Healthcare associated infections in the NICU

Nosocomial infections are a growing problem in the neonatal intensive care unit (NICU) along with methicillin-resistant Staph aureus (MRSA), vancomycin-resistant enterococci, multidrug- resistant gram negative organisms, Candida and respiratory virii.

“All infections acquired in the NICU are hospital-associated, said Robert Baltimore, MD, Yale University School of Medicine. They all share common risk factors.” “Intravascular access devices are the number one association with infection in the NICU,” said Baltimore. Other risk factors include low birth weight, premature birth, length of NICU stay and antimicrobial exposure. One of the most common MRSA strains is USA-300, adds Patricia Ferrieri, MD, University of Minnesota, Minneapolis. “What began as a community associated MRSA is now found in hospitals around the world.” Group B Streptococci are another common cause of NICU infections.

“Regardless of the organism, control measures include the identification and isolation of the index case and surveillance of infants who shared a room or equipment with the index patient, Dr. Ferrieri said.” Surveillance includes mucosal cultures, antimicrobial susceptibility testing, and genetic typing to identify shared strains. Surveillance of health care workers may also help identify the route of transmission.

Credit antibiotic use for much of the increase in NICU infections. Up to 70% of neonates in the NICU get antimicrobials, noted Denise Bratcher, DO, University of Missouri-Kansas City School of Medicine. Hand hygiene remains the single most important control method, but additional measures are needed. Environmental cultures are particularly important in stopping gram negative outbreaks, Bratcher said. It is not uncommon to find environmental sources such as shared electronic thermometers, monitor leads, pulse oximeters, even swings.

On the treatment side, she advised targeting likely or known pathogens rather than using broad spectrum antimicrobials.