maternal - child health · 2016-05-28 · maternal - child health abnormal colonisation that occurs...

203

Maternal - Child Health

Infection prevention and control strategies for mother and child are based on the principle of combined care. In many birthing centres, the mother oft en labours, delivers, and recovers in the same room. Wherever possible the mother and child are cared for together. For neonates requiring intensive care, the newborn’s environment must be clearly delineated, with spatial separation between incubators. The sharing of equipment and supplies must be preceded by thorough cleaning, and appropriate disinfection/sterilisation. The blood and body fl uids of mother and child are assumed to be potentially infectious and standard precautions should be applied for all patient care.Prevention strategies include hand hygiene, patient hygiene, environmental cleaning and immunisation.

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Key points

Chapter 14Maternal - Child

HealthSandra Callery

204

IFIC Basic Concepts of Infection Control

Background

The World Health Organization (WHO) estimates that approximately 210 million women become pregnant each year and that 529,000 die from complications. In the immediate post-partum period, sepsis and haemorrhage are the commonest causes of maternal death. 99% of these maternal deaths occur in developing countries.

Similarly, 99% of the estimated 4 million annual neonatal deaths occur in developing countries. Severe infections cause more than one-third of deaths; these are not always carefully recorded, however the commonest are likely to be sepsis, pneumonia, tetanus, and diarrhoea.1

Neonatal Risks and Infections

Neonatal infections occur in the fi rst 28 days of life.2 These infections may be contracted:

In utero, by the transplacental route.Intrapartum, when in contact with the maternal genital tract, blood, or stool.Postpartum, when in contact with the mother, family, and visitors, other neonates in the nursery, healthcare workers, or contaminated equipment.

Risk factors for neonatal infections include:Maternal infections Foetal gestational age at the time of the infectionComplications of delivery

o Invasive procedures and interventions, such as foetal monitoring devices

o Premature rupture of membranes > 24 hours. o Caesarean section delivery (associated with respiratory distress syndrome and possible infection).

Premature infants are at increased risk for infection due to:The absence of normal microbial fl ora which increases the risk of colonisation with pathogens.The colonisation of gastrointestinal fl ora (this risk diff ers between breast-fed babies versus formula-fed babies).

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205


Abnormal colonisation that occurs most oft en in newborns in neonatal intensive care units (NICU).Fragile, underdeveloped organs that normally provide a barrier to infectious pathogens, such as the skin and lining of the lung.A poor immune (antibody) response.

Common infections for full-term newborns are superfi cial infections of the skin, eye, and mucous membranes. Additional infections occur in intensive care, such as bacteraemia associated with central lines, pneumonia, and gastrointestinal infections. Microorganisms associated with neonatal infections include Staphylococcus aureus, coagulase negative staphylococci, Group B streptococci, Escherichia coli, and Candida. Other pathogens oft en associated with outbreaks in the nursery include Klebsiella, Serratia, Enterobacter, Citrobacter, and Pseudomonas species.2

Maternal Risks and Infections

Healthcare-associated maternal infections are acquired in hospital and did not exist before admission. These infections are typically att ributable to the health care sett ing up to 10 days post-partum. Most surgical site infections are considered healthcare-associated up to 30 days post procedure.3

Maternal risk factors for infection include: 1) prolonged rupture of membranes (>24 hours), 2) obesity (interferes with wound healing), 3) diabetes mellitus, and 4) invasive tests and procedures.

Common infections include:Endometritis – infection of the lining and wall of the uterus (endometrium and myometrium).Mastitis – infl ammation and infection of the breast.Caesarean surgical site infections. Episiotomy site infections – infection at the site of the incision of the perineum.Sepsis - bloodstream infection which causes a systemic infl ammatory response.

Endometritis is oft en polymicrobial with both anaerobic and aerobic bacteria (e.g., Group A streptococcus, Group B streptococcus, Staphylococcus sp., Escherichia coli, Bacteroides, and Clostridium sp.). Staphylococcus aureus is the

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206


pathogen most oft en associated with mastitis. The pathogens associated with surgical site infections are typically endogenous to the patient, most oft en skin fl ora or bacterial fl ora of the lower genital tract.4

Prevention Strategies

As with all patients, use standard precautions/routine practices. Specifi c practices focused on the mother and child include:

Gloves are worn for all contact with mucous membranes, non-intact skin, and moist body substances.

a. Gloves are changed aft er each infant and/or procedure b. Gloves are not necessary for contact with the intact skin of an infant c. Gloves are worn for all diaper changes d. Gloves are worn when handling the infant aft er delivery prior to bath or adequate removal of mother’s body fl uid e. Sterile gloves are worn for the delivery f. Clean gloves are worn when handling soiled linen and waste

