Nosocomial infections acquired in the hospital, are a primary problem of preterm and term infants who are hospitalized longer because of a medical illness. Healthy, term infants ill in <1% of cases. The lower the birth weight of the newborn, the higher the risk of infection. most frequent nosocomial infections are centrovenously-associated bloodstream infections (CLABSI) and nosocomial pneumonia.
Some infections are acquired in utero or post partum more after admission to the nursery as a mother. Some infections (Streptococcus Group B, herpes simplex virus), it is not clear whether the cause lies in the mother or in the hospital environment. Nosocomial infections acquired in the hospital, are a primary problem of preterm and term infants who are hospitalized longer because of a medical illness. Healthy, term infants ill in <1% of cases. The lower the birth weight of the newborn, the higher the risk of infection. most frequent nosocomial infections are centrovenously-associated bloodstream infections (CLABSI) and nosocomial pneumonia. Etiology In newborns with Staphylococcus aureus (methicillin-sensitive or methicillin-resistant) skin infections, the most common nosocomial infection. Although the nursing staff, the nasal mucosa is colonized with S. aureus, a potential source of infection for neonatal infections, but colonized newborns and mothers are the main reservoir. The umbilical cord rest, nose and groin commonly affected during the first few days of life. Often most diseases do not occur until after the child was discharged home. In infants with very low birth weight (VLBW; <1500 g) Gram-positive bacteria cause 70% of infections. Most are coagulase-negative staphylococci. Gram-negative bacteria such as Escherichia coli, Klebsiella, Pseudomonas, Enterobacter, and Serratia, cause 20% of cases. Fungi (Candida albicans and C. parapsilosis) are responsible for 10% of infections. The type of infection and antibiotic resistance vary between hospitals and stations and change with the times. Sometimes so-called epidemics occur when a particularly virulent pathogen colonizes a station. Infections are favored because the underweight premature babies have to undergo many invasive procedures (arterial and venous indwelling catheter, intubation, CPAP, nasal or nasojejunal feeding tubes). The longer a child is hospitalized in a special ward and the more interventions take place, the higher the likelihood of nosocomial infection. Prevention measures to reduce S. aureus colonization A prevention of colonization and infection in special nurseries and intensive care units for infants. Hand hygiene monitoring in infectious Occasionally antibiotics vaccinations reduction of colonization The frequency of colonization with S. aureus can be reduced strength by bathing of infants in a 3% hexachlorophene, but the substance is particularly true for children with a low birth weight to be neurotoxic and is therefore no longer used. The American Academy of Pediatrics recommends a dry skin care for babies; This has resulted in some hospitals to an increase in the frequency of colonization with S. aureus, and epidemics. In these cases, to reduce the incidence of colonization the umbilical care with bacitracin or Mucipirocin ointments has proven to the umbilical cord, nasal passages and the Zirkumzisionswunde. Routine compromising the personnel or the environment are not recommended. Neonatal units and neonatal intensive care units A prevention of colonization and infection in special daycare requires providing enough space and staff. In intensive care units 120 sq ft should (about 11.2 m) for each child and 8 ft (about 2.4 m) are available between the incubators or Wärmebettchen from corner to corner in each direction in multiple beds. A personal key of 1: 1 to 1: 2 is required. On the infant nursing station in shared rooms, a space of 120 sq ft (about 11.2 m) for each child and 4 ft (1.2 m) should be between incubators or Wärmebettchen (from corner to corner in each direction) are available , A personal key of 1: 3 to 1: 4 is required. In addition, suitable methods, especially for the establishment and maintenance of invasive catheter and a very thorough cleaning, disinfection and sterilization of the material after use for routine should include. Active monitoring of compliance with the hygiene methods is essential. Formal evidence-based protocols for the insertion and the central storage catheter reduce the rate of centrovenously-associated sepsis significantly. Likewise, a group of methods and procedures has been identified that reduce nosocomial pneumonia in the neonatal intensive care unit. These include staff education and training, active surveillance for nosocomial pneumonia, raising the head end of the bed of an intubated newborns to 30-45 ° and careful oral hygiene. It can also be helpful, so to lie the baby in a lateral position that the endotracheal tube comes to rest with the ventilator in the horizontal plane. Hand Hygiene Other preventive measures include careful hand hygiene. Cleaning with alcohol preparations is as effective as soap and water in reducing the bacterial bacterial counts on the hands. If your hands are visibly dirty, however, they should be washed with soap and water. Incubators only offer limited protection by insulation; the interior and exterior of these units will be settled rapidly, so the chance of contamination of the hands and forearms of the staff is great. The normal precautions when handling blood and body fluids may offer additional protection. Infection control Active surveillance of infections is important. During an epidemic, it makes sense, ill and merge colonized infants and to provide by the same nurses. The children should be followed for the dismissal out for a month to review the effectiveness of measures to prevent an epidemic. Antibiotics Prophylactic antibiotic therapy is not effective in general, accelerated the development of resistance and alters the natural flora of infants. Under special circumstances, one antibiotic against certain pathogens may be considered such. B. penicillin G as prophylaxis against group A streptococci (see Table: Recommended doses of selected pareneraler antibiotics for newborns). Vaccinations Every child who is hospitalized during this time should, with inactivated vaccines according to the routine vaccination schedule (see Table: Recommended vaccination schedule for the age of 0-6 years and STIKO) are immunized. Viral vaccines (eg. As rotavirus vaccine) will only be given at the time of discharge to prevent infection in the hospital. Summary Nosocomial infections are a primary problem of preterm and term infants who are hospitalized due to an illness for a long time. The lower the birth weight is, the higher the risk of infection, particularly in newborns with central catheters, endotracheal tubes, or both. A careful procedure for introducing and holding of catheters, tubes and devices is essential for prevention. Formaliserte practices improve compliance with the hygiene regulations. Antibiotic prophylaxis is not recommended, except perhaps during a confirmed epidemic in the nursery with a specific pathogen.