GROUP 6

No Name Matric Number

1 Mercy Binti Kalu ADMW1/2020(K)0174
2 Moinis Binti Kurutok ADMW1/2020(K)0175
3 Norain Binti Awang ADMW1/2020(K)0178
4 Nordayana Binti Yunus ADMW1/2020(K)0179
5 Norheiza Binti Mohd. Benedict ADMW1/2020(K)0180
OBJECTIVES
1. Definition Of Infection in
Newborn
2. Risk Factor Of Infection In
Newborn
3. Early Prevention To Avoid
Infection In Normal Newborn
4. Nursing Care Managing Normal
Newborn With Risk Of Infection.
 INTRODUCTION
Newborn babies have weak immune systems. This cause
newborn babies get sick very fast. Most infections in newborn
babies are caused by bacteria, and some by viruses.

A mother’s birth canal contains bacteria, especially if they

have an active infection. During childbirth, the baby can
swallow or breathe in the fluid in the birth canal, and bacteria
or viruses can get into their lungs and blood. The baby can
become sick during childbirth or within the first few days after
birth. As the bacteria or viruses multiply, the newborn baby
can become ill very quickly.
Amanda Sheppard, PhD, Applied Scientist,AboutKidsHealth, The
Hospital for Sick Children. (2009, October). Infection in newborn babies.
01
 “Infection's in newborn may acquired
during prenatal development or in the
first four weeks of life (neonatal period).
Infection in newborn may be contracted
by mother to child transmission, in
the birth canal during childbirth, or
contracted after birth.
Some infections are apparent soon after
delivery, while others may develop in
the postnatal period. .”

Mary T. Caserta (October 2015). "Overview of Infection in

Newborn". Merck Sharp & Dohme Corporation.
 Infection In Newborn
Estimate 36% Of Newborn
Deaths, Ranking It As One Of
The Three Major Cause Of
Newborn Deaths Worldwide
(Along With Preterm Birth
And Birth Asphyxia).

UNICEF, Who 2015

UNICEF. (2020). Infection Prevention and
Control at Neonatal Intensive Care Units.
02
 RISK FACTORS FOR NEONATAL INFECTIONS
Ø Premature birth (< 37 weeks)
Maternal risk factor Ø premature and prolonged time (> 18 hours) of membranes rupture
Ø maternal peripartum infection Cortese, F. Scicchitano.(2015, December ).
Early and Late Infections in Newborns

Newborn risk Ø Lower birth weight (ELBW>VLBW)

Ø Younger gestational age
factors that
Ø Immunology of the neonate: Immunocompromised, immature, ineffective
increase the risk of and inadequate levels of antibodies
infection Ø Co-morbidities (e.g.: congenital conditions)

Care-related risk Ø Presence of invasive medical devices

Ø Overcrowding and Understaffing
factors that
Ø Contact with colonized/ infected family, visitors, or healthcare workers
increase the risk of Ø Increased length of stay
infection Ø Poor hygiene in facilities and personnel healthcare

UNICEF. (2020). Infection Prevention and

Control at Neonatal Intensive Care Units.
03
Ø Personal Ø Environmental Ø Equipment Ø Personal Ø Hygiene Ø Restricted
-Hygiene/hand surfaces use in Hygiene Ø Immunization visitor
washing Ø Clean bassinet Monitor Ø Breast Ø Social - Avoid
-No accessories / baby cot V/sign such feeding distancing overcrowded
Ø Personnel Periodically as : Ø Cord care Ø Separate/ Ø Visitor
health such as Thermometer, Isolation for etiquette
URTI bp cuff, Unhealthy - Hand
-avoid handling stethoscope, etc Baby washing
newborn Ø Inj. Tray –
Ø PPE each infant
Ø Procedure one tray
- In blood taking or
Cord Toilet.
- Aseptic Technique
Ø Antibiotics as UNICEF. (2020). Infection Prevention
prophylaxis and Control at Neonatal ward.
 1. PERSONNEL HEALTHCARE (DR. & NURSE)
Personal hygiene - Hygiene/hand washing & No accessories
Ø Hands and accessories are the most common vehicle to transmit health care-
associated pathogens.
ü Health care workers should perform a
Any health-care worker, caregiver or person wash of their hands and arms to above
involved in patient care needs to be the elbows, with care to cleaning all
concerned about hand hygiene parts of the hands and beneath the nails
• Therefore hand hygiene concerns you! You before their shift begins and before
must perform hand hygiene to: handling a newborn
1.Protect the patient against harmful germs
carried on your hands and accessories or
present on his/her own skin.
2.Protect yourself and the health-care
environment from harmful germs. UNICEF. (2020). Infection
Prevention and Control at
Neonatal Intensive Care Units.
 1. PERSONNEL HEALTHCARE (DR. & NURSE)
PERSONNEL HEALTH STATUS
ü All staff working in ward should be screening first and
identify their health status.
ü Staff who had Sign symptom of URTI, diarrhoea or other
disease – Avoiding handling newborn to protecting the infant
from infected health care workers.

