Neonates are highly susceptible to infections, necessitating stringent infection prevention measures in healthcare settings. Key strategies include effective hand hygiene, proper nursery design, vigilant staff practices, and targeted interventions for specific infections. Continuous education and surveillance are essential to maintain low infection rates and protect vulnerable infants.

1. 1
Neonatal Infection Prevention
and Control
Dr. Rami H. Alabadla
Infection Control specialist
Head of Palestinian Society For Infection Control

2. Neonates ,High Risk For Infection
The neonate is
immunocompromised.
Neonatal HAI rates vary with the
level of care required.
Invasive devices
The difficulty in confirming
diagnoses result in widespread use
of broad-spectrum
antibiotic 2

3. Neonates , High Risk For Infection
 The ill neonate readily becomes colonized
with abnormal flora.
 Colonized newborns are a major source of
infection for other infants in the NICU
 Hands of caregivers is a major mode of
transmission between infants.
 Contaminated equipment and supplies
 Bloodstream infections are the most
prevalent infections in the NICU
3

4. Infections in NICU & nursery
 The neonate can acquire infection
1. antepartum (prenatal) ,
2. intrapartum (perinatal)
3. or postpartum (postnatal)
 Distinction between perinatal and
postnatal HAl is important
 In newborn nurseries, infections
rates 0.3 to 1.7 per 100 admissions.
 Rates are much higher in NICUs
4

5. Sites of Infection
 Blood stream Infections (BSI)
 Central Nervous System Infections
 Pneumonia
 Gastrointestinal Infections
 Necrotizing Enterocolitis
 Urinary Tract Infection
 Surgical Site Infection
 Skin, Subcutaneous, and Mucosal
Infections
5

6. Prevention Includes Interventions Related
To :
Nursery design, staffing,
Routine newborn care, hand
hygiene,
Cleaning, and disinfection;
Precautions for specific infections,
infected mothers, personnel,
family, and visitors with
transmissible infections;
6

7. Infection Prevention in Nursery Design and
Construction
 The nursery should be located in a low
traffic area with restricted access. The
design should provide adequate space for
appropriate care of the infant and for the
necessary patient care equipment
 Space should be added for sinks, desks,
cabinets, computers, and corridors.
 Air supply for the NICU should undergo
filtration of at least 90 percent, and 6 ACH.
7

8. Infection Prevention in Nursery Design and
Construction
 Newborns and patient care equipment
should be protected from exposure to
dust and debris during any
maintenance, construction, or other
dust-generating activities .
 Renovation procedures in the NICU
require maximum barriers and
protection of the ventilation
system.
8

9. Infection Prevention and Nursery Staffing
 Staff should be adequate for care the
infants and hand cleansing between
patient contacts
 one neonatal registered nurse for every
:
1. 6-8 infants in nursery
2. 3-4 patients in SCBU
3. 1-2 patients in NICU
9

10. Infection Prevention Strategies
:
1. hand hygiene before and after contact
with each infant
2. Not sharing equipment and supplies
between infants
3. Preventing infection from
contaminated feedings, water, air, or
infected healthcare personnel and
visitors .
4. Adherence to aseptic technique
10

11. Infection Prevention in Routine Newborn
Care
 Umbilical Cord Care Natural cord drying
is recommended -keeping clean and dry.
The routine use of topical antiseptics no
benefit.
 Skin Care Maternal blood and meconium
should be removed with sterile cotton
sponges and warm water , personnel should
implement Contact Precautions
- Bathing with an antiseptic agent is not
recommended for routine newborn care,
but is indicated in an outbreak 11

12.  Eye (Conjunctival) Care
o At delivery, the eyes of the neonate
should be cleaned with sterile cotton to
remove secretions and debris.
o Topical prophylaxis against neonatal
eye infection should be administered
within 1 hour of birth. Application of
sterile ophthalmic ointment containing
0.5 % erythromycin or 1 % tetracycline.
o Single dose containers should be used.
12

13. Infant Feeding
 Breast milk provides immunological as
well as nutritional benefits and is
reported to reduce the risk of sepsis in
premature infants.
 Commercial powdered formulas are
not sterile and should be used only if
there is no alternative.
13

14. Prevention of infections associated with
intravascular catheters
 Two major sources of intravascular device-
associated bloodstream infection:
1. Colonization of the intravenous device, or
catheter-associated infection .
2. Contamination of the fluid administered
through the device, or infusate -associated
infection.
14

