge and Percentage of Weight Loss* _______grams (_____%)

Estabishment of Breast Feeds YES / NO

Passage of Meconium YES / NO

Passage of Urine YES / NO

Eye Examinaon (Cataract)

Ce Paate

Murmurs & Femoral Pulses

Hip Examinaon (DDH)

Genitals

Examinaon of the Back

New Born Screening

Biirubin leves (Any vaue > 6 mg/dl on day 1 – No discharge) (TSB / TCB) _____ mg/d

SpO2 (< 95% needs evauaon) _____________%

BCG / OPV / Hepas B (1) YES / NO

Complaints from Mother

Review on

Name of the Doctor

CHECKLIST FOR DISCHARGE OF HEALTHY NEWBORN

* (Of concern weight loss : > 5% on day 1 and day 2 and > 10% aer day 3)


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DISCHARGE FROM NICU

YES NO

Weight, OFC at birth and at Discharge

Temperature Stability

Accepng Spoon/Paade or Breast feeds

IV lines removed

Newborn screening (basic or Expanded)

Mother condent of Handing the Newborn

Mother Trained on Spoon feeds

Medicaon advise- how to give/ when to stop Muvitamins/Iron/Cacium suppementaon

Adding HMF Any other ora medicaon

Danger Signs Explained

Skin/Cord care Expained Sponge bath 2.5kgs

Oil massage

Cap, Socks, Miens Powder with pu

No oi insaon or bowing of Ears/Nose

Expain about need for praccing KMC at home

Summary Explained and given to Parents

Foow up dates-when/purpose of foow up Expained(Anthropometry/Jaundice/BERA/NSG/ROP)

Inform about Vaccinaon dates/ Immunisaon schedue


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YES NO

TRANSPORT KIT

Endotrachea Tubes – #2.0, #2.5, #3.0 & # 3.5

Laryngoscope

Bade Size – #0 & #1

Face Mask – Pre-term and Term

laryngoscope with Extra Baeries – 2 in number

Nasa Prongs

Oxygen Tubes

Prediuted Drugs (Adrenaine 1:10,000, NaHCo3, Dopamine, Dobutamine,

Calcium gluconate).

IV uids (2 in number) : Pediadrip Set, Norma Saine, 10% Dextrose, 5% Dex-trose, Sterie Water for Injecon

Feeding Tubes

Mucus Sucker

Sucon Catheters

Portabe Sucon

Glucometer with Strips

Stethoscope

Puse Oximeter (Baery charged) with Extra Set of Probes

Syringe Pump (Baery Charged)

Syringes (5 in number) 1 cc, 2 cc, 5 cc, 10 cc

3 way Extension

Bood Pressure Cu

Sterile Towel, Head Cap

IV Cannua 24 No. (5 in number)

IV Cannula and ET Plasters

Sterie Coon, Diapers

Oxygen Source (in the ambulance)

Incubator / Thermostat

Transport Venator, Neopu

New Set of Venator Tubings

TRANSPORT CHECKLIST

Baby Name : ___________________________________ M. R. No. _________________________

Age: ______________ Sex: M / F Gest.Age: _________wk Birth weight : ________gms

Transport Doctor :_______________ Transport Nurse:_______________ Date & Time of ca : _____________


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YES NO

PROCEDURE CHECKLIST

Temperature

HR

RR

GRBS

Bood pressure

SPO2

CFT

Respiratory Support – CPAP / Oxygen / Venaon

Vitamin K given

Medicaons Received, Dose, Timings, Route

Any Invesgaons Sent

X-ray Chest Done

Any Relevant History

IV Cannua (No. of days)

Counseing of Parents done Regarding Need for Transport

Wrien Informed Consent Taken for Transport from Aendants

Copy of Maternal Records

Copy of Neonata Treatment Record

Receiving Team Informed about the Baby

Intervenons done during Transport

STABILIZATION POST TRANSPORT

Temperature

GRBS

Handover given to Doctor : _________________________ Nurse : _________________________

Time of handover : ________________________________


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Pp fu fd Yes n

Hands Washed before Cleaning and Sterilizing Feeding Utensils Dedicated Sink used for Cleaning Feeding Utensils

Cg Feeding & Preparaon Utensis (E.g. Paada, Cups, Spoons, boes) washed in Hot Soapy Water. Dedicated Soap and Sponge/Brush Used for Ceaning.

Aer washing, Utensis Rinsed Thoroughy in Safe Water.

szg Washed Utensils Completely Submerged In Large Pan Filled with Water,

Pan Covered with a lid, Brought to a Roing Boi and kept Covered UnUtensis Needed.

Surface Ceaned & Disinfected before Feed Preparaon

Hands Washed before Utensils are Removed with a Sterilized Forceps Steriized Cheate/Forcep used to Remove Utensi has a date < 24 hours od

Kee Fied With At least 1 litre Fresh Safe Drinking Water (Water Boied Previ-ousy Not Re Used).

Safe Drinking Water Boied Un a Roing Boi. (Boed Water Preferaby notused, if used its aso Boied)

Water used Within 30 Minutes of Boiing (So that it Remains at a Temperature ofat east 70ºC )

Appropriate Amount of Boied Water Poured into Steriized Feeding Vesse(30m for Every Scoop). Formua powder added to the Water. (If a Batch Made in a

Larger Container, the Container Used is Cleaned andSteriized and Maximum 1 litre Prepared at one me).

Mixed Thoroughly with a Cleaned and Sterilized Spoon

Formua Cooed By Hoding the Boom Haf of the Utensi/Boe Under Cod/Tap Water without Contaminang Contents

lbg Type of Formua, Infant’s Name or ID, Time and Date of Preparaon, and Preparer’s Name.

Temperature of Formula Feed Tested on inside of wrist before giving to Baby

le over feed Thrown away

CHECKLIST FOR PREPARATION OF FORMULA FEED


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Denominators for neonatal intensive Care Unit (niCU)

Month : Year :

Date D = 1501-2500 g Weight >2500gm Total

Pts IVF CL Vent O2 IV TPN Pts IVF CL Vent O2 IV TPN Pts III II KMC

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30


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level 3 DailY form

Baby of : IP: No .

DAY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15DATE

GESTATION

WEIGHT

RESP VENTIlATION

CPAP

OXYGEN

FLIUIDS IV CANNUlA

CENTRAl lINES

IV FLUIDS

TPN

EBM

FORMULA

HMF

DRUGS ANTIBIOTICS

ANTIFUNGAlS

INOTROPES

ANTICONVUlSANTS

SEDATIVES

BlOODCOMPONENTS

PACKED RBC

PRP / SDP

FFP

IMAGING ECG

NSG

ECHO

X-RAY

ROP ROP Screening

NEXT REVIEW

Notes :


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level 2 DailY form

Baby of : IP: No .

