Effective Strategies for the Prevention of Nosocomial Sepsis in Extremely Premature Infants

Yun Sil Chang

doi:10.7599/hmr.2009.29.4.354

Journal List > Hanyang Med Rev > v.29(4) > 1044033

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chang: Effective Strategies for the Prevention of Nosocomial Sepsis in Extremely Premature Infants

Review Article

Hanyang Medical Reviews 2009; 29(4): 354-361.

Published online: 30 November 2009

DOI: https://doi.org/10.7599/hmr.2009.29.4.354

Effective Strategies for the Prevention of Nosocomial Sepsis in Extremely Premature Infants

Yun Sil Chang, M.D., Ph.D.

Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (yschang@skku.edu)

Received 31 August 2009 Accepted 20 September 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nosocomial sepsis or late onset sepsis is among the leading causes of mortality and morbidity in extremely low birth weight infants hospitalized to neonatal intensive care units (NICU). Prevention of nosocomial sepsis is based on strategies that aim to limit susceptibility to infections by enhancing functional maturities, and ameliorating extrinsic risk factors by limiting transmission of organisms and by promoting the judicious use of antimicrobials. Several clinical strategies which are available include; hand hygiene practices; prevention of central venous catheter-related septicemia; judicious use of therapeutic or prophylactic antimicrobials; proper skin care; and early trophic enteral feeding with human milk. The implementation of these proper clinical strategies and maintaining of surveillance system in individual NICU for prevention of nosocomial infection is quite effective and important to reduce the incidence of noscomial sepsis of extremely premature infants and ultimately to improve their survival and quality of life.

Keywords: Sepsis, Extremely low birth weight (ELBW), Nosocomial, Prevention, Neonate

Figures and Tables

Fig. 1

Maintenance of maximal barrier precautions for performing central venous catheterization in neonatal intensive care unit include; setting the sterile field with large drape; and wearing of sterile gown and glove with mask and hat.

Fig. 2

Aseptic maintenance of hubs and stopcocks of central catheter with their putting on sterile green drape aside extremely premature infant within incubator.

References

1. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004; 292:2357–2365.

2. Adams-Chapman I, Stoll BJ. Prevention of nosocomial infections in the neonatal intensive care unit. Curr Opin Pediatr. 2002; 14:157–164.

3. Auriti C, Maccallini A, Di Liso G, Di Ciommo V, Ronchetti MP, Orzalesi M. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect. 2003; 53:25–30.

4. Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1996; 98:357–361.

5. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA, Levine GL, Stover BH, Siegel JD, Jarvis WR. Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey. J Pediatr. 2001; 139:821–827.

6. Golombek SG, Rohan AJ, Parvez B, Salice AL, LaGamma EF. "Proactive" management of percutaneously inserted central catheters results in decreased incidence of infection in the ELBW population. J Perinatol. 2002; 22:209–213.

7. Schwab F, Geffers C, Barwolff S, Ruden H, Gastmeier P. Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J Hosp Infect. 2007; 65:319–325.

8. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, Fanaroff AA, Lemons JA, Donovan EF, Oh W, Stevenson DK, Ehrenkranz RA, Papile LA, Verter J, Wright LL. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1996; 129:63–71.

9. Beck-Sague CM, Azimi P, Fonseca SN, Baltimore RS, Powell DA, Bland LA, Arduino MJ, McAllister SK, Huberman RS, Sinkowitz RL, et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J. 1994; 13:1110–1116.

10. Johnson-Robbins LA, el-Mohandes AE, Simmens SJ, Keiser JF. a characterization of risk associations in infants <1,000 g. Biol Neonate. 1996; 69:249–256.

11. Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B. Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics. 2002; 109:34–39.

12. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W, Bauer CR, Korones SB, Shankaran S, Laptook AR, Stevenson DK, Papile LA, Poole WK. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002; 110:285–291.

13. Saiman L. Strategies for prevention of nosocomial sepsis in the neonatal intensive care unit. Curr Opin Pediatr. 2006; 18:101–106.

14. Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev. 2004; 17:638–680. table of contents.

15. Shah SS, Ehrenkranz RA, Gallagher PG. Increasing incidence of gram-negative rod bacteremia in a newborn intensive care unit. Pediatr Infect Dis J. 1999; 18:591–595.

16. Hwang JH, Choi CW, Chang YS, Choe YH, Park WS, Shin SM, Lee M, Lee SI. The efficacy of clinical strategies to reduce nosocomial sepsis in extremely low birth weight infants. J Korean Med Sci. 2005; 20:177–181.

17. Kim BL, Whang JH, Kang CK, Sim JW, Kim SS, Chang YS, Park WS, Choi ES. The changes of incidence of nosocomial sepsis, and risk factors in extremely low birth weight infants. J Korean Soc Neonatol. 2002; 9:12–20.

18. Haas JP, Larson EL. Measurement of compliance with hand hygiene. J Hosp Infect. 2007; 66:6–14.

19. Pittet D, Boyce JM. Revolutionising hand hygiene in health-care settings: guidelines revisited. Lancet Infect Dis. 2003; 3:269–270.

