Strategy for Infection

Control in NICU
Dr. B. Hennebry
 Scale
• More than 10% of births worldwide are premature.

• Until 2017 infection was the leading cause of

death in the neonatal period.

• In the first five years of life infection is still the

leading cause of death.

• Infant mortality has dropped…

• BUT neonatal deaths have increased in proportion

 Response
• Acceptance

• Target identification

• Planning

• Implementation

• Assessment

• Cycle
 Infection Control

• Is easy!

• Is cheap!

• Is effective!

• Is fun!
Basic Principles
 Applications in NICU

• Infectious Agents:

• Be aware of local epidemiology.

• Be aware of most common organisms.

• Be cautious in applying external protocols.

 Applications in NICU

• Reservoir

• People - staff and families

• Equipment - single-use or sterilised

• Water - plumbing
 Applications in NICU
• Portal of Exit

• Secretions (sweat), Droplets (respiratory), Excretions

(poor hand hygiene)

• Mode of Transmission

• Contact (family, staff, procedures), Droplet (isolation

procedures, shared space), Airborne (shared space),
Vectorborne (siblings)
 Applications in NICU
• Portal of Entry

• Respiratory tract

• Skin

• Instrumentation

• Susceptible Host

• Premature babies

• Stratify risk

• Isolate where possible

• Rationalise antibiotic use

 Strategies

• Identify Target

• Easily practicable

• Easily implemented

• Easily audited
 Hand Hygiene
• Is effective:

• Multiple trials in various countries demonstrate consistent

reduction in nosocomial infection rate.

• Is cost-effective

• Alcohol hand rub can be produced mixing 70% ethanol with

glycerine

• Is practical

• Pre-existing protocols and packages

• Lends itself to audit

 Line Infection

• CLABSIs are the most common nosocomial

infection in the NICU

• Central lines are life saving and life preserving

• There are certain key points during insertion and

life of the line for infection
 Line Infection
• Moments of susceptibility

• Insertion

• Early life

• Access

• Re-dressing
 Bundles

• “A bundle is a structured way of improving the

processes of care and patient outcomes”

• Protocol

• Equipment

• Training
 Bundles

• Protocol

• Easily accessible to whole MDT

• Enforceable

• Audit
 Bundles

• Equipment

• Reproducible/standardised

• Available

• Realistic
 Bundles

• Training

• Formalised

• Multi-disciplinary

• Enforceable
 Bundles

• Are effective

• Are labour intensive

• May be expensive
 Antibiotic Stewardship

• Use of broad-spectrum antibiotics in the

community affects NICU patients

• Many infants may be admitted to NICUs already

colonised with multi-drug resistant bacteria
 Antibiotic Stewardship

• Local epidemiology is key

• Resources should be used to limit use and

duration of antibiotics
 Nutrition

• Breast feeding is associated with reduced rates

of sepsis on NICU
 Implementation

• Multidisciplinary

• Stepwise

• Sustained

• Audited
 Implementation

• Team strategies

• Infection control teams

• CVC teams

• “Champions”
 Implementation
• Identify one target

• Implement change

• Education

• Modeling

• Assess

• Improve
 Caveat

• Prevention of infection is multifactorial

• We should remain interested in outcomes

 Caveat
• Simple is best

• Aim for continual improvement

• Accept reality

• Involve other departments

• Persevere
 A Lesson from History
• Ignaz Semmelweis (1818-
1865)

• Suggested hand disinfection

as a way to reduce “pueperal
fever” (GAS infection)

• Poorly communicated to
obstetricians

• Findings largely ignored till

after his death
Thank You

Any Questions?