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Prevention and Protection of Common Health Care Associated Infections in the Neonatal Intensive Care Unit

Year 2019, , 176 - 182, 31.12.2019

Handan Alay

https://doi.org/10.34084/bshr.487845
Cited By: 1

Abstract

Health care associated infections in the neonatal intensive care unit cause increased morbidity, mortality and increased cost. More permeable and immature skin and mucous membranes of the newborns, impaired host defense mechanisms, invasive procedures used for treatment or monitarization, and the use of broad-spectrum antibiotics provide the basis for the presence of health care associated infections. In this composition, I aimed to present an overview of prevention strategies from health care associated often encountered infections in the neonatal intensive care units in line with guidelines.

Keywords

Neonatal intensive care unit healthcare associated infections prevention

References

  • 1. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Ulusal sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Rehberi. Ankara, 2017;2-3.
  • 2. Payne NR, Carpenter JH, Badger GJ, Horbar JD, Rogowski J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics. 2004;114(2):348-55.
  • 3. Boghossian NS, Page GP, Bell EF, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple gestation births. J Pediatr. 2013;162:1120–4.
  • 4. Polin RA, Denson S, Brady MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics. 2012;129(4):1085-93.
  • 5. Hooven TA, Polin RA. Healthcare-associated infections in the hospitalized neonate: a review. Early Hum Dev. 2014 ;90(1):4-6.
  • 6. Fisher D, Cochran KM, Provost LP, et al. Reducing central line – associated blood stream infections in North Carolina NICUs. Pediatrics. 2013;132:e1664–71.
  • 7. Bizzarro MJ, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K; Central Venous Catheter Initiative Committee. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2010;31(3):241–248.
  • 8. Cimiotti JP, Haas J, Saiman L, Larson EL. Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 2006;160(8):832–836.
  • 9. Garland JS, Uhing MR. Strategies to prevent bacterial and fungal infection in the neonatal intensive care unit. Clin Perinatol. 2009;36(1):1–13.
  • 10. Garland JS. Strategies to prevent ventilatorassociated pneumonia in neonates. Clin Perinatol. 2010;37(3):629–643.
  • 11. Payne NR, Finkelstein MJ, Liu M, Kaempf JW, Sharek PJ, Olsen S. NICU practices and outcomes associated with 9 years of quality improvement collaboratives. Pediatrics. 2010;125(3):437–446.
  • 12. Riley EL, Stark RA. Guidelines for perinatal care. Seventh edition. American Academy of Pediatrics; The American College of Obstetricians and Gynecologists.2014.
  • 13. Bolon MK. Hand hygiene: an update. Infect Dis Clin N Am. 2016;310:591–607.
  • 14. Selwyn S. Microbiology and ecology of human skin. Practitioner 1980;224:1059–62.
  • 15. Price PB. Bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. J Infect Dis 1938;63:301–18.
  • 16. Sprunt K, Redman W, Leidy G. Antibacterial effectiveness of routine hand washing. Pediatrics 1973;52:264–71.
  • 17. Harbarth S, Pittet D, Grady L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J. 2002;21(6):489–495.
  • 18. Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ. 2015;351:h3728. doi:10.1136/bmj.h3728.
  • 19. Aboelela SW, Stone PW, Larson EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect. 2007;66(2):101–108.
  • 20. Pittet D, Allegranzi B, Boyce J; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30(7):611–622.
  • 21. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor milk versus preterm formula as substitutes for mothers’ own milk in the feding of extremely premature infants. Pediatrics. 2005;116:400–6.
  • 22. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low birth weight infants. Arch Pediatr Adolesc Med. 2003;157:66–71.
  • 23. Patel AL, Johnson TJ, Engstrom JL, et al. Impact of early human milk on sepsis and health care costs in very low birth weight infants. J Perinatol. 2013;33:514–9.
  • 24. Flidel-Rimon O, Friedman S, Lev E, et al. Early enteral feeding and nosocomial sepsis in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F289–292.
  • 25. Ronnestad A, Abrahamsen TG, Medbo S, et al. Late – onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics. 2005;115:e269–76.
  • 26. Engur D, Cakmak BC, Turkmen MK, Telli M, Eyigor M, Guzunier M. A milk pump as a source for spreading Acinetobacter baumannii in a neonatal intensive care unit. Breastfeed Med. 2014;9:551–4.