Gowns and/or plastic aprons are worn for holding infant to a uniform. Cohorting of infants with the same infection helps prevent spread of infections in the nursery. Parent/infant contact is encouraged, except for the occasional case when there is a risk of transmitt ing infection. Labouring mothers may shower or bathe. Post-partum, instruct patient on daily perineal care aft er toileting. Reviewing good hygienic policies with parents is vital to protect both mother and infant from acquiring or spreading infections. Additional precautions may be indicated for infants colonised or infected with microorganism(s) epidemiologically signifi cant to the facility.Suspected or confi rmed infections should be handled according to the guidelines in Table 14.1.

Mothers and infants with the following infections/microorganisms are managed using standard precautions/routine practices; mothers and infants may have contact; and breast feeding is allowed: amnionitis, Chlamydia, bacterial conjunctivitis, cytomegalovirus, endometritis (unless

1.

2.

3.

4.

5.

6.

207


group A streptococcus), gonococcal infections, hepatitis B and C, herpes simplex, listeria, Staphylococcus epidermidis and other coagulase negative staphylococcal infections, group B streptococci infection/colonisation, toxoplasmosis, urinary tract infection, West Nile virus, wound infection, and yeast. Also included in this group:

tuberculosis in mother (pulmonary or laryngeal on eff ective treatment, extrapulmonary, or positive skin test)mastitis/abscess due to S. aureus (for premature infants it may be prudent to withhold milk from a breast with mastitis/for breast abscess, recommended to refrain from breast feeding from aff ected breast until treated and abscess drained)S. aureus pneumonia/skin lesions in infant (during outbreak situations, additional precautions and cohorting of infants may be required)

Patients with acquired immune defi ciency syndrome, HIV or Human T-Cell Lymphotrophic Virus I/II (HTLV I/II) are cared for using standard precautions, contact is permitt ed; however mothers are not allowed to breast feed their child.

Infants and/or mothers with diagnosed or suspected infections transmitt ed by the airborne route must be placed in a single room with negative pressure and the door closed. Masks or respirators should be worn according to policy.Priority for single room accommodation should be given to mothers who soil articles in the environment with body substances and those colonised or infected with microorganism(s) epidemiologically signifi cant to the facility. Environmental cleaning – For labour and delivery suites, post-delivery remove soiled linens using gloved hands. The delivery table/bed and the immediate patient environment should be cleaned aft er each use. Use non-toxic disinfectants for cleaning neonatal equipment and incubators. Avoid phenolic disinfectants. Breast milk is protective as it provides specifi c IgA antibody and helps establish normal fl ora in the neonate. See Table 14.1 for maternal/newborn infections and recommendations for breastfeeding. Provide post-partum hygiene for the mother and infant immunisations as required. For facilities with litt le room and overcrowding, consider kangaroo mother care. This includes skin to skin positioning of the baby on the mother’s chest. Antepartum, intrapartum, and postpartum: Maintain

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7.

8.

9.

10.

11.

12.

13.

208


standard precautions with designated areas for bathing, toilet, and hand washing facilities for patients. Refrain from communal use of ointments and lotions; mother should bring in her own lotions and creams. Post-partum – Encourage mothers to perform hand hygiene before breast feeding.

Prenatal assessment This is used to identify risk factors for maternal / newborn infection and focus prevention strategies.

Screen women for Group B streptococcus (GBS) at 35-37 weeks gestation. GBS-positive mothers should receive treatment if they are symptomatic. Colonised mothers should receive prophylactic penicillin at the time of delivery (ante-partum).

Screen for human immunodefi ciency virus (HIV) and Hepatitis B virus. If a mother is Hepatitis B surface antigen positive, the infant should receive hepatitis B immune globulin and the fi rst dose of Hepatitis B vaccine within the fi rst 12 hours of life. HIV positive mothers should refrain from breastfeeding unless alternatives are not available.

Antepartum - Screen mothers upon admission for symptoms of infection, such as new onset of fever and other respiratory symptoms, e.g., new onset of cough, rash, or diarrhoea. If the patient responds “yes” to the any of these conditions, initiate the appropriate additional precautions and spatial separation from other patients (> 2 metres). If airborne infections are suspected, e.g., pulmonary Mycobacterium tuberculosis or varicella, then place patient in single room with the door closed and initiate airborne precautions.

