Infection is one of the major causes of neonatal death. so, here is the presentation on Infection control in newborns or neonates. Hope it helps!

1. INFECTION CONTROL IN NEWBORNS
SUBMITTED TO:
Mrs. Pushpa Kerketta
Clinical tutor
College of nursing
Rims, Ranchi
SUBMITTED BY:
Priyanshu Sainy
Roll no.-24
Basic B. Sc Nursing 4th year
College of Nursing
Rims, Ranchi
SUBMITTED ON: 19/04/21
OBSTETRICAL AND MIDWIFERY NURSING

2. EXPLAINING ABOUT
 Neonatal infections/Neonatal Sepsis
 Early onset sepsis vs Late onset sepsis
 Risk factors
 Modes of acquiring infections
 Symptomatology of Neonatal infections
 Policies and Techniques for Infection Control in
Neonatology
 Management of Infection in baby
 Role of nursing in Infection control

3. INTRODUCTION
Infection is one of the leading causes of neonatal death in the developing countries. The
neonates are more susceptible to infection because they lack in natural immunity and take some
time for the acquired immunity to develop. Full immunocompetence requires both natural and
acquired immune mechanisms.
Small and sick newborns admitted in hospitals are at a greater risk of acquiring infections while
they are hospitalized. While infection prevention and control trainings are generic, specific
orientation is required for service providers working at neonatal intensive care units(NICU).
Babies in our NICU often have immature immune systems. They are exposed to many different
caregivers and may have multiple blood tests, IV lines and other invasive procedures. The care
needed for babies is for their growth. It is the prevention of infection in newborns.

4. NEONATAL INFECTIONS
Neonatal infections are infections of the neonate (newborn) acquired during prenatal
development or in the first four weeks of life. Neonatal infections may be contracted
by mother to child transmission, in the birth canal during childbirth, or contracted
develop in the postnatal period.

5. NEONATAL INFECTIONS

6. There is a higher risk of infection for preterm or low birth weight neonates. Infant respiratory distress
syndrome is often a condition of preterm neonates that can have long term negative consequences, it
can also arise following an infection. In some instances, neonatal respiratory tract diseases may increase
the susceptibility to future respiratory infections and inflammatory responses related to lung disease.
Antibiotics can be effective for neonatal
infections especially when the pathogen
is quickly identified. Instead of relying
solely on culturing techniques, pathogen
identification has improved substantially
with advancing technology; however,
neonate mortality reduction has not
kept pace and remains 20-50%. While
preterm neonates are at a particularly
high risk, all neonates can develop
infection.

7. Natural or innate immunity involves responses that do not require previous exposure to
microorganisms. These include intact skin and mucus membranes and gastric acid and digestive
enzymes that act as first line defense against infection in the neonate. Immediately after birth,
the infant’s bowel is not colonized with normal protective flora, and the skin is more easily
irritated and damaged.
a. Natural or Innate Immunity
b. Acquired Immunity
Acquired or specific immune responses are the responses that develop and improve with
ongoing exposure to a pathogen or organism. Although the infant has some immune
protection from the mother, largely he must actively acquire this immune response.
Immunoglobulins are deficient at birth. Antibody levels are limited. Breastfeeding increases the
infant’s immune protection through the transmission of secretory IgA in breast milk. During the
early weeks of life, the infant also has deficiencies in both the quantity and quality of
neutrophils.

8. INFECTIONS ACQUIRED BEFORE OR DURING BIRTH
 Toxoplasmosis
 Rubella
 Cytomegalovirus infection
 Herpes Simplex Virus
 Acquired Immunodeficiency Syndrome
 Varicella Zoster Virus
 Chlamydia Infection
 Hepatitis B virus
 Syphilis
 Gonococcal infections
 Ophthalmia Neonatorum

10. INFECTIONS ACQUIRED AFTER BIRTH
 Skin Infections
 Omphalitis
 Respiratory infections
-Nasopharyngitis and rhinitis
-Neonatal pneumonia
 Gastrointestinal Infections
-Gastroenteritis
-Necrotizing enterocolitis
 Urinary tract infections
 Meningitis

11. EARLY ONSET SEPSIS
 Within 72 hours of birth
 Organisms in genital tract of mother and in the
delivery area
 Perinatal risk factors
 72 hours or later
 Organisms in home or hospital
 Health care providers
 Generalised sepsis
LATE ONSET SEPSIS