DAY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

DATE

GESTATION

WEIGHT

lENGTH

OFC

CAlORIES (kg/day)

PROTEIN (kg/day)

RESP OXYGEN

FLIUIDS IV CANNUlA

CENTRAl lINES

IV FLUIDS

TPN

EBM

FORMULA

SUPPlEMENTS

HMF

DRUGS VITAMIN A

CAFFEINE

3 % SAlINE/BICARB

ANTIBIOTICS

BlOODCOMPO-NENTS

PACKED RBC

lABS PCV

Na

CALCIUM

ENBS /NBS

IMAGES NSG

2D ECHO

X-RAY

ROP Findings:

Notes :


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CHECKLIST – SETTING UP NICU (8 – 16 BEDS)

lc d z Yes n

Restricted Access Isoaon Room

Temperature, Humidity and Pressure in each level of care

Proximity to labour Room/Transport Area/Imaging Faciity

Ramp/Passage/li for Transport of Newborn

No Thoroughfare / No Access to Other Faciies Through NICU

Self Closing Device On Door

100 Sq Cear Space Per Bed (50 Sq Baby Areas + 50 Sq Anciary Areas).

Baby Care Divided Into 2 or 3 Secons. Visibiity from Nurses Staon

acy c Yes n

Recepon Area

Parents Waing lounge

Counselling Room

Examinaon Room

Side Lab

Oce /Administraon Room- Near Entrance/ Eectronic Data Recording

Mothers Area For Breast Mik Expression/ Feeding Area- Breast Pump

Mik Bank

Autoclave Facility

Change Room/ Rest Room/Toiets

Store Room

linen Washing/laundry Room- Automac Washing Machine And Dryer

Dirty Uity Room


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NICU Area Yes n

Hand Wash Area

Hands Free Elbow Operated Taps

Stainess Stee/ Porceain Sink with Size 24” Wide x 16” front to Back x 10”Deep Designed to avoid Spashing and water Stagnaon.

Adjacent Wa Non- Porous And Non-Absorbent/ Ties

Soap Dispenser With Liquid Soap

Hand Dryer or Disposable Towels or Tissues

Trash Bin

Pictorial Chart For Hand Wash

Addiona Hand Washing Within 20 Feet Of Every Bed Minimum 3 Feet Away One Washbasin for Every 4 Beds

Cean Uity Area

Space For Hoding Sterie Trays/Syringes/Infusion Set/ IV Fuid/Diapers etc.

Dirty Uity Area

ecc nd

24 Hour Uninterrupted Supply

A Generator With 25-50 KVA Capacity And a Servo Stabiiser (3 Phase)

6-8 Centra Votage Stabiised Outets Per Bed: 5 Amps (4) and 15 amps (4)

lighng Coo White Fuorescent Tubes, Preferaby CFl or lED (light-Eming Diodes)mchc nd

Fooring : Durabe, non-porous, non-teretogenic

Walls Glaze Tiles up to 7 feet

24 Hours Water Supply

Gazed Windows at least 2 Feet Distance away from Baby Bed

Visible Day Light

Avoid Bright light/Separate Procedure lighng

Suppy and Exhaust Venaon/Air Temp 26-28 c

2-Oxygen Outet/2-Compressed Air Outet/1- Sucon Outet- Per Venated Bed

1-Oxyegn Outet/1- Compressed Air Outet/1- Sucon Outet Per Non Venated Bed

Fire Safety Pan- Fire Exits/Dampeners/Safety Cercate

Sewer And Water Connecon And No Objecon Cercate


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eup Yes n

Venator and Appropriate Circuits

CPAP Machine

laminar Fow for IV Fuid Mixing & TPN Preparaon

Phototherapy Unit, Single Head, High Intensity

Infusion And Syringe Pump

Oxygen Hood, S & M Sizes Incuding Connecng Tubes

Thermometer, Cinica,Digita,32-43ºC

Scae (Baby, Eectronic) 10 kg (


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CHECKLIST FOR SURGERY

YES NO

PreoPerative

Informed Consent Taken

High Risk Consent Taken

Case Sheet Prepared (Shiing Notes)

Procedure Risk Expained – By Pediatrician / Neonatoogist

– By Pediatric Surgeon / Anaesthest

Basic Invesgaons : Bood Group, CBP (lavender top), Sr. Eectroytes, B. Urea,Sr. Creanine (Red top) PT, APTT (Bue top), BT, CT

Inform Anaesthest for Pre Anaesthec Check-up

Inform Operaon Theatre

Prophyacc Anbioc before Surgery

Reserve Bood Products (PRBC/FFP) aong with Cross Matching Sampe in BoodBank

Bood Products Needed for Surgery at east 3 hrs before Surgery

Proper IV Access to Baby

ET Tube Posioned

Shi with Warmer

OPERATIVE

Case Sheet sent to OT

Thermoreguaon during Surgery Panned

Bood Products sent to OT

PostoPerative

Bed Ready before Baby Arrives in NICU

Venator (if necessary) kept Ready

ET Tube Posion Conrmed

Operaon Notes

Post-operave Counseing

Advice by Surgeon

Analgesics

Time of Feeding

Time of Suture Removal


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CENTRAL LINE INSERTION CHECKLIST

YES NO

BEFORE THE PROCEDURE

Perform Hand Hygiene

Wear Cap, Mask, Sterile Gown and Sterile Gloves

Prepare the Inseron Site as Per Protoco Skin Prepared With Chorhexidine in 70% Isopropy Acoho

Souon Generousy Appied by Back and Forth Fricon Rub for around 30 Seconds

Souon Aowed to Dry for 2 minutes Before Skin Is Punctured

Cover Enre Paent with a Sterie Drape

Did Physician Maintain a Sterile Field during the Procedure

Sterie Dressing Appied to Cover Inseron Site

SITE SPECIFIC INSERTION

Umbilical

Upper Limb

Saphenous

Others

Raonae

Form Completed by

CENTRAL LINE MAINTENANCE BUNDLE

G Date Date Date Date Date Date

Daily review of line necessity

(During Consultant Rounds)

Dedicated lumen for TPN 0700 – 1300 hrs.

1300 – 1900 hrs.

1900 – 0700 hrs.

Asepcally accessing hub

and scrubbing hub with 2%

Chorhexidine +

70% acoho

0700 – 1300 hrs.

1300 – 1900 hrs.

1900 – 0700 hrs.

