Safety_Infection_Control_Ante_PPT_MK__1_

Safety and Infection Control in the Antenatal Settings

• Presented by: Melissa King, MSN, RN

Objectives

• By the end of this submodule, students will:

  • Analyze the use of evidence-based practice when providing care to the childbearing person with antenatal needs.

  • Distinguish quality improvement measures to reduce risk and harm to persons and providers during the antenatal period.

Effects of Teratogens on a Fetus

• Definition of Teratogen:

  • Any factor, chemical, or physical element that adversely affects the fertilized ovum, embryo, or fetus.

• Factors Influencing Damage:

  • Strength of teratogen.

  • Timing of teratogen.

  • Teratogen’s affinity for specific body tissues.

Nursing Process: Assessment

• Focus on risk of exposure:

  • Environmental exposures: Home, work, food exposures.

  • Typical diet & habitual exposure: Smoking, drug use, alcohol use.

  • Health history: Infection history and recent risk of exposure.

Teratogenic Maternal Infections: Toxoplasmosis

• Definition: Protozoal infection that can adversely affect the fetus.

• Human Infection Occurs By:

  • Ingestion of raw or undercooked meat.

  • Contact with infected cat feces.

• Transmission to Fetus:

  • Crosses the placental barrier if acquired during pregnancy.

  • More severe effects if infection occurs in the first trimester.

  • Highest transmission risk during the third trimester.

Precautions Against Toxoplasmosis

• Cook meat thoroughly.

• Avoid touching mouth or eyes while handling meat.

• Wash surfaces that come in contact with uncooked meat.

• Avoid uncooked eggs and unpasteurized milk.

• Wash fruits and vegetables prior to eating.

• Wash hands well after working with soil or handling animals.

• Avoid direct or indirect contact with cat feces.

Teratogenic Maternal Infections: Rubella (German Measles)

• Effects:

  • Severe effects include hearing impairment, cognitive and motor challenges, cataracts, cardiac defects, IUGR, thrombocytopenic purpura, and dental and facial clefts.

• Testing: Check titers; a result >1.0 indicates immunity.

• Note: Cannot be immunized during pregnancy.

Other Effects of Rubella

• Heart disease, petechiae and purpura, microcephaly, eye anomalies (cataracts, glaucoma, strabismus, etc.).

Teratogenic Maternal Infections: Herpes Simplex Virus (Genital Herpes Infection)

• Transmission: Spread by intimate contact; can cross the placenta.

• Consequences of Infection:

  • 1st trimester: Severe anomalies or spontaneous abortion.

  • 2nd and 3rd trimester: High incidence of premature birth, IUGR, neurologic disease, and continuing infection after birth.

• Delivery Guidance: If lesions present at birth, cesarean section is advised.

• Medications: Acyclovir or Valacyclovir can be safely administered orally during pregnancy, starting at 36 weeks.

Maternal Infections: Cytomegalovirus (CMV)

• Symptoms at Birth (10% of infected newborns):

  • Asymptomatic in most cases but can develop progressive hearing loss, hepatosplenomegaly, chorioretinitis, small size for gestational age, petechiae, purpura, jaundice, and microcephaly.

• Treatment for Neonates: Ganciclovir treatment may protect against hearing loss and developmental impairment.

Maternal Infections: Syphilis

• Transmission Mode: Sexual; crosses placenta or may occur via amniotic fluid.

• Screening: All women should have syphilis serology in the first trimester or at the first antenatal visit.

• Fetal Effects: Spontaneous abortion, stillbirth, prematurity, congenital syphilis.

• Treatment: Benzathine Penicillin G IM.

Other Infections

• Varicella Zoster (Chicken Pox): Check immunity before pregnancy; live vaccine available.

• Hepatitis B: Newborn treatment if positive—Hepatitis B + Immunoglobulin within 12 hours.

• Group Beta Strep: Test at 35-36 weeks; treatment during labor if positive or unknown.

Chlamydia & Gonorrhea

• Common and rapidly spreading STIs.

• Risk to Infant: Transmitted during birth can cause ophthalmia neonatorum.

• Prophylactic Treatment: Antibiotic ointment in the eyes immediately after birth; antibiotic treatment if diagnosed prenatally.

Other Infections: HIV

• Screening: Based on risk; goal is to prevent perinatal infection of newborn.

• Prenatal Treatment: Monitor viral load; oral Zidovudine; maintain CD4 >500 during pregnancy.

• Delivery Preparation: Minimize risk of newborn exposure—preferred Cesarean birth; no invasive procedures.

Teratogenic Maternal Exposures: Vaccines & Drugs

• Avoid: Live vaccines.

• Medication Risk Categories:

  • A: No risk to fetus.

  • B: Minimal risk.

  • C: Risk shown in animals.

  • D: Risk shown in humans.

  • X: Risk proven, outweighs any possible benefit.

• Herbal Supplements: Safety not rated by FDA.

• Illicit Drug Use, Alcohol, Tobacco:

  • Recreational drugs can have teratogenic effects—IV use increases risk.

  • Alcohol can lead to Fetal Alcohol Spectrum Disorders; tobacco increases risks of stillbirth and SIDS.

Antenatal Patient Safety: Avoiding Errors

• Key Practices: Documentation, thorough screening, counseling, treatment, follow-up, and compliance.

• Importance of Communication: Ensure appropriate follow-up for newborns, if indicated.

Nursing Process & Perinatal Infections

• Nursing Diagnosis: Risk for infection (fetus/newborn).

• Assessment Points: Risk factors, gestational age, maternal infections, signs/symptoms of neonatal infection.

• Interventions: Review prenatal and delivery records, provide eye prophylaxis, observe neonate for signs and symptoms of infection, monitor labs.

• Outcomes: Neonate vital signs within normal range; free from signs and symptoms of infection.

References

• Silbert-Flagg, JoAnne, Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family, 9th Edition, Wolters Kluwer Health | Lippincott Williams & Wilkins, Philadelphia, 2023.