Neonatal Eye Care for Midwifery Staff within the PCT Guidelines

CLINICAL GUIDELINES
Neonatal Eye Care for Midwifery Staff within the PCT Guidelines
For use in:
Care of the Neonate
For use by:
Community Midwives
Used for:
Clinical Staff
Document Owner:
Clinical Audit Facilitator, Midwifery
Board approved:
Policy Sub Committee
Policy Indexed:
HStHCL160
Version Number: 3.0
Effective From: July 2010
Effective To: July 2013
Status:
Clinical Guidance
Statutory and legal
requirements
Implementation Lead
n/a
Professional Development Manager
The Trust is committed to an environment that promotes equality and embraces diversity both
within our workforce and in service delivery. This document should be implemented with due
regard to this commitment.
This document seeks to uphold the duties and principles contained within the Mental Capacity
Act. All Staff within the PCT should be aware of its implications
It is PCT policy to reduce the risk of Health Care Associated Infection. All infection Prevention
and Control policies relevant to this document must be adhered to.
This policy is due for review in July 2013 after this date, policy and process documents may
become invalid. Policy users should ensure that they are consulting the current version of this
document.

Table of Contents
Rationale......................................................................................................................................3
Development................................................................................................................................3
Background..................................................................................................................................3
Clinical evidence of infection........................................................................................................4
Alerts............................................................................................................................................4
Guidelines for Neonatal Eye Care................................................................................................4
References...................................................................................................................................7
Appendix 1 ...................................................................................................................................8
Equality Impact Assessment Tool .............................................................................................8
Appendix 2 ...................................................................................................................................9
Dissemination and Training Plan...............................................................................................9
Appendix 3 ................................................................................... Error! Bookmark not defined.
Checklist for Document Development ....................................... Error! Bookmark not defined.
Page 2 of 9

RATIONALE
To provide guidance on neonatal eye care in the absence of evidence via randomised
controlled trials. To prevent the introduction of infection via unnecessary interventions. To aid
identification of signs of eye infection before investigation and treatment. To ensure
investigation and treatment of appropriate cases.
DEVELOPMENT
Halton Midwifery Audit Group made up of representatives of each Midwifery Team, conducted
literature searches and consulted local hospitals, paediatricians and microbiologists before
producing the original guidelines in 2003. A literature search was carried out for the review in
January 2008 (ATHENS, ebooks (MyLibrary), ejournals (Proquest), ADITUS, NHS National
Library for Health, Oxford Journals, etc.)
BACKGROUND
CONGENITAL LACRIMAL OBSTRUCTION (Blocked Tear Duct) (Young and MacEwen 1997)
NB: Later literature cites the work of Young & MacEwen and adds nothing further
• Patency of the lower end of the nasolacrimal duct is not complete until birth.
• A membranous obstruction may persist in up to 70% of neonates.
• If this impatency persists it results in watering and discharge from the eye.
• There is a high rate of spontaneous resolution with 70% of affected babies being free of
symptoms by 3 months.
• Can persist up to 12 months and then needs referral for opthalmological assessment.
• Characteristic presentation is persistent epiphora (watering) and mucopurulent
(white/creamy) discharge usually affecting only one eye although both eyes may be
affected in up to 20% of cases.
• The affected eye usually has a white conjunctiva with no evidence of infection.
• Crusting on the lid margin is common and parents may report the eyelids being stuck
together.
• Presents within the first few days after delivery.
Page 3 of 9

• There is NO EVIDENCE to support the use of antibiotics and these should only be used
when there is clinical evidence of infection.
CLINICAL EVIDENCE OF INFECTION
• Conjunctivitis - characterised by redness of the white of the eye.
• New swelling of the affected eyelid(s) - not connected to birth trauma.
• Purulent discharge - characterised by yellow/green colour.
• Changes to the lining of the lower lid - a plushy, hyperaemic appearance is typical of
chlamydia infection (Young J and MacEwen CJ 1997) which is more persistent and does
not respond to usual treatment. (Johnston 1998).
ALERTS
• Severe purulent discharge (especially at Day 1 or 2 postpartum) requires a normal swab
to be taken. Request urgent Gram Stains on specimens on accompanying microbiology
request form, to exclude Gonococcal infection (Thureen et al 1999).
• If suspicious of herpes, discuss specimen with Public Health Laboratory and General
Practitioner (G.P.).
• If suspicious of chlamydia, specialised swabs should be taken by a qualified practitioner
after removing discharge from the eyes using sterile saline. (Chlamydia are intracellular
pathogens and pus is a very poor quality specimen).
GUIDELINES FOR NEONATAL EYE CARE
ACTION
RATIONALE
1 In all cases
1
Explain all procedures to parents
To obtain informed consent
Document procedures as appropriate
To fulfill record keeping requirements
as per Nursing & Midwifery Council
2005
Thorough hand washing before and
after any procedure as per Infection
Control Team policy
To prevent the introduction of
infection
Equipment for procedures: clean
container; cool, boiled water; cotton
Page 4 of 9

wool
2 Routine
2
At delivery: if there is an indication to
do so wipe the eye area, with a dry
sterile swab, by wiping from the inner
aspect to the outer aspect of the eye
using one swab once only
To prevent the introduction of
infection
At bathing: the eyes do not need to be
routinely washed (Sweet B 1999)
Advice to parents:
Thorough handwashing and
general hygiene
To prevent the introduction of
infection
To report any discharge from
baby's eye to midwife
Of the high incidence of blocked
tear duct (70%) "incidence so high
and resolution so common that it
could be regarded as within the
range of normal development"
(Young J, MacEwen CJ 1997)
To facilitate health promotion
To reduce parental anxiety
To enable parents to be fully
informed
3
Management of Neonatal Eye
Discharge
3
(a)
Without signs of infection (see page 3)
(a)
Reassure parents
Wash hands
To reduce anxiety
To prevent the introduction of
infection
To prevent/alleviate crusting
Wipe away secretions, by wiping from
the inner aspect to the outer aspect of
the eye using one swab once only and
using cool boiled water (Johnston
1998)
Dispose of clinical waste appropriately
Be alert for signs of infections
To prevent cross infection
To facilitate early recognition of
infection
(b)
With signs of infection (see page 3)
(b)
Page 5 of 9