Check entry site for inammaon

with every change of dressing

Baby’s Name : __________________________________ M. R. No. _______________ Date : ________________

Start Time : ______________ Procedure Performed By: __________________Assisted by : _________________


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YES NOEQUIPMENT LIST

Surfactant of Desired Brand

Desired Voume / Number of Vias Ordered

Syringes – 5 m, 10 m, 2 m

Surgica Bade

Infant Feeding Tube 5 Fr, 6 Fr

Endotrachea Tube of Sizes – 2, 2.5, 3, 3.5

Funconing laryngoscope with Straight Bade of Size 00, 0, 1

Ambu Bag with Reservoir

Masks of dierent Sizes

Oxygen Connecon Tubes

Sterie Goves / Cap / Mask / Gown

Midazolam

Tegaderm / Duropore

Scissors

Stethoscope

Sucon Catheter Pulse Oximeter

PROCEDURE CHECKLIST YES NO

laryngoscope Funcon Checked

Cap / Mask

Hand-washing Done

Gloves put on

Oxygen Tube Connected

Sucon Catheter Connected

SURFACTANT ADMINISTRATION

Baby's Name __________________________________ M. R. No. _______________ Date : ________________

Gestaon Age__________wk Weight ___________ gm Time : ________________

Dr. ______________________________________ Nurse In-charge __________________________

Consent taken from parents : YES / NO X-ray done : YES / NO

ET tube size used _____________________ Surfactant administered at :_____________________Hours of ife

Pre-surfactant Fio2 _________% PEEP_________cmH

2O PIP __________cmH

2O

Surfactant brand – Curosurf / Survanta / Neosurf Voume__________ No. of Aiquots __________

Time taken to nish procedure __________minutes


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Pressure of Vacuum Set 100 cmH2O

Infant Feeding Tube Cut at Desired Length

Surfactant Loaded in Syringe

Sedaon Given

Posioning of Infant

Intubated with Correct Size ET Tube

Air Entry Checked

Saturaons Checked

ET Tube Fixed at Lip with Duropore

Surfactant given Asepcay

Connected to CPAP / Venator

Pressure / FiO2 Reset

Procedure Notes Wrien on Case Sheet


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YES NO

EQUIPMENT LIST

Funconing laryngoscope with Straight Bade 00, 0, 1

Ambu Bag with Reservoir

Masks of Dierent Sizes

Oxygen Connecon Tubes

Sterile Gloves

Endotrachea Tubes of Dierent Sizes (Based on Infant Weight )

Cap / Mask / Goves

Midazolam

Syringes – 5 ml

Tegaderm / Duropore

Scissors

Sucon Catheter

Orogastric Tube

Pulse Oxymeter

Stethoscope

YES NO

PROCEDURE CHECKLIST

laryngoscope Funcon Checked

Cap / Mask / Hand wash / Goves

Oxygen Tube Connected to Central Oxygen

Sucon Catheter Connected and Pressure Set to 100 cmH20

Sedaon

Posioning of Infant

Procedure Done

Saturaon Maintained

Air entry checked

ET Tube Fixed at Lip with Duropore

Extra Length of ET Tube Cut

X-ray Chest Ordered / ET Tube Posion Rechecked and Reposioned

ET Tube Card Fied / Date and Time Noted

Connected to Venator

Procedure Notes Done

CHECKLIST FOR INTUBATION

Baby Name : ___________________________________ M. R. No. _________________________

Age: ______________ Gest.Age: _________wk Birth weight : ________gms Date & Time : _______________ Indicaon : Emergency / Eecve E. T. No. __________________ E.T. Fixed at _____________ cms


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YES NO

EQUIPMENT LIST

Vygon Poypropyene Catheter 12 Fr with Trocar and Connector

Scalpel

IV Cannua 20 G

Peritonea Diaysate Fuid (1.7%)

IV Set – 2

Empty Boe for Draining

3 way Connector

Xyocaine (2%)

2 m, 10 m Syringes

Dressing set with Steriium, Betadine

Sik Thread and Neede for Suture

Peritoneal Dialysis Chart

Cap / Mask / Gown

Latex Glove 2 Pairs

Fixing Tape

Nasogastric Tube No. 5 Fr / 6 Fr

Drapes – 2

YES NO

PROCEDURE CHECKLIST

Cap / Mask worn

Hand-washing Done

Gown and then Gloves put on

Pre procedure Decompression of Abdomen

Catheterisaon of Badder

Skin preparaon with 2% Chorhexidine

Dressing and Draping

Site of Inseron Propery Seected – Right / le

PERITONEAL DIALYSIS




Consent taken from parents : YES / NO

Indicaon : Hyperkaemia / Anuria last creanine: ____________ Urine output ast 24 hrs: ____________


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Catheter Inserted and Fixed

PD Fluid Connected

Heparin Added into PD Fluids

Hemostasis Maintained

Check for Obstrucon, Beeding, Disodgement, leakage, Extravasaon, Infecon

PD Chart Propery Prepared and Nurses Expained on Documentaon

Volume of PD Fuid per Exchange

Frequency and Duraon of Exchanges Recorded

Fi Time, Dwe Time, and Drain Time Ceary Wrien

Weight Charng Daiy

Signs of Peritonis Expained to Duty Nurse

Menon When to Stop PD

Eectroyte Monitoring / Rena Proe Monitoring Chart

Peritonea Diaysis Procedure Notes Wrien


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CHeCKlist eXCHanGe transfUsion

P exchg CdPaor : Yes / No Biirubin Encephaopathy : Yes / No If Yes, Stage _____________________________

Findings : __________________________________________________________________________________

Respiratory Support : Yes / No Sickness Status : Heathy / Sick

Medicaons : 1_______________________ 2 _________________________ 3 ______________________




Consent taken from parents : YES / NO Indicaon : ______________________________

Max TSB : _______ mg/dl TSB before Exchange : ______ mg/dl

Voume of Bood Exchange_______ m (2 x 80 x Birth Weight in kgs) Aiquot Voume _______ m

Number of Aiquots : _________ Baby’s Bood Group : __________ Mother’s Bood Group_________

ABO/Rh Incompabiity : YES / NO If YES, Specify__________________________________________________

Start Time : __________ End Time : _________

DONOR BAG NO. DATE OF COLLECTION GROUP CROSS CHECKED BY

YES NO

EQUIPMENT LIST

Bood Ordered

Mother Sample Obtained for Cross Match

Umbiica Catheter 3.5 Fr, 5 Fr, 6 Fr, 7 Fr

Gloves Latex (2 Pairs)

Dressing Set

Cap / Mask / Gown (2 Pairs)

Spirit / Betadine / Chorhexidine 2%

Drapes (2)

Syringe 5 m (2), 10 m (2), 2 m (2)

IV Cannua 24 No. (1)

Three Way Stop Cock (2)

