Neonatal intensive care units (NICU) have in the past saved the lives of many babies who are born prematurely, with low birth weights or with different health conditions. Despite the survival chances created in the NICU, there are simultaneous risks especially as babies contained in the NICU have weak or immature body defenses. This is even made worse by illnesses that babies in NICU may have.
The definition of Nosocomial infections is not standardized (Sohn et al. 2001, p 15). However, there is a clear agreement amongst medics that nosocomial infections are infections that the baby may get from the mother during delivery, and which become part of the baby’s flora (Mayhall 2004, p. 851). The infections may occur at any body site and must be acquired during hospitalization (Newsby 2008, p 222). The Centre for disease control defines Nosocomial infections as diseases that occur three days or more after birth usually in a NICU setting. Other definitions however indicate that the infections happen 5 to 7 days after birth (Taeusch et al 2005, p. 578).
Nosocomial infections, unlike nosocomial sepsis, usually affect the urinary tract, the central nervous system and the blood stream. The former however is more of a blood stream infection (Clark et al 2004, p 24). However, not all infections transmitted from the mother to the child are classified as nosocomial infections. The likes of Herpes simplex Virus, Hemolytic streptococci, and the Hepatitis B virus are not considered nosocomial (Mayhall 2004, p. 851). Transmission of nosocomial infections is mainly through four common modes of transmission. The first is contact transmission, whereby the pathogens are passed to the neonates through direct contact with a contaminated person. The second mode of transmission is through common sources like medication, devices, blood or nutrition. The third form of transmission is through air, while the fourth and less common in NICU is transmission through vectors (Root et al 1999, p. 61)
Risk factors of nosocomial infections
Among the most prominent risk factors of nosocomial infections is premature births (Ozgunes et al, 2005). This is mainly because the baby is barely ready to face the environment outside its mother womb. In connection with this, the second risk factor is the under developed immune system, which is mainly as a result of the premature birth. A third risk factor is low antibody production by the baby. This in turn means that the baby’s body cannot produce enough anti-bodies necessary for immunity purposes. Fourthly, the baby suffers low cellular immunity which leads to inadequate barrier function of the body against infections (Harris 2007 p. 17).
Other risks factors are presented by invasive medical procedures such as surgery and invasive medical devices such as intravascular catheters or endotracheal tubes (Seifert et al, 2004, p. 518). They may also be caused by intravenous nutrition of parenteral nutrition. Other causes also include poor neonate handling, especially with unclean hands, overcrowding in the NICU thus making it even more possible for infections to spread and NICU staffing issues that may introduce invasive organisms in the nursery (Taeusch et al, 2005, p. 580, Bennet, 2007, p. 430). The longer an infant stays in NICU, the higher is the risk of getting a nosocomial infection.
According to Harris (2007, p. 9), 117 organisms have overtime been identified by medics as the main cause of nosocomial infections in NICU. The most common was the Coagulase-negative staphylococci, which accounted for 31.6 percent infections. The second most common organism was enteroccocci accounting for 10.3 percent of all infections. The Escherichia coli was third accounting for 8.5 percent of all NICU infections. In fourth place was pseudomonas aeruginosa accounting for 6.8 percent of all infections. Klebsiella pneumoniae, candida albicans and enterobacter cloacae all held fifth place with each accounting for 6 percent of all nosocomial infections in NICU (Harris, 2007, p. 9).
Incidence of nosocomial infection in NICU
Nosocomial infections are most commonly superficial (Taeusch et al 2005, p 580). They affect the skin, eyes or mouth and include infections such as abscesses, pustules, bullous impetigo and omphalitis (MCmillan et al, 2006, p. 532, Wood et al 2007, p 265, Visscher et al 2009, p 230). Epidemics such as diarrhea are uncommon although they cannot be completely ruled out. According to Taeusch et al (2005, p. 580) and Aly Et al, (2005, pp. 1513-1518), infections of the blood stream are the basis of the huge percentile of nosocomial infections in the NICU. Other cases involve the respiratory tract and the gastro-intestinal tract.
A study carried out in North Korea in 2006 to determine the incidence of nosocomial infections in the country revealed that 148 neonates out of the 218 admitted NICU patients had acquired infections during their stay in the NICU. 64.2 percent had single infection incidences, while 44.6 percent registered cumulative infection incidences (Jeong et al, 2006). In the United States, the incidences of Nosocomial infections were found to be more prevalent in neonates with very-low birth weights (Zafar et al 2001, pp. 1098-1104). It was also found that the wide use of antibiotics may be a predisposing factor to the infections (Clark et al, 2004, p. 382).
In Taiwan, a research carried out on 528 infants revealed that 11.4 percent of them had nosocomial infections. The prevalence rate in this country was put at 17.5 percent. Just like everywhere elsewhere, children with very-low birth weights were at more risk of contracting the nosocomial infections (Su et al 2009, pp. 190-195). In a 1994 study of the rate of incidence of nosocomial infection in Oakland, US, it was reported that 5 percent of surveillance cultures performed on neonates had blood stream nosocomial infections. As such, blood stream infections accounted for 50 percent of all nosocomial infections in the NICU. 3 percent of the neonates were also found to have lower-airway infections (Saene et al, p. 417).
Most common pathogen
Gram-negative organisms
The gram-negative organisms are pathogens that are a major cause of blood stream nosocomial infections (Taeusch et al, 2005, p. 583). They cause diseases such as meningitis and pneumonia. The gram-negative pathogens include strains such as Escherichia coli, pseudomonas, acinetobacter, serratia, salmonella spp, and haemophilus spp among others (p. 583). Neonates infected with neo-negative organisms are 3.5 times more likely to die from the infections that those infected with other forms of nosocomial infections.
Fungal infection
Fungal infection is responsible for an approximated 12 percent of nosocomial infections in NICU (p. 538). Fungal infections however appear to affect underweight and premature neonates more. Other identified risk factors include prolonged use of anti-biotics, long use of catheters; lipid emulsions use and extended use of mechanical ventilation (Kaufman & Fairchild, 2004, p. 639).
Viral organisms
The respiratory synctical virus is the most common viral organisms causing nosocomial infections in the NICU. Others include rotavirus, varicella, entrevirus and influenza. The most common means through which the viral organisms are spread is through infected family members or caregivers (p. 583).
Effects of nosocomial infections in the short term
Nosocomial infections in the NICU lead to increased instances of mortality rate, especially because the neonates have low immune systems thus making them more prone to death upon infection. Those who may not succumb to the infections end up staying in NICU for longer thus increasing their chances of re-infection. With the prolonged stay in NICU, it is inevitable that the cost of care goes up (Mahieu et al 2001, p 24). This affects the parents, insurance companies and governments (Stratton et al, 2003). Children who suffer nosