# data[].attributes.body
Adams-Chapman, I. & Stoll, B. J. (2002). Prevention of nosocomial infections in the neonatal intensive care unit. Current Opinion in Pediatrics, 14 (2), 157-164.

Biswas, A., Bhattacharya, S. D., Singh, A. K., & Saha, M. (2019). Addressing hand hygiene compliance in a low- resource neonatal intensive care unit: a quality improvement project. Journal of the Pediatric Infectious Diseases Society, 8(5), 408–413.

Kuti, Ogunlesi, Oduwole, Oringanje, Udoh, & Meremikwu, (2019). Hand hygiene for the prevention of infections in neonates. The Cochrane Database of Systematic Reviews, 2019(5), CD013326.

Larson, E. L., Cimiotti, J., Haas, J., Parides, M., Nesin, M., Della-Latta, P., & Saiman, L. (2005). Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units. Archives of pediatrics & adolescent medicine, 159(4), 377–383.

Pasricha, Valiquette, Singh, Pasricha, Jimal, & Khurshid, (2021). Neonatal intensive care unit

hand hygiene: Exploring current practice and adherence barriers in a Canadian hospital. Canadian Journal of Infection Control, 36(2), 77–85.

Polin, R. A., Denson, S., Brady, M. T., Committee on Fetus and Newborn, & Committee on Infectious Diseases (2012). Strategies for prevention of health care-associated infections in the NICU. Pediatrics, 129(4), e1085–e1093.

World Health Organization (WHO). (2009). A guide to the implementation of the WHO multimodal hand hygiene improvement strategy.

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- Project leader: Someone to run the whole change (letting staff know of up coming implementation and how everything will work/ presenting the change), monitor data, and continue to follow up-to-date research on the subject.
- Change champions: Individuals assigned to each pod to make sure that staff is being compliant with the change; this is vital in assuring that the data collected is accurate and based on proper cooperation by everyone

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- CINAHL, Cochrane Database of Systematic Reviews, Medline, PubMed
- NICU, neonatal intensive care unit, hand washing, hand hygiene, infection control, hospital acquired infections, compliance, health care–associated infection, nosocomial infection, neonate, newborn

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In order to analyze the success of hand scrubbing prior to shift report, we suggest two different measures.

1) Monitor hospital associated infection rates:
- Was there a change in the occurrence of these types of infections since the implementation of this protocol?
- Was there a difference in occurrence of hospital associated infections between the pods?

2) Staff surveys:
- Survey staff about how and if they feel the change has made a difference in daily practice.
- "Do you feel that scrubbing prior to shift report has been beneficial in being able to directly interact with patients and their environment upon arrival to the NICU?"
- "How often would you say you have needed to interact with the patient or their environment prior to or during shift report?"
- "Do you feel this new practice has affected workflow, either positively or negatively?"

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In order to adequately gauge the success of this change, we would start by implementing this action plan in two pods of the NICU (i.e. just pods 1 and 2 will scrub prior to shift report). This first phase would span 8 weeks. After the first phase is done, analysis of the data would help to guide whether the trial was successful and suggests further expansion of this protocol to the rest of the unit. If the results showed that in fact there was a significant indication to expand this practice to the rest of the unit, further follow up studies would be performed for the first year of implementation.

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In NICU nurses, does scrubbing prior to handoff report compared to after handoff report minimize the risk of spreading infection to patients?

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Our recommendation, based on the evidence, is that medical staff should be performing hand scrubbing, per hospital guidelines, upon entry to the NICU and prior to beginning shift report.

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The desired outcomes would be that the compliance with hand scrubbing prior to shift report would be 100% and would help decrease infection rates in the NICU.

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Scrubbing in involves washing hands up to the elbows with soap and water for 2-3 minutes. After the "scrub," surgical alcohol based hand rub is applied to clean, dry hands. On our unit scrubbing is completed by nurses after report and safe start. This could pose an issue if a nurse interacts with the patient's environment during hand off, and or, is required to participate in an emergency event prior to scrubbing in.