209


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Ant

ibio

tic R

esis

tant

M

icro

orga

nism

s -

Mot

her

Van

com

ycin

-res

ista

nt

Ente

roco

ccus

(VRE

) or

met

hici

llin-

resi

stan

t S.

aur

eus (

MRS

A):

Con

tact

Pre

caut

ions

Stan

dard

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

M

RSA

- In

fant

to ro

om

with

wom

an

Ant

ibio

tic R

esis

tant

M

icro

orga

nism

s -

Infa

ntSt

anda

rd P

reca

utio

ns

VRE

or M

RSA

: Con

tact

Pr

ecau

tions

Perm

itted

Pe

rmitt

ed

MRS

A -

Sing

le ro

om

pref

erre

d. I

f ope

n co

ncep

t nur

sery

, the

n sp

atia

l sep

arat

ion

from

ot

her i

nfan

ts re

quir

ed

(>2

met

res)

Chi

cken

pox

Mot

her i

ll –

heal

thy

term

infa

nt

Air

born

e Pr

ecau

tions

Infa

nt ro

om in

with

m

othe

rPe

rmitt

ed

Perm

itted

Chi

cken

pox

Mot

her i

ll –

Infa

nt in

N

ICU

Air

born

e Pr

ecau

tions

M

othe

r may

not

vis

it th

e N

ICU

Stan

dard

Pre

caut

ions

un

til d

ay 1

0. A

s of

day

10

thro

ugh

day

28 s

tart

A

irbo

rne

Prec

autio

ns

Not

per

mitt

ed

Perm

itted

(as

expr

esse

d br

east

milk

)

Prov

ide

vari

cella

zos

ter

imm

une

glob

ulin

(V

arIg

) to

infa

nts

whe

re o

nset

of

mat

erna

l dis

ease

is <

5 da

ys p

rior

to d

eliv

ery

or w

ithin

48

hour

s af

ter d

eliv

ery5

Tabl

e 14

.1. M

ater

nal/C

hild

Infe

ctio

us D

isea

ses

and

Infe

ctio

n Pr

even

tion

and

Con

trol

Man

agem

ent (

Tabl

e ad

apte

d fr

om S

unny

broo

k H

ealth

Sci

ence

s C

entr

e, T

oron

to, O

ntar

io, 2

010)

.5-6

210


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Chi

cken

pox

Infa

nt in

NIC

U

Onl

y pa

rent

s an

d vi

sito

rs w

ho a

re

imm

une

may

vis

it

Air

born

e Pr

ecau

tions

Perm

itted

if w

oman

is

imm

une

Perm

itted

Prov

ide

vari

cella

zos

ter

imm

une

glob

ulin

(V

arIg

) to

infa

nts

whe

re o

nset

of

mat

erna

l dis

ease

is <

5 da

ys p

rior

to d

eliv

ery

or w

ithin

48

hour

s af

ter d

eliv

ery5

Con

junc

tiviti

sA

deno

viru

s -

Mot

her

Con

tact

Pre

caut

ions

No

shar

ing

of to

wel

s,

face

clo

ths,

pill

ows,

lin

ens

Stan

dard

Pre

caut

ions

Hea

lthy

term

infa

nt:

Room

in

No

shar

ing

of to

wel

s,

linen

s

Perm

itted

Infa

nt in

NIC

U:

Mot

her N

OT

to g

o to

N

ICU

Perm

itted

as

expr

esse

d br

east

milk

Con

junc

tiviti

sA

deno

viru

s - I

nfan

t St

anda

rd P

reca

utio

ns

Con

tact

Pre

caut

ions

No

shar

ing

of p

atie

nt

care

item

s

Che

ck fo

r Chl

amyd

ia,

vira

l, a

nd b

acte

rial

pa

thog

ens.

211


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Dia

rrho

ea

Mot

her -

Bact

eria

l(s

uspe

cted

or

conf

irm

ed)

Stan

dard

Pre

caut

ions

Si

ngle

room

with

toile

t St

anda

rd P

reca

utio

ns

Hea

lthy

term

infa

nt:

Perm

itted

with

St

anda

rd P

reca

utio

nsPe

rmitt

ed

Infa

nt in

NIC

U: N

ot

perm

itted

unt

il as

ympt

omat

ic fo

r 48

hour

s

Perm

itted

as

expr

esse

d br

east

milk

Dia

rrho

ea

Mot

her -

C. d

iffi

cile

Con

tact

Pre

caut

ions

Sing

le ro

om w

ith to

ilet

Stan

dard

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

Dia

rrho

ea

Mot

her -

Vir

al

(e.g

., n

orov

irus

)

