Masking and Gowning in Nurseries for the Newborn Infant

Abstract

SummaryAn investigation amongst full-time newborn babies in two nurseries has been carried out in an attempt to discover the tsLual routes of spread of Stapli. aur(eius.Initially 53 babies were all found to be nasal carriers by the 10th day, and 11 out of 12 of these babies also carried staphylococci in their stools. Examination of bedding suggested that this was not the immediate source of staphylococci, and prevention of possible contamination from the staff by the use of chlorhexidine handcream or gowns made little difference.The use of triple dye to the umbilicus and individual gowns for each baby, both as separate and as combined measures, prodluced a reduction in the nasal carriage rate on the 12th day of life by about 25-30%.No evidence was obtained that babies gained staphylococci from their mothers, but there was evidence that staphylococci on the mothers' breasts came from their babies.We wouild like to thlank Dr. At birth babies were allotted at random to one of these two nurseries. In one nursery (the " masked " nursery) a strict masking and gowning regime was in operation. in the other (the " unmasked " nursery) no masks or gowns were worn. The attendant staff was common to both nurseries. In the masked nursery all personnel entering the nursery.whether doctors, nurses, or clcaners. donned a mask and gown. The masks consisted of four layers of gauze with a i cellophane ' insert, and extended below the chin. The nursing staff changed their masks at least every hour. The masks were autoclaved in a drum and when required were renmoved from the drum with sterile forceps. The instructions were that while being worn the mask should not be touLched at all bn hand. On discarding, the masks were dropped into a lidded receptacle containing antiseptic. Gowns donned before entering the nursery were put on in an ante-room, where they were kept hanging when not in Luse.In addition to the gown worn on entering the nursery each cot carried a folded gown which was worn when the baby in that cot was being handled. All gowns were changed every 24 hours or when soiled. They were not autoclaved, but one sta,2e of the laundering was to raise the temperature of the washing water to 200°F. (930 C.) for 10 minutes. In the unmasked nursery nurses wore their ordinary uniform, the apron of which was changed daily or when soiled.For the first two days the babies were taken to their mothers for feeding. In the case of the babies fr-om the masked nursery the mothers were masked and gowned with the baby's " individual" gown. Thereafter the mothers fed their infants in the nurseries, and again in the masked nur-sery they were appropriately masked and gowned.Mothers were permitted to handle their own babies only. If any baby developed an infection in either nursery he was immediately removed to an isolation nursery. The babies from the masked nursery were bathed in a bathroom kept for them only; those in the unmasked nursery were bathed in another bathroom. There was thus no direct contact between the babies from the two nurseries. ...

Prevention of Staphylococcal Sepsis in a Maternity Hospital by Means of Hexachlorophane

“…The incidence of sepsis was unaffected: 8 out of 99 infants developed lesions of the skin, compared with 5 out of 100 infants in the previous 11 weeks. These results are in line with those of Forfar and Maccabe (1958), who found that the wearing, by nurses, of gowns individual to each baby made no significant difference to staphylococcal crossinfection.…”

What cord care--if any?

“…Of 136 colonised infants on ward A, only 29 (21%) 3 matched with phage types isolated from staff working on that ward compared with 104 )6 (68%) of 152 on ward B. The phage types seen in cross infection episodes were not isolated 5 any more often from the attending staff than other phage types.…”

“…( The umbilicus has long been recognised as a site of colonisation with Staphylococcus aureus1 whence it can spread from infant to infant causing skin infections and from infant to mother causing breast abscesses.2 The use of hexachlorophane as an umbilical antiseptic treatment prevents colonisation and cross infection,3 4 whereas barrier nursing does not. 5 Doubts about the safety of hexachloro-phane6 7 led to its withdrawal from use with a subsequent increase in staphylococcal infection.8 Chlorhexidine was introduced as an alternative and found to be effective9 and safe. '0 It is now accepted that hexachlorophane, used properly, is also safe"I and it has been reintroduced, though there has been little in the way of comparison between it and chlorhexidene.…”

Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use

“…25-31,37,52-55 Multiple studies have also failed to demonstrate that the routine use of cover gowns decreased bacterial colonization of infants or overall nosocomial infection rates. 29-31 Cover gowns were not well-defined in the articles; however, it is believed that isolation gowns, with or without barrier claims, were used for these studies.…”