1. Background

â–º Routinely infected neonates
      ♦ Universal precautions

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

â–º 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

â–º The concepts of barrier nursing

â–º Contact prevention

â–º Personal protective equipment

â–º Respiratory prevention

3. Barrier nursing concept

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

â–º Spread of infections through
      ♦ contaminated surfaces or hands, fomites, droplets,
         inhaling aerosols, etc

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

4. Universal precautions

â–º Standard precautions exercised during routine nursing care

â–º Assume everyone infected

â–º 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

â–º 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

â–º Body fluids handling
      ♦ After donning appropriate PPE
      ♦ Discard in yellow bin

â–º 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

â–º Firstly, gown

â–º Mask or respirator

â–º Goggles or face shield

â–º Gloves

8. Personal protective equipment - Donning

9. Removing PPE

â–º Gloves

â–º Face shield or goggles

â–º Gown

â–º Mask or respirator

10. Removing PPE- steps

11. Airborne precautions

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

â–º Special air handling and negative pressure ventilation of
    the room

â–º Generally not available

12. Summary

â–º Barrier nursing is an effective way of preventing infection
    spread within SNCU

â–º Universal precautions should be exercised during usual
    SNCU care

â–º 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

â–º Respiratory isolation is required for infections with the risk
    of airborne transmission