Неонатальна госпітальна інфекція

Using a topical antiseptic agent during routine bathing and/or skin preparation for sterile procedures can help reduce bacterial skin colonization in newborns. Chlorhexidine-based products are increasingly used for this purpose, but the U.S. Food and Drug Administration warns of risk of skin irritation and chemical burns in infants < 2 months of age. The American Academy of Pediatrics recommends dry umbilical cord care, but this practice may result in high rates of colonization with S. aureus, and epidemics have occurred in some hospitals. During disease outbreaks, application of triple dye to the cord area or bacitracin or mupirocin ointment to the cord, nares, and circumcision site reduces colonization. Routine cultures of personnel or of the environment are not recommended.

Prevention of colonization and infection in special care nurseries requires provision of sufficient space and personnel. In intensive care, multipatient rooms should provide 120 square ft (about 11.2 square m)/infant and 8 ft (about 2.4 m) between incubators or warmers, edge-to-edge in each direction. A nurse:patient ratio of 1:1 to 1:2 is required. In intermediate care, multipatient rooms should provide 120 square ft (about 11.2 square m)/infant and 4 ft (about 1.2 m) between incubators or warmers, edge-to-edge in each direction. A nurse:patient ratio of 1:3 to 1:4 is required.

Proper techniques are required, particularly for placement and care of invasive devices and for meticulous cleaning and disinfection or sterilization of equipment. Active monitoring of adherence to techniques is essential. Formal evidence-based protocols for inserting and maintaining central catheters have significantly decreased the rate of central line-associated bloodstream infection.

Similarly, a group of procedures and protocols that reduce healthcare-associated pneumonia in the neonatal ICU have been identified; these include staff education and training, active surveillance for healthcare-associated pneumonia, raising the head of an intubated neonate's bed 30 to 45°, and providing comprehensive oral hygiene. Placing the neonate in a lateral position with the endotracheal tube horizontal with the ventilator circuit also may be helpful.

(See also current Centers for Disease Control and Prevention [CDC] guidelines for the prevention of S. aureus infections [2020] and CLABSI [2022] in the neonatal ICU.)

Other preventive measures include meticulous attention to hand hygiene. Cleansing with alcohol preparations is as effective as soap and water in decreasing bacterial colony counts on hands, but if hands are visibly soiled, they should first be washed with soap and water. Incubators provide limited protective isolation; the exteriors and interiors of the units rapidly become heavily contaminated, and personnel are likely to contaminate their hands and forearms. Universal blood and body fluid precautions add further protection.

Active surveillance for infection is done. In an epidemic, establishing a cohort of diseased or colonized infants and assigning them a separate nursing staff are useful. Continuing surveillance for 1 month after discharge is necessary to assess the adequacy of controls instituted to end an epidemic.

Prophylactic antimicrobial therapy is generally not effective, hastens development of resistant bacteria, and alters the balance of normal flora in the neonate. However, during a confirmed nursery epidemic, antibiotics against specific pathogens may be considered—eg, penicillin G for prophylaxis against group A streptococcal infection ( Дивитися таблицю: Рекомендовані дози окремих парентеральних антибіотиків для новонароджених).

Inactivated vaccines should be given according to the routine schedule to any infant who is in the hospital at that time. Live viral vaccines (eg, rotavirus vaccine) are not given until the time of discharge to prevent spread of vaccine virus in the hospital.