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

Staff in the NICU should remove all jewelry from elbows down to hands and wash their hands for at least 15 seconds with soap and water or use an alcohol-based hand rub, with a recommended duration of 2-3 minutes for the initial scrub of the day, followed by 1-2 minutes for subsequent hand hygiene events, to prevent healthcare-associated infections. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend hand hygiene as the single most important method of preventing transmission of infectious agents 1.

Hand Hygiene Protocol

• Remove all jewelry, watches, and artificial nails from the hands and wrists up to the elbows
• Use antimicrobial soap or alcohol-based hand rub with at least 60% alcohol content
• Ensure coverage of all surfaces including between fingers, backs of hands, wrists, and forearms
• Vigorously rub hands with attention to fingernails, cuticles, and interdigital spaces
• Dry hands thoroughly with disposable paper towels

According to the AAP, hands should be disinfected with an alcohol-based hand rub or washed with soap and water before and after each patient encounter or an encounter with the patient’s immediate environment 1. The CDC also recommends keeping fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears 1.

Importance of Hand Hygiene in NICU

• Neonates, especially premature infants, have immature immune systems and are highly susceptible to healthcare-associated infections
• Jewelry harbors microorganisms that may not be eliminated during routine hand hygiene
• Artificial nails have been linked to outbreaks of infection in NICUs
• Regular audits of hand hygiene compliance and ongoing education for staff help maintain these standards and protect this vulnerable patient population

It is essential to follow this strict protocol to prevent healthcare-associated infections in the NICU, as recommended by the CDC and AAP 1.

From the Research

Hand Hygiene in NICU

• The evidence-based practice (EBP) for hand hygiene in NICU settings involves using alcohol-based hand sanitizers as an effective alternative to hand washing when hands are not heavily soiled 2, 3.
• Studies have shown that alcohol-based hand sanitizers can reduce the transmission of healthcare-associated infections and are well-tolerated by healthcare workers 4, 5.
• The correct procedure for hand hygiene involves applying enough sanitizer to cover all surfaces of the hands, rubbing hands together until dry, and paying special attention to areas between fingers, under nails, and the backs of hands 6.

Removing Jewelry for Hand Hygiene

• There is no specific evidence provided in the studies regarding the removal of jewelry from elbows down to hands for hand hygiene in NICU settings.
• However, it is generally recommended to remove jewelry that may interfere with hand hygiene or create a barrier to effective cleaning 6.

Duration of Hand Washing

• The studies do not provide a specific recommendation for the duration of hand washing in NICU settings.
• However, one study mentions that the SaniTwice method involves "hand washing" for 15 seconds with alcohol-based hand sanitizer, followed by thorough cleaning with paper towels while hands are still wet 3.
• Another study mentions that hand decontamination using alcohol-based hand gels or soap and water should be performed for an adequate amount of time to ensure effective removal of microorganisms 6.

Best Arm/Hand Hygiene Practice

• The best arm/hand hygiene practice involves using alcohol-based hand sanitizers as an effective alternative to hand washing when hands are not heavily soiled 2, 3.
• Studies have shown that alcohol-based hand sanitizers can reduce the transmission of healthcare-associated infections and are well-tolerated by healthcare workers 4, 5.
• The correct procedure for hand hygiene involves applying enough sanitizer to cover all surfaces of the hands, rubbing hands together until dry, and paying special attention to areas between fingers, under nails, and the backs of hands 6.