  • 27. Wilkins M, Hall-Stoodley L, Allan RN, Faust SN. New approaches to the treatment of biofilm – related infections. J Infect. 2014;69(l1):47–52.28. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line associated bloodstream infections in acute care hospitals: 2014 update. Infection Cont Hosp Epidemiol. 2014;35:753–71.
  • 29. Patrick SW, Kawai AT, Kleinman K, et al. Health-care associated infections among critically ill children in the US, 2007–2012. Pediatrics. 2014;134:705–12.
  • 30. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against antifungal colonization and infection in preterm infants. New Engl J Med. 2001;345:1660–6.
  • 31. Manzoni P, Stolfi I, Pugni L, et al. A multicenter randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007;356:2483–95.
  • 32. Benjamin Jr DK, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics. 2006;117: 84–92.
  • 33. Aydemir C, Oguz SS, Dizdar EA, et al. Randomized controlled trial of prophylactic fluconazole versus nystatin for the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2011;96:F164–8.
  • 34. Aliaga S, Clark RH, Laughon M, et al. Changes in the incidence of candidiasis in neonatal intensive care units. Pediatrics. 2014;133:236–242.
  • 35. Benjamin Jr DK, Hudak ML, Duara S, et al. Effect of fluconazole prophylaxis on candidiasis and mortality in premature infants: a randomized clinical trial. JAMA. 2014;311:1742–9.
  • 36. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; ; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care—associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36.
  • 37. Azab SF, Sherbiny HS, Saleh SH, et al. reducing ventilator associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle” : a cohort study. BMC Infect Dis. 2015;15:314.
  • 38. Rosenthal VD, Rodriguez-Calderon ME, Rodriguez-Ferrer M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: impact of a multidimensional strategy to reduce ventilator associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol. 2012;33:704–10.
  • 39. Cotten CM, Taylor S, Stoll B, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics. 2009;123:58–66.
  • 40. Kuppala V, Meinzen-Derr J, Morrow A, Schibler KR. Prolonged initial antibiotic treatment is associated with adverse outcomes in prematüre infants. J Pediatr. 2011;159:720–5.
  • 41. Smith A, Saiman L, Zhou J, et al. Concordance of gastrointestinal tract colonization and subsequent bloodstream infections with gram-negative bacilli in very low birth weight infants in the neonatal intensive care unit. Pediatr Infect Dis J. 2010;29:831–5.
  • 42. Madan JC, Slari RC, Saxena D, et al. Gut microbial colonization in prematüre neonates predicts neonatal sepsis. Arch Dis Child Fetal Neonatal Ed. 2012;97:F456–62.
  • 43. Greenwood C, Morrow AL, Lagomarcino AJ, et al. Early empiric antibiotic use in preterm infants is associated with lower bacterial diversity and higher relative abundance of Enterobacter. J Pediatr. 2014;165:23–9.
  • 44. Arboleya S, Sanchez B, Milani C, et al. Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics. J Pediatr. 2015;166:538–44.
  • 45. Clark RH, Bloom BT, Spitzer AR, Gerstman DR. Empirical use of ampicillin and cefotaxime, compared with ampicillin and gentamicin for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics. 2006;117:67–74.
  • 46. Dellit TH, Owens RC, McGowan JE Jr, et al Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–177.
  • 47. Cleminson J, McGuire W. Topical emollient for preventing infection in preterm infants. Cochrane Database Syst Rev. 2016;1:CD 001150.
  • 48. William A. Rutala, David J. Weber, and the Healthcare Infection Control Practices Advisory Committee
(HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.

Yenidoğan Yoğun Bakım Ünitesinde Sık Görülen Sağlık Hizmeti İlişkili Enfeksiyonlarından Korunma ve Önlenmesi

Year 2019, , 176 - 182, 31.12.2019

Handan Alay

https://doi.org/10.34084/bshr.487845
Cited By: 1

Abstract

Sağlık bakım hizmeti
ile ilişkili enfeksiyonlar yenidoğan yoğun bakım ünitelerinde  morbidite, mortalite ve maliyet artışına
neden olmaktadırlar. Yenidoğanların daha geçirgen ve olgunlaşmamış cilt  ve mukozaları, bozuk konak savunma
mekanizmaları, tedavi veya monitarizasyon amacıyla kullanılan invaziv işlemler
ve geniş spektrumlu antibiyotik kullanımı sağlık hizmeti ilişkili
enfeksiyonların görülmesine zemin hazırlamaktadırlar. Bu klinik çalışma ile
yenidoğan yoğun bakım ünitelerinde sıklıkla karşılaştığımız sağlık hizmeti
ilişkili enfeksiyonlardan korunma ve önlem stratejilerine rehberler
doğrultusunda bakış sunmak istedik.

