Infection Control Practices in the NICU: What is Evidence-based?

Abstract

has disclosed that she is a member of the speakers' bureau for Sanofi Pasteur. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/device. AbstractNosocomial infections cause significant morbidity and mortality in neonatal intensive care unit (NICU) patients. Neonates, particularly those who are preterm and low birthweight, are at higher risk of acquiring infections compared with term and older infants. As a result, many interventions have been established in the NICU to attempt to decrease the infants' risk of acquiring infection. Over time, various interventions have been adopted as "standard of care," but other practices vary substantially from one unit to another. This review examines several infection prevention strategies used in the NICU and reviews the literature related to such practices. Evidence-based recommendations are made when supportive scientific evidence is available for this specific patient population.Objectives After completing this article, readers should be able to:1. Review evidence-based recommendations related to hand hygiene practices in the NICU. 2. Describe the appropriate use of personal protective equipment to protect the healthcare worker and infant from infectious pathogens. 3. Review evidence related to neonatal skin antisepsis for central venous catheter insertion. 4. Review the evidence supporting routine influenza and pertussis vaccination for NICU clinicians.

Gloving and Touch Practices of Neonatal Nurses

“…Gloves are commonly worn with the intent to reduce the transmission of infection among hospitalized patients and between healthcare providers and patients; however, hand contamination can occur even when gloves are worn during patient care 11. Hand hygiene remains the most effective, evidence-based measure for preventing infection in the NICU12; however, researchers have found that hand hygiene compliance among healthcare providers is low when gloves are worn 10,15. Despite high rates of self-reported compliance with hand hygiene practices,15 healthcare providers' observed compliance is typically much lower 11,15.…”

“…These institutions are enforcing universal gloving practices with all NICU patient contact. 12 However, in their drafted recommendations for infection control in the NICU, the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention (CDC) currently offers no recommendation for universal gloving to prevent the spread of infection. 13 The Advisory Committee points to the lack of high-quality evidence associating universal gloving practices with decreased rates of neonatal infection.…”

“…Many institutions have adopted conservative approaches to infection prevention in the NICU due to the immaturity of the neonate's immune system and high risk for healthcare-acquired infections. These institutions are enforcing universal gloving practices with all NICU patient contact 12. However, in their drafted recommendations for infection control in the NICU, the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention (CDC) currently offers no recommendation for universal gloving to prevent the spread of infection 13.…”

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

“…Hand washing, isolation, surveillance, seasonal screening of visitors for potential infection, and validating the immunization status of the sibling visitors may be challenging. 23 Nurses must advocate for premature infants to ensure patient safety and prevent infection that can lead to long-term sequelae. 2 …”