840 LETTEES TO THE EDITOfl
kept in there, e.g., pens, stethoscope, etc.
3. Before entering, remove rings and wrist
watches and do not put them on again until
you leave.
4. The gowns are autoclaved and must be put
on with the same precautions as in a surgi-cal operating room; e.g. , if the gown is
in-side out, push your arm through from the
inside surface without contaminating the
outer surface, and do not pull up the sleeves until your hands are washed and dried. 5. Scrub hands and wrists thoroughly on first
entrance, wash hands after handling a baby, telephone, etc., before handling the next baby.
6. Do not handle anything in the nursery
(charts, time sheets, etc.) or permit anyone
else to do so, until the hands are properly
washed.
7. Turn taps on with hand, turn them off with the paper towel after you have finished
dry-ing with it.
8. A daily bath or shower is advisable for
anyone working in nurseries for the newborn.
Washable clothing should be changed with
appropriate frequency (underclothing,
hand-kerchiefs, etc.).
9. NB. If by chance you should touch your
nose or face, wash hands immediately, be-fore handling anything else in the nursery.
10. Promptly isolate any baby suspected of
having infection, or one whose mother is suspected of having transmissible infection.
1 1. Do not use hankerchiefs in the nurseries. If necessary to use something (e.g., to smother a sneeze), use a clean diaper, discard it carefully and wash hands.
12. Anything which falls on the floor is
con-taminated. Discard disposable paper, boil
articles if possible (brushes, nipples, etc.).
Otherwise wash with soap and water if
pos-sible (e.g., stethoscopes), or wipe carefully
with alcohol and lay aside to dry. 13. Nursery doors must be kept closed.
To THE EDITOR:
The recommendations for the design of
new-born nurseries recently made by the Commit-tee Ofl Fetus and Newborn resulted from the efforts of members of the Committee and
well-qualified consultants to evaluate the present
state of knowledge concerning the problems in
the control of infections ill newborn infants.
During the deliberations the Committee was
painfully aware of the fact that, with respect
to many aspects of this subject, there was a
dearth of acceptable experimental evidence. Under these circumstances the group was
obliged to make educated guesses.
Doctor Harvie points out that the
recommen-dations of the Committee leave “an impression of finality.” The Committee 011 Fetus and
New-born welcomes the opportunity to proclaim
that its recommendations are not in any sense immutable. The Committee waits for the
re-suits of critical studies which will permit it to base its future recommendations on firm
foun-dations. However, the construction of new
hos-pitais in the United States and renovation of
older IlIlits cannot be postponed to await these
results. For this reason the Committee has
felt obliged to make interim recommendations based on what it considers to be the best
cur-rent information. As was stated in its report,
“The principles enumerated . . . may need
revision as more data become available.”
The Committee hopes that Dr. Harvie and
others will present evidence which will permit it to change the present recommendations.
WILLIAM A. SILvERMAN, M.D., Chairman
Committee on Fetus and Newborn
American Academy of Pediatrics
To THE EDITOR:
I have read with great interest the thought-ful commentary by Dr. Fred H. Harvie on the Special Report of the Committee on Fetus and
Newborn relating to Standards for Planning
and Design of Newborn Nurseries (PEDIAmIC5,
25: 1083,
1960).
IllaSmuch as this report wasissued during my term as Chairman of the
Committee, I have requested permission of
Dr. William Silverman, tile present Chairman,
to SuI)mit a reply together with his.
Firstly, I believe that it is important to stress
that the special meeting which resulted in the issuance of the report was concerned primarily
with problems in the design and construction
of newborn nurseries and not with the basic techniques which are to be followed in the actual operation of the nursery. This Commit-tee had received numerous requests for
infor-mation from individuals and hospitals about to embark OIl construction or reconstruction of
newborn nurseries, and it became apparent
that the plans which were available in the
Standards and Recommendations for Hospital
Care of Newborn Infants were out of date and
required revision. It was appreciated that tile
recommendations would have to be based upon
limited knowledge, but the urgency of the
situation demanded that positive action be
Corn-LETTERS
TO
THE
EDITOR
841mittee Oil Fetus and Newborn invited repre-sentatives from the several organizations listed
ill the report and, ill addition, a group of
con-sultants selected on the basis of special
knowl-edge and experience in the area which was to be considered. Although these consultants were not listed in the report it might be desirable to do so now. They were: Dr. Edward C. Cur-DCII of the Academy Committee on Control of
Infectious Diseases, Dr. Robert M. Heavennich
of the Academy Committee on Hospital Care,
Dr. Heinz Eichenwald, Director, and Miss Lois
Fasso, RN. , Head Nurse, of the Nursery
Re-search Unit, The New York Hospital-Cornell
Medical Center, Dr. August Groeschel,
Associ-ate Director, The New York Hospital, Mr.