Keywords

Yenidoğan Yoğun bakım Ünitesi Sağlık hizmeti ilişkili enfeksiyon korunma

References

  • 1. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Ulusal sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Rehberi. Ankara, 2017;2-3.
  • 2. Payne NR, Carpenter JH, Badger GJ, Horbar JD, Rogowski J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics. 2004;114(2):348-55.
  • 3. Boghossian NS, Page GP, Bell EF, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple gestation births. J Pediatr. 2013;162:1120–4.
  • 4. Polin RA, Denson S, Brady MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics. 2012;129(4):1085-93.
  • 5. Hooven TA, Polin RA. Healthcare-associated infections in the hospitalized neonate: a review. Early Hum Dev. 2014 ;90(1):4-6.
  • 6. Fisher D, Cochran KM, Provost LP, et al. Reducing central line – associated blood stream infections in North Carolina NICUs. Pediatrics. 2013;132:e1664–71.
  • 7. Bizzarro MJ, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K; Central Venous Catheter Initiative Committee. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2010;31(3):241–248.
  • 8. Cimiotti JP, Haas J, Saiman L, Larson EL. Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatr Adolesc Med. 2006;160(8):832–836.
  • 9. Garland JS, Uhing MR. Strategies to prevent bacterial and fungal infection in the neonatal intensive care unit. Clin Perinatol. 2009;36(1):1–13.
  • 10. Garland JS. Strategies to prevent ventilatorassociated pneumonia in neonates. Clin Perinatol. 2010;37(3):629–643.
  • 11. Payne NR, Finkelstein MJ, Liu M, Kaempf JW, Sharek PJ, Olsen S. NICU practices and outcomes associated with 9 years of quality improvement collaboratives. Pediatrics. 2010;125(3):437–446.
  • 12. Riley EL, Stark RA. Guidelines for perinatal care. Seventh edition. American Academy of Pediatrics; The American College of Obstetricians and Gynecologists.2014.
  • 13. Bolon MK. Hand hygiene: an update. Infect Dis Clin N Am. 2016;310:591–607.
  • 14. Selwyn S. Microbiology and ecology of human skin. Practitioner 1980;224:1059–62.
  • 15. Price PB. Bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. J Infect Dis 1938;63:301–18.
  • 16. Sprunt K, Redman W, Leidy G. Antibacterial effectiveness of routine hand washing. Pediatrics 1973;52:264–71.
  • 17. Harbarth S, Pittet D, Grady L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J. 2002;21(6):489–495.
  • 18. Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ. 2015;351:h3728. doi:10.1136/bmj.h3728.
  • 19. Aboelela SW, Stone PW, Larson EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect. 2007;66(2):101–108.
  • 20. Pittet D, Allegranzi B, Boyce J; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30(7):611–622.
  • 21. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor milk versus preterm formula as substitutes for mothers’ own milk in the feding of extremely premature infants. Pediatrics. 2005;116:400–6.
  • 22. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low birth weight infants. Arch Pediatr Adolesc Med. 2003;157:66–71.
  • 23. Patel AL, Johnson TJ, Engstrom JL, et al. Impact of early human milk on sepsis and health care costs in very low birth weight infants. J Perinatol. 2013;33:514–9.
  • 24. Flidel-Rimon O, Friedman S, Lev E, et al. Early enteral feeding and nosocomial sepsis in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F289–292.
  • 25. Ronnestad A, Abrahamsen TG, Medbo S, et al. Late – onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics. 2005;115:e269–76.
  • 26. Engur D, Cakmak BC, Turkmen MK, Telli M, Eyigor M, Guzunier M. A milk pump as a source for spreading Acinetobacter baumannii in a neonatal intensive care unit. Breastfeed Med. 2014;9:551–4.
  • 27. Wilkins M, Hall-Stoodley L, Allan RN, Faust SN. New approaches to the treatment of biofilm – related infections. J Infect. 2014;69(l1):47–52.28. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line associated bloodstream infections in acute care hospitals: 2014 update. Infection Cont Hosp Epidemiol. 2014;35:753–71.
