From the Guidelines
Evidence-based practice for hygiene in the NICU recommends that staff, including nursing students, should remove all jewelry from the elbows down to the hands before providing care. This includes rings, watches, bracelets, and artificial nails. Hand hygiene should involve washing with antimicrobial soap and water for at least 20 seconds, paying special attention to areas between fingers, under nails, and thumbs. Alcohol-based hand rubs (containing at least 60% alcohol) can be used when hands are not visibly soiled 1.
Key Points for Hand Hygiene in NICU
- Remove all jewelry from elbows down to hands before providing care
- Wash hands with antimicrobial soap and water for at least 20 seconds
- Use alcohol-based hand rubs when hands are not visibly soiled
- Pay special attention to areas between fingers, under nails, and thumbs during hand hygiene
Professional organizations like the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) emphasize these practices specifically for neonatal care because jewelry harbors microorganisms that can cause healthcare-associated infections in vulnerable neonates. Rings, in particular, significantly increase bacterial counts on hands even after washing, as demonstrated by studies showing that skin underneath rings is more heavily colonized than comparable areas of skin on fingers without rings 1.
Importance of Hand Hygiene in NICU
- Neonates have immature immune systems and thin skin barriers, making them highly susceptible to infections
- Infections can lead to serious complications or death in neonates
- Hand hygiene is critical to prevent the transmission of pathogens in the NICU
Nursing students in the NICU should absolutely remove all jewelry below the elbows, keep nails short, natural, and unpolished, and perform thorough hand hygiene before and after patient contact. This practice is critical because neonates, especially premature infants, are at high risk for healthcare-associated infections. Following the guidelines for hand hygiene, as outlined by the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force 1, is essential for preventing the spread of infections in the NICU.
From the Research
Hand Hygiene in NICU
- Hand hygiene is a critical aspect of infection prevention and control in healthcare settings, including NICU 2, 3.
- The use of personal protective equipment, including gloves, is essential in preventing the spread of infections 4.
- Hand hygiene practices, such as washing hands with soap and water or using alcohol-based hand gels, are effective in reducing healthcare-associated infections 3.
Jewelry and Hand Hygiene
- Studies have shown that hand adornments, such as jewelry, can interfere with proper hand hygiene practices and contribute to the spread of infections 5.
- The epic guidelines recommend that hand jewelry and false finger nails should be kept short, clean, and free from nail polish 5.
- It is recommended that healthcare workers, including those in NICU, avoid wearing jewelry on their hands and arms to prevent interference with hand hygiene practices.
Recommendations for Nursing Students in NICU
- Nursing students in NICU should follow the same hand hygiene practices and guidelines as healthcare workers, including avoiding jewelry on their hands and arms 5.
- Nursing students should prioritize hand hygiene and use personal protective equipment, such as gloves, to prevent the spread of infections 4.
- By following these guidelines, nursing students can help prevent healthcare-associated infections and ensure a safe environment for patients in NICU 2, 3.