What are the evidence-based practices (EBP) for staff hygiene in the Neonatal Intensive Care Unit (NICU), specifically regarding jewelry wear from elbows down to hands and hand washing duration?

From the Guidelines

Staff in the neonatal intensive care unit (NICU) should remove all jewelry, watches, and artificial nails from the hands and forearms up to the elbows and perform hand hygiene for at least 15-30 seconds with an alcohol-based hand rub or antimicrobial soap and water, as this is the most effective method for reducing bacterial counts and preventing healthcare-associated infections 1.

Key Recommendations for NICU Staff

• Remove all jewelry, watches, and artificial nails from the hands and forearms up to the elbows to prevent harboring of pathogens and interference with proper hand hygiene 1
• Perform hand hygiene for at least 15-30 seconds with an alcohol-based hand rub or antimicrobial soap and water, as this is the most effective method for reducing bacterial counts and preventing healthcare-associated infections 1
• Use alcohol-based hand rubs for routine hand hygiene when hands are not visibly soiled, as they are more effective than soap and water for reducing bacterial counts 1
• Use antimicrobial soap and water for visibly soiled hands or when exposure to spores (e.g. Clostridium difficile) is likely to have occurred 1
• Keep nails short, natural, and unpolished, as artificial nails and chipped polish harbor microorganisms 1

Importance of Hand Hygiene in NICU

• Neonates have immature immune systems and are particularly vulnerable to healthcare-associated infections, which can lead to serious complications or death
• Strict adherence to hand hygiene protocols is critical in the NICU setting to prevent the transmission of infectious agents and ensure the best possible outcomes for patients
• The "bare below the elbows" approach is recommended because rings, watches, and bracelets can harbor pathogens and interfere with proper hand hygiene 1

From the Research

Hand Hygiene in Neonatal Intensive Care Units (NICUs)

• Hand hygiene is considered the most important measure in preventing hospital-acquired infections in NICUs 2, 3.
• The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend hand hygiene as a crucial step in preventing healthcare-associated infections.

Best Practices for Arm/Hand Hygiene

• Proper hand hygiene involves washing hands with soap and water for at least 20 seconds, or using an alcohol-based hand sanitizer for at least 15 seconds 2, 4.
• Hand hygiene should be performed before and after patient contact, and after contact with patient body fluids or surroundings 3.
• Removing jewelry from elbows down to hands is not explicitly mentioned in the provided studies, but it is a common practice in healthcare settings to minimize the risk of infection transmission.

Professional Organizations' Recommendations

• The American Academy of Pediatrics (AAP) and the Society for Healthcare Epidemiology of America (SHEA) recommend hand hygiene as a key component of infection prevention and control in NICUs 2, 3.
• The CDC and WHO provide guidelines for hand hygiene in healthcare settings, including NICUs, which emphasize the importance of proper hand hygiene technique and frequency 2, 4.

Specific Recommendations for Neonatal ICUs

• A study published in the Journal of Hospital Infection found that senior nurses in NICUs achieved higher scores for handwashing technique, and that nurses who held positive feelings about the atmosphere in their NICU also scored higher 4.
• Another study published in the American Journal of Infection Control found that compliance rates for hand hygiene were higher in nurses (57%-66%) than in physicians (29%-52%) in pediatric and neonatal ICUs 3.