Nosocomial Infections In Neonatal Intensive Care Units Research Articles

Persistent microbial contamination of incubators despite disinfection.

In neonatal intensive care units (NICUs), hygiene and disinfection measures are pivotal to protect neonates from nosocomial infections. This study aimed to evaluate the efficacy of the classical incubators disinfection procedure and to follow-up neonates housed in the incubators for the development of late-onset sepsis (LOS). In a tertiary NICU, 20 incubators were monitored for bacterial contamination at three times: before disinfection, after disinfection, and 24 h after turning on and housing a new neonate. Clinical data of neonates housed in these incubators were retrieved from the medical records. All 20 incubators were contaminated at the 3 times of the study, mainly on mattresses and balances. Coagulase-negative Staphylococci, Enterococcus, and Bacillus-resisted disinfection while enterobacteria and Staphylococcus aureus were eradicated. After 24 h, the bacterial colonisation was similar to the one observed before disinfection. The bacteria isolated on incubators were also found on the caregivers' hands. During the study, two preterm neonates developed a LOS involving a bacterial species that has been previously isolated in their incubator. Pathogenic contaminants persist on incubators despite disinfection and represent a risk for subsequent infection in preterm neonates. Improvements are needed concerning both the disinfection process and incubator design. Procedures of disinfection that are usually recommended in NICUs do not allow for totally eradicating bacteria from incubators. Preterm neonates are housed in incubators colonised with potentially pathogenic bacteria. The control of nosocomial infections in NICUs requires further researches concerning mechanisms of bacterial persistence and ways to fight against environmental colonisation.

Bacterial contamination of neonatal intensive care units: How safe are the neonates?

BackgroundIntensive care units (ICU) are essential healthcare facility for life threatening conditions. Bacterial contamination of objects/instruments in ICU is an important source of nosocomial infections. This study is aimed to determine the level of bacterial contamination of instruments/objects which are commonly touched by healthcare workers and frequently come in contact with the neonates.MethodsThis hospital based prospective study was conducted in neonatal intensive care unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal. A total of 146 samples collected from surfaces of incubators, radiant warmers, suction tips, ventilators, stethoscopes, door handles, weighing machines, mothers’ beds, phototherapy beds, laryngoscope, telephone sets, blood pressure machine, etc. formed the material of the study. Isolation, identification and antibiotic susceptibility of the bacterial isolates was performed by standard techniques. Blood culture isolates from NICU patients during the study period were compared with the environmental isolates.ResultsOut of 146 samples, bacterial growth was observed in 109. A total of 119 bacterial isolates were retrieved from 109 samples. Three common potential pathogens isolated were Escherichia coli (n = 27), Klebsiella species (n = 21) and Staphylococcus aureus (n = 18). Majority of E. coli and Klebsiella isolates were from incubators, suction tips and mothers’ beds. Majority of S. aureus isolates were cultured from radiant warmers. Among S. aureus isolates, 33.3% (6/18) were methicillin resistant. Majority of the bacterial isolates were susceptible to gentamicin and amikacin. Common potential pathogens isolated from blood culture of NICU patients were S. aureus and Klebsiella species.ConclusionHigh degree of bacterial contamination of objects/instruments in NICU was recorded. Isolation of potential pathogens like E. coli, Klebsiella species and S. aureus is a major threat of nosocomial infections. Blood culture data of NICU reflects possibility of nosocomial infections from contaminated sites. Gentamicin and amikacin may be used for empirical therapy in suspected cases of nosocomial infections in NICU.

Risk factors and prevention strategies of nosocomial infection in neonatal intensive care unit (NICU)

With the development of management in NICU,nosocomial infection increases gradually.Nosocomial infection monitoring is very important for improving the survival rate of the newborn and crutial for updating the management of NICU.This article discussed the risk factors and prevention strategies of nosocomial infection in NICU. Key words: Nosocomial infection; Risk factor; Neonatal intensive care unit

Sources of bacteria causing nosocomial infections at NICU of Ghaem Hospital in Mashhad, Iran