PPE & PROCEDURE

ü Use of personal protective equipment appropriate while handling newborn

ü Not sharing equipment and supplies between infants
ü Safe use and disposal of sharps
ü Using invasive medical devices judiciously
ü Strictly adhering to aseptic techniques
KKM Policies & Procedures on
Infection Prevention and Control 2019
 1. PERSONAL HEALTHCARE – CORD TOILET
The studies done by Imdad(2013), effectiveness antiseptics use in Umbilical
cord care such as choloroxidine 1:2000. There is significant evidence to
suggest that topical application of chlorhexidine to umbilical cord reduces
neonatal mortality and omphalitis in community and primary care settings.
Imdad A, Bautista RM, Senen KA, Uy MV, Mantaring III JBlas, Bhutta ZA, Umbilical
cord antiseptics for preventing sepsis and death among newborns. (2013, May).

Perform recommended cord care:

•For newborns born in low NMR settings (in health facilities and home), use clean, dry cord
care.
•In settings with high NMR (>30 per 1000): Apply 7.1% chlorhexidine digluconate (i.e., 4%
chlorhexidine) aqueous solution or gel for 7 days on umbilical cord stumps of infants born at
home.
•With aseptic technique and dressing done from clean to dirty. UNICEF. (2020). Infection Prevention and
Control at Neonatal Intensive Care Units.
Dr. Indication In Initiation Antibiotic Prophylaxis
Antibiotics being started when the newborn is at risk of infection ,or may
have an infection. Infections can occur when germs cross from mum into
baby during labour. Infection in newborn can be very serious if left untreated.
There are two possible reasons:
1. Newborn is showing signs of possible infection – these include:
Ø Fast or laboured breathing
Ø A grunting noise
Ø A high or low temperature
Ø Poor feeding or lethargy (sluggish) - more than is normal for a newborn baby
Ø Jaundice requiring light therapy in the first 24 hours of life.

2. Newborn is at higher risk of infection

To decrease the risk of infection usually antibiotics are given to the high-risk
newborn. Sherwood Forest hospital. Starting antibiotics
means to your baby. (February 2019).
ANTIBIOTIC FOR PROPHYLAXIS
Other than that, in maternal side
Intrapartum prophylaxis
- women in labour identify and assess any risk factors for early-onset
neonatal infection. Throughout labour monitor for the emergence of
new risk factors, such as intrapartum fever higher than 38°C, the
development of chorioamnionitis and pre labour rupture of
membrane.

Treatment:
Give IM or IV Ampicillin dan gentamicin for at least 2 days and
assess, continue treatment only if there is a signs of sepsis
Lai Nai Ming, Choo Yao Mun & Azanna Ahmad
Kamar. (2019). Neonatal Antibiotic Guideline
ANTIBIOTIC FOR PROPHYLAXIS

Localized infections of the eye

- For eye it is advisable to place tetracycline, chloromycetin or

erythromycin ointment or drops routinely into both eyes to prevent
Gonococcal conjunctivitis. The use of erythromycin or tetracycline
will also decrease the risk of conjunctivitis due to Chlamydia.