August Hoenack and Mr. George Ivanick,
architects in the Division of Hospital and
Mcdi-cal Facilities, U.S.P.H.S., Mr. Roger Mellem,
architect with the American Hospital Associa-tioli, Dr. Warren Wheeler, Professor of
Pedi-atrics and Bacteriology, Ohio State University, and Dr. Jack Metcoff, Director of Pediatrics, Michael Reese Hospital. Only through the
gen-erous cooperation of all of these consultants
was the Committee able to approach the many
complex problems involved in the design of
newborn nurseries and to assure that the
rec-ommendations, insofar as ponsible, would be applicable on a national level, adaptable to
services of varvmg size, and flexible enough to
adjust to such practical aspects as personnel shortages, architectural feasibility, expense, etc.
Following tile meeting a set of five different plans for newborn nurseries was made avail-able for distribution, upon request, by the
U.S.P.H.S., alid the following statement
ac-companving these plans is worthy of note.
“These preliminary plans are examples of
nurs-cries designed in accordance with the princi-pies of the Committee and are subject to
further study and refinement. However, they
may serve as gmdes in understanding current
concepts of design and construction of the
Ilewborn nursery. From comment received by
the Committee to date it would appear that
these plans have been of great value to groups
and individuals involved in the hospital care
reliable nurse. “ However, it was
im-pressed upon us from many sources that
the use of nonprofessional help is now
of a very practical necessity. As
men-tioned in the report, a survey was carried
out in cities and in hospitals of varying
size to determine the ratio of nursing
personnel to infants and the type of per-sonnel which could be employed. The
figures given represent an acceptable
minimum as based upon the opinion of
nursery supervisors. I would certainly
agree with Dr. Harvie’s statement that
nursery personnel should not have duties
outside the Maternity Unit during any
single working period.
2. Space: The recommendation of 30 square
feet per infant was based upon
experi-mental evidence presented to the
Corn-rnittee on the transmission of air-borne
infection from infant to infant. I would disagree with Dr. Harvie, therefore, that
the principal importance of space is in
relation to the working ease for
person-nd. The recommended space allotments,
as given in the report, do not require that the nurse change her gown each time she picks up a different baby.
3. Vi.rihility, Small Units and Partitions: It
was the consensus of the various
con-sultants that while infection is introduced ilito the nurser’ i)y the attendant
person-nd, the spread of infection is primarily
from infant to infant. In considering methods to limit the spread of infection in a nurser’ the separation of infant from
infant, as above, and the limitation of the number of infants in any single unit were considered to be among the most
effica-cious. Placing the nursing station within
the unit would again require the use of
large nurseries. On the other hand, the
design of small units with central
nurs-ing stations permits separation of the
in-fants and more efficient use of the
avail-able personnel.
With regard to the statement on cubicles,
Corn-842
LETFERS TO THE EDITORPittsburgh, Pa.
able. Therefore, the statement was made as
follows : “To prevent the spread of infection
from infant to infant, it should be impossible to crowd basinettes together-this can probably he best accomplished by cubicle partitions.”
There was certainly no feeling or belief on the
part of any member of the Committee that cubicles were of any value as a barrier to the spread of infection per se nor, in fact, was there actually a recommendation that they
again be included in the actual construction of
the nursery. In fact, in the actual plans for the
various nurseries which have been distributed
cubicles are not portrayed in any of the
de-signs.
I should like to emphasize that the
Commit-tee did not, in this report, recommend change
in any of the basic techniques as now stated in
Hospital Care of New Born Infants, and in fact
this special report was prepared as a
supple-ment to the existing booklet.
If the special report of the Committee on
Fetus and Newborn has served to stimulate the
very careful appraisal of current nursery
tech-niques as exemplified by Dr. Harvie’s critique,
thell it has served at least one very useful pur-pose. For it is only through the exchange of ideas and opinions between the Academy mem-bers and their Committees that continued
rogress will be made.
IRVING SCHULMAN,
M.D.
Chicago, Ill.
Accidents from Doors
To THE EDITOR:
The screen door shown in the Figure is the
cause of frequent preventable accidents oc-curring especially during the summer months.
The accident usually involves a young child
who is running out the doorway and as the
door slams shut, puts a hand out to stop it. If
enough force is exerted, the hand, arm or
pos-sibly head and neck will crash through the
thin glass. The results may be either mild or
severe lacerations of the arm; most of the
trauma may be incurred when the child
with-draws the arm back across the jagged glass.
Laceration of the neck area may be life
threat-ening.
The doors are built with two or three
see-tions and the sections are filled with either
glass or screen fillers. Unfortunately parents
prefer the glass fillers, as the screen is easily
broken or pushed through. It is the glass filler,
however, that frequently is involved in
pre-ventable accidents. The parents should be warned of the danger of these doors. A fancy
metal guard is available and I recommend
installing this on the door. This will protect
the screen, or the child if the glass filler is
used, and help prevent unnecessary accidents.
