Reducing Staphylococcus Aureus Infection in the Neonatal Intensive Care Unit

Introduction:

The first Staphylococcus aureus infection outbreak in hospitals was in the late 1800s. The rates of Staphylococcus aureus infections are highly seen in neonates, commonly in low birth weight infants and preterm infants. Numerous outbreaks have been reported in neonatal intensive care units (NICUs) concerning Methicillin-resistant Staphylococcus aureus (MRSA) infections. More than 33,000 hospital-associated infections are reported in NICUs in the United States every year.

How Does Staphylococcus Infection Spread?

The hospital-associated infections (HAIs) are responsible for mortality and morbidity in hospitalized neonates. In addition, low birth weight infants and preterm neonates have an increased risk of infection susceptibility because of their immature immune systems and increased length of hospital stay.

What Are the Consequences of Staphylococcus Infection in NICU?

Neonatal infections can have long-term effects. It includes poor neurodevelopment and growth outcomes, even with the proper therapy. S. aureus infection can spread from persons, things in the environment, or during labor or after birth, colonizing newborns asymptomatically.

What Are the Measures and Steps for the Prevention and Control of Infection in NICU?

There is an increased risk of Staphylococcus aureus infection in neonates who acquire S. aureus colonization. The main aim is to prevent and control S. aureus transmission in NICUs. Despite different infection control strategies and measures, S. aureus remains a threat to neonates. Further steps for prevention and infection control in NICU include:

Infection Control Step 1: Prevent Entry of Microbes into the NICU

• Cleaning Immediate Environment - Newborn skin can be colonized by the organisms from the resuscitation room, labor room, and maternal vaginal flora. Methods to prevent this include cleaning the perineum, cleaning the delivery surface, cleaning cord and cord care, using clean instruments, and ensuring that nothing unclean is introduced into the vagina. The equipment used should be autoclaved and cleaned regularly.

• NICU Design: The NICU should have controlled access with a minimum distance of four feet between two infant beds. An airborne infection isolation room and a hand-free washing station should be available, and an area for storage of clean material near the room's entrance should be provided. Infant beds should be at a distance of 20 feet from the hand washing station. The hand-washing sink should be large enough to control the water splashing. Hand-washing guidelines and instructions must be provided. In addition, enough space should be provided for soap and towel dispensers.

• Hand Hygiene:

1. 1. Washing hands for 20 seconds before and after contact with patients.
   2. Wash hands for 40 to 60 seconds before entering the NICU.
   3. Remove all the accessories before washing hands.
   4. Follow the step-by-step hand-washing guide.

• Using Alcohol-Based Hand Rubs: Alcohol-based hand rubs are proven more effective than standard ones. Around 2 to 3 ml (milliliter) of hand rub must be applied over the surface of palms and fingers.

• Rules for Visitors: Microbes enter the NICU through the persons who visit NICU, so the entry restriction is a must. Sick people and children should not be allowed in the NICU. Infected infants should be kept in an isolation room. Cell phones should be restricted.

• Jewelry and Fingernails Policy: Healthcare workers should not wear artificial nails and jewelry. Instead, natural nails should be kept short.

• Gowning to Reduce Nosocomial Infections: There is a reduction in the rate of nosocomial infection observed during the gowning period compared to the non-gowning period.

Infection Control Step 2: Prevention of Proliferation of Microbes In the NICU

In the NICU proliferation of microbes can be prevented by maintaining a good housekeeping routine. Wet areas must be avoided in the NICU as dry places are unlikely to harbor microbes.

Infection Control Step 3:

• Nurse-to-Patient Ratio - All the NICU units should have many neonatal nurses. The recommended ratios are 1:1, 1:2, and 1:3.

• Use Disposables - Make use of disposable materials. There must be a separate syringe and medication for each baby. Pens or X-ray films must not be kept near the baby, and a new catheter and needle must be used each time.

• Use Laminar Flow System for Drugs, Fluids, and TPN Preparation - Use a laminar flow system as fluids decrease the local complication rate.

Infection Control Step 4:

Cord Care: Practice clean cord care as this can prevent cord infections.

Skin Care: Prevent skin injury by applying less adhesive tape and taking precautions during adhesive removal. Bathing can be avoided and instead, sponging can be tried.

Precautions During Procedure:

• Starting the procedure with hand scrubbing.

• Cleaning the skin with betadine and spirit.

• Wear disposable gloves.

Precautions During Handling of Catheters: Educating and training healthcare workers is essential, along with following all the guidelines step by step.

Precautions During Endotracheal Intubation and Suction - Wearing a mask, surgical scrub, gown, and gloves is required. Following all the guidelines is necessary during endotracheal intubation and suction.

Infection Control Step 5:

Infection control methods must be followed while breastmilk feeding or preparation of formula milk. The importance of breastfeeding and the promotion of its benefits to infants and young children should be made. In addition, the importance and use of colostrum must be encouraged.

Infection Control Step 6:

Early discharge may be associated with a reduction in infection rate.

Infection Control Step 7:

Decreasing the susceptibility of the baby to infection. Colostrum milk has proved to have a low incidence of nosocomial infections. However, for low-weight babies, antifungal prophylaxis is recommended.

Infection Control Step 8: Infection Control Protocols

The health care workers and others should cooperate and work together to reduce the risk of infections for staff and patients. The hospital should establish an infection control committee to use proper resources and measures to prevent infections. Training and education should be provided for all the staff and nurses.

Conclusion:

The mortality and morbidity of the neonate can be decreased by following strict infection control strategies and preventing the entry of microbes into the NICU. The risk of S. aureus infection increases in neonates with S. aureus colonization. The avoidance of illness in newborns who are at risk is the primary motivation behind attempts to stop and control S. aureus transmission in NICUs. Any newborn infection may result in long-term consequences, such as poor prognosis and detrimental long-term neurocognitive outcomes. NICU patients with MRSA, and occasionally MSSA, are decolonized in practice with the goal of halting the spread of invasive illnesses and avoiding further transmission.