Background & Objectives: As one of the most vital sections in every hospital, the Neonatal Intensive Care Unit (NICU) is where controlling nosocomial infections play an important role in recovery and health improvement of patients. In the present study, effort has been made to find out the Sources of bacteria causing nosocomial infections in order to prevent nosocomial infections in NICU. Material & Methods: In this cross-sectional research, the involving bacteria were identified by collecting samples from hands and nipples of 50 mothers who regularly came in NICU to visit and breastfeed their babies. In addition, samples were collected from hands of 50 hospital staff, breast milk from 50 mothers, airstream in HVAC system, and 50 of the medical equipments available at NICU. Results: This study indicated that in respect of frequency, coagulase-negative staphylococci, Klebsiella pneumonia, and Escherichia coli were the main bacteria isolated from mothers’ hands and nipples, hands of the staff, feeding bottles and breast milk samples. As for the airstream in HVAC system, however, no types of bacteria were observed. Conclusion: Coagulase-negative Staphylococci and Klebsiella pneumonia are the most widespread colonized bacteria causing nosocomial infections such as neonatal sepsis in NICU. Having isolated the highest amount of Coagulase-negative staphylococci and Klebsiella pneumonia, the present study revealed that hands and nipples of the mothers, hands of the staff, feeding milk bottles and the containing breast milk are among the major Sources of bacteria causing nosocomial infections at NICU. With regard to the cultured samples of the airstream in HVAC system, there existed no types of bacteria therefore, it could not have been a Sources of bacteria at NICU.

Viral outbreaks in neonatal intensive care units: What we do not know

BackgroundNosocomial infection is among the most important causes of morbidity, prolonged hospital stay, increased hospital costs, and mortality in neonates, particularly those born preterm. The vast majority of scientific articles dealing with nosocomial infections address bacterial or fungal infections, and viral agents are often disregarded. This analysis reviews the medical literature in an effort to establish the incidence, types of pathogens, and clinical features of noncongenital neonatal viral infections.MethodsThis analysis was performed using the worldwide database of health care–associated outbreaks (http://www.outbreak-database.com). Items analyzed included causative pathogens, types of infection, source of outbreaks, and measures taken to stop outbreaks.ResultsThe outbreak database contained a total of 590 neonatal outbreaks, of which 64 were originated by viruses, 44 of which (68.75%) were reported from neonatal intensive care units (NICUs). The 5 most frequent viral agents were rotavirus (23.44%), respiratory syncytial virus (17.19%), enterovirus (15.63%), hepatitis A virus (10.94%), and adenovirus (9.38%).ConclusionOur analysis of the viral origins of nosocomial infections in NICUs can be a valuable tool in the investigation of neonatal infections. The mortality rates reported in this analysis demonstrate the significance of noncongenital viral infections in NICUs and the need for more effective outbreak prevention strategies.

Nosocomial infections in neonatal intensive care units: Cost-effective control strategies in resource-limited countries

Background: Nosocomial infections or hospital-acquired infectionsconstitute a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating these infections; underscoring the need for preventive intervention measures.Objectives: This review aims to highlight the global burden of nosocomialinfections in neonatal intensive care units (NICUs), to discuss their epidemiology and clinical spectrum, as well as the costeffective control strategies in resource-limited settings.Sources: Sources of information were from Google searches andPubMed- linked articles using the key words- nosocomial infections,neonatal intensive care unit, control. Related articles from hard copiesof medical literature and journals were also gathered.Results: Although paucity of data exists on the incidence of nosocomialinfections in NICUs in developing countries, reports from developedcountries indicate a range of 6% to 25%. Much higher figures were noted in some developing countries. Several risk factors for nosocomial infections were identified but varied in different NICUs surveyed. Effective control strategies have been recommended but hand washing or hand hygiene appears universally applicable in both developed and resource-limitedcountries. Economic analyses of these strategies in developed countrieshave established their costeffectiveness while the adaptability of hand hygiene program to resource-limited settings has been demonstrated in a World Health Organization pilot study in sub- Saharan Africa.Conclusion: Hand washing or hand hygiene by health-care personnelremains the most important evidence-based and cost-effective controlstrategy for the spread of nosocomial infections in NICUs in resource-limited countries.Key words: nosocomial infections; neonatal intensive care unit;control.

Emerging viral infections in neonatal intensive care unit

Nosocomial infections are the most important cause of morbidity and mortality among neonates and mostly in infants admitted to neonatal intensive care units (NICU). The total number of neonates who develop nosocomial infections per admission varies from 6.2 to 30%. The role of nosocomial virus infections is generally neglected in the actual epidemiologic scenario mostly due to the lack of data in the medical literature. Based on a worldwide database of health care-associated outbreaks (http://www.outbreak-database.com) we performed an analysis of the incidence, type of pathogens and clinical features of neonatal viral outbreaks especially those reported in NICUs. We also describe, as an example of emerging virus in NICU, a Norovirus outbreak along with clinical presentation that varies from mild to moderate clinical symptoms like vomiting, gastric remainder, diarrhoea, abdominal distension or severe presentation like necrotizing enterocolitis. and measures implemented for terminating the outbreak. In conclusion, our study analyses the viral origins of nosocomial infections in NICU and underline that the role of viral agents in neonatal nosocomial infections needs to be further investigated even in diseases traditionally considered of bacterial origin like necrotizing enterocolitis.