Lai Nai Ming, Choo Yao Mun & Azanna Ahmad

Kamar. (2019). Neonatal Antibiotic Guideline
 2. ENVIRONMENTAL CARE
Poor hygiene conditions in healthcare facilities and
inadequate Infection Prevention & Control (IPC) practices
allow for more bacteria to survive in the healthcare facility
Ø These bacteria can cause Hospital Acquired Infection (HAI)
WHO, 2014
in patients who have come in for a variety of health visits,
Environment care including labour and delivery.
Ø Environmental surfaces or objects contaminated with blood, other body
fluids, secretions or excretions should be cleaned and disinfected as soon
as possible using standard hospital detergents/disinfectants
Ø Clean regularly to remove visible soil (blood, milk, body fluids) and reduce
microbial burden.
Ø Cleaning should always be carried out from “clean” areas to “dirty” areas, in
order to avoid contaminant transfer.
Ø Change periodically bassinet/ baby cot.
UNICEF. (2020). Infection Prevention and Control at Neonatal ward.
 3. EQUIPMENT / INSTRUMENT CARE
ü Injection tray should be change after care of one infant and a
new injection should be use for handling the next infant.
ü Use only sterile water in nebulizers and humidifiers.
ü Equipment such as bassinets, cribs, warmers need to be
change periodically
ü Wrap or cover linens during transport and store them in
closed cabinets to prevent contamination
ü Avoid placing toys that cannot be adequately cleaned, such
as stuffed toys
UNICEF. (2020). Infection Prevention
and Control at Neonatal ward.
 4. MOTHER – PERSONAL HYGIENE

◼ Advice mother keeping the body clean helps prevent infection.

◼ Hand washing with soap is the most important hygiene action she can
take, especially before preparing food/milk and after going to the toilet.
◼ If possible, a woman should wash her body every day with clean water,
before attending the child.
◼ Maintain breast hygiene - It is essential to maintain the hygiene of breasts
as any infection may also spread to the baby. Rinsing the breasts in water
after breastfeeding is a postnatal hygiene tip mother can follow.
Postnatal Care Module: 14. Health
Promotion Issues after Pregnancy. (n.d.).
Website, A., & Magazine, A. (2017, January 20).
Postnatal Hygiene and its Importance.
 4. BREAST FEEDING
BREASTFEEDING REDUCES RISK
FOR INFECTIONS
ü Breast milk has been associated with a lower risk of sepsis and necrotizing
enterocolitis in preterm infants.
ü Immunologic properties of breast milk secretory IgA.
ü Specific macrophages and lymphocytes.
ü Secretory molecules with antibacterial properties.
ü All may all contribute to this protective effect of breastfeeding.

Infections have been associated with contaminated breast milk pumps and refrigerated
storage practices.(UNICEF,2020)
- So that as need to give Health Education and awareness toward mother.
UNICEF. (2020). Infection Prevention and
Control at Neonatal Intensive Care Units.
 4. MOTHER
- BREAST FEEDING (HANDLING & STORAGE)
ü For mothers expressing, ensure hand hygiene and expression of milk into sterile
containers.
ü Clean the containers with hot, soapy water after each use, before they are sterilized.
ü For mothers using a breast pump:
q Wash all pump components that are in contact with milk with hot, soapy water after
each use, dry thoroughly, and store in a clean place.
q Sterilize or high-level disinfect pump components daily.
ü Store milk in sterile, labelled containers covered securely.
ü Label with infant’s name, date of birth and date of pumping.
ü When stored in a refrigerator or freezer with milk for other infants, place all the
feeds for each infant into a larger, labelled, cleanable bin or zip-lock bag, one for
each infant.
ü Clean and disinfect the container after the infant is discharged.
UNICEF. (2020). Infection Prevention and
Control at Neonatal Intensive Care Units.
4. MOTHER - UMBILICAL CORD CARE
Basic knowledge given to mother regarding the cord care:-

ü After the umbilical cord is cut at birth, a stump of tissue

remains attached to baby's belly button (navel).

ü The stump gradually dries and shrivels until it falls off,

usually 1 to 2 weeks after birth. It is important to keep the
umbilical cord stump and surrounding skin clean and dry.