20. Freeman J, Goldmann DA, Smith NE, Sidebottom DG, Epstein MF, Platt R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med. 1990; 323:301–308.

21. Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK Jr. Prevention and treatment of nosocomial sepsis in the NICU. J Perinatol. 2004; 24:446–453.

22. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. The Hospital Infection Control Practices Advisory Committee. Center for Disease Control and Prevention, U.S. Guidelines for the prevention of intravascular catheter-related infections. Pediatrics. 2002; 110:e51.

23. Aly H, Herson V, Duncan A, Herr J, Bender J, Patel K, El-Mohandes AA. Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics. 2005; 115:1513–1518.

24. Kilbride HW, Wirtschafter DD, Powers RJ, Sheehan MB. Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics. 2003; 111:e519–e533.

25. Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M, Fisher RG, Alexander KA. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics. 2001; 107:1272–1276.

26. Karlowicz MG, Hashimoto LN, Kelly RE Jr, Buescher ES. Should central venous catheters be removed as soon as candidemia is detected in neonates? Pediatrics. 2000; 106:E63.

27. Isaacs D. Unnatural selection: reducing antibiotic resistance in neonatal units. Arch Dis Child Fetal Neonatal Ed. 2006; 91:F72–F74.

28. Chang YS, Kim YJ, Koo SH, Lee JH, Hwang JH, Choi CW, Shim JW, Kim SS, Ko SY, Lee EK, Park WS. Outcomes and management of fetal infats with birth weight bleow 500 g at a teritiary center. Korean J Pediatr. 2005; 48:939–945.

29. Park SE, Jeon GW, Choi CW, Hwang JH, Koo SH, Kim YJ, Lee CH, Chang YS, Park WS. Evaluation of perinatal and management factors associated with improved survival in extremely low birth weight infants. Korean J Pediatr. 2005; 48:1324–1329.

30. Calil R, Marba ST, von Nowakonski A, Tresoldi AT. Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins. Am J Infect Control. 2001; 29:133–138.

31. Craft AP, Finer NN, Barrington KJ. Vancomycin for prophylaxis against sepsis in preterm neonates. Cochrane Database Syst Rev. 2000; CD001971.

32. Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, Tridapalli E, Corona G, Giovannozzi C, Farina D, Arisio R, Merletti F, Maule M, Mosca F, Pedicino R, Stronati M, Mostert M, Gomirato G. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007; 356:2483–2495.

33. Faix RG. Prophylactic fluconazole decreases incidence of invasive candidiasis in preterm infants. J Pediatr. 2007; 151:553–554.

34. Ohlsson A, Lacy JB. Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants. Cochrane Database Syst Rev. 2004; CD000361.

35. Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, Alam MA, Black RE, Santosham M. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005; 365:1039–1045.

36. Conner JM, Soll RF, Edwards WH. Topical ointment for preventing infection in preterm infants. Cochrane Database Syst Rev. 2004; CD001150.

37. Hylander MA, Strobino DM, Dhanireddy R. Human milk feedings and infection among very low birth weight infants. Pediatrics. 1998; 102:E38.

38. Flidel-Rimon O, Friedman S, Lev E, Juster-Reicher A, Amitay M, Shinwell ES. Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004; 89:F289–F292.

39. Lee HY, Lee GY, Kim MJ, Jeon GW, Shim JW, Chang YS, Park WS. The effect of early enteral trophic feeding within 24 hours after birth in extremely low birth weight infants of 26 weeks and less, and birth weight below 1000 g. J Korean Soc Neonatol. 2007; 14:59–65.

40. Bin-Nun A, Bromiker R, Wilschanski M, Kaplan M, Rudensky B, Caplan M, Hammerman C. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr. 2005; 147:192–196.

41. Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Biol Neonate. 2002; 82:103–108.

42. Lin HC, Su BH, Chen AC, Lin TW, Tsai CH, Yeh TF, Oh W. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2005; 115:1–4.

43. Bell EF. Preventing necrotizing enterocolitis: what works and how safe? Pediatrics. 2005; 115:173–174.

44. Alfaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2008; CD005496.

45. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, Verter J, Temprosa M, Wright LL, Ehrenkranz RA, Fanaroff AA, Stark A, Carlo W, Tyson JE, Donovan EF, Shankaran S, Stevenson DK. NICHD Neonatal Research Network. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. Pediatrics. 2001; 107:E1.

46. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, Tyson JE, Poole WK. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007; 196:147.e1–147.e8.

47. Kim JK, Seo HJ, Park SK, Jung YJ, Choi SH, Chang YS, Park WS. The changes in incidence and pathogens of late onset sepsis in extremely low birth weight infants. In : The 58th Annual Fall Meeting of Korean Pediatrics Society; 2008. p. 468A.

48. Jeon GW, Park SE, Choi CW, Hwang JH, Chang YS, Park WS. The effects of early enteral feeding in extremely low birth-weight infants. Korean J Pediatr. 2005; 48:711–715.

49. Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP, Schlosser J, Martone WJ. Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership. JAMA. 1996; 275:234–240.

TOOLS

Similar articles