Prevention and treatment of neonatal nosocomial infections

Abstract

Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more resistant strains.

Nurses in NICUs’ views on nosocomial infection prevention

“…The majority of nurses have a basic understanding of the subject (70%). However, the current study's degree of knowledge is lower than that discovered by this research[ 10 ] which found 87%. Such disparities in knowledge among nurses in these studies could be attributable to the lack of infection prevention and control training education, as nurses who attended in-service training courses scored highly on knowledge tests.…”

“…This conclusion is similar to that of study findings[ 27 ] who found that the amount of practice was >58%. However, it is lower than the 74% discovered by research evidence,[ 10 ] but it is greater than many other studies, which revealed that this level of practice accounted for 52%[ 28 ] and 58%,[ 29 ] respectively. This gap in results could be attributable to individuals' differing views toward using infection control measures.…”

Nurses in NICUs’ views on nosocomial infection prevention

“…The majority of nurses have a basic understanding of the subject (70%). However, the current study's degree of knowledge is lower than that discovered by this research[ 10 ] which found 87%. Such disparities in knowledge among nurses in these studies could be attributable to the lack of infection prevention and control training education, as nurses who attended in-service training courses scored highly on knowledge tests.…”

“…This conclusion is similar to that of study findings[ 27 ] who found that the amount of practice was >58%. However, it is lower than the 74% discovered by research evidence,[ 10 ] but it is greater than many other studies, which revealed that this level of practice accounted for 52%[ 28 ] and 58%,[ 29 ] respectively. This gap in results could be attributable to individuals' differing views toward using infection control measures.…”

Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review

“…Another South African study reported on a predominance of Gram-positive organisms, at 68.7%, however it included CoNS, but with it excluded Gramnegative organisms predominated at 57%, similar to findings in this study [45]. Gram-negative organisms have been shown to predominate in LMIC compared to HIC, where Gram-positive organisms tend to predominate [4,44,46]. Both Acinetobacter baumannii and Klebsiella pneumoniae have emerged as leading pathogens in many neonatal units, responsible for many hospital outbreaks [4,25,45,[47][48][49].…”

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

“…Breast milk has been considered to have a protective effect against infections due to its anti-infective, microbiome-modulating, and immune-stimulatory properties [34][35][36]. In this study, we found that every single day increase in failure to breast feeding during the study period signi cantly increased the odds of sepsis with odds ratio of 1.13, as with failure to spoon feeding (OR 1.14).…”

Nurses in NICUs’ views on nosocomial infection prevention

“…The majority of nurses have a basic understanding of the subject (70%). However, the current study's degree of knowledge is lower than that discovered by this research[ 10 ] which found 87%. Such disparities in knowledge among nurses in these studies could be attributable to the lack of infection prevention and control training education, as nurses who attended in-service training courses scored highly on knowledge tests.…”

“…This conclusion is similar to that of study findings[ 27 ] who found that the amount of practice was >58%. However, it is lower than the 74% discovered by research evidence,[ 10 ] but it is greater than many other studies, which revealed that this level of practice accounted for 52%[ 28 ] and 58%,[ 29 ] respectively. This gap in results could be attributable to individuals' differing views toward using infection control measures.…”

Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review

“…Another South African study reported on a predominance of Gram-positive organisms, at 68.7%, however it included CoNS, but with it excluded Gramnegative organisms predominated at 57%, similar to findings in this study [45]. Gram-negative organisms have been shown to predominate in LMIC compared to HIC, where Gram-positive organisms tend to predominate [4,44,46]. Both Acinetobacter baumannii and Klebsiella pneumoniae have emerged as leading pathogens in many neonatal units, responsible for many hospital outbreaks [4,25,45,[47][48][49].…”

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

“…Breast milk has been considered to have a protective effect against infections due to its anti-infective, microbiome-modulating, and immune-stimulatory properties [34][35][36]. In this study, we found that every single day increase in failure to breast feeding during the study period signi cantly increased the odds of sepsis with odds ratio of 1.13, as with failure to spoon feeding (OR 1.14).…”

Nurses in NICUs’ views on nosocomial infection prevention

“…The majority of nurses have a basic understanding of the subject (70%). However, the current study's degree of knowledge is lower than that discovered by this research[ 10 ] which found 87%. Such disparities in knowledge among nurses in these studies could be attributable to the lack of infection prevention and control training education, as nurses who attended in-service training courses scored highly on knowledge tests.…”

“…This conclusion is similar to that of study findings[ 27 ] who found that the amount of practice was >58%. However, it is lower than the 74% discovered by research evidence,[ 10 ] but it is greater than many other studies, which revealed that this level of practice accounted for 52%[ 28 ] and 58%,[ 29 ] respectively. This gap in results could be attributable to individuals' differing views toward using infection control measures.…”

Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review

“…Another South African study reported on a predominance of Gram-positive organisms, at 68.7%, however it included CoNS, but with it excluded Gramnegative organisms predominated at 57%, similar to findings in this study [45]. Gram-negative organisms have been shown to predominate in LMIC compared to HIC, where Gram-positive organisms tend to predominate [4,44,46]. Both Acinetobacter baumannii and Klebsiella pneumoniae have emerged as leading pathogens in many neonatal units, responsible for many hospital outbreaks [4,25,45,[47][48][49].…”

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

“…Breast milk has been considered to have a protective effect against infections due to its anti-infective, microbiome-modulating, and immune-stimulatory properties [34][35][36]. In this study, we found that every single day increase in failure to breast feeding during the study period signi cantly increased the odds of sepsis with odds ratio of 1.13, as with failure to spoon feeding (OR 1.14).…”