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Pathophysiology
Factors predisposing NICU infants to nosocomial infections include each of the following:
1. Immaturity of humoral and cellular immune defense mechanisms
2. Breach of natural mucous membrane and skin barrier defense barriers
3. Instrumentation with foreign bodies (endotracheal tubes, intravascular catheters)
4. Alteration of "normal" flora through antimicrobial pressure (frequent use of empiric antibiotics)
5. Overgrowth of Candida spp. Promoted by use of steroids and broad spectrum antibiotics
6. High census, crowding, suboptimal nurse: patient ratios that promote transmission of nosocomial organism from one infant to another through poor hand washing
7. Environmental contamination
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 to all body fluids and excretions, non-intact skin and mucous membranes. The following techniques are included:
Hand washing (whether or nosocomial infections, hospital-acquired infections not gloves are worn)
Gloves should be worn when touching blood, body fluids, and items contaminated with these fluids.
Masks, eye protection and face shields if eyes, nose, and mouth are likely to be sprayed during patient care activities
Non-sterile gowns during procedures
Patient care equipment should be handled in a manner that 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:
1. Personnel and patients who have been exposed and are susceptible to varicella should be identified.
2. Varicella-zoster immune globulin (VZIG) should be administered to
D. Candidates for VZIG after a significant exposure has occurred include:
1. Immunocompromised children without history of chickenpox (including HIV-infected)
2. Susceptible, pregnant women.
3. Newborn infants whose mothers had onset of varicella within the 5 days before or within 48 hours after