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 forearms up to the elbows, and wash hands for 40-60 seconds with soap and water or use an alcohol-based hand rub for 20-30 seconds when hands are not visibly soiled. The "bare below the elbows" approach is widely adopted because rings, watches, and bracelets harbor microorganisms and impede proper hand cleaning 1. Long fingernails and artificial nails should be avoided as they harbor more pathogens.

Some key points to consider for hand hygiene in the NICU include:

• Removing all jewelry, watches, and artificial nails from the hands and forearms up to the elbows to prevent harboring microorganisms and impeding proper hand cleaning 1
• Washing hands with soap and water for 40-60 seconds or using an alcohol-based hand rub for 20-30 seconds when hands are not visibly soiled 1
• Performing hand hygiene before entering the NICU, before and after patient contact, after removing gloves, and when moving between patients 1
• Using an alcohol-based hand rub as the preferred method of hand hygiene in most situations, as it is convenient, acts rapidly, and is highly effective in inactivating microbes 1
• Washing hands with soap and water instead of an alcohol-based hand rub whenever they are visibly soiled or contaminated with blood or other body fluids, if exposure to spores is likely to have occurred, before eating, and after using the toilet 1

The scientific rationale behind these practices is that neonates, especially premature infants, have immature immune systems and are highly susceptible to healthcare-associated infections. Proper hand hygiene is the single most effective measure to prevent pathogen transmission in the NICU environment. Regular audits of hand hygiene compliance and ongoing education for staff help maintain adherence to these critical practices that directly impact neonatal outcomes.

From the Research

Evidence-Based Practice for Hygiene in NICU

• The evidence-based practice (EBP) for hygiene in the Neonatal Intensive Care Unit (NICU) emphasizes the importance of hand hygiene in preventing healthcare-associated infections 2, 3, 4, 5, 6.
• According to the studies, hand hygiene is considered the single most effective tool to prevent healthcare-associated infections, and compliance rates vary among healthcare workers, with nurses generally having higher compliance rates than physicians 2.
• The Centers for Disease Control and Prevention (CDC) recommend a minimum of 20 seconds for hand washing, and a study found that a video didactic at the point of care can increase hand hygiene compliance in the NICU 3.
• The World Health Organization's (WHO) multimodal hand hygiene improvement strategy has been shown to be effective in improving hand hygiene compliance among healthcare workers, and includes elements such as system change, education, monitoring, and performance feedback 4.
• There is no specific evidence to support the practice of wearing no jewelry from elbows down to hands, but it is generally recommended to minimize jewelry and other items that may interfere with hand hygiene 5, 6.

Best Arm/Hand Hygiene Practices

• The CDC recommends washing hands with soap and water for at least 20 seconds, or using an alcohol-based hand rub if soap and water are not available 3.
• The WHO recommends the use of alcohol-based hand rub as the preferred method for hand hygiene in healthcare settings, as it is faster and more effective than washing with soap and water 4.
• A systematic review found that both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers 5.
• Another systematic review found that hand hygiene compliance rates of approximately 60% are associated with lower hospital-acquired infection incidence rates, but high-quality evidence is needed to support the implementation of specified targets for hand hygiene compliance rates 6.