ü The basic care helps prevent infection. It may also help the
umbilical cord stump to fall off and the navel to heal more
quickly.
Health Link BC, Umbilical Cord Care.
(2019, June)
 5. BABY
- Preventing Infection In The Newborn At The Time Of Birth
•Keep the baby in a clean area and follow standard precautions for newborn resuscitation.
•Ensure that resuscitation team wears appropriate PPE; non-sterile, fluid-proof, long-
sleeved gowns, face-shields or goggles and masks, boots or shoe covers, and non-sterile
gloves.
•Wear non-sterile gloves for contact with the newborn until after the first bath.
•Wipe both of the new-born's eyes with a sterile gauze square and discard the wet cloth.
Use a separate square for each eye and wipe from the inner corner to the outer corner.
• Keep the newborn warm.
• After delivery, do not perform routine suction or aspiration.
In the presence of meconium-stained amniotic fluid:
• Do not perform tracheal suctioning and avoid suctioning of the mouth and nose before
initiating PPV for infants who do not start breathing on their own.
• For newborns who do not start breathing on their own by 1 minute after birth, start PPV
WHO, UNICEF, UNFPA 2013
with room air with a self-inflating bag and mask.
5. BABY
- Infection prevention and control within the first hour of life
• Initiate early breastfeeding within 1 hour of birth.
• Encourage exclusive breastfeeding.
• Apply antiseptic eye drops or ointment (e.g., tetracycline ointment) to both eyes
once, according to national guidelines.
• Administer vitamin K and recommended immunizations (birth dose of oral polio
vaccine and HBV vaccine), using safe injection practices and sharps safety.
• Apply relevant IPC precautions (Transmission-Based Precautions and
prophylaxis) to those who are exposed or infected during or before birth (e.g.,
congenital syphilis, rubella, HIV, HBV, and other infectious diseases).
WHO, UNICEF, UNFPA 2013
 5. BABY - IMMUNIZATION / VACCINATION
Ø Immunisation works by triggering the immune system to fight against
certain diseases. If a vaccinated person comes in contact with these
diseases, their immune system is able to respond more effectively. This
either prevents the disease from developing or reduces the severity.

Vaccination such as Bacillus ü All babies should get the first shot of hepatitis B
vaccine within first 12 hours after birth.
Calmette Guérin (BCG) and
Hepatitis B vaccine (HBV), do
demonstrate safety and some
efficacy at birth, providing proof of
principal that certain antigen-
adjuvant combinations are able to
elicit protective neonatal
responses. Demirjian, A., & Levy, O. (2009, January). Safety and
efficacy of neonatal vaccination.
5. BABY - IMMUNIZATION / VACCINATION

Worldwide, infectious diseases cause death of > 2

million newborns and infants less than 6 months of
age.

“Significant reduction of this burden will require

development of early life vaccination, including
vaccines effective when given at birth, the most
reliable point of global healthcare solution”.
Demirjian, A., & Levy, O. (2009, January). Safety and
efficacy of neonatal vaccination.
 5. BABY - separate / isolation
- baby cot distancing unhealthy baby
“ When waiting to be picked up, an ill child who is being
excluded should be in a location when no contact occurs
with those who have not already been exposed to their
infection. Often, it is best for the child not to be moved to
another space to prevent their illness from spreading
throughout the facility and to maintain good supervision of
the child. In some programs, a staff member who knows
UNICEF. (2020). Infection Prevention
and Control at Neonatal ward. the child well and who is trained to care for ill children may
care for the child to a space set aside for such care and
where others will not be exposed.”
ü Infants with suspected infection should be isolated from other
healthy neonates and cared.
American Academic of Pediatrics. (2018).
Reducing the Spread of Illness in Child Care.
 6. Ward regulation
- avoid overcrowded in ward
- visitor etiquette
ü Do not allow family members to visit or assist with other infants.

ü Visitor’s hygiene
Another postnatal hygiene that must be followed is the visitor’s hygiene. Both the mother and
the baby can pick up infections from visiting friends and family and it is advisable to limit their
number to prevent you or your baby from getting any infections.