12. RISK FACTORS INCREASING NEONATAL INFECTIONS
Factors
• Prematurity
• Meconium aspiration
• Postpartum endometritis
• Low birth weight
• Premature rupture of membranes
• Vaginal Discharge
Notes
• Birth before 40 weeks gestation
• Inspiration of stool in utero
• Inflammation of the uterus after birth
• <40weeks gestation
• <12 hours
• Abdominal discharge can be a result of infection

14. MODES OF ACQUIRING INFECTION
 Antenatal
i. Transplacental: Maternal infections that can affect the fetus through
transplacental route are predominantly the viruses. They are Rubella, CMV,
herpes virus, human immunodeficiency virus(HIV), chickenpox and hepatitis
B virus. Other infections are syphilis, toxoplasmosis and tuberculosis.
ii. From amniotic fluid: Amnionitis(also known as chorioamnionitis) following
premature rupture of membranes can affect the baby following aspiration or
ingestion of the infected amniotic fluid.

16.  Intranatal:
i. Aspiration of infected liquor during labor in which early rupture of
membranes and repeated internal examinations occur. This may lead to
either congenital or neonatal pneumonia.
ii. While the fetus is passing through the vagina, contamination of the eyes can
occur with gonococci leading to ophthalmia neonatorum. Contamination
with Candida albicans can lead to oral thrush.
iii. Improper asepsis, while caring for the umbilical cord may lead to cord sepsis.

18.  Postnatal:
i. Transmission of infection due to human contact as from infected mother,
relatives or hospital staff.
ii. Cross infection from an infected baby in the nursery or postnatal unit.
iii. Infected utensils used for feeding or bathing- clothing and airborne.

20. ORGANISMS
 Soon after birth, the baby becomes colonized
by bacteria derived from the mother, like
staphylococcus on the skin, streptococcus in the
respiratory tract and E. coli in the
gastrointestinal tract. This colonization takes
place particularly, in those high risk situations
mentioned before where obstetric care is
suboptimal. Neonatal anerobic infections are
uncommon.
Bacteriodes Fragilis
Pepto Streptococcus
Fusobacteria Sepsis
Common
pathogens
are

21. SYMPTOMATOLOGY OF NEONATAL SEPSIS
a) GENERAL
 Lethargy
 Refusal to suck
 Poor cry
 Poor weight gain/excessive weight loss
b) RESPIRATORY SYSTEM
 Cyanosis
 Apnea
 Chest retractions
 Tachypnea
 Grunt

22. c) CENTRAL NERVOUS SYSTEM
 Seizures
 Neck retardations
 Bulging Fontanel
 Poor neonatal reflexes
 Not Arousable, comatosed
d) HYPOTENSION
 Poor perfusion
 Shock

23. e) GI
 Distension Abdomen
 Diarrhea
 Vomiting
f) TEMPERATURE PROBLEMS
g) OTHERS
 Excessive Jaundice
 Bleeding
 Renal failure

24. POLICIES FOR INFECTION CONTROL IN NEONATOLOGY
 All neonatal care units staff shall be familiar with the infection control practices that minimize the
infection risk in the staff and newborns.
 Strict hand hygiene compliance according to WHO-5 moments of hand hygiene.
 Handling of neonates shall be minimized.
 Equipment & supplies should not be shared between infants.
 Visitor management.

25. TECHNIQUES USED FOR INFECTION CONTROL
 Clean Technique
o Aseptic techniques
o Sterile techniques
 All these techniques include:
• Patient
• Environment
• Equipments
• HCW

26. Clean Techniques- It is used for routine patient care procedures; Eg.- patient exam, taking pulse, temperature,
BP
, feeding, social touch.
Aseptic Neonatal Care Practices-
o Peripheral Venous Catheter(PVC) Insertion
o IV Therapy
o Preparation of IV Fluids
o Administration of IV medicines/drugs
Sterile Techniques- Surgical Asepsis is used in procedures designed to prevent bloodstream infection &
surgical site infection, eg., insertion of umbilical line, central line, surgeries.

27. INFECTION CONTROL PRECAUTIONS IN NEONATOLOGY UNITS
BARRIER PRECAUTIONS
Gloves:- Single-use gloves are recommended during all patient contact.
Gowns:- A gown protects the infant from contact with the wearer’s clothing and prevents contamination of
the healthcare worker’s exposed skin with the infant’s flora. A gown shall be worn if a newborn is to be
handled outside the incubator where direct contact is expected.

