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Nosocomial Infections

Pathophysiology

Factors predisposing NICU infants to nosocomial infections include each of the following:

B. Universal precautions have been renamed "standard precautions," because these precautions are recommended for all patients to protect health care workers from infectious body fluids. These apply nosocomial infections, hospital-acquired infections to all body fluids, Nosocomial Infections Hospital-acquired Infections secretions, and nosocomial infections, hospital-acquired infections excretions, non-intact skin and mucous membranes. The following techniques Nosocomial Infections Hospital-acquired Infections are included:

Hand washing (whether or nosocomial infections, hospital-acquired infections not gloves are worn)

Gloves should be worn when touching blood, body fluids, Nosocomial Infections Hospital-acquired Infections secretions, excretions, and items contaminated with these fluids.

Masks, eye protection and face shields if eyes, nose, and mouth Nosocomial Infections Hospital-acquired Infections are likely to be sprayed during patient care activities

Non-sterile gowns during procedures

Patient care equipment should be handled in a manner that Nosocomial Infections Hospital-acquired Infections prevents skin and mucous membrane exposures and contamination of clothing

Blood-borne pathogen exposure should be avoided

Mouthpieces, resuscitation bags, and other ventilation devices should be available (no mouth to mouth)

Appropriate precautions for MRSA infections include:

Isolation in a separate room (private room or isolation unit)

Contact precautions to control transmission which includes (1) gloves at all times, (2) hand washing with an antimicrobial agent after glove removal, (3) gowns at all times

Contact transmission, the most important and frequent route of transmission in nosocomial infections, has two modes: direct and indirect

Airborne precautions are used for M. tuberculosis, rubeola and varicella including:

Private room

Negative air-pressure ventilation (minimum: 6 changes per hour)

Masks at all times

Respirator masks for pulmonary tuberculosis

Droplet precautions should be used when organisms from infected person (sneezing, coughing) are propelled a short distance and deposited on health care worker's mucosa (eg, N. meningitidis, diphtheria, pertussis, respiratory viruses, rubella, streptococcal pharyngitis or scarlet fever). Specific precautions to be used are:

Private room (preferred)

Use of a mask if within 3 feet of patient

Strategies for controlling the outbreak would be to encourage the following:

Adherence to hand washing policy and other contact precautions

Minimize number of persons with access to infected patients

Surveillance of all NICU infants for MRSA infection

Isolation of MRSA infected infants

Cohorting of admissions into "clean" areas

Dedicate specific health-care workers to provide one-on-one care for infected infants

Educate all personnel caring for NICU patients as to the importance of control measures for MRSA

Ensure sufficient space between infant beds (4 to 6 ft)

Diminish census and optimize nurse:infant ratios

Monitor compliance with control measures

Varicella Exposure

Infection Control

A. Employee illnesses that preclude work include conjunctivitis, diarrhea and vesicular rashes.

B. All pediatric health care workers should be screened by history and/or serologic testing to document their immune status to specific infectious agents. Vaccination should be provided for all employees who are nonimmune to specific agents and who do not have contraindications to receiving a specific vaccine. These infectious agents are d

C. The following control measures are recommended after inadvertent nosocomial exposure to a health care worker infected with varicella:

D. Candidates for VZIG after a significant exposure has occurred include: