Re: Special care nursery

07/08/2012 at 6:38 pm #69259

TERRI CRIPPS

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TERRI CRIPPS

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Hi,

Having worked in Paediatrics, Special Care and Infection Control I, too, see it from both sides.

Maybe there could be a designated short visiting time for siblings to visit the new baby which would limit the time the new baby was exposed to any potential disease while keeping the family happy, after a quick screening using the tool, from the nurse caring for the baby. Hand Hygiene can always be taught to older children and encouraged at the same time. The sibling then does not feel left out but it would be short so they can’t get too bored. This would require commitment from both the family and the staff. I agree it should be seen as a hospital wide guideline, then the families know the deal to begin with and the nurse is not targeted as being too strict.

One problem I have is families wanting to bring in small babies to visit a child with an infectious disease. Not only immediate family but extended family and visitors as well. When we explain that the child in isolation is infectious and should not be visited by small babies and toddlers, they get upset. Then the staff give in and let them visit. And so the cycle of infection continues. Any tips?

Thanks,

[cid:image001.jpg@01CD74CB.27A60FF0]
[cid:image002.jpg@01CD74CB.27A60FF0]

Congrats your first time post worked!!

Thanks Kate for your feedback and as Jane mentioned as well, there are complexities with this issue.

My way of thinking is educate regarding illness and Hand Hygiene. Perhaps a screening tool would be helpful.

Thanks for your input, it is very much appreciated.

Kind regards,

Rebecca O’Donnell | Infection Control Co-ordinator
St Vincent’s Hospital Toowoomba | 22-36 Scott Street TOOWOOMBA 4350
T 07 4690 4042 | F 07 46904400
E rebecca.o’donnell@stvincents.org.au | W http://www.stvincents.org.au

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Hi,

Hope this post works, first time posting!

From working in paediatrics and neonatal ICU, and as an Infection Control Nurse, I see it from both sides. An additional challenge to those already mentioned is keeping young siblings from visiting other cots/ touching trolleys etc. It’s a hard ask to keep a young child contained to a cot space in a more open ICU setting, and as mentioned by Jane, hard to screen for symptoms when they will be either downplayed or infectious prior to actual symptoms presenting. I think having written guidelines that all of the staff are aware of and also information for parents explaining what is expected from the hospital (thus taking some of the “blame” away from the individual nurse at the bedside trying to restrict visiting) and the reasons why visiting of younger siblings might be restricted or not permitted can help. On the other side, it’s so important that younger siblings get to be a part of the new babies life, I’m not sure a complete ban is always necessary. Obviously during an outbreak or with ongoing issues things need to be reviewed and individual facilities face their own challenges that need individual solutions.
From an NICU/ SC environment perspective, the aim is to try and keep things calm and quiet, and this is also a challenge if younger children are spending extended lengths of time there, it does get boring! So perhaps considering the guideline in a broader context of general aims of the unit might help?
Not having worked for a few months now in the area, I can’t quite remember what is actually done in our facility however! Sorry!

Kind regards

Kate Herbert, Clinical Nurse
Infection Prevention and Control
Royal Hobart Hospital

On Tue, Aug 7, 2012 at 3:00 PM, Rebecca O’Donnell <Rebecca.O'Donnell@stvincents.org.au> wrote:
Jane I appreciate your input. You have certainly bought up some great points to discuss further. Yes a screening tool may be something to consider. Thank you for sharing your experiences and information.

Again your time is very much appreciated.

Kind regards,

HI Rebecca
Great question, I guess the risk lies with the capability for the department for screening of children who may be visiting the nursery to exclude signs of droplet or gastrointestinal infection? As you know influenza is infectious for two days prior to symptoms.

Here at the RCH Bris we have see several cases of ‘hospital acquired’ infection in at risk patients brought in by siblings, children will randomly vomit when they have norovirus and have limited personal hygiene.

In fact 3 years ago we excluded all children under 14yrs from visiting in the inpatient baby area due to the repeated infections brought in this way. Yes this is difficult logistically for parents and siblings and less family centred care but we felt protecting the already compromised infants had to be foremost in our recommendations. We find that visitors/siblings minimise their infections and potential risks as they are so keen to visit with the sick patient and they don’t well understand the consequences to the sick patient.

It is left up to the nurse in charge of the ward in special circumstances to adjust this on a case by case basis such as for those with multiple births.
Also our baby room has ‘viewing’ windows for siblings to see the baby rather than directly visit.

In my experience working at NICU and SCN who did not allow any visits from children under 14yrs this screening and control of visitors would then conceivably fall to the nurse at bedside and could potentially create some quite challenging interpersonal situations.

Being creative I would wonder if you could incorporate a infectious symptoms screening tool for use at the bedside, could this require some discussion and or documentation with each group of visitors.

regards
Jane

Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s HealthQueensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth
Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth
Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth
Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth
Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth
Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth

>>> “Rebecca O’Donnell” <Rebecca.O'Donnell@STVINCENTS.ORG.AU> 7/08/12 11:23 >>>
Good morning,

I would love some feedback regarding restrictions of visitors to Special care nurseries.

Who do you restrict? Other siblings?

I feel as long as Hand hygiene is performed and the visitor is well I personal feel that there is no real significant risk.

Some of our staff feel that in the case of twins, one goes home and one stays in the nursery then the well twin shouldn’t visit as the baby might pose a threat to the babies in Special care (perhaps from a whooping cough point of view).

Thanks,

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