  • 29. Patrick SW, Kawai AT, Kleinman K, et al. Health-care associated infections among critically ill children in the US, 2007–2012. Pediatrics. 2014;134:705–12.
  • 30. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against antifungal colonization and infection in preterm infants. New Engl J Med. 2001;345:1660–6.
  • 31. Manzoni P, Stolfi I, Pugni L, et al. A multicenter randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007;356:2483–95.
  • 32. Benjamin Jr DK, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics. 2006;117: 84–92.
  • 33. Aydemir C, Oguz SS, Dizdar EA, et al. Randomized controlled trial of prophylactic fluconazole versus nystatin for the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2011;96:F164–8.
  • 34. Aliaga S, Clark RH, Laughon M, et al. Changes in the incidence of candidiasis in neonatal intensive care units. Pediatrics. 2014;133:236–242.
  • 35. Benjamin Jr DK, Hudak ML, Duara S, et al. Effect of fluconazole prophylaxis on candidiasis and mortality in premature infants: a randomized clinical trial. JAMA. 2014;311:1742–9.
  • 36. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; ; Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care—associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004;53(RR-3):1–36.
  • 37. Azab SF, Sherbiny HS, Saleh SH, et al. reducing ventilator associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle” : a cohort study. BMC Infect Dis. 2015;15:314.
  • 38. Rosenthal VD, Rodriguez-Calderon ME, Rodriguez-Ferrer M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: impact of a multidimensional strategy to reduce ventilator associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol. 2012;33:704–10.
  • 39. Cotten CM, Taylor S, Stoll B, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics. 2009;123:58–66.
  • 40. Kuppala V, Meinzen-Derr J, Morrow A, Schibler KR. Prolonged initial antibiotic treatment is associated with adverse outcomes in prematüre infants. J Pediatr. 2011;159:720–5.
  • 41. Smith A, Saiman L, Zhou J, et al. Concordance of gastrointestinal tract colonization and subsequent bloodstream infections with gram-negative bacilli in very low birth weight infants in the neonatal intensive care unit. Pediatr Infect Dis J. 2010;29:831–5.
  • 42. Madan JC, Slari RC, Saxena D, et al. Gut microbial colonization in prematüre neonates predicts neonatal sepsis. Arch Dis Child Fetal Neonatal Ed. 2012;97:F456–62.
  • 43. Greenwood C, Morrow AL, Lagomarcino AJ, et al. Early empiric antibiotic use in preterm infants is associated with lower bacterial diversity and higher relative abundance of Enterobacter. J Pediatr. 2014;165:23–9.
  • 44. Arboleya S, Sanchez B, Milani C, et al. Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics. J Pediatr. 2015;166:538–44.
  • 45. Clark RH, Bloom BT, Spitzer AR, Gerstman DR. Empirical use of ampicillin and cefotaxime, compared with ampicillin and gentamicin for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics. 2006;117:67–74.
  • 46. Dellit TH, Owens RC, McGowan JE Jr, et al Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–177.
  • 47. Cleminson J, McGuire W. Topical emollient for preventing infection in preterm infants. Cochrane Database Syst Rev. 2016;1:CD 001150.
  • 48. William A. Rutala, David J. Weber, and the Healthcare Infection Control Practices Advisory Committee
(HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.
There are 47 citations in total.

Details

Primary Language Turkish
Subjects Infectious Diseases
Journal Section Review
Authors

Handan Alay

Publication Date December 31, 2019
Acceptance Date September 26, 2019
Published in Issue Year 2019

Cite

AMA Alay H. Yenidoğan Yoğun Bakım Ünitesinde Sık Görülen Sağlık Hizmeti İlişkili Enfeksiyonlarından Korunma ve Önlenmesi. J Biotechnol and Strategic Health Res. December 2019;3(3):176-182. doi:10.34084/bshr.487845

Cited By

Determination of the effects of hand hygiene education given to nursing students in intensive care unit on hand microbiota
Genel Tıp Dergisi
https://doi.org/10.54005/geneltip.1445855

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