Determinants of Nosocomial Infection in 6 Neonatal Intensive Care Units: An Italian Multicenter Prospective Cohort Study

Nosocomial infections are still a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). To describe the epidemiology of nosocomial infections in NICUs and to assess the risk of nosocomial infection related to the therapeutic procedures performed and to the clinical characteristics of the neonates at birth and at admission to the NICU, taking into account the time between the exposure and the onset of infection. A multicenter, prospective cohort study. A total of 1,692 neonates admitted to 6 NICUs in Italy were observed and monitored for the development of nosocomial infection during their hospital stay. Data were collected on the clinical characteristics of the neonates admitted to the NICUs, their therapeutic interventions and treatments, their infections, and their mortality rate. The cumulative probability of having at least 1 infection and the cumulative probability of having at least 1 infection or dying were estimated. The hazard ratio (HR) for the first infection and the HR for the first infection or death were also estimated. A total of 255 episodes of nosocomial infection were diagnosed in 217 neonates, yielding an incidence density of 6.9 episodes per 1,000 patient-days. The risk factors related to nosocomial infection in very-low-birth-weight neonates were receipt of continuous positive airway pressure (HR, 3.8 [95% confidence interval {CI}, 1.7-8.1]), a Clinical Risk Index for Babies score of 4 or greater (HR, 2.2 [95% CI, 1.4-3.4]), and a gestational age of less than 28 weeks (HR, 2.1 [95% CI, 1.2-3.8]). Among heavier neonates, the risk factors for nosocomial infection were receipt of parenteral nutrition (HR, 8.1 [95% CI, 3.2-20.5]) and presence of malformations (HR, 2.3 [95% CI, 1.5-3.5]). Patterns of risk factors for nosocomial infection differ between very-low-birth-weight neonates and heavier neonates. Therapeutic procedures appear to be strong determinants of nosocomial infection in both groups of neonates, after controlling for clinical characteristics.

Advances in prevention and control of nosocomial Infection in neonatal intensive care unit

The incidence of nosocomial infections in the neonatal intensive care unit(NICU) is high. Nosocomial infections is one of the most common causes of neonatal death in critically ill neonates. Strategies for the prevention nosocomial infections include hand hygiene practices,prevention of central venous catheter-related infection and ventilator-associated pneumonias, antifungal prophylaxis, skin care, early enteral feeding and probioties. Effective prevention and control nosocomial infections in NICU may decrease neonatal mortality,hospitaliztion stay and hospital costs.This review focuses on the latest preventive strategies for nosocomial infections in NICU. Key words: Intensive care unit; Nosocomial infection; Prevention and control; Infant,newborn

Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system

A national nosocomial surveillance system for neonatal intensive care patients with a very low birthweight was set up in Germany in 2000 (NEO-KISS). Forty-eight neonatal intensive care units (NICUs) participated in the programme, which focused upon nosocomial bloodstream infections (BSIs) and pneumonia. Only data from NICUs participating for at least three years were included and the years compared. The relative risks and their 95% confidence intervals (CIs) were calculated and a multiple logistic regression analysis performed to identify significant risk factors. Twenty-four units that met the selection criteria accumulated data for 3856 patients and 152 437 patient-days in their first three years of participation. The incidence density of BSIs decreased significantly by 24% from 8.3 BSIs per 1000 patient-days in the first year to 6.4 in the third year. In the multiple logistic regression analysis, BSI in the third year of participation was significantly lower than in the first year of participation (odds ratio=0.73, 95% CI 0.60-0.89). The year of participation was an independent risk factor for BSI but not for pneumonia. Our data suggest that participation in ongoing surveillance of nosocomial infections in NICUs, requiring individual units to feedback data, may lead to a reduction in BSI rates.

Extra Mortality of Nosocomial Infections in Neonatal ICUs at Eight Hospitals of Argentina, Colombia, Mexico, Peru and Turkey. Findings of the International Nosocomial Infection Control Consortium (INICC)