Bood Transfusion Set

IV Set (2)

Pasc or Gass Boe for Disposa of Bood

Saine / Sterie Water

Transparent Dressing


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Paper Tape / Tegaderm / Duropore

Surgica Bade

Sucrose Analgesia

Exchange Cycle Chart Prepared

Cyce Voume and Cyce Number Determined

YES NO

PROCEDURE CHECKLIST

Umbiica Cannuaon Done

Umbilical Catheter in-situ

Proper Asepc Precauons taken during Cannuaon

Back Fow Checked

Need of Periphera Artery

Phototherapy Connued During Procedure

Bood Bag No. and Bood Group Cross-checked

Three Way Connected to Umbilical Catheter

Bood Bag Sucienty Warm

Transfusion Set and IV Set Properly Connected

Cycle Started with Pull Out

Same Volume Pushed In

Bag Mixing done Intermienty

Hemodynamics Monitored

Desired Number of Cyces Done

Bood Voume was Sucient for Cyces

IVIG Dose Administered

last Aiquot sent for PCV, TSB and Cacium

Procedure Notes Wrien

Compicaons During the Procedure:_____________________________________________________________

Post Exchange Transfusion: HR _____ RR ______ SpO2 ________ Bood Pressure _______

Respiratory Support ______________ Other Remarks _________________________

iuc: P-exchg tu

1. Start feeding aer _____ hours 2. RBS at _____ TSB at _______hours

3. Injecon vitamin K 1mg IM stat 4. Medicaons : _____________

5. Monitor a) HR________ houry b) RR________houry c) SpO2

______houry d) BP_______ houry

6. Preserve Bood sampe for a) Cross-match b) DCT and Recuocyte Countc) Donor bood for next 24 hours (in case of reacon report to bood bank)


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YES NO

EQUIPMENT LIST

Umbiica Catheter 3.5 Fr, 5 Fr, 6 Fr, 7 Fr

Gloves Latex (2 pairs)

Dressing Set

Cap / Mask / Gown (2 pairs)


Measuring Tape

Drapes (2)

Syringe 5 m (4), Saine / Sterie Water



Surgica Bade

IV Fuids Prepared (Dextrose 10%, TPN etc) / IV Set

Sucrose

YES NO

PROCEDURE CHECKLIST

Length of Insertion from Shoulder to Umbilicus Length and Chart

Cap Mask Worn / Handwash / Gown / Goves

Site Preparaon with Spirit and Betadine

Site Covered with Drapes

Proper Size Umbilical Catheter Inserted Depending on Size of Vein and Artery

Back Fow Checked

Fixed at Measured Length with Transparent Tape and Tegaderm

Flushed with Saline

X-ray Ordered or Posion Checked with Utrasound and Fixed

Posion of UVC / UAC Noted Down on Card

Vital and Temperature of Infant Checked

Haemostasis Secured

Bionecter Used and IV Fuids Connected

Heparin Connected to Umbilical Artery Line

Periodica Checks for loca Signs of Inammaon / Sweing

Watch for Lower Limb Colour and Perfusion

Hub of Line Covered with Sterile Gauze


CHECKLIST FOR UMBILICAL LINE

Baby Name : ___________________________________ M. R. No. _________________________

Age: ______________ Gest.Age: _________wk Birth weight : ________gms Date & Time : _______________

Dr. ________________________ Assisng Nurse : ________________ Time taken __________________ mins


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YES NO

EQUIPMENT LIST

PICC line Size (Depending upon Site of Inseron)

Gloves Latex (2 pairs)

22 Gauze Cannula

Dressing Set

Cap / Mask / Gown (2 pairs)

Measuring Tape

Drapes (2)


Syringe 5 ml (2)

Saine / Sterie Water



IV Fuids Prepared (Dextrose 10%, TPN etc) / IV set

Sucrose

YES NO

PROCEDURE CHECKLIST

Site Seecon for Inseron

Length of Line to be Inserted Measured

Cap Mask Worn

Hand Scrub Performed

Gown and then Gloves Worn

Site Preparaon with Spirit and Betadine/ Chorhexadine

Site Covered with Drapes

Cannula Inserted at Selected Site

Guide Wire Passed (Seldinger Technique)

PICC line Inserted Taking Care of A Asepc Precauons

Guide Wire Removed

Back Fow Checked

Fixed at Measured Length

CHECKLIST FOR PERIPHERALLY INSERTED CENTRAL VENOUS LINE

Baby Name : ___________________________________ M. R. No. _________________________

Age: ______________ Gest.Age: _________wk Birth weight : ________gms Date & Time : _______________

Dr. ________________________ Assisng Nurse : ________________ Time taken __________________ mins

Site : Antecubita – Right Arm / le Arm Saphenous – Right / le Popitea – Right / le


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Fixed with Transparent Tape and Tegaderm

Flushed with Saline

X-ray Ordered or Line Tip checked with Ultrasound

Posion Rechecked and Fixed (line Tip in SVC or IVC)

Vitals and Temperature of Infant Checked

Haemostasis Secured

Limb Checked for Signs of Ischemia

Bionecter used and IV Fuids / TPN Connected

Hub of Line Covered with Sterile Gauze


Periodica Checks for loca Signs of Inammaon / Sweing


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CHECKLIST FOR INTRAVENOUS CANNULATION

YES NO

EQUIPMENT LIST

Sterile gloves

24 G Cannua Preferaby 2 in Number

Ansepc Souon (2% Chorhexidine in 70% Isopropy Acoho) / Betadine

Syringe 5 ml and 2 ml

Three Way with 10 cm Extension

2 × 2 Gauze / Coon Bas

Vacuum Coecon Tubes and Adaptor

Bood Cuture Boe (if bood cuture to be taken)

Saline or Heparin Lock



IV Fuids Prepared (Dextrose 10%, TPN etc) / IV Set

PROCEDURE CHECKLIST

Cannula Placement Yes No

Trained Person

Document Reason – Emergency / Panned / Number of Aempts Made

Maximum 2 Aempts per person

Pasc Tray Ceaned with Soap and then Ceaned with 70% Acoho Wipe

Operator and Baby to be Comfortabe

Sucrose or Breast Mik for Baby to Reieve Pain

Hand Hygiene – WHO 5 steps

Check Baby Identy

Choose Appropriate Size Cannula and Appropriate Vein Site

Gloves

Torniquet not too Tight (if used)

Cean site with 2% Chorhexidine + 70% Propy Acoho Working Outwards andAow to Dry for 30 – 60 seconds

