1. Background

► Routinely infected neonates
      ♦ Universal precautions

► Under certain situations - more stringent measures needed
      ♦ Highly contagious infections
      ♦ Multidrug resistant organisms
      ♦ Immuno-compromised patients

► Barrier nursing is a set of interventions consisting of
    stringent infection control practices so as to prevent
    spread of infections in such situations

2. Learning objectives

► The concepts of barrier nursing

► Contact prevention

► Personal protective equipment

► Respiratory prevention

3. Barrier nursing concept

► Set of interventions
      ♦ Stringent infection control practices
      ♦ Prevents spread to other neonates/ healthcare workers

► Spread of infections through
      ♦ contaminated surfaces or hands, fomites, droplets,
         inhaling aerosols, etc

► Aim is to prevent spread
      ♦ from one baby to another
      ♦ to medical staff
      ♦ outside of unit and hospital

4. Universal precautions

► Standard precautions exercised during routine nursing care

► Assume everyone infected

► Includes
      ♦ Hand hygiene
      ♦ Use of gloves, gowns, masks during handling patients'
         body fluids
      ♦ Prevention of fomites
      ♦ Disinfecton of anything which comes in contact with the
         baby

5. Cohorting

► For multidrug infections
      ♦ Universal precautions - strengthened
      ♦ Neonate(s) cohorted away from rest of the neonates
      ♦ Separate health care professionals
      ♦ Appropriate PPE
      ♦ Separate biomedical waste disposal

6. Body substance isolation

► Body fluids handling
      ♦ After donning appropriate PPE
      ♦ Discard in yellow bin

► If secretions or excreta are highly contagious
      ♦ Special way to donn PPE
      ♦ Special way to discard PPE
      ♦ Each neonate requires separate PPE
      ♦ Appropriate separate biomedical disposal

7. Donning Personal Protective Equipment

► Firstly, gown

► Mask or respirator

► Goggles or face shield

► Gloves

8. Personal protective equipment - Donning

9. Removing PPE

► Gloves

► Face shield or goggles

► Gown

► Mask or respirator

10. Removing PPE- steps

11. Airborne precautions

► In cases of airborne transmission of infectious agents
      ♦ Airborne droplet residue (5 µm or smaller)

► Special air handling and negative pressure ventilation of
    the room

► Generally not available

12. Summary

► Barrier nursing is an effective way of preventing infection
    spread within SNCU

► Universal precautions should be exercised during usual
    SNCU care

► In case of neonates with highly contagious infections,
    appropriate PPE should be worn in addition. The particular
    sequence of donning and removal of PPE must be adhered to

► Respiratory isolation is required for infections with the risk
    of airborne transmission