Nicu Nosocomial Infections Preventing Nicu Nosocomial Infections

NICU Nosocomial Infections

Preventing NICU Nosocomial Infections

Rhine (2006) writes an editorial to appeal to clinicians staffing neonatal intensive care units (NICUs) to increase their awareness of patient safety measures because a large number of studies have shown that educating and training clinicians on how to prevent nosocomial infections (NI) can have a significant positive impact on patient outcomes. The author was motivated to write this editorial because of the findings from a NICU study completed at the University of Alabama in Birmingham (UAB). The main findings of this study were clinician education, especially concerning hand hygiene, together with NICU culture, can significantly reduce NIs in the NICU over the long-term.

The UAB NICU intervention capturing the attention of Rhine (2006) involved a number of steps, but it was unclear which ones were individually the most effective. The author admits this, while at the same time suggesting that a systematic intervention which changes NICU culture could have a greater benefit that any single safety measure. The interventions considered most important by the author can be inferred from the order in which they were presented in the editorial: (1) hand hygiene, (2) NICU patient safety culture, (3) environmental hygiene, (4) improved catheter insertion and maintenance techniques, and (5) breastfeeding/antibiotic use.

The first claim is supported by the generally accepted principle that proper hand hygiene reduces the risk of microbial transfers to and from patients (Rhine, 2006). The author describes the patient zone as a boundary across which passage should be accompanied by the use of alcohol-based foams and gels. The second claim is supported by the author's personal experience staffing the Stanford University NICU, together with the UAB NICU findings, which suggest NICU cultural norms can have a significant impact on patient outcomes. For example, empowering nurses to intervene when patient safety is being unnecessarily risked, even by a senior physician, sends a message that patient safety takes precedent over reputation, rank, and fragile egos. When implemented in the right spirit all stakeholders, especially nursing staff, become students and teachers in a collaborative effort to reduce NICU NIs. If parents are likewise invited to participate in enforcing hand hygiene the overall effect is to create a culture where all stakeholders become invested in preventing NICU NIs.

The third claim is supported by a number of research studies that have revealed clinicians are frequently ignorant of environmental hygiene issues (Rhine, 2006). One example given by the author was a survey result revealing that stethoscopes were rarely, if ever, cleaned by 45% of the clinicians at one emergency department. The classic 'white coat' can also be a significant source of microbes if not laundered daily. The fourth claim is supported by the UAB findings which revealed that daily surveillance for NI can inform clinicians whether infections are occurring during catheter insertion or maintenance, thereby helping clinicians improve their technique. The fifth claim is supported by several studies that suggest breast feeding allows the mother to create antibodies against microbes resident on the infant and then pass these immune agents to the infant through breast milk. Antibiotic use is also terminated in the absence of infections, thereby fostering protection by the infant's commensal flora.