15. CDC recommendation for the
Prevention of CVC related Infections
 hand hygiene before CVC insertion
 avoiding insertion of CVC in femoral
sites
 preparation of the skin insertion site
 using maximal sterile barriers when
inserting CVC (cap, mask, sterile gown,
sterile gloves, and a sterile full body
drape)
 removing the CVC as soon as possible .
15

16. CDC Recommendation For The Prevention Of
Umbilical Catheter Related Infections
 Remove and do not replace umbilical artery
or umbilical venous catheters if any signs of
CRBSI, vascular insufficiency in the lower
extremities, or thrombosis are present
 Cleanse the umbilical insertion site with an
antiseptic before catheter insertion. Avoid
tincture of iodine but other iodine-containing
products can be used
 No recommendation can be made regarding
attempts to salvage an umbilical catheter by
administering antibiotic treatment through
the catheter 16

17.  Do not use topical antibiotic ointment or creams
on umbilical catheter insertion sites because of
the potential to promote fungal infections and
antimicrobial resistance
 Add low-doses of heparin (0.25 to 1.0 U/ml) to the
fluid infused through umbilical arterial catheters
 Remove umbilical catheters as soon as possible
when no longer needed . Optimally, umbilical
artery catheters should not be left in place >5
days.
 Umbilical venous catheters should be removed as
soon as possible when no longer needed, but can
be used up to 14 days if managed aseptically.
17

18. Injection Safety
• Safe injection practices are recommended,
These include use of single-dose vials
rather than multidose vials, especially
when medication will be administered to
multiple patients , If multidose vials must
be used, should be using aseptic
technique.
 Avoid transferring medications from one
container to another for ease of
administration, 18

19. Reduction of Risk from Blood Transfusions
 Blood products should be used with
caution and with consideration of risks
and benefits. In many countries, blood
donors are routinely screened for HBV,
HCV, HIV, HTLV-1, HTLV- 11, and syphilis.
 Cellular blood components for LBW infants
should be obtained from
CMV-seronegative donors or
treated to remove CMV.
19

20. Ventilator-associated pneumonia (VAP)
:
That develops in patients who have
been intubated and have received
mechanical ventilation for at least
48 hours
20

21. Practices are Necessary in Prevention of
VAP
 Ventilator circuits should not be changed routinely
 Periodically drain and discard any condensate that
collects in the tubing of a mechanical ventilator
 Use sterile water to fill bubbling humidifiers
 No clear recommendation is available regarding
use of heat-and-moisture exchangers or heated
humidifiers
 Respiratory filters should not be used routinely.
Use filters in patients with suspected or confirmed
pulmonary TB
21

22. PRECAUTIONS FOR PREVENTION OF
ASPIRATION
 Use of noninvasive ventilation, when possible
 Perform orotracheal intubation unless
contraindicated
 The head of the bed should be elevated at an
angle of 30 to 45 degrees
 Oropharyngeal cleaning and decontamination
should be performed with an aseptic agent
 Stress ulcer prophylaxis may be provided with
proton-pump inhibitors
22

23. The Best Methods To Reduce The Incidence
of CAUTis
 Avoid unnecessary urinary catheters
 Insert urinary catheters using aseptic
techniques
 Maintain urinary catheters based on
recommended guidelines
 Review catheter necessity daily and
remove promptly
23

24. Prevention of Transmission of
Microorganisms from Newborns:
Routine Procedures
 Current guidelines for isolation
precautions recommend certain basic
practices for the care of all patients
 Hand Hygiene
 Gowns , Gloves
 Masks and Protective Eyewear
 Disinfection of Equipment between
Patients
24

25. Isolation Strategies
 Isolation strategies in the nursery are
determined by the mode of transmission of
the pathogen(airborne, droplet, or contact).
 It is not necessary to place a newborn
requiring Transmission-based Precautions
in a single room if:
1. The infection is not airborne
2. There is sufficient space area between
newborn stations
25

26. Isolation Strategies
3. There are adequate numbers of
nursing with sufficient time for
appropriate hand hygiene.
4. There is an adequate number of sinks
for hand hygiene.
5. Continuing instruction is given
to personnel about the mode of
transmission of infections
26

27. Prevention of Transmission from the
Mother with Infection
 Transmission of infection from mother to
newborn usually occurs during delivery,
and postpartum separation of mother and
newborn is rarely indicated.
 Most maternal postpartum infections are
urinary or gynecological, caused by
endogenous flora, and not transmissible
with basic hygienic measures.
 A mother with a communicable infection
should wash her hands before handling her
infant
27

28. Prevention of Transmission from Visitors
 Each nursery should develop a clearly
defined visiting policy that allows
family members to visit while
minimizing risk to the infants .
 Visitors can introduce communicable
diseases such as varicella, pertussis, or
RSV into a nursery, with potentially
serious results.
28