Con

tact

Pre

caut

ions

Sing

le ro

om w

ith to

ilet

Hea

lthy

term

infa

nt:

Perm

itted

with

St

anda

rd P

reca

utio

ns

Perm

itted

Infa

nt in

NIC

U:

Wom

an is

not

pe

rmitt

ed in

the

NIC

U

until

asy

mpt

omat

ic fo

r 48

hou

rs

Perm

itted

as

expr

esse

d br

east

milk

Con

tact

Pre

caut

ions

Sing

le ro

om w

ith to

ilet

212


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Dia

rrho

ea

Infa

nt -

Bact

eria

l (s

uspe

cted

or

conf

irm

ed)

Stan

dard

Pre

caut

ions

C

onta

ct P

reca

utio

ns

Perm

itted

Pe

rmitt

ed

Dia

pere

d in

fant

s re

quir

e C

onta

ct

prec

autio

ns fo

r the

du

ratio

n of

illn

ess

Dia

rrho

ea

Infa

nt -

Vir

al (e

.g.,

noro

viru

s)St

anda

rd P

reca

utio

ns

Con

tact

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

Dia

pere

d in

fant

s re

quir

e C

onta

ct

Prec

autio

ns fo

r the

du

ratio

n of

illn

ess

Ente

rovi

rus

Mot

her

Con

tact

Pre

caut

ions

Sing

le ro

om

Hea

lthy

term

infa

nt:

Perm

itted

with

St

anda

rd P

reca

utio

nsPe

rmitt

ed

Infa

nt in

NIC

U:

Wom

an is

not

pe

rmitt

ed in

the

NIC

U

until

asy

mpt

omat

ic

Perm

itted

as

expr

esse

d br

east

milk

Ente

rovi

rus

Infa

ntSt

anda

rd P

reca

utio

ns

Con

tact

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

Con

tact

Pre

caut

ions

Sing

le ro

om

Hep

atiti

s, ty

pe A

M

othe

rSt

anda

rd P

reca

utio

ns

Stan

dard

Pre

caut

ions

A

fter p

roph

ylax

is o

f in

fant

Afte

r pro

phyl

axis

of

infa

nt

213


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Her

pes

sim

plex

Mot

her -

Ora

l or

muc

ocut

aneo

us

(i.e.

, col

d so

re)

Stan

dard

Pre

caut

ions

See

Infa

nt -

Asy

mpt

omat

ic

Perm

itted

Tota

l roo

min

g-in

pr

efer

red

Perm

itted

if th

ere

are

no h

erpe

tic le

sion

s on

th

e br

east

Inst

ruct

the

wom

an o

n ha

nd h

ygie

ne, t

o w

ear

a m

ask

or c

over

lesi

on

whe

n ar

ound

her

in

fant

, not

kis

s in

fant

w

hile

lesi

on is

pre

sent

, an

d to

avo

id to

uchi

ng

affe

cted

are

a

Her

pes

sim

plex

Mot

her -

Whi

tlow

Stan

dard

Pre

caut

ions

See

Infa

nt –

A

sym

ptom

atic

Dir

ect/h

ands

-on

cont

act i

s N

OT

perm

itted

May

pum

p an

d di

scar

d m

ilk u

ntil

lesi

ons

are

gone

or m

ay n

urse

if

the

wom

an d

oes

not

touc

h he

r inf

ant (

i.e.,

som

eone

els

e ho

lds

and

posi

tions

the

infa

nt)

Her

pes

sim

plex

Infa

nt -

Asy

mpt

omat

icSt

anda

rd P

reca

utio

ns

Con

tact

Pre

caut

ions

Fo

r dur

atio

n of

in

cuba

tion

peri

od (u

p to

4 w

eeks

)

Perm

itted

Pe

rmitt

ed

Her

pes

sim

plex

Infa

nt -

Sym

ptom

atic

Stan

dard

Pre

caut

ions

C

onta

ct P

reca

utio

ns

Perm

itted

Pe

rmitt

ed

214


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Her

pes

zost

er(s

hing

les)

Mot

her –

loca

lised

Stan

dard

Pre

caut

ions

in

sin

gle

room

O

nly

imm

une

staf

f m

ay c

are

for p

atie

nt

Stan

dard

Pre

caut

ions

Perm

itted

Tota

l roo

min

g-in

pr

efer

red

Mot

her m

ay n

ot g

o to

nu

rser

y un

til le

sion

s ar

e cr

uste

d

Perm

itted

if le

sion

s ar

e no

t on

brea

st.