Do Not Papate Vein Aer Disinfecng Skin

Stylet Removed from Cannula to be Placed back in Tray

T-camp / 3-way to be Used at End Port

Fresh Cannua to be Taken for Every Aempt

Aer Cannua is Paced Fush with 1 m of 0.9% Saine

Safe Disposal of Stylet


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YES NO

Cannula Dressing

Secured Using Sterile Clean Polyurethane Dressing (Tegaderm)

Occusive / Opaque / Adhesive Dressing (Preferaby not to be used)

Steristrips Used before Dressing to Secure Cannula

Cannula Care

Daiy Once Inspecon and Documentaon of Cannua Site for Signs of Phebis i.e.Erythema / Redness / Sweing

Remove Cannua if Signs of Phebis Present or IV Therapy not Required

IV Flow Rates Cross Checked

Potena Irritant Infusions Given in Bigger Caibre Veins

Preferabe to Avoid Bood Samping from Cannua

Change Dressing if Visibly Soiled or Soaked

Before and Aer Administraon of Drug Fush 1 cc 0.9% Saine

For Giving Injecon and Bouses Foow Hand Hygiene / Cean Port or Hub of Cannuawith 2% Chorhexidine and Aow to Dry

For Bouses or Injecon Use 5 or 10 cc Syringes and Not 2 cc Syringe

Change IV Infusion Set Daily

Infusion / Syringe Pump to Administrate IV Fuid Therapy


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GENERAL YES NO

Does the organizaon have wrien Procedures and Poicies for Infecon Con-trol

Is there enough IEC (Informaon, Educaon and Communicaon) materia(e.g. Hand Hygiene, Waste Segregaon)

Has the sta received any training on infecon contro (E.g. Trained in hand

decontaminaon, the use of persona protecve equipment, the safe use and

disposa of sharps) Ask a member of medica, nursing and anciary sta

Do healthcare workers have appropriate supplies (materials for hand

decontaminaon, sharps containers, persona protecve equipment)

HAND HYGIENE YES NO

Faciity checkist for hand washing staon suppies: Percentage of sinks fu-

ing all the criteria

Faciity checkist for correct hand washing: Percentage of hand washingencounters with all components adhered to

ENVIRONMENT YES NO

Overa appearance of the environment is dy and uncuered with ony

appropriate, clean and well maintained equipment and furniture

The environment and equipment smells clean, fresh and pleasant

The foowing items are cean and free from spashes, soi, m, dust, nger-prints, and spillage

The compete oor, incuding edges and corners Baby weighing scaes Resuscitaon Equipment : AMBU Bag, laryngoscope, Sucon Boes,

Oxygen and Sucon Tubes Equipment : Warmers / Incubators, Monitors, Infusion Pump, Venator /

CPAP

Maress on Warmer / Incubator is free of rips and tears and is visiby cean Waste receptacles are clean

All high and low surfaces are free of dust

Fans are clean and free from dust

There is an idened area for the storage of cean and sterie equipment

A dirty uity is avaiabe

A separate sink is avaiabe for decontaminaon of paent equipment

USE OF PERSONAL PROTECTIVE EQUIPMENT YES NO

Sterile and non-sterile gloves (powder free) are available in all clinical areas

Observaon of gove uses of ateast one heathcare (Incudes correctindicaon, correct method of wearing goves, hand hygiene before and aerwearing gloves)

Are aprons avaiabe (Autocaved reusabe inen/ Disposabe pasc aprons)

Are cean face masks and eye protecon equipment avaiabe

INFECTION CONTROL AUDIT CHECKLIST


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SAFE USE AND DISPOSAL OF SHARPS YES NO

Is the sharp container appropriate (Size, shape, material) for its use

Is the sharp container ocated in a safe posion that avoids spiage

Is the sharp container used for any purpose other than the disposal of sharps

Is the sharp container not ed above the ine/ more than 3/4 fu

Is the sharp container disposed of every 3 months even if not fu

Is the sharp container temporarily closed when not in use

WASTE DISPOSAL YES NO

Is there cinica waste signage (posters) idenfying waste segregaon avaiabein all areas

Is there evidence that the waste contractor is registered with a valid licence(check records)

Is waste segregaon happening with coour coded bins and coour codedpasc bags ining the containers

Is the waste storage area cean and dy

There is no storage of waste in corridors or in other inappropriate areas inside/outside the faciity whist waste is awaing coecon.

All waste bins are visibly clean – externally and internally

There are no overed bags. Bags are no more than 2/3 fu.

SPILLAGE AND/OR CONTAMINATION WITH BLOOD/BODY FLUIDS YES NO

Sodium hypochorite souon in the strength 1:10,000ppm (1%) is avaiabe

Sta is aware of how to preprare 1% Hypochorite souon.

FEEDING YES NO

Is a Water steriizer avaiabe and funconing with hot water?

Is there a cean area for preparaon of feeds and a sink avaiabe for

decontaminaon and ceaning of used feeding vesses? Observe whether feeding utensils are allowed to remain in boiling water for

atleast 5min

ASEPTIC NON TOUCH TECHNIQUE YES NO

Ateast 1 asepc technique observed by using the Asepc Non Touch

Technique (ANTT) Too. (E.g. bood samping, IV ine inseron, IV uid

preparaon and aachment to IV port etc) Percentage of absoute compiance

to a 10 steps


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sp apc n tuch tchu CuBd

spgDug

mkg

Two Persons doing the Procedure

Hand Hygiene before the Procedure

Hand Hygiene for the Assistant

Ceaning the Troey / Surface where Equipment kept

Assistant Opening the Equipment Appropriately

Appropriate Glove use during the Procedure

Sterile Field for the Procedure

Ceaning of the Site of Procedure (wait for 30 seconds)

Protecon of the Key Parts a the Time

Hand Hygiene aer the Procedure

Adherence to a 10 steps

asePtiC non toUCH teCHniqUe CHeCKlist: aUDit


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ru n-vd bd Yes n

Open Radiant Warmer

Oxygen Port - 1

Eectric Socket 5 Ampere- 1 & 15 Ampere-1

Hand Rub Dispenser

Syringe Pump

Infusion Pump

Spo2 Monitor

Mucus Aspirator

Infant Feeding Tube

Paade/Gavage

Syringes

Measuring Tape

Binaura Stethoscope

Sterie Coon/Gauze

Trash Bins

egcy eup d mdc ty quy Yes n

Resuscitator/Ambu Bag 1

laryngoscope With Bade 00/0 1

ET Tube Sizes 2.5/3.0/3.5/4.0/1 1

IV Cannua Nos 23/24 2 Each

Feeding and sucon tube Fr 6/7/8 1 Each

Syringes 5/10cc 2 Each

3-way connect- 100cm &10 cm

Surgica Bade 1

Suture Material 1

Adhesive Tapes 1

Neede Hoder 1

ICD Trocar/Under Water Sea Bag 1

Artery Forceps 1

Medicines- Adrenaline, Calcium Gluconate,

Atropine, Midazolam, Dopamine,

Dobutamine,Norma Saine , Phenobarbitone


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HAND HYGIENE

For Hand Washing

Running water with arge washbasins which require ie maintenance, with an spash devices andhands-free controls. Soap or ansepc depending on the procedure.