Reassure parents
To reduce anxiety
Wash hands
To prevent cross infection
Take swabs separately from each eye
and label containers appropriately
To enable identification of results
Transport in medium with completed
documentation including any relevant
maternal history of sexually transmitted
disease/vaginal discharge
If suspicious of chlamydia, see Alerts
on page 3 of these guidelines
To enable culture and sensitivity
tests at the laboratory
To ensure appropriate specimen for
laboratory testing
Inform GP of findings and
investigations
Advise parents to wipe away
secretions by wiping from the inner
aspect to the outer aspect of the eye
using one swab once only and using
cool boiled water (Johnston 1998)
To facilitate good communication &
liaison and commence treatment if
required by GP
To prevent/alleviate crusting.
4 If Treatment Required
4
If treating while awaiting results,
ensure preparations are used which
will not interfere with chlamydia
cultures if taken subsequently (Allen
2001)
As determined by swab results and
prescribed by G.P.
Refer back to G.P. if no improvement
following treatment
To avoid interference if chlamydia
swabs subsequently required
To ensure appropriate treatment
To facilitate further investigations
Page 6 of 9

REFERENCES
Reference
ALLEN K (2001) Correspondence from Consultant
Microbiologist, St Helens & Knowsley Hospitals Trust
Relevance
(whole
document or
section,
please state)
Evidence
Grade
JOHNSTON PGB (1998) The Newborn Child Churchill
Livingstone. USA and London
NURSING & MIDWIFERY COUNCIL (2004) Code of
Professional Conduct NMC London
NURSING & MIDWIFERY COUNCIL (2005) Guidelines for
Records & Record keeping NMC London
SWEET B (1999) Maye’s Midwifery (Ed.) Harcourt, London
THUREEN PJ, DEACON J, O'NEILL P, HERNANDEZ J
(1999) Assessment and Care of the Well Newborn
Saunders. USA
YOUNG JOH, MacEWEN CJ (1997) Managing Congenital
Lacrimal Obstruction in General Practice. British Medical
Journal Vol. 315 2 nd August 1997 pp293-296
Halton & St Helens PCT Policies:
Consent to Examination or Treatment Policy (Oct 2007)
Record Keeping Policy (Jan 2008)
Infection Control Policy No 2 – Handwashing (Jan 2007)
Infection Control Policy No 1 – Universal Precautions (Jan
2007)
Page 7 of 9

APPENDIX 1
Equality Impact Assessment Tool
To be completed with the corporate document when submitted to the appropriate committee for
consideration, approval and ratification.
1. Does the corporate document affect one group
less or more favourably than another on the basis
of:
Yes/No
Race No
Ethnic origins (including gypsies and travellers) No
Nationality No
Comments
Gender Yes Women only
Culture No
Religion or belief No
Sexual orientation including lesbian, gay and
bisexual people
Age No
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
2. Is there any evidence that some groups are
affected differently?
3. If you have identified potential discrimination, are
there any exceptions valid, legal and/or
justifiable?
4. Is the impact of the policy/guidance likely to be
negative?
No
No
No
Yes
5. If so can the impact be avoided? N/A
6. What alternative are there to achieving the
policy/guidance without the impact?
7. Can we reduce the impact by taking different
action?
If you have identified a potential discriminatory impact of this corporate document, please refer it
to [insert name of appropriate person], together with any suggestions as to the action required
to avoid/reduce this impact. For advice in respect of answering the above questions, please
contact [insert name of appropriate person and contact details].
No
N/A
No
Page 8 of 9

APPENDIX 2
Dissemination and Training Plan
To be completed with the corporate document when submitted to the appropriate committee for
consideration, approval and ratification. The status column must be given a Red, Amber or
Green rating with evidence to demonstrate an action has been completed.
DISSEMINATION PLAN
Title of document: Neonatal eye care for
Midwifery staff
Dissemination Lead: (Print name and
contact details)
Angela O’Neill
0151 495 5054
Angela.oneill@hsthpct.nhs.uk
Proposed action to retrieve out-of-date
copies of the document: Inform team
leaders to remove and replace with
current document.
Date finalised: June 2010
Previous document already being used? Yes
If yes, in what format and where? Electronic/Intranet. Hard
copies with team leaders.
Withdraw from the internet/intranet/portal
To be disseminated to: All Halton
Midwives
Disseminated
by whom?
Timescale
(Date)
Status
R A G
Paper
or
Electronic
Comments
Trust Times
Team Brief
Training sessions (Give Details Below)
Other (Give Details Below)
Team leaders July 2010 Red Both
Training Timescale Owner Status
R A G
Training Event (Please provide details of available training venues/dates to
educate staff about this document)
Training Plan Lead (Please provide details of staff who will be responsible
for overseeing this training)
Compliance Monitoring:
Midwives practice is monitored annually by the supervisor of midwives and
daily by their peers.
Timescale Owner Status
R A G
Methodology to be used for monitoring/audit (please include PCT
Audit Proposal Form)
Responsibilities for conducting monitoring/audit
Frequency of monitoring/audit (e.g. annually, 6 monthly etc) Annually Red
Process for reviewing/reporting results Ongoing Amber
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Denotes: Action partially implemented.
Denotes: Action complete.
Page 9 of 9