An ounce of prevention is worth a pound of cure.
The importance of appropriate and sustained infection prevention and control (IP&C) practices in the neonatal intensive care unit (NICU) cannot be overstated as infants in the NICU are extremely vulnerable to health-care-acquired infections (HAIs). This chapter introduces the basic components of an IP&C program, including the roles of workforce health and safety and the clinical microbiology laboratory. In addition, strategies to reduce HAIs in the NICU, including staff education, transmission precautions, and bundle practices to reduce central-line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonia (VAP) are described. Reduction of HAIs must be accompanied by effective surveillance for HAIs and multidrug-resistant organisms (MDROs). This is particularly important in an era of mandatory reporting. Finally, this chapter describes evidence-based antimicrobial stewardship interventions.
Throughout the chapter, citations are provided from the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) authoritative guidelines on prevention strategies for HAIs. This federal advisory board has infection control experts from the Society for Healthcare Epidemiology of America (SHEA), Infectious Disease Society of America (IDSA), and the American Academy of Pediatrics (AAP).1 In addition, the CDC provides guidelines and tools through the National Healthcare Safety Network (NHSN) system to assist hospitals to develop surveillance, analysis, and reporting systems for HAIs that can enable interventions, when necessary (http://www.cdc.gov/nhsn/).
Discussion of the pathophysiology and treatment of bacterial and viral pathogens, including MDROs, is beyond the scope of this chapter; these topics are addressed in other chapters in this guide.
COMPONENTS OF INFECTION PREVENTION AND CONTROL PROGRAMS
Administrative support is crucial to secure the resources and infrastructure needed to provide an effective IP&C program to serve the NICU. As NICUs are part of larger hospitals and health care systems and may be the only pediatric unit within some hospitals, the administrative leadership should be educated by the IP&C program and NICU leadership about the unique needs of the neonatal population. Elements of education should include the types of HAIs that neonates can acquire; the morbidity associated with these infections (ie, increased length of stay, health care costs, and potential mortality); preventive strategies and the cost of such strategies, including maintaining adequate bedside nurse staffing; reporting requirements to institutional committees, local health departments, and other regulatory bodies; relevant Joint Commission patient safety goals and priorities; the potential impact of HAIs on hospital reputation; and the role of families and visitors.
Support for IP&C efforts must be provided by NICU medical and nursing leadership as well as the bedside health care professionals and ancillary caregivers (eg, respiratory therapists, radiology technicians, phlebotomists, and environmental service workers). Regular presentations should be made to the administrative leadership and the NICU team by the IP&C staff, who should serve on the NICU quality council. ...