A JOURNEY TOWARDS WATER LESS NEONATAL INTENSIVE CARE UNIT (NICU)

Abstract

Premature infants are traditionally nursed in an open bay Neonatal Intensive Care Unit (NICU), making them extremely vulnerable to recurrent outbreaks from the hospital-built environment (including water sources). Our experience, like many others, has shown that plumbing in hospital premise can harbour pathogens that result in healthcare-associated infections.In 2016, the National University Hospital of Singapore NICU-infection control multidisciplinary workgroup was set up to monitor and implement strategies to reduce late-onset-sepsis (LOS).Various water free and avoidance of tap water use measures were taken to further reduce incidence of LOS since 2016-17 .This included use of alcohol based hand-rub for routine hand hygiene and before performing procedures such as insertion of central lines. Sinks in close proximity to patient beds were closed. In August 2022, a new NICU was designed to have only 1 sink in clinical area. Existing sinks underwent scheduled monthly change of P-trap. Irrigated sterile water replacing warmed tap water was used to bathe the premature infants. We define this as ‘Water Less NICU care’. Ongoing measures for infection control (e.g., antibiotic policy, high hand hygiene compliance of healthcare personnel, NICU acuity and admission, nurse-patient ratio etc.) remained unchanged. The rate of late onset sepsis (LOS) rate among very low birth weight (babies born below 1500 grams) babies declined from baseline 12.5%(2015) to around 5-6% per year between 2016-2021 period. We believe implementation of Water Less NICU care has contributed to the reduction in LOS for VLBW babies. It is doable and an important step towards sustainable infection control in the NICU.