Onl

y im

mun

e vi

sito

rs/

sibl

ings

to v

isit

Var

IG is

not

indi

cate

d fo

r inf

ant i

f the

mot

her

has

zost

er;6 h

owev

er, i

f in

fant

is <

32 w

eeks

, V

arIG

is to

be

give

n

Her

pes

zost

er

(shi

ngle

s)M

othe

r –

diss

emin

ated

Air

born

e Pr

ecau

tions

Im

mun

e st

aff o

nly

Term

infa

nt ro

omin

g-in

: Sta

ndar

d Pr

ecau

tions

Perm

itted

Tota

l roo

min

g-in

pr

efer

red

Mot

her m

ay n

ot g

o to

nu

rser

y un

til le

sion

s ar

e cr

uste

d

Perm

itted

if le

sion

s ar

e no

t on

brea

st

Infa

nt in

NIC

U:

Air

born

e Pr

ecau

tions

da

y 10

from

1st

ex

posu

re to

day

21

of

last

exp

osur

e (o

r day

28

if in

fant

has

bee

n gi

ven

Var

IG)

Infa

nt in

NIC

U:

Wom

an m

ay N

OT

go

to th

e N

ICU

unt

il le

sion

s ar

e cr

uste

d.

Infa

nt in

NIC

U:

Prov

ide

expr

esse

d m

ilk.

215


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Infl

uenz

aM

othe

r

Dro

plet

and

Con

tact

Pr

ecau

tions

Si

ngle

room

pre

ferr

edSt

anda

rd P

reca

utio

ns

Hea

lthy

term

infa

nt:

Perm

itted

Wom

an m

ust w

ear a

su

rgic

al m

ask

whe

n w

ithin

2 m

etre

s of

in

fant

Infa

nt in

NIC

U:

Wom

an is

not

pe

rmitt

ed to

go

to

NIC

U

Infa

nt in

NIC

U:

Perm

itted

as

expr

esse

d br

east

milk

Infl

uenz

aIn

fant

Stan

dard

Pre

caut

ions

Dro

plet

and

Con

tact

Pr

ecau

tions

Perm

itted

Pe

rmitt

ed

Dur

ing

outb

reak

si

tuat

ions

, add

ition

al

prec

autio

ns a

nd

coho

rtin

g of

infa

nts

may

be

requ

ired

Mea

sles

(Rub

eola

) M

othe

r ill

– Te

rm,

heal

thy

infa

nt

Air

born

e Pr

ecau

tions

Imm

une

staf

f onl

y

Onl

y im

mun

e fa

mily

an

d vi

sito

rs p

erm

itted

Stan

dard

Pre

caut

ions

Ro

om in

with

wom

an

Perm

itted

if ro

omin

g in

w

ith w

oman

May

pro

vide

exp

ress

ed

brea

st m

ilk if

not

ro

omin

g in

Infa

nt s

houl

d re

ceiv

e im

mun

e gl

obul

in (I

G)

Con

side

r acu

te

resp

irat

ory

illne

sses

to

be in

fluen

za d

urin

g in

fluen

za s

easo

n

216


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Mea

sles

(rub

eola

) M

othe

r ill

– in

fant

in

NIC

U

Air

born

e Pr

ecau

tions

Im

mun

e st

aff o

nly

Onl

y im

mun

e fa

mily

an

d vi

sito

rs p

erm

itted

8 da

ys fr

om 1

st

expo

sure

to 1

2 da

ys

from

last

exp

osur

e -

Air

born

e Pr

ecau

tions

Wom

an n

ot p

erm

itted

in

NIC

U u

ntil

4 da

ys

afte

r the

app

eara

nce

of

the

rash

Perm

itted

as

expr

esse

d br

east

milk

onl

y un

til

wom

an n

o lo

nger

in

fect

ious

Infa

nt s

houl

d re

ceiv

e im

mun

e gl

obul

in (I

G).

Fam

ilies

& V

isito

rs:

Imm

unity

is d

efin

ed a

s pr

evio

us h

isto

ry o

f m

easl

es o

r hav

ing

rece

ived

mea

sles

va

ccin

eM

easl

es (r

ubeo

la)

Infa

nt il

l or e

xpos

ed

(i.e.

