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How to minimize infection in premature neonates

May 13 2015

Infants in neonatal intensive care units (NICUs) are highly susceptible to infection due to the immaturity of their immune systems.

In a comprehensive review of healthcare practices, Dr Legeay and Jean Ralph Zahar from Angers in France (article),  recommend a major overhaul of infection prevention in the neonatal ICU. Infection was not only potentially fatal and a significant risk factor for neurological development problems, but incurred high medical costs. 

Bloodstream infection with coagulase negative staphylococci, Staphylococcus aureus, Candida albicans, and several gram negative bacteria causing ventilator associated pneumonia are the big problems. Rates of candida bloodstream infections are 1.6 to 3.0% in very low birthweight infants and up to 15 to 20% in extremely-low-birthweight infants. A rise in trhe number of cases of Candida parapsilosis and Candida glabrata infections have been noted.
Colonisation with Candida spp. is common in NICUs;  around 50% of infants admitted are colonized by the end of the first week of life, increasing to 64% by 4 weeks of age. One-third of colonised neonates develop an IFI during their hospitalization.

The authors recommendations are:

  •  Improving hand hygiene is a critically important intervention and should be a primary goal of any NICU. Successful interventions include education, monitoring, performance feedback, reminders and motivation of healthcare workers.
  • Prevention of central venous catheter infection is reduced by shortening the duration of catheterization and avoiding unnecessary use of catheters. Precautions during insertion and management of catheters (ANTT) are also crucial. 

  • Avoid unnecessary empirical broad-spectrum antibiotic therapy and shorten antibiotic duration. Long and unnecessary use selects resistant bacteria and increases the risk of invasive fungal infections.
  • Successful management and prevention of outbreaks requires sufficient facilities for cohorting colonised and infected infants. The spread of multi-drug-resistant organisms is exacerbated by inadequate spacing between cots, high occupancy rates and low nurse/infant ratios. Optimal staffing ratios for neonatal nurses appear 
reduces infection and mortality in neonates. Environmental contamination is an important reservoir of organisms, and the use of equipment dedicated to each infant with  enhancing routine cleaning, is  very important.