Preventing Neonatal Infections
Preventing Neonatal Infections
Preventing Neonatal Infections
Control of Infection
on NICU
Dr Catherine Smith
SpR Neonatology
July 2007
Start
Hospital acquired infection is a
significant cause of morbidity and
mortality on the neonatal unit.
We all have a large role to play in
reducing hospital acquired infection.
This training package covers important
ways in which YOU can do this.
Remember, infections kill babies.
Next
Infection Control Training Menu
• Introduction
Hospital acquired sepsis is a serious problem for infants in neonatal intensive care
units. Infections are associated with increased morbidity and mortality and a
prolonged hospital stay1.
Infants born more prematurely and with lower birth weights are at greater risk due to
immature immune responses such as low immunoglobulin concentrations, reduced
phagocytosis, poor skin and gut barrier function2.
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Jewellery, watches & other accessories
• Jewellery, watches and other accessories are
places for bacteria to lodge and are difficult to
decontaminate.
Make sure your hands are completely dry before handling babies.
• When entering or leaving the nursery, and between bays Treat the
nursery as a clean area, do not rest items (e.g. clinical notes) on
incubators or cots that are not clean
• Clean hands with alcohol rub after you have finished handling a
baby or their surroundings
Procedure
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Procedure
• Use an aseptic technique
• Wash your hands & use alcohol rub as described
• Wear sterile gloves
• Clean the skin over and around your chosen site with an alcohol wipe
for 30 seconds and allow to dry9
• Use a cannula and collect blood from the hub using a sterile needle
and syringe
• Collect at least 0.5ml of blood, 1ml in bigger babies8
• Place the blood into 1 neonatal blood culture bottle
• Fill out the details thoroughly on the request card
• Ensure sample reaches the laboratory as soon as possible
– Call for a porter (24 hours a day)
• Document in the notes
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Infection
• The presence of a central line makes blood stream infections harder to clear. Infection is more likely when there are a
greater number of line lumens. Also, the risk of infection in a femoral line is higher than at other sites.
• Coagulase negative staphylococcal septicaemia may be cleared by giving antibiotics via the central line. However, if
more than 3 positive cultures are obtained when taken daily after the first positive result then the catheter should be
removed.
• Some organisms are notoriously more difficult to clear and in these cases the line should be removed more quickly after
the positive culture is obtained in infants who are clinically unwell. In particular, there is evidence that if central lines are
not removed immediately upon the diagnosis of Candida septicaemia then there is a high rate of morbidity and mortality 14.
• The decision to remove a central line should be made by the neonatal consultant, particularly in infants with difficult
venous access.
• Replacing a central line which has been removed due to infection should be delayed for at least 48 hours. During which
time appropriate antibiotics should be given peripherally. Replacement is dependent upon the clinical condition of the
baby, infection markers and blood culture results.
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How to dress a percutaneous long line
When a long line has been inserted it should be secured using steri-strips and a
sterile adhesive dressing eg. IV3000.
The silastic line should be looped and secured prior to securing the hub. It is
important to ensure that no tension is placed on the silastic line during securing.
The steri-strips should be completely covered by the IV3000 dressing. The steri-
strips and IV3000 dressing must not fully encircle the limb. They may, therefore,
need to be cut to size.
The dressings should be replaced using a very careful 2 person aseptic technique, ensuring the line is not
dislodged. This does NOT mean sticking a new dressing over the top. See the recommended technique on the
following page.
There is no clear evidence to support regular routine dressing changes particularly in the neonatal population
where the loss of the catheter at dressing change outweighs the risk of not redressing 15.
Other Interventions
•Minimise the number of skin punctures16
–Incompetent skin increases the risk of sepsis
–Use arterial lines if in situ for blood sampling
–Use the appropriate heel sampling device to avoid repeated punctures
–Cluster blood tests and gases to avoid multiple unnecessary punctures
•Enteral feeding
–Feeding with human breast milk has been shown to reduce rates of nosocomial sepsis
–Use of early trophic feeds also reduces rates of nosocomial infection 17
•Use of iv immunoglobulin
–Trials have shown reduced infection rates but no long-term benefits associated with prophylactic iv
immunoglobulin and therefore this is not recommended 18
•NICU design
–The number of sinks/intensive care space, space between incubators, availability of equipment and
NICU air ventilation systems have been related to infection rates 19.
Hand-washing
Parents and visitors should be shown how to wash their hands and use alcohol rub. When babies are
in incubators only their parents and staff should be allowed contact with them.
Toys in incubators
Toys kept in incubators may be reservoirs for hospital acquired infection. One study cultured toys and
grew bacteria in 98% of cases. During the study 42% of babies had positive blood cultures and 63% of
these were the same organism as grown from the toys 20. We advise that toys should not be kept in
humidified incubators.