, exp

osed

in N

ICU

)St

anda

rd P

reca

utio

ns

Wom

an im

mun

e –

perm

itted

to s

ee in

fant

Perm

itted

Wom

an su

scep

tible

–

wom

an n

ot p

erm

itted

to

see

infa

nt

Perm

itted

as

expr

esse

d br

east

milk

onl

y un

til

infa

nt n

o lo

nger

in

fect

ious

Men

ingi

tis

Nei

sser

ia m

enin

giti

dis/

H

aem

ophi

lus

influ

enza

e

Dro

plet

Pre

caut

ions

un

til 2

4 ho

urs

afte

rap

prop

riat

ean

timic

robi

al th

erap

y

Con

side

r inf

ant a

co

ntac

t of t

he m

othe

r

Air

born

e Pr

ecau

tions

217


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Mum

psM

othe

r

Dro

plet

/Con

tact

Pr

ecau

tions

Imm

une

staf

f onl

y

Onl

y im

mun

e fa

mily

an

d vi

sito

rs p

erm

itted

Stan

dard

Pre

caut

ions

Term

infa

nt: P

erm

itted

Te

rm in

fant

: Per

mitt

ed

Infa

nt in

NIC

U:

Wom

an is

not

to g

o in

th

e N

ICU

unt

il 9

days

af

ter t

he o

nset

of t

he

paro

tid s

wel

ling

Infa

nt in

NIC

U:

Expr

esse

d br

east

milk

un

til 9

day

s af

ter t

he

onse

t of t

he p

arot

id

swel

ling

Mum

ps In

fant

in N

ICU

Ex

pose

d or

ill

Stan

dard

Pre

caut

ions

Dro

plet

/Con

tact

Pr

ecau

tions

sta

rtin

g 10

da

ys fr

om 1

st e

xpos

ure

to 2

6 da

ys fr

om la

st

expo

sure

Sing

le ro

om

Imm

une

staf

f onl

y

Onl

y im

mun

e fa

mily

an

d vi

sito

rs p

erm

itted

Wom

an im

mun

e –

perm

itted

to s

ee in

fant

Perm

itted

Wom

an su

scep

tible

–

wom

an n

ot p

erm

itted

to

see

infa

nt

Perm

itted

as

expr

esse

d br

east

milk

Fam

ilies

& V

isito

rs:

Imm

unity

is d

efin

ed

as a

pre

viou

s hi

stor

y of

mum

ps o

r hav

ing

rece

ived

mum

ps

vacc

ine

218


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Pedi

culo

sis

(Hea

d Li

ce)

Con

tact

Pre

caut

ions

Pr

ecau

tions

rem

ain

in

plac

e un

til a

fter

wom

an h

as b

een

appr

opri

atel

y tr

eate

d

Stan

dard

Pre

caut

ions

Hea

lthy

term

infa

nt:

Perm

itted

Perm

itted

Infa

nt in

NIC

U:

Perm

itted

onc

e w

oman

ha

s be

en a

ppro

pria

tely

tr

eate

d

Infa

nt in

NIC

U:

Perm

itted

as

expr

esse

d br

east

milk

unt

il w

oman

has

bee

n ap

prop

riat

ely

trea

ted

Pert

ussi

s M

othe

rD

ropl

et P

reca

utio

ns

Sing

le ro

om

Stan

dard

Pre

caut

ions

Hea

lthy

term

infa

nt:

Perm

itted

Rein

forc

e ha

nd

hygi

ene

and

wea

r a

surg

ical

mas

k w

hen

with

in 2

met

res

of

infa

nt

Perm

itted

Infa

nt in

NIC

U: N

ot

perm

itted

unt

il 5

days

of

app

ropr

iate

an

tibio

tic tr

eatm

ent

com

plet

ed

Perm

itted

as

expr

esse

d br

east

milk

219


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Pert

ussi

s In

fant

Stan

dard

Pre

caut

ions

Con

tact

Pre

caut

ions

C

onsi

der c

ohor

ting

Prec

autio

ns re

mai

n in

pl

ace

until

5 d

ays

of

appr

opri

ate

antib

iotic

tr

eatm

ent h

as b

een

com

plet

ed

Perm

itted

Pe

rmitt

ed

Res

pira

tory

Vir

us

Infe

ctio

ns

Mot

her i

ll

Dro

plet

/Con

tact

Pr

ecau

tions

Sing

le ro

om

Hea

lthy

term

infa

nt:

Perm

itted

Rein

forc

e ha

nd

hygi

ene

and

wea

r a

surg

ical

mas

k w

hen

with

in 2

met

res

of

infa

nt

Infa

nt ro

omin

g-in

: Pe

rmitt

ed

Infa

nt in

NIC

U: N

ot

perm

itted

Infa

nt in

NIC

U:

Perm

itted

as

expr

esse

d br

east

milk

Res

pira

tory

Vir

us

Infe

ctio

ns

Infa

nt il

lSt

anda

rd P

reca

utio

nsD

ropl

et /C

onta

ct

Prec

autio

nsPe

rmitt

ed

Perm

itted

Dur

ing

outb

reak

si

tuat

ions

, add

ition

al

prec

autio

ns a

nd

coho

rtin

g of

infa

nts

may

be

requ

ired

.

