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A Nurse's Perspective on Decreasing the Incidence of NEC

Jennifer L Dizon, BSN, BA, RN-WCCM, CCM
February 17, 2022

As a registered nurse, people would ask my specialty or at which unit I worked. When I said that I was a nurse in the Neonatal Intensive Care Unit (NICU), they told me that it took a special person to work in the NICU. I completely agreed with this calling. It was a blessing to take care of premature babies and watch them grow. These itty bitties (as we pleasantly referred to them) could weigh as small as 800 grams, or about the size of two cans of soda. Because it was a NICU, we nurses had to be extra careful with infection control and prevention. Sadly, Necrotizing Enterocolitis (NEC) would occasionally invade.

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Here are some steps I believe that we in the healthcare community can take in order to decrease the incidence of NEC. 

1. Handwash and “Scrub In”

Before clocking in for my 12-hour shift, I would drop off my food in the breakroom and enter the NICU to perform a three-minute scrub using chlorhexidine gluconate (CHG) and water. I wet my arms with warm water, and pumped CHG into my hands before setting the wall timer for three minutes. I meticulously scrubbed from my fingertips to my elbows for the entire three minutes before rinsing the suds with water. I pointed my arms downward so that the CHG, bubbles and water dripped past my fingertips toward the sink and down the drain. Not only were healthcare providers and staff required to complete this scrub, but all parents and visitors as well.

When infection rates appeared to decrease, the NICU lowered the timed three-minute scrub to just 30 seconds. Soon after, however, the infection rates of NEC incidences increased. Our unit felt that this was directly correlated to the decreased amount of time required for an initial scrub upon entering the NICU, therefore transporting more germs to the babies. We quickly returned to the three-minute scrub and noticed the NEC rates decreasing yet again.

2. Store Personal Devices in Sealed Plastic Bags

With the increased use of personal electronic devices, we required all staff, parents, and visitors to place their devices into sealed, plastic sandwich-sized bags. We instructed parents that they could still use their cellular phones by dialing and swiping through the clear, plastic bags. By containing germs within these bags, it appeared that this helped with decreasing the incidence of NEC and spreading other infections.

3. Local Milk Bank

We encouraged mothers to pump breast milk and save colostrum for their babies. However, some mothers encountered challenges with milk production especially if their babies were born prematurely. If mothers could not produce enough breast milk, we provided resources to them. Some mothers successfully followed recipes or remedies to help with milk production.

I should mention that there are claims that premature babies fed fortified cow’s milk-based formulas are at higher risk of developing NEC. Read here to learn more about the risk and the ongoing lawsuits against Similac and Enfamil.

If mothers had little luck with improving their milk production, we explained that donor human milk (DHM) could be administered to their babies. Mothers who produced an excess amount of breast milk could donate especially after their own babies discontinued breastfeeding, or whose refrigerator/freezer storage could no longer accommodate excess milk. Donors as well as their DHM were screened before being accepted at the milk bank.

Because premature babies were not yet developed to feed on their own, many required tube feedings until reaching a certain gestational age when they could attempt bottle feeding. The feeding tube would be inserted in either the baby’s nostril or mouth and end in the stomach. The milk was placed in a syringe and set on a pump with a timer. Typically, tube feedings were set for 30 minutes, yet some preemies might need 45 or 60 minutes.

4. Separate NEC Babies from Well Babies

I remember providing care to several babies in the NICU, particularly a set of twin girls. Each twin was settled into her own incubator. While preparing for feedings, we took vital signs, changed diapers and assessed. One day, I noticed that one of the twins was lethargic. She was previously alert, active and attentive. While repositioning her into a supine (face up) position, I unwrapped her swaddle and there appeared to be vomit from her previous feeding. Her abdomen also seemed to be bloated and firm. I unwrapped her diaper to measure her abdominal girth and compared it to her previous measurement. I looked in her diaper and saw blood-tinged stool. I alerted the physician, who ordered stat (immediate) lab draws to check for any infection, and an X-ray to check for pneumatosis or air.

When the X-ray technician arrived, the twins’ mother happened to walk into the NICU. Upon seeing her distraught and surprised facial expressions, I explained what occurred and the necessary interventions. By keeping her informed, she was thankful that this was caught as soon as possible. The affected twin’s feeding would be placed on hold until the lab and X-ray results were available. The twins’ mother verbalized understanding. Unfortunately, her baby girl was diagnosed with NEC. Her feedings were held for 10 days, and she would receive antibiotic treatment, repeat lab draws and X-rays.

Even though one twin was diagnosed with NEC, her sister was not. Twin girl #1 was relocated away from her sister and other well babies during her treatment for NEC. Luckily, she recovered well, continued her NICU course and was discharged home after her sister. If there was more than one baby with NEC, we typically grouped them together on one side of the NICU to help with preventing the spread of NEC or other infections.

5. Wipe Equipment and Workspaces

If incubators or bedspaces were vacant, it was important to keep those areas clean to decrease the incidence of NEC and other infections. Environmental Services would thoroughly clean bedspaces and incubators before admitting or transferring a new baby. After feedings, changing diapers, procedures and drawing medications, we wiped down equipment and workspaces as well. Thoroughly washing hands after removing gloves and before moving to the next baby’s bedspace was crucial.  

In conclusion, from my experience as a NICU nurse, we took necessary precautions to help decrease the incidence of NEC. Although NEC did occur, it was imperative to keep the babies’ parents informed of the diagnoses and plans of action. Encouraging breast milk production or access to DHM from a local milk bank was essential to decreasing the prevalence of NEC. Maintaining distance between babies diagnosed with NEC from well babies, as well as keeping equipment and workspaces clean also helped. Most important, scrubbing in for three minutes with CHG and placing personal devices in clear, sealed plastic bags contributed to the decreased rates of NEC.

*The opinions expressed in this post are solely those of the author and do not necessarily reflect those of Select Justice and are not to be taken as medical facts. Consult with your doctor if you have further questions.

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