Faciies for drying without contaminaon (disposabe towes if possibe)

For Hand Disinfecon

Acohoic rubs with ansepc and emoient Ges which can be Appied to Physicay Cean Hands. Hand Rub Shoud Contain Minimum 60% Acoho and Preferaby 70% or More Acoho.

Hand Care Take Care of your Hands by Reguary Using a Protecve Hand Cream or loon, ateast Daiy. Do not Rouney Wash Hands with Soap and Water Immediatey before or

aer using an Acoho-Based Hand Rubs. Do not use Hot Water to Rinse your Hands. Aer Hand Rubbing or Hand Washing et your Hands Dry Competey before pung on Goves. Do not Wear Arcia Fingernais or Extenders when in Direct Contact with Paents.

Keep Natura Nais Short.

Personal Hygiene A Sta must Maintain Good Persona Hygiene. Nais must be Cean and Kept Short. Fase Nais Shoud not be Worn. Hair must be Worn Short or Pinned Up. Beard and Moustaches must be Kept Trimmed Short and Cean.


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HOUSEKEEPING PROCEDURES IN THE NICU

To Minimize The Transmission of Microorganisms From Equipment and the Environment, Adequate Methods for

Ceaning, Disinfecng and Steriizing must be in Pace.

Few Denions

Cleaning

Removing Foreign Materia (Soi, Organic Maer, Microbes) from an object. It is Best Done with Cean and Cod

Running Water. Somemes Mid Disinfecon With 0.5% Chorine Is Required Before Ceaning. Most Environmenta

Objects (Foors, Was, Sinks) Require Ony Mid Disinfecon and then Ceaning. A objects in the NICU Require

Cleaning.

Disinfecon

Disinfecon Is Removing a Pathogenic Microbes Except Spores. A Objects must be Ceaned before Disinfecon.

This is Required for a objects that come in Contact with Baby (Warmers, Equipment, linen, Coon, Gauze, Baby

Beongings Etc.). Disinfecon is done with moist heat (70 to100° C) or with Chemicas (2% Gutaradehyde, 6%Hydrogen Peroxide, 0.2 -0.3% Peracec Acid). When using Chemicas for Disinfecon, These Shoud not Come in

Contact with the Newborn.

Steriizaon

This is Remova of A living Microbes Incuding Spores. This Is Required for a objects that Invade the Body

(Orogastric tube, Catheters, and Venator Circuits). Steriizaon is done with Autocave/Dry Heat/Ethyene Oxide

Gas.

Decontaminaon

It invoves Ceaning, Disinfecon and Steriizaon

Responsibiity of Housekeeping Sta

Cleaning Floors-(Including Counseling room, Handover, Triage, Changing and Feeding Rooms)

Foor Mopping. Once per shi and as and when needed in case of spi.

Surface Ceaning - Daiy (Horizonta Surfaces, Window Sis, Doorknobs, light Switches, Furniture in Nursing

Staon, Racks).

Surface Ceaning , When Soied (Was, Window Binds, Window Curtains.)

Sucon Jars, Oxygen Humidiers, Sucon Tubing.

Main Scrub Area & Sinks

Slippers

Coecng Soied linen

Waste Emptying

Ceaning Waste Disposa Bins

Cleaning of Toilets

Once a Shi

Floor Cleaning, Surface Cleaning, Disposal Of Waste

Once daily

Scrub Areas and Sink, Sucon Jars, Oxygen Humidier, Sippers and Waste Bins, Soied linen, Toiets


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The Formua for Making a Diute Chorine Souon From Any Concentrated Hypochorite Souon Is:

Check Concentraon (% Concentrate) of the Chorine Product You are Using. Determine Tota Parts Water Needed Using the Formua Beow. Tota Parts (TP) water = [%Concentrate ] - 1 % Diute Mix 1 part concentrated beach with the tota parts water required.

Example: Make a diute souon (0.5%) from 5% concentrated souon

STEP 1: Cacuate TP water: [ 5.0% ] - 1 = 10 – 1 = 9 0.5 %STEP 2: Take 1 Part Concentrated souon and add to 9 parts water.

The Formua For Making a Diute Souon From a Powder of Any Percent Avaiabe Chorine Is:

Formua for making Chorine Souon from Dry Powders:

Check concentraon (% concentrate) of the powder you are using. Determine grams bleach needed using the formula below.

Grams/liter = [ % Diute ] X 1000

% Concentrate Mix measured amount of beach powder with 1 itre of water.

Example: Make a diute Chorine-reeasing souon (0.5%) from a Concentrated Powder (35%).

STEP 1: Cacuate grams/itre: x 1000 = [ 0.5% ] X 1000 = 14.2 g / l 35%STEP 2: Add 14.2 grams (Approximatey 14 g) to 1 itre of water.

WHO (1989) recommends 0.5% Chorine Souon for Decontaminang Instruments and Surfaces Before Cean -ing. In addion, Because of the Potenay High load of Microorganisms And/Or Other Organic Materia (Boodor Other Body Fuids) On Soied Items, Using a 0.5% Souon for Decontaminaon Provides a wider Margin ofSafety.



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Cleaning Methods Of Housekeeping Surfaces

Cleaning Should Start with the Least Soiled Area and move to the most soiled area and from High to Low

Surfaces.

Wet Mopping

Is the Most Common and Preferred Method to Clean Floors.

Doube-Bucket Technique

Two Dierent Buckets are used, One Containing a Ceaning Souon and the other Containing Rinse Water.

The Mop is aways Rinsed and wrung out before it is Dipped into the Ceaning Souon. The Doube-Bucket

Technique Extends the life of the Ceaning Souon (Fewer Changes are Required), Saving both labor and

Material Costs.

Dusng

Is Most Commonly Used for Cleaning walls, Ceilings, Doors, Windows, Furniture and Other Environmental

Surfaces. Cean Coth or Mops are Weed with Ceaning Souon Contained in a Basin or Bucket. The Doube-Bucket

System Minimizes the Contaminaon of the Ceaning Souon.

Dry Dusng shoud be avoided and Dust Coths and Mops Shoud Never be Shaken to avoid the Spread of

Microorganisms.

Dusng Shoud be Performed in a Systemac way, Using a Starng Point as a Reference to Ensure that a

Surfaces Have been Reached.