Stan

dard

Pre

caut

ions

220


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Rub

ella

Mot

her

Dro

plet

pre

caut

ions

Imm

une

staf

f onl

y

Dro

plet

pre

caut

ions

Imm

une

staf

f onl

y

Hea

lthy

term

infa

nt:

Perm

itted

Hea

lthy

term

infa

nt:

Perm

itted

Fam

ilies

and

vis

itors

: Im

mun

ity is

def

ined

as

havi

ng re

ceiv

ed

rube

lla v

acci

ne o

r la

bora

tory

evi

denc

e of

im

mun

ity

Infa

nt in

NIC

U:

Wom

an c

anno

t go

into

th

e N

ICU

unt

il 7

days

af

ter t

he o

nset

of t

he

rash

Infa

nt in

NIC

U:

Expr

esse

d br

east

milk

as

the

wom

an c

anno

t go

into

the

NIC

U u

ntil

7 da

ys a

fter t

he o

nset

of

the

rash

Rub

ella

Infa

nt (C

onge

nita

l)St

anda

rd P

reca

utio

ns

Dro

plet

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

C

onge

nita

lly in

fect

ed

infa

nts

may

she

d vi

rus

for u

p to

2 y

ears

.

Scab

ies

Con

tact

Pre

caut

ions

Prec

autio

ns re

mai

n in

pl

ace

until

wom

an h

as

been

app

ropr

iate

ly

trea

ted

Stan

dard

Pre

caut

ions

Hea

lthy

term

infa

nt:

Perm

itted

onc

e w

oman

ha

s be

en a

ppro

pria

tely

tr

eate

d

Perm

itted

onc

e w

oman

ha

s be

en a

ppro

pria

tely

tr

eate

d or

may

pro

vide

ex

pres

sed

brea

st m

ilk

Infa

nt in

NIC

U:

Perm

itted

onc

e w

oman

ha

s be

en a

ppro

pria

tely

tr

eate

d

Infa

nt in

NIC

U:

Perm

itted

onc

e w

oman

ha

s be

en a

ppro

pria

tely

tr

eate

d or

may

pro

vide

ex

pres

sed

brea

st m

ilk

221


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Stap

hylo

cocc

us a

ureu

s M

othe

r - M

ajor

W

ound

(not

con

tain

ed)

Con

tact

Pre

caut

ions

St

anda

rd P

reca

utio

ns

Perm

itted

if d

rain

ing

can

be a

dequ

atel

y co

ntai

ned

– se

e co

mm

ents

Perm

itted

Cha

nge

dres

sing

and

w

oman

's go

wn,

and

ha

ve w

oman

per

form

ha

nd h

ygie

ne p

rior

to

cont

act w

ith in

fant

Stre

ptoc

occa

l Dis

ease

(G

roup

A)

Mot

her -

Min

or

Wou

nd In

fect

ion

(con

tain

ed)

Sing

le ro

om u

ntil

24

hour

s af

ter e

ffect

ive

trea

tmen

tSt

anda

rd P

reca

utio

ns

Perm

itted

Pe

rmitt

ed

Stre

ptoc

occa

l Dis

ease

(G

roup

A)

Mot

her -

Maj

or

wou

nd in

fect

ion

or

endo

met

ritis

Sing

le ro

om u

ntil

24

hour

s af

ter e

ffect

ive

trea

tmen

tSt

anda

rd P

reca

utio

ns

Perm

itted

Pe

rmitt

ed

It m

ay b

e ad

visa

ble

to

with

hold

milk

from

br

east

with

mas

titis

un

til 2

4 ho

urs

of

effe

ctiv

e tr

eatm

ent

Stre

ptoc

occa

l Dis

ease

(G

roup

A)

Mot

her -

Inva

sive

D

isea

se

Sing

le ro

om u

ntil

24

hour

s af

ter e

ffect

ive

trea

tmen

t.St

anda

rd P

reca

utio

nsPe

rmitt

ed a

fter 2

4 ho

urs

of e

ffect

ive

trea

tmen

t

Perm

itted

afte

r 24

hour

s of

effe

ctiv

e tr

eatm

ent

222


Infe

ctio

n/M

icro

orga

nism

Mat

erna

lPr

ecau

tions

New

born

Prec

autio

nsM

othe

r/In

fant

Con

tact

Brea

st F

eedi

ngC

omm

ents

Stre

ptoc

occa

l Dis

ease

(G

roup

A)