29. Prevention of Transmission from the
Inanimate Environment
 The nursery should be kept clean and dust
free. Floors, work surfaces, and other
horizontal surfaces should be cleaned
daily with an Environmental hospital
disinfectant, Walls, and window blinds
should be cleaned sufficiently often to
prevent accumulation of dust. Cleaning
methods used should minimize dust
 In addition to cleaning and disinfection
between patients .
29

30. Enhancement of Neonatal Defenses
 Active Immunization
o Failure to vaccinate newborns who will
have prolonged hospitalization places them
at risk if in hospital exposure occurs.
o Newborns in hospital should receive
diphtheria, tetanus, acellular pertussis,
inactivated polio, H. influenzae type b
conjugate, and pneumococcal conjugate
vac. at 2 mon. of age
o Newborns born to mothers who are
HBsAg positive should receive HBV vaccine
at birth regardless of gestational age
 Postexposure prophylaxis is 30

31. Immunotherapeutic Agents
 Intravenous administration of gamma
globulin has not had reliable efficacy in
preventing infections in premature
newborns.
 Immunoglobulin with high antibody titer
to RSV and monoclonal anti-RSV antibody
are protective against RSV disease and are
recommended for selected high-risk infants
 Neutrophil transfusions are not
a practical prophylactic intervention
31

32. Prevention of Transmission to and from
Personnel
 An immunization history should be obtained
before employment.
 Personnel should be immune to rubella,
measles, mumps, varicella, and HBV; should
have received a dose of acellular pertussis
vaccine; and should receive influenza vaccine
annually.
• Tuberculin reactivity should be determined on
employment
• Employees should be informed about the risks
of transmission of communicable infections to
newborns and instructed to report acute
infections. 32

33. Monitoring Occurrence of Healthcare-
associated Infections
 Surveillance for neonatal HAIs is a
monitor of quality of care and early
detection of infection & to be monitored
infection rate .
 An outbreak investigation should be
undertaken when there is a significant
increase in the rate of infection at a
certain body site or with a particular
microbe
33

34. Surveillance Cultures
 Recommendations for routine use of
surveillance cultures targeting specific
antimicrobial resistant pathogens have
increased recently
 Surveillance cultures may be useful in
identifying colonization of infants for
implementation of Transmission-based
Precautions to reduce transmission
of these organisms in a closed environment
(e.g., newborn nursery, SCBU, or NICU).
34

35. The CDC's & National Healthcare Safety
Network (NHSN)
 stratifies data by birth-weight groups,
using birth weight as a marker for
severity of underlying illness. Data are
also stratified by NICU level of care.
 Infection rates vary by device type and
(device days).
 Data are collected for (CLABSI), (VAP)
and (CAUTI).
35

36. Surveillance for the newborn nursery
Mortality rate Death Admission
36
may be appropriate if devices are not
involved.

37. Surveillance for NICU
 where infection risk is related to length of stay,
infection per 1,000 patient-days is a more
relevant denominator
37
>2500 g 1501-2500
g
1001-1500
g
751-1000 g < 750 g
Admissio
n
Death
Mortality
Length of
stay
 For device-associated infections, days of
device use should be used. (CABSI , VAP ,
CAUTI)

38. A study on the knowledge of the workers in
the nursery sections
Hand
Hygiene
Injection
Safety
Aseptic Technique
Ventilators Associated
Pneum
onia
Personal ProtectiveEquipm
ent
Cleaning &
Disinfectant
Isolation
Neonate
Antiseptic &
disinfectant
Laundry
Occupational Health
and
Safety
Environm
ental Cleaning
0
20
40
60
80
100 75 74 71 57 54 49 44 43 42 41 38 38
76 73 52 48 53 55 42 34 38 58 55 48
Avarege knowledge of Nurses & Doctors = 52%
Nurses n=50
Doctors n=15
38

39. Causes of Defect The Applications of
Infection Control Policies and Procedures
lack of knowledge
lack of communication
lack of resources'
lack of concepts (misconceptions)
lack of compliance
lack of rewarding system
Lack of Surveillance & control
39

40. Conclusions
Neonates are at high risk of acquiring of infections
in the hospital environment
.
Risk can be reduced by appropriate infection
prevention measures
 Provide annual training and education for
infection control polices and procedure.
 Provide a suitable place for the nursery
Department
 Regular observation and surveillance
 Provide resources and supply
 Increase number of nurse , and prevent of
evening - night shift
 Follow-up and supervision of the antibiotic use
40

41. 41