Food Protection Trends - July/August 2023 - 358

GENERAL INTEREST PAPER
A Personal Perspective Regarding Hygiene Practices
at a UK Neonatal Intensive Care Unit
Ellen W. Evans*
ZERO2FIVE Food Industry Centre Food and Drink Research Unit, Cardiff Metropolitan University, 200 Western Avenue,
Llandaff, Cardiff, Wales CF5 2YB, UK
SUMMARY
In November 2020, I gave birth to an extremely premature
baby who lived for just 32 days, this time was spent together
at a specialist neonatal intensive care unit (NICU) in the
United Kingdom. In this general interest article, I discuss
my personal experiences as an NICU parent and share my
personal reflections related to the hygiene practices at the
NICU. I provide my perspective detailing the consistent
and thorough approach to hand hygiene among NICU
staff, and in contrast, I share my concerns regarding the
hygiene perceptions and practices of NICU mothers when
expressing breastmilk. I conclude with the areas in which
I believe further research is required and opportunities
exist to support mothers to express breastmilk safely and
hygienically.
OVERVIEW
Hygiene practices of the NICU team
The neonatal intensive care unit (NICU) where we
received care operated a " bare below the elbow " policy
that required parents and all health care professionals to
wash their hands and forearms in designated hand washing
stations located throughout the unit. Emphasis was placed
on the importance of parental hand hygiene when entering
the unit, as well as before and after opening the incubator.
This was communicated verbally by staff, such as the NICU
receptionist and specialist nurses. The importance was
reinforced by observable hand washing behavior among
all health care staff and non-health care staff supporting
parents on the unit. Visible signage at the point of entry also
communicated the need for and importance of hand hygiene.
Governmental emphasis on the importance of hand
hygiene practices in response to the COVID-19 pandemic
at the time may have enhanced the emphasis and efficacy of
hand hygiene practices within the unit.
I have spent a great deal of time observing a vast number
of hand hygiene attempts, albeit in food manufacturing and
consumer-based research (4-6); therefore, I naturally, and
unintentionally, observed how people on the unit (including
neonatal nurses, nurse practitioners, registrars and trainee
doctors, neonatology consultants, pediatric surgeons, the
NICU psychologist, the hospital chaplain, reception staff,
and hygiene staff) implemented hand hygiene attempts. I
seldom believed that the hand hygiene practices I observed
358 Food Protection Trends July/August
at the NICU could be improved. This was quite different
from the research I've undertaken in food manufacturing
businesses, where I've found that although most food
handlers attempt to implement hand hygiene, these attempts
are not fully compliant with recommended hand hygiene
protocols. For example, hand washing durations are often less
than 20 s, all parts of the hands are not rubbed, and sanitizer
may not be used after hand washing (4, 6).
There was a positive culture regarding the importance of
hand hygiene at the NICU. The hygiene staff took pride in
their role of cleaning hand washing facilities and replenishing
hand hygiene products. I watched in amazement how nurses
would remain calm, instantly and instinctively implement
thorough hand hygiene practices, and don gloves at critical
times that required immediate medical intervention. On no
occasion did I feel that inadequately cleaned or ungloved
hands entered our son's incubator.
Maintaining hand hygiene came at a cost for many
of the NICU team; I recall conversations with neonatal
nurses regarding how constant hand washing during three
consecutive 12.5-h shifts would result in skin irritation and
how they searched for barrier creams to help maintain skin
integrity. This was something that I also struggled with due
to frequent and thorough hand washing. The skin on my
hands was inflamed, dry, itchy, cracked, and painful. At times,
I dreaded washing my hands because I couldn't face using
the harsh liquid hand soap, coarse paper towels, and strong
sanitizer. Regardless of this, I was aware of the importance
of hand hygiene. It felt like doing the right thing, in terms of
hand hygiene, was contagious at the NICU. All I can do is
commend the neonatal nurses and the NICU team for their
exemplary approach to hand hygiene.
Mothers' hygiene practices when expressing breastmilk
Given the positive hand hygiene culture at the NICU,
most parents implemented appropriate hand hygiene
attempts when entering the NICU. However, my biggest
area of concern related to the hygiene practices of mothers
when expressing breastmilk. Mothers like me were urged to
express breastmilk at least 8 times a day. Given the amount of
time spent at the NICU, we were able to express breastmilk
beside the incubator or in a dedicated expressing room where
breast pumps and cold-water sterilizing units, labeled for
the mother of each infant at the NICU, were stored. Health
*Author for correspondence. Phone: +44.0.2920.205836; Fax: +44.0.2920.416982; Email: elevans@cardiffmet.ac.uk

https://www.foodprotection.org/files/food-protection-trends/jul-aug-23-Evans.pdf

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