Using Care when wet Dusng Equipment and Surfaces above the Paent to avoid Paent Contact with the

Detergent/Disinfectant.

When Doing High Dusng (Ceiing Ties And Was), Check for Stains that may Indicate Possibe leaks. (leaks

Should be Repaired as soon as Possible because Moist Ceiling Tiles Provide a Reservoir for Fungal Growth.)

Part of the Ceaning Strategy is to Minimize Contaminaon of Ceaning Souons and Ceaning Toos.

Another source of contaminaon in the ceaning process is the ceaning coth or mop head, especiay if esoaking in dirty ceaning souons. laundering of coth and mop heads aer use and aowing them to dry before

re-use can hep to minimize the degree of contaminaon. A Simpied Approach to Ceaning Invoves Repacing

Soied Coths and Mop Heads with Cean Items Each Time A Bucket of Detergent/Disinfectant is Emped and

Repaced with Fresh, Cean Souon.)

Ceaning Souon Shoud be Prepared Daiy Since another Reservoir for Microorganisms in the Ceaning Process

may be Diute Souons of the Detergents Or Disinfectants, Especiay if the Working Souon is Prepared in a

Dirty Container, Stored for long Periods of me, or Prepared Incorrecty. Appicaon of contaminated ceaning

souons, parcuary from sma quanty aeroso spray boes or with equipment that might Generate Aerosos

during operaon, shoud be avoided, Especiay in High-Risk Paent areas.

Making Sucient Fresh Ceaning Souon for Daiy Ceaning, Discarding any Remaining Souon, and Drying out

the Container wi hep to Minimize Containers that Dispense liquid as Opposed to Spray-Nozze Dispensers (e.g.,

Quart-Sized Dishwashing liquid Boes) can be used to appy Detergent/ Disinfectants to Surfaces and then to

Ceaning Coths With Minima Aeroso Generaon.

Ceaning Strategies For Spis of Bood and Body Substances:

Cean Spis with a 0.5% Chorine Souon.

Cean Spis of Bood, Body Fuids and other Potenay Infecous Fuids Immediatey:

For Small Spills

Whie Wearing Uity or Examinaon Goves, Remove Visibe Materia Using a Coth Soaked in a 0.5% Chorine

Souon, then wipe Cean with a Disinfectant Ceaning Souon.

For Large Spills

Whie Wearing Goves, Food the Area with a 0.5% Chorine Souon, Mop up the Souon and then Cean asusual with Detergent and water.



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Chemical

Soak

10 – 24 minutes

Autoclave

Pressure : 106 kpa

(15 b/inch sq)

T e m p e r a t u r e:121° C

(250° F)

Dry Heat

170° C

Boi

or Steam

Chemical

Soak 20 minutes

How to Clean Soiled and Contaminated Cleaning Equipment

Step 1: Decontaminate ceaning equipment that has been contaminated with bood or body uids by

soaking it for 10 minutes in a 0.5% Chorine Souon or other ocay avaiabe and approved

disinfectants.

Step 2: Wash cleaning buckets, cloths, brushes and mops with detergent and water daily, or sooner if visibly

dirty.

Step 3: Rinse in clean water.

Step 4: Dry completely before reuse. (Wet cloths and mop heads are heavily contaminated with

microorganisms.).

a dc cg bjc h w

Disinfecon with hot water Temperature Duraon1. sy eup 80° Cu 45–60 cd

2. l 70° Cu 25 u 95° Cu 10 u


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Ceaning schedue for Nursing Sta:

1 Object Disinfecon Method

2 Warmer/Incubator When In Use Soap & Water

3 Sterilizer Soap & Water

4 Oxygen hood Soap & Water

5 Feeding Utensils (Paladay, Spoon, Katories etc.) Soap and water & Boi For 10 Minute

6 Refrigerator Defrost & Soap & Water

7 Stethoscope/Thermometer/ Measuring Tape Acoho/Spirit

8 Feeding Utensis Shef/Bathing Tray Shef 1% Baciocid*

9 TPN Room ( laminar Fow, Dressing Troey) 1% Baciocid

10 Infusion Pump /Monitor/Bedside Tabe 1% Baciocid

11 Warmer/Incubator When Not In Use 1% Baciocid & Rinse We With Water

12 Unused Biomedica Equipment 1% Baciocid

13 Crash Troey/Other Pasc Trays 1% Baciocid

14 Ambu Bag & Mask Soap & Water and Eo or 2% Cidex

15 Nasa Canua Oxygen Soap & Water & Eo

16 Oxygen & Sucon Boes Soap & Water & Eo

17 Oxygen & Sucon Tubes Eo Steriizaon

18 Swab Container, Injecon And Medicine Tray Wash With Soap & Water / Autocave

19 Sets For Procedures Wash With Soap & Water/ Autocave

20 Cheatle Forceps Autoclave

21 Steel Drums Autoclave

22 Baby linen, Banket, Banket Cover Wash & Autoclave

23 Coon Gauze Autoclave

*1% Baciocid is Prepared By Adding 50m Baciocid + 5 litre Water

Soap and Water to be used Instead of Baciocid aer the Inia Outbreak of Infecon Subsides.


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Hand Hygiene Wash Hands with Soap and Water (Foow a 6 Steps for Minimum 60sec )

Wear Mask, Cap and Gloves Do Not Touch Baby /Baby’s Environment with Goves. Handwash / Handrub Aer Removing the Goves

Endotracheal Tube Care During Intubaon Asepc Technique to be Maintained, Mask And Goves to be Worn

Ora Intubaon is Preferred over Nasa

Humidicaon Heated Humidier is a Must Inspired Gas At 370C and 100% Reave Humidity Use Dised Water in the Humidier.

Aways use the Auto-Fi Technique for the Humidier to water. No Condensaon in Inspiratory limb Drain Condensate to Water Trap Consider Condensate as an Infecous Waste and Discard accordingy Handwash aer Contact with Condensate

Respiratory Equipment Care Venator Circuits and Oxygen Therapy Equipment Shoud be Readiy Avaiabe CPAP Systems Aowed to remain on Stand-By for no longer than 12 hrs Resuscitaon bags not to be laid on bed, to be Hung Outside Of Bed.

