Infection Control In The Neo-Natal Intensive Care Unit

Infection Control In The Neo-Natal Intensive Care Unit

Introduction

Immature Immunocompromised patients in the neonatal intensive care unit (NICU) are one patient group most at risk of acquiring healthcare-associated infections (HCAIs) (Urrea et al 2009, Schelonka et al 2009). In these patients HCAIs are defined as, 'those which occur beyond 48 hours of birth and are caused by pathogens that are not maternally derived' (Polin and Saiman 2009), or if infection occurs 72 hours after admission to the NICU (Urrea at al 2009). While one study by the UK Neonatal Staffing Study Group found wide variations in HCAI rates in NICUs in the UK, it concluded that UK levels were similar to those of other developed countries (Parry et al 2011). HCAI is one of the leading causes of adverse events in the neonate, increasing the severity of illness, length of hospital stay and healthcare cost, and negatively affecting the infant's neurodevelopment and growth (Parry et al 2011). The control and prevention of HCAI in the NICU is a major challenge for healthcare workers. (Adams-Chapman and Stoll 2009, Pessoa-Silva et al 2010).

Causes of colonisation, contamination and cross-infection

Colonisation is the term used to describe the process where a group of micro-organisms grow and multiply on or in the body without invading the surrounding tissues and causing damage (Horton and Parker 2009). This process is usually a stable defensive mechanism that begins at birth and continues as contact is made with people and the environment. The effective natural first-line defence barrier of the skin and mucous membranes of the stratum corneum are thin in the premature infant, allowing excess water loss and easy entry for micro-organisms (Palmer et al 2008). A patient's normal skin flora is also altered by antibiotic therapy or from contact and cross-infection and colonisation by hospital micro-organisms from the hands of healthcare workers or contaminants in the surrounding environment. Invasive monitoring, central and peripheral intravenous catheters and insertion of nasogastric tubes are routine practices in the NICU, but all carry a high risk of contamination from the hands of healthcare workers. Total pa rentera! nutrition and mechanical ventilation are also associated with HCAI in the neonate (Kawagoe et al 2010).

Equipment

Equipment in the NICU can easily become colonised with bacteria and micro-organisms. Incubators are warm humid environments nurturing the growth of infant and micro-organisms. Incubator colonisation and contamination with bacteria also occur from the hands of healthcare workers and it is not uncommon for incubator tops, ports and doorknobs to quickly become colonised with bacteria(Horton and Parker 2009). In an effort to reduce the risk of cross-infection many NICUs regularly change the infant's incubator. This is usually done on a weekly basis based on the manufacturer's recommendations, but there is no evidence in the literature to support the need for and frequency required for this practice.

In some NICUs it is customary that most patient equipment is cleaned by a member of the ward team. However, cleaning regimens should be designed to ...