BACKGROUND/OBJECTIVES: Our goal was to determine the extra mortality (EM) of the health care associated infections (HAI) at Neonatal intensive care units (ICU) of hospitals members of the INICC in Argentina, Colombia, Mexico, Peru and Turkey. METHODS: We conducted a case control analysis nested in a prospective cohort study in 8 Neonatal ICUs at 8 hospitals members of the INICC, between 2003 and 2005 (3 years) to analyze the extra mortality of patients with central vascular catheter associated blood stream infection (CVC-BSI), mechanical ventilator associated pneumonia (VAP), and catheter associated urinary tract infection (CA-UTI). All patients were assessed for mortality. Patients who died were called cases, while those who did not die, were called controls. RESULTS: From 2003 to 2005, we enrolled 1,529 patients, representing 14,800 bed days. The overall HAI rate was 7.8 per 100 patients and 8.0 per 1000 bed days. The CVC-BSI rate was 16.1 per 1000 CVC days, the VAP rate was 10.6 per 1000 device days, and CA-UTI rate was 5.3 per catheter days. 201 out of 1,529 (13.1%) patients without HAI died; 22 out of 65 patients (33.8%) with CVC-BSI died, the extra mortality of CVC-BSI was 22.1%, (RR, 2.89; 95% CI, 1.85-4.51; P, 0.0000); 7 out of 29 patients (24.1%) with VAP died, the extra mortality of VAP was 12.4%, (RR, 2.06; 95% CI, 0.97-4.39; P, 0.0557); 0 out of 1 patients (0.0%) with CA-UTI died, the extra mortality of CA-UTI was −11.7%, (RR, 0.00; 95% CI, -undef-; P, 0.7321). CONCLUSIONS: This study has identified that CVC-BSI is significantly associated with higher mortality.

Risk Factors for Nosocomial Infection in a Neonatal Intensive Care Unit

To determine risk factors for nosocomial infection in a neonatal intensive care unit (NICU). A prospective, open cohort study. A 22-bed NICU. Neonates admitted to a single NICU during 1994-1998 were included in the study. Outcome variables included central venous catheter (CVC)-associated primary bloodstream infection (BSI), non-CVC-associated primary BSI, pneumonia, and overall nosocomial infection. Independent variables included birth weight, use of mechanical ventilation (MV), duration of MV, use of a CVC, duration of CVC use, duration of NICU stay, gestational age, congenital malformation, maximum (ie, worst) base excess, and maximum and minimum fraction of inspired oxygen (FIO(2)) for maintaining appropriate blood saturation levels during the first 12 hours after NICU admission. A total of 1051 neonates were admitted to the NICU. Overall, 358 NIs were diagnosed. Non-CVC-associated primary BSI was the most frequent nosocomial infection (in 195 neonates [54.5%]), followed by pneumonia (46 [12.8%]), and CVC-associated primary BSI (35 [9.8%]). The mortality rate was 16%. In the final logistic regression model, the following 5 risk factors were found to be predictive of nosocomial infection development: use of MV, longer duration of MV, longer duration of CVC use, longer duration of NICU stay, and low maximum appropriate Fio(2). Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in NICUs. In our cohort, birth weight showed no influence on the development of nosocomial infection. Low maximum Fio(2) influenced the occurrence of overall nosocomial infection.

Épidémiologie des infections nosocomiales en néonatalogie

Epidemiology of nosocomial infections in neonates has to be described according to our definitions (early onset GBS diseases excluded) and according to levels of care. Nosocomial risk exists in maternity departments (3% in postnatal beds), incidence rates are 7.5–12.7% or 1.3–8.5 per 1000 days in neonatal care units and 14.2% or 11.7 per 1000 days in neonatal intensive care units (NICU). Gram-positive cocci bloodstream infections are the most common nosocomial infections in NICU but viral gastroenteritis are more frequent in neonatal care units. Risk factors are low birthweight, small gestational age and intravascular catheter in NICU, and for viral nosocomial infections, visits and winter outbreaks.

Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey

Objectives: Patients admitted to neonatal intensive care units (NICUs) are at high risk of nosocomial infection. We conducted a national multicenter assessment of nosocomial infections in NICUs to determine the prevalence of infections, describe associated risk factors, and help focus prevention efforts. Study design: We conducted a point prevalence survey of nosocomial infections in 29 Pediatric Prevention Network NICUs. Patients present on the survey date were included. Data were collected on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes. Results: Of the 827 patients surveyed, 94 (11.4%) had 116 NICU-acquired infections: bloodstream (52.6%), lower respiratory tract (12.9%), ear-nose-throat (8.6%), or urinary tract infections (8.6%). Infants with infections were of significantly lower birth weight (median 1006 g [range 441 to 4460 g] vs 1589 g [range 326 to 5480 g]; P < .001) and had longer median durations of stay than those without infections (88 days [range 8 to 279 days] vs 32 days [range 1 to 483 days]; P < .001). Most common pathogens were coagulase-negative staphylococci and enterococci. Patients with central intravascular catheters (relative risk = 3.81, CI 2.32-6.25; P < .001) or receiving total parenteral nutrition (relative risk = 5.72, CI 3.45-9.49; P < .001) were at greater risk of bloodstream infection. Conclusions: This study documents the high prevalence of nosocomial infections in patients in NICUs and the urgent need for more effective prevention interventions. (J Pediatr 2001;139:821–7)