Mot

her -

Pha

ryng

itis

(str

ep th

roat

)

Dro

plet

Pre

caut

ions

Sing

le ro

om

Stan

dard

Pre

caut

ions

Perm

itted

afte

r 24

hour

s of

effe

ctiv

e tr

eatm

ent

Perm

itted

afte

r 24

hour

s of

effe

ctiv

e tr

eatm

ent

Stre

ptoc

occa

l Dis

ease

(G

roup

A)

Infa

ntSt

anda

rd P

reca

utio

ns

Con

tact

Pre

caut

ions

Pe

rmitt

ed

Perm

itted

Syph

ilis

Mot

her -

M

ucoc

utan

eous

C

onta

ct P

reca

utio

ns

Stan

dard

Pre

caut

ions

Pe

rmitt

ed a

fter 2

4 ho

urs

effe

ctiv

e tr

eatm

ent

Perm

itted

afte

r 24

hour

s ef

fect

ive

trea

tmen

t

It m

ay b

e ad

visa

ble

to

with

hold

milk

from

br

east

with

mas

titis

un

til 2

4 ho

urs

of

effe

ctiv

e tr

eatm

ent

Syph

ilis

Infa

nt -

Con

geni

tal

Stan

dard

Pre

caut

ions

C

onta

ct P

reca

utio

ns

Perm

itted

Pe

rmitt

ed

Tube

rcul

osis

Mot

her -

Pul

mon

ary

or la

ryng

eal –

new

ly

diag

nose

d, o

n in

adeq

uate

trea

tmen

t or

non

com

plia

nt

Air

born

e Pr

ecau

tions

St

anda

rd P

reca

utio

ns

Not

per

mitt

ed u

ntil

wom

an is

no

long

er

infe

ctio

us

Mot

her m

ay p

rovi

de

expr

esse

d br

east

milk

Con

tinue

Air

born

e Pr

ecau

tions

unt

il th

e m

othe

r no

long

er

cons

ider

ed in

fect

ious

223


References

UNICEF. ( 2009). The State of the World’s Children-Maternal and Newborn Health. Geneva: World Health Organization. htt p://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf [Accessed July 26, 2011]APIC Text Infection Control and Epidemiology, 3rd Edition (Chapters 37, 38, 39). Washington, DC: Association of Professionals for Infection Prevention and Control and Epidemiology, 2009.PIDAC. Provincial Infectious Diseases Advisory Committee - Best Practices Guidelines for Surveillance in Health Care Settings. Toronto: Ministry of Health and Long Term Care, 2008. htt p://www.oahpp.ca/resources/pidac-knowledge/best-practice-manuals/surveillance-of-health-care-associated-infections.html [Accessed July 27, 2011]Wilks D. The Infectious Diseases Manual, 2nd ed. Malden, Massachusett s: Blackwell Publishing, 2003; 249-262.National Advisory Committ ee on Immunization. (2006). Canadian Immunization Guide 7th edition. Ott awa, Canada: Public Health Agency of Canada.Committ ee on Infectious Diseases. The Red Book 28th Edition. Elk Grove Village, Illinois: American Academy of Pediatrics, 2009.

Further Reading

Provincial Infectious Diseases Advisory Committ ee (PIDAC): Best Practice Guidelines for Routine Practices and Additional Precautions – In all health care settings, Ministry of Health and Long Term Care, Toronto, Canada, 2010. htt p://www.oahpp.ca/resources/pidac-knowledge/best-practice-manuals/routine-practices-and-additional-precautions.html [Accessed July 27, 2011]World Health Organization (WHO): Practical Guidelines for Infection Control in health Care settings, WHO Regional Offi ce, India, 2004. http://www.wpro.who.int/NR/rdonlyres/006EF250-6B11-42B4-BA17-C98D413BE8B8/0/practical_guidelines_infection_control.pdf [Accessed July 26, 2011]World Health Organization (WHO): Recommendations for Routine Immunization 2010. htt p://www.who.int/immunization/policy/immunization_tables/en/index.html [Accessed July 26, 2011]World Health Organization, Geneva, 2010. Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child

1.

2.

3.

4.

5.

6.

1.

2.

3.

4.

224


Health. htt p://whqlibdoc.who.int/hq/2010/WHO_FCH_10.06_eng.pdf [Accessed July 26, 2011]

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