Infection control in paediatrics.
Minimising the risk of infections in a paediatric and neonatal setting poses different challenges for paediatric infection control practitioners and the nurses caring for their patients.
At the Royal Children's Hospital (RCH) in Melbourne the infection control team promotes many interventions to reduce the rate of hospital acquired infections.
Most practices, such as appropriate decontamination of equipment and waste management, remain the same as in adult settings. However the age of the child, developmental stage and previous exposures to infections are some of the factors that can influence their susceptibility to infections.
Premature babies with immature immune systems and newborns yet to undergo immunisation for vaccine preventable disease such as pertussis are at risk of acquiring infections both in the community and in hospital.
Many babies and toddlers are admitted to hospital with evolving medical conditions and can undergo invasive diagnostic and surgical procedures which increase the risk of infection. Some children are admitted with a non-specific illness and fever which may not be confirmed as an infection for several days.
Children in large paediatric referral hospitals have often been in several metropolitan or country hospitals, increasing their exposure to a variety of infection risks and sources. Infection control practices need to reflect the potential risk for these age groups.
Management of children with infectious diseases needs to be flexible to accommodate for seasonal outbreaks of viral infections and include cohorts of children with similar symptoms.
Toys need to be included in equipment cleaning and should be able to: be dismantled; not retain water; and be easily cleaned between each child's use. This is especially important for the under three year age group who put everything into their mouths which potentially spreads respiratory viruses.
There are more opportunities for transmission of infections through the close physical contact nurses have with their patients. Increased handling can occur in emergency situations when basic infection control practices like hand hygiene may be omitted.
As children have close contact with their environment, stringent cleaning of floors, furnishing and spills becomes another means to reduce possible risks.
Ensuring all staff are immunised for vaccine preventable diseases protects both patients and staff. Families should be discouraged from bringing siblings to visit if they have an infection or a recent contact with an infectious disease, as it may spread to other hospitalised children.
Nursing staff need to ensure that parents or carers who participate in their child's care understand the importance of infection control practices especially hand hygiene. The parent information pamphlet at RCH informs new parents that they may ask staff members: "Have you washed your hands?"
The RCH website "Wash Up" was developed as part of a Victorian Department of Human Services funded project to investigate hand hygiene compliance and interventions in paediatric, neonatal and obstetric settings. It includes activities and information for both parents and children on the importance of hand hygiene. http://www.washup.org.au
Educating all health care workers on risk and infection control interventions ensures that they can work with parents and carers for the best possible outcome for the child.
Hospitalised children are reminded of good hand hygiene practices through the promotion of "Germ Buster of the Week" shown on the weekly in-house children's TV show "Macadamia".
SUE SCOTT IS THE INFECTION CONTROL COORDINATOR AT THE ROYAL CHILDREN'S HOSPITAL IN MELBOURNE, VICTORIA