4.1 Placement of neonates/assessment for infection risk

Undertake assessment for infection risk at the point of entry into the unit before placement of the neonate is decided. This assessment is the minimal microbiological testing required and any additional testing would be determined by the clinical presentation of the neonate. The potential for transmission of infection should be continuously reviewed throughout the stay/period and must be documented in the clinical notes.

Neonates who present as a cross infection risk include those who:

• have been transferred from another unit in Scotland with an ongoing incident/outbreak or
• were born outside Scotland
• have previously been positive with a Multidrug Resistant Organism (MDRO)

From mothers who have:

• been hospitalised outside Scotland in the previous 12 months
• had no antenatal care
• been previously positive with a MDRO e.g. Multidrug Resistant Staphylococcus Aureaus (MRSA) or Carbapenemase Producing Enterobacteriaceae (CPE)

If a neonate is considered to be a cross infection risk then the clinical judgement of those involved in the management of the baby should assess the placement by prioritising the incubator/cot in a suitable area pending investigation i.e. place in a single room or cohort area/room with a wash hand basin.

Information/advice must be given to parents/carers of all neonates; particularly during outbreaks/incidents

4.2 Healthcare infection, incidents, outbreaks and data exceedence

In addition to the definitions in Chapter 3, in a neonatal unit investigation by IPCT is also required if:

• a single case of infection with an alert organism is identified
• two or more cases of colonisation with the same organism; linked in time and place are identified

Assigning staff to nurse only infected/colonised neonates may also be required. During outbreaks or incidents the ratio of staff to neonates may need to increase and it may be necessary to restrict admissions to the area.

4.3 Personal care of neonates

Due to the vulnerability of some neonates the use of tap water for personal care requires consideration and this is outlined in Guidance for neonatal units (NNUs) (levels 1, 2 & 3), adult and paediatric intensive care units (ICUs) in Scotland to minimise the risk of Pseudomonas aeruginosa infection from water. For example, an assessment should be made on the neonate’s condition and whether tap water can be used or if an alternative, such as sterile water, is considered more appropriate.

In addition incubators/cots should not be placed near any water source where spraying or splashing may occur.