Resuscitaon Bags Shoud be Repaced Once a Week The Circuit to be Posioned Parae to the Baby and in Dependent Posion

Posion of Infant 30 degree eevaon of the head end latera Decubitus is the Preferred Posion Frequent Change in Posion

Stress Ulcer Prophylaxis Acid Gastric Content Prevent Bacteria Coonisaon Avoid Using Antacids-Such as Ranidine Sucrafate is Preferred over Ranidine when required

Oral Hygiene Ora Sucon to Prevent Pooing of Secreons Aways Sucon Nose before the Mouth Moisten the Lips with Saline Avoid Reusabe Sucon Tubes for Ora Sucon Mucus Bub Sucon Avoided for Ora Sucon Chorhexidine Ora Appicaon is opona

Enteral Feeds

Encourage Oral Feeds through the Orogastric Tube Prefer EBM over formua Trophic Feeds if not on Enteral Feeds

Shorten Duraon of Intubaon and Venaon Consider Use of Non Invasive Venaon Wean O Invasive Venaon as soon as possibe Prevent Unpanned Extubaon Avoid Unnecessary Re-Intubaon

Post Extubaon Frequent Change in Posion Ora and Nasa Sucon Nebuisaon SOS

Watch for Respiratory Distress

ventilator assoCiateD PneUmonia (vaP) BUnDle


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Inseron Bunde

Estabish a Centra line Kit or Cart to Consoidate a Items Necessary for the Procedure Perform Hand Hygiene with Hospita-Approved Acoho-Based Product

or Ansepc-Containing Soap before and Aer Papang Inseron Sites and before and aer

Inserng the Centra line Use Maxima Barrier Precauons (Incuding: Sterie Gown, Sterie Goves,

Surgical Mask, Cap, & Large Sterile Drape)

Disinfect Skin with Appropriate Ansepc (2% Chorhexidine, 70% Acoho)

before Catheter Inseron

Minimize the Number of Access Ports

Keep Connecng Ports with UVC/UAC away from Diaper Area

Use Either a Sterie Transparent Semi-Permeabe Dressing or Sterie Gauze to Cover The Inseron

Site

Prefer Upper Limb Veins over Lower Limb Veins

Ensure the Catheter Tip at Proper Posion No Bood Stains around the Inseron Site

Maintenance Bunde

Perform Hand Hygiene with Hospita Approved Acoho-Based Product or Ansepc Containing

Soap Before and Aer Accessing a Catheter or Before and aer Changing the Dressing

Evauate The Catheter Inseron Site Daiy for Signs of Infecon and Dressing Integrity

If the Dressing is Damp, Soied, or loose Change Dressing Asepcay and Disinfect

the Skin around the Inseron Site with an Appropriate Ansepc

Develop and Use Standardized Intravenous Tubing Setup and Changes

Maintain Asepc Technique when Changing Intravenous Tubing

and when Entering the Catheter Incuding “Scrub the Hub”

Daiy Review of Catheter Necessity with Prompt Remova when No longer Essena

Hub Care Bunde

Cleanse Hands with Soap and Water

Put on Gloves

Establish Sterile Field Under Access Port

Place Syringes on Edge of Sterile Field

Scrub Access Port with Chorhexidine for 10 Seconds and Aow to Dry

(Clean Outside and on top but not inside the Hub)

Pick up Syringe Keeping Tip Sterile

Aach Syringe to Hub, Keeping Connecons Sterie

Administer Fush Souon Keeping Connecons Sterie

CENTRAL LINE ASSOCIATeD BlooD stream infeCtion (ClaBsi)


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Parentera Nutrion

Start Aminoacids ateast 1g/Kg/Day on Day 1 Increase Aminoacids to 3 to 4 G/Kg/Day on Day 2 And lipids to 3g/Kg/Day on Day 2 or ASAP

Connue TPN Entera Feeds 100m/Kg/Day

Aways Use Centra line for Giving Parentera Nutrion

Heparin 1U/m in the TPN souon

Both lipid and Amino-Acid Souons to be protected from Sunight

Entera Nutrion

Early Trophic Feedings

Strategies to Improve Rates of Materna lactaon (Eary Pumping by the Mother,

Mothers Entry into the NICU, Mother invoved in Baby Care Acvies, Reieve Pain and Stress,

lactaon Counseor, Gaactogogues) Improved Use of Human Mik Preferenay, both in the NICU and beyond Discharge.

Mothers own Milk the ideal choice.

Colostrum a Must

For VlBW Infants Forcaon of Human Mik Shoud be done with Mu-Component Human Mik

Forers (HMF) once the Infant is on 150m/Kg/Day of Entera Feeds

For Infants On Formula Feeds

Asepsis on Preparaon of Feeds

Actua Powder to Water Rao

Water at 80oC during Preparaon of Feeds

One feed, one preparaon. e over thrown out Eary Non Nutrive Sucking (NNS) on Empty Breast of the Mother

Increased Emphasis on Growth as part of Daiy NICU Care

Daily Weight, Weekly Length and OFC

Promote Kangaroo Mother Care During Intermediate Care and During NNS

Appropriate nutriona support during the transion to home phase of care; (i.e. Sharing Growth

Charts, Kangaroo Mother Care, Specic Post-Discharge Nutriona Recommendaons,

Access to Pediatric Diecian, Etc.)

Vitamin A Prophyaxis In Infants With A Birth Weight less Than 1250 Grams

To Prevent Chronic Lung Disease

NUTRITION BUNDLE


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Ca Received >30mins Before Impending Premature Deivery

Open Warmer Preparaon In labour Room OT

Pre Warm Open Warmer At 100% For >10min Before Arriva

Warm 2 Sets of linen for >10mins

Incubator Preparaon In NICU

Warm Transport Incubator to 36 Degree C

Warm NICU Incubator to 36 Degree C

Incubator Humidity >60%

Equipment Preparaon In NICU

Venator or CPAP, Oxygen, Sucon Apparatus

Resuscitaon Kit / Intubaon Troey

Weighing Scale, Pediatric Drip Set, SpO2 Monitoring

Resuscitaon Of Baby As Per NRP

Pace Baby in Zip-lock Or Cover Enre Body Except the Face with Pasc Wrap

aer Inia Assessment Of Heart Rate, Breathing And Coor

Shi Baby To Pre-Warmed Transport Incubator Post Resuscitaon

Receive Baby In Nicu In Transport Incubator And Covered In Zip-lock/Pasc Wrap

Weigh The Baby Before Transferring From Transport Incubator To Nicu Incubator

Temperature On Admission Within 10 Minutes : Axiary

Recheck Houry Euthermic and then aer 6hrs

If Norma Temperature, Remove Zip-lock/Pasc Wrap

PREVENTION OF HYPOTHERMIA IN ELBW AND VLBW INFANTS


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Conference Secretariat

Fernandez Hospital Pvt. Ltd.

Bogukunta, Hyderabad – 500001.

Phone : 91-40-40632569 Mobie : 8886360023

Dr. Srinivas Murki : 9392470351

Fax : 91-40-24753482

Emai: [email protected] :www.iapneocon2012. org

Nicu Checklist Bundles Infection Control 1

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