ü Screen visitors and exclude

-for signs of infection- fever, respiratory infection, diarrhoea, and draining skin infection
-Do not allow ill visitors to enter the ward with the exception of the mother, who may be
allowed to care for the infant after consultation with ward staff.
04
 Vera, Matt (2019, March 20). Risk for
Infection – Nursing Diagnosis & Care Plan.
 Vera, Matt (2019, March 20). Risk for
Infection – Nursing Diagnosis & Care Plan.
 3. Health
1. Asses Level Of
Education
Mother
Knowledge
4. Inform
Mother
2. Monitor Regarding Sign
Vital Sign & Symptom Of
Infection
Vera, Matt (2019, March 20). Risk for
Infection – Nursing Diagnosis & Care Plan.
 Ø Knowledge plays an influential and significant part of a
patient’s life and recovery.
Ø It may include any of the three domains: cognitive domain
(intellectual activities, problem-solving, and others); affective
domain (feelings, attitudes, belief); and psychomotor domain
(physical skills or procedures).
Ø It is the duty of the nurse to determine with the patient what
to teach, when to teach, and how to teach certain matters and
concerns on health.
According to Dorothea Orem’s Self-Care Theory
“The goal of nursing was to render the patient capable of
meeting self-care needs, a process that often includes patient
teaching”
Wayne, Gil Wayne (2019, March 14). Deficient Knowledge – Nursing Diagnosis & Care Plan.
 Monitor the signs of actual
infection (abnormal reading):

1. Temperature
Normal temperature :36.8°c - 37.2°c

2. Pulse
Normal Pulse :120/min – 160/min

3. Respiration
Normal Respiration : 35-40/min

4. Blood Pressure
Normal BP :70/40mmHg -95/55 mmHg
Susan C. Kim MD - Pediatrics & Adam Husney MD.
(2019, June). Vital Signs in Children.
 i. Umbilical Cord Care At Home
1.Keep the stump clean.
- Swab the stump with rubbing alcohol after every diaper change. The stump might
heal faster if left alone. If the stump becomes dirty or sticky, clean it with
antiseptic provide — then dry it by holding a clean, absorbent cloth around the
stump or fanning it with a piece of paper.

2. Keep the stump dry.

- Expose the stump to air to help dry out the base. Keep the front of your baby's
diaper folded down to avoid covering the stump. In warm weather, dress your
baby in a diaper and T-shirt to improve air circulation.

3.Stick with sponge baths.

- Sponge baths might be most practical during the healing process. When the
stump falls off, you can bathe your baby in a baby tub or sink. Let the stump fall
off on its own. Resist the temptation to pull off the stump yourself.
American Pregnancy Association. Umbilical Cord
Care: Cleaning and Signs of Infection. (2020, May 05)
ii. Hand Washing & personal hygiene
To Teach Mother

Make sure mother perform

hand wash before handling
baby to prevent infection.

UNICEF. (2020). Infection Prevention and

Control at Neonatal Intensive Care Units.
ü
iii. Breast feeding
Encourage mother to give breastfeeding as soon as baby born because 1st milk
has colostrum which is contain antibody. E.g : immunoglobulin 1gA-to prevent
baby from infection.
ü Fully breastfeeding in 6 month and continue until 2years
iV. Immunization/ vaccination

ü Ensure baby get immunization as schedule

E.g :- BCG , Hep B

Azzimawati, R. (2016, June 08).

Immunisation Schedule.
 4. SIGN & SYMPTOM OF INFECTION
ü Fever
ü redness and discharge from umbilical cord

* ENCOURAGE MOTHER TO SEEK TREATMENT IF SIGN

AND SYMPTOM OF INFECTION PERCENT.
SIGNS OF INFECTION MAY INCLUDE IF THE CORD:
Ø The base appears red or swollen
Ø Continues to bleed
Ø Oozes yellowish or white pus
Ø Produces a foul-smelling discharge
Ø Seems painful to baby

Signs of infection of the umbilical cord stump can result in omphalitis (a life-
threatening infection of the umbilical cord). This is considered a serious condition and
needs to be treated immediately.
American Pregnancy Association. Umbilical Cord
Care: Cleaning and Signs of Infection. (2020, May 05)
CONCLUSION
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