PAHO recommendations

Arising from a technical mission carried out by a multidisciplinary team from the Pan American Health Organization (PAHO), Jamaica’s health ministry has been advised to implement a number of recommendations to reduce the risk of bacterial outbreaks in special-care nurseries.

National recommendations:

• Conduct national and subnational infection prevention and control self-assessments.

• Conduct full infection prevention and control assessment in the three visited health facilities utilising the PAHO Rapid Evaluation Guide for Hospital Programmes for Prevention and Control of Nosocomial Infections, which will require two to three external assessors over the course of two days.

• Implement a standardised Healthcare Associated Infection (HAI) surveillance system in all high-dependency units.

• Strengthen microbiology support at the health facility level to identify most common bacterial pathogens as cause of healthcare associated infections in high-dependency unit nurseries.

Hospital recommendations:

• Optimise staffing levels – newborns receiving intensive care (1:2) and newborns receiving intermediate care (1:3).

• Conduct high-level disinfection of semi-critical items like laryngoscope blades using chemical disinfectants to prevent pneumonia associated with mechanical ventilation.

• Wear a gown to enter a patient isolette and remove it on exit. Put on gloves before entering a patient isolette and remove them on exit. Perform hand hygiene immediately after gown and glove removal, before contact with another patient.

• Ensure spacing of at least 1m between the edges of beds.

• Evaluate peripheral catheter insertion site daily and remove umbilical venous catheters as soon as possible to prevent bacteria associated with central or peripheral venous catheters.

• Maintain hot and cold water temperatures at recommended levels.

• Prepare injections in a designated, clean area where contamination by blood and body fluids is unlikely and properly label multi-dose vials.

• Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.

• Properly discard used sharps and glass ampoules immediately after use.

• Perform most cleaning, disinfection, and sterilisation of patient-care devices in a central processing department in order to more easily control quality.

• Store clean medical devices in a designated room or a defined place. Wrapped, sterile goods should be stored in closed lockers or cabinets, not on open shelves.

• Position refrigerators away from direct heat or sunlight and have a temperature monitoring device to document the internal temperature at least once daily.