What are the evidence-based practices (EBP) for staff hygiene in the Neonatal Intensive Care Unit (NICU), specifically regarding jewelry wear and hand hygiene protocols?

From the Guidelines

Evidence-based practice (EBP) for hand hygiene in the NICU recommends that staff should remove all jewelry, watches, and artificial nails from the hands and wrists up to the elbows, and wash their hands for 2-3 minutes for the initial scrub of the day, followed by 1-2 minutes for subsequent hand hygiene events, as supported by 1 and 1. The recommended hand hygiene protocol is crucial in preventing healthcare-associated infections in vulnerable neonates.

• Key components of the protocol include:
  • Removing all jewelry, watches, and artificial nails from the hands and wrists up to the elbows to prevent harboring of microorganisms 1
  • Washing hands with antimicrobial soap and warm water for 2-3 minutes for the initial scrub of the day, and 1-2 minutes for subsequent hand hygiene events 1
  • Using a systematic approach to clean hands from fingertips to elbows
  • Drying hands with disposable paper towels
  • Using alcohol-based hand rub between patient contacts when hands are not visibly soiled 1 The rationale behind these practices is that jewelry and artificial nails can harbor microorganisms, and the extended washing time ensures mechanical removal of transient flora and reduction of resident microorganisms, which is essential for preventing potentially life-threatening infections in this high-risk population.
• It is also important to note that:
  • Hand hygiene adherence in health-care facilities might be improved by providing personnel with individual containers of alcohol-based hand rubs, hand lotions or creams, and feedback regarding hand-hygiene adherence/performance 1
  • Alcohol-based hand rubs have good or excellent antimicrobial activity against all microorganisms, except for bacterial spores 1
  • Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water, but they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of healthcare workers 1

From the Research

Evidence-Based Practice for Hygiene in NICU

• The evidence suggests that hand hygiene is a crucial aspect of preventing hospital-acquired infections in healthcare settings, including NICU 2, 3, 4, 5.
• According to the studies, hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce healthcare-associated infections 4, 5.
• The World Health Organization (WHO) multimodal hand hygiene improvement strategy has been shown to be effective in improving hand hygiene compliance among healthcare workers 4, 5.
• The strategy includes system change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate 4.

Hand Hygiene Practices

• The studies recommend that healthcare workers should wash their hands for at least 20 seconds, but the optimal duration is not specified 2, 3.
• It is recommended that healthcare workers should not wear jewelry on their hands, including rings, watches, and false fingernails, as they can harbor bacteria and interfere with proper hand hygiene practices 6.
• The epic guidelines recommend that hand jewelry and false finger nails should be kept short, clean, and free from nail polish 6.

Best Arm/Hand Hygiene Practices

• The evidence suggests that the use of alcohol-based hand rub is more effective than washing with soap and water in reducing bacterial carriage on hands 4, 5.
• The WHO recommends the use of alcohol-based hand rub as the preferred method for hand hygiene in healthcare settings 4, 5.
• It is recommended that healthcare workers should perform hand hygiene at the right moments, including before and after patient contact, before and after putting on and removing gloves, and after exposure to bodily fluids 2, 3, 4, 5.