Dear Colleagues

 

I was wondering whether anyone can provide me with an evidence based article justifying this for neonates in incubators and providing me the rationale. For a baby in an incubator how would a cap and mask reduce infection

 

Alok

Can you clarify - do you wonder whether (in PICO-format):

• P: infants with PICC lines
• I: with a facemask and a head cap
• C: compared to no mask/cap
• O: reduce the risk of PICC-related infections?

Could you share a photo (given parental consent)?

We nurse as usual, i.e. does not use any special gear if the baby has a PICC-line. But I have no PubMed reference on our practise...

 

As I understand the question relates more to the moment the PICC-line is inserted.

I think the question can contemplate both meanings

1- The infant already has a PICC in place.

2- In some units the PICCs are being inserted with the infant inside a closed isolette  (incubator) through the arm side windows, as our NICU in Japan. Thus the question of putting on a mask and overhead could be more questionable.

I don't know a study which compared using /or not masks and overheads for inserting PICCs, but here we always put them on during PICCs insertion, but during sampling and handling we don't.

 

Very valid question

Which will make me ask more in PICO

P NEONATES INSIDE INCUBATORS

I WEARING SCRUP SUITS 

C NO SCRUP SUITS ORDINARY HALF SLIEVE CLOTHES

O REDUCE THE RISK OF INFECTIOS

My opinion for insertion definitely yes. It is invasive entry and we work with sterile items. To prevent CLABSI anytime you work with any CVL or PICC in open form (insertion, dressing, set changing) you should be in full PPE because you are opening sterile consumables and instruments. Cap and mask protect area from contamination by hair fall or any droplet cobtamination. Many times I was witness of the doctor's and nurse's groups talking above sterile table during insertion or line changing and I think it is big risk to remove mask for sure. Cap I can may be think about. We always have to think that our little patients are fragile and we have to rise our precautions up compared to other units with older patients. 

Yes Zuzana the PICC insertion is a sterile procedure when done at bedside(does not require the use of an  operating room) a suitable sterile field must be established and maintained throughout the procedure  also use the cap and the mask.

Agreeing with Zuzana & Varady here.

Where is the evidence that it reduces CLABSI rates

 

Most studies I know use "bundles" - so insertion with maximum sterile precautions were used in most settings, but I have not seen any study that only looks at using  cap/face-mask in incubators. I would say the possible research question is also one about equipoise.. how much hassle is it to put on cap and mask for a potential higher risk of infection that can have quite deleterious effects. Is sterile material also handled outside of the incubator (i.e. unpacking the catheter etc.)? Then it probably still might make sense.