28. PERSONAL PROTECTIVE EQUIPMENTS
Head Cap
Goggles
Gloves
Gowns
Masks
Shoe
cover

29. PREVENTION OF TRANSMISSION OF INFECTIONS BETWEEN
NEONATES
Single Room Isolation
To prevent the spread of communicable diseases. Newborns with documented or suspected infection with
communicable or epidemiologically important pathogen.
Visitor’s management
No visiting time.
Visitors shoulb be treated on a individual basis.
View babies through the viewing box.
If mandatory to enter in the unit, allow only parents after rounds with hand hygiene protocol and use protective
clothing.
Staffing Norms
Adequate staff is mandatory to allow for hand washing between patient’s contact.
Normal – Staffing ratio is 1:6 to 8 infants.
Intermediate - Staffing ratio is 1:2 to 3 infants.
NICU – 1 professional nurse for every 1-2 infants.

30. Linen Handling
Ensure that linen handling policy is adhered to present cross-infection.
Waste Disposal
Handling & Processing infections waste.
Waste must be placed in color coded, leakage proof bags, collected with barrier precautions like gloves.
Soiled diapers & medical waste should be collected 3-6 hourly.
Proper disposal of sharps to be practiced to prevent needle stick injuries.

31. NEONATOLOGY UNIT EMPLOYEE HEALTH
 Personnel allocated to work in this unit should be immune to Rubella, Measles, Polio & chicken pox.
 HBV and yearly influenza vaccination should be offered.
 Proper PPE should be readily available for use, when blood splashes & body fluids spillages are
anticipated.
 Infection safety and sharp disposal to be practiced to prevent needle stick injuries.

32. MANAGEMENT OF INFECTION IN BABY
 The midwife’s role in the management of fetal and neonatal infection includes prevention, assessment,
diagnosis and treatment of infection.
 PREVENTION
i. Encouraging and assisting the mother with breastfeeding, thus increasing the
infant’s immune protection.
ii. Ensuring careful and frequent hand-washing by all caregivers to prevent the spread
of infection.
iii. Always using individual equipment for each infant.
iv. Having the infant rooming-in with his/her mother.
v. Isolating infected babies when necessary.
vi. Observing for and appropriately treating any infection in the mother prior to the
infant’s birth.

33. ASSESSMENT AND DIAGNOSIS
i. CBC
ii. Urinalysis
iii. Swabs from nose, throat and umbilicus
iv. Chest X-ray
v. Lumbar puncture if CNS signs are present
vi. Testing of cord blood, amniotic fluid and placental tissue for specific
organisms

34. TREATMENT OF INFECTION
 The objectives of treatment essentially is the prevention of septicemia and
septic shock and a reduction in the short and long term effects of the
infection.
i. Baby should be isolated.
ii. To control infection by adequate and appropriate antibiotics.
iii. To maintain general conditions, change the feeding route.
iv. Adequate oxygenation is to be ensured.
v. Prophylactic antibiotics such as ampicillin, amikacin, cefotaxime should be
provided.

35. NURSING INTERVENTIONS
i. The baby is to be nursed in a warm thermoneutral environment
with the midwife observing for any temperature instability.
ii. Maintenance of good hydration and the correction of electrolyte
imbalance with demand of feeding and intravenous fluids, as
required.
iii. Any infant with septic shock is to be cared for in a neonatal
intensive care unit as it is a life-threatening emergency.
iv. Where possible, it is best to avoid separation of the mother and
baby.
v. If the baby requires, being in the nursery, parents could be
encouraged to spend time with their baby.

36. ROLE OF NURSING IN INFECTION CONTROL
 Guidelines for preventing exposure to blood, body fluids, secretions, excretions, broken skin, or mucus
membranes.
 Based on the concept that body fluids from any patient can be infectious.
 Should be used on every patient.
 Use necessary PPE for protection.
 CDC guidelines requires us to use category- specific isolation in addition to Standard Precautions when a
patient is known or suspected to have an infection.

37. GUIDELINES TO BE FOLLOWED:
 Follow Contact isolation.
 Used to prevent transmission of microorganisms spread :
a. By large, moist droplets inhaled by or landing on the mucus membranes of the susceptible host.
b. On very small particles that drift on air currents

38. EVALUATION
1. What is neonatal infection?
2. What are the risk factors?
3. The symptoms of respiratory infection
include:
 Apnea
 Lethargy
 Gastroenteritis
 Hypothermia
4. Name the test to diagnose neonatal
pneumonia.
5. Enlist any one nursing intervention done.

39. THANK YOU
for your patience!