Neonatal Infection Prevention & Control
- before and after each contact w/ a patient remains
Objective
- know basic neonatal infection prevention
and control
Maternal Immunization and Antenatal Prophylaxis
- neonates have immature immune system
- mmunization of the mother against vaccine-
preventable diseases protects the infant by passive
immunity w/ transplacental transfer of Abs at least
st
during the 1 months of life
- certain congenital conditions are also prevented by
immunization of women of childbearing age (note: live
virus vaccines like MMR and varicella are
contraindicated during pregnancy)
- tetanus toxoid, tetanus-diphtheria toxoid (Td) or
tetanus-diphtheria-acellular pertussis (Tdap) vaccines
are given IM and protect the mother and baby
- vaccinations that can be administered safely
during pregnancy and may be beneficial: influenza
(if > 14wks AOG), hepatitis A and B, pneumococcal
- maternal treatment w/ intrapartum IV antibiotics for the
prevention of group B streptococcal infections has
been proven to decrease the incidence of early-onset
neonatal sepsis
- Revised Management Guidelines (from US CDC
and Prevention in 2010) identified the following
situations that warrant maternal intrapartum IV
Penicillin (preferred), Ampicillin/Cefazolin at least 4
hours prior to delivery of the infant:
1. (+) antenatal rectovaginal cultures or
molecular test at admission for GBS (except
for women who would undergo CS w/o labor
or rupture of amniotic membranes
2. Unknown maternal colonization status < 37
weeks AOG, rupture of membranes > 18
hours, maternal temperature >38 C
3. GBS bacteriuria during current pregnancy
4. Previous infant w/ invasive GBS disease
(sepsis, pneumonia, meningitis)
Infection Control in the NICU
- Revised Systems of Precautions for Preventing
Transmission of Hospital Infections- categorizing
infection control precautions as standard or
transmission-based
- all obstetric and NICU staff as well as other persons
who have significant contact w/ NBs should be free of
transmissible infectious dse personnel should not
move between or from other areas of the hospital
- persons caring for mothers and NBs should be
immunized against MMR, VZ, hepatitis B, DPT and
influenza
- screen staff for TB and contact w/ the patient must be
restricted for personnel w/ active TB until adequate
treatment is initiated and non-infective status is verified
- healthcare workers who have mucosal and
percutaneous exposure to blood-borne pathogens
(hepatitis B, HIV) must undergo post-exposure
evaluation and follow-up examinations
- neonatal care units should have a defined program for
cleaning, sterilization and disinfection of patient care
areas, equipment and supplies
- co-bedding have potential benefits in thermoregulation
but put 1 sibling at exposure risk if the other sibling is
infected
- parents and healthcare workers may serve as vectors
in infection transmission
- other measures that reduce infection rate:
§ breastfeeding
§ shorter duration of invasive indwelling foreign
bodies
§ judicious use of antibiotics
§ safe injection practices
§ aseptic preparation and delivery of IV
solutions
*Standard Precautions
- should be used consistently for all patients
regardless of the diagnosis or suspected/confirmed
infection status recognizing the importance of all
body fluids and contaminated items in the
transmission of health care-associated infections
(proper hand hygiene and PPEs)
*Hand Hygiene
the single most important routine practice in the
control of infection
- alcohol-based hand rubs should not be used when
hands are visibly soiled w/ blood or other
proteinaceous materials or if exposure to bacterial
spores has likely occurred
- bactericidal agents most useful for handwashing in
the NICUs: 4% chlorhexidine gluconate, iodophor
preparations (active against a broad sprectrum of G
(+) and G (-) organisms)
- Hexachlorophene-based preparations may be
useful during outbreaks of Staphylococcus aureus
infections but are not recommended for routine
handwashing
- 5 Moments of Hand Hygiene (as part of WHO’s
“Clean Care is Safer Care” campaign by defining
the key moments for hand hygiene interwoven in
the natural workflow of care and expressed in a
simple, easy-to-learn and logical manner)
- 5 Moments of Hand Hygiene One should
practice hand hygiene…
1. before touching a patient
2. before performing a clean or aseptic
procedure
3. after body fluid exposure risk
4. after touching a patient
5. after touching a patient’s surroundings
- transmission-based precautions are
intended specifically for patients w/
suspected or documented infection or
colonization w/ pathogens that are
highly transmissible or
epidemiologically significant requiring
stricter precautions than the standard
ones
3 Categories of Precautions
1. Airborne Precautions
- designed to prevent dissemination of either
airborne droplet nuclei (particle residue < 5 um of
evaporated droplets containing microorganisms
that remain suspended in the air for long periods)
or dust particles containing infectious spores or
agents
- single patient room w/ (-) pressure ventilation w/
air exhausted to the outside
- use of masks (at least N95 for infectious PTB) by
susceptible healthcare workers
- infections requiring airborne isolation: measles,
varicella, TB
- neonates are usually ineffective disseminators of
infectious bacterial or viral aerosols
- neonates are usually ineffective disseminators of
bacterial or viral aerosols
- neonates w/ documented or suspected viral
infection that canspread by airborne transmission
should be separated from other neonates by:
1. transferring them from the neonatal unit
into a private room
2. rooming-in w/ the mother
3. enclosing of all the other neonates in the
area into incubators
2. Droplet Precautions
- intended to prevent the transmission of infectious
agents from large particle droplets that do not
remain suspended in the air
- sneezing, coughing, talking and during certain
procedures like suctioning and direct
laryngoscopy
- isolation in a private room is recommended for
cohort patients w/ the same infection w/ at least 3
feet of separation
- susceptible healthcare workers should wear
surgical masks on entry into the room or when
working w/in 3 feet of the patient
- infectious agents requiring droplet
precaution:
§ pertussis, rubella, mumps,
parvovirus B19,respiratory viruses,
bacterial meningitides
 3. Contact Precautions
- designed to the reduce the risk of transmission of
infections either by direct contact w/ the body
surface or indirectly by exposure to contaminated
intermediate objects
- isolation in a private room or by cohorting, clean
non-sterile gloves and gowns should be worn at
all times especially during direct contact w/ the
patient, environmental surfaces or items in the
patient’s room
- infections w/c require contact isolation:
§ MDR bacteria
§ RSV
§ Rotavirus
§ Other causes of gastroenteritis
§ Cutaneous herpes infections
Neonatal Immunization
- immunizations against TB and Hepatitis B should be
given soon after birth
6
- BCG vaccine (2-8 x 10 CFU/ml of live attenuated M.
bovis): 0.5ml via the intradermal route
- recombinant Hepatitis B surface Ag vaccine: 0.5ml
st
IM on the anterolateral thigh w/in the 1 12 hours
regardless of maternal immunization status
note: birth dose is proven to be effective in
decreasing the risk of developing chronic
Hepatitis B infection from perinatal
transmission from mothers who are chronic
Hepatitis B virus carriers, even if the Hepatitis
B Ig could not be administered w/in 12 hours
from birtj
note: If a PT infant weighing < 2kg was given
st
the 1 dose, the dose is not counted towards
the completion of the immunization series
and 3 additional doses is needed
- inactivated form of Polio vaccine rather than the oral
form should be given while infant is still at the NICU
- PT infants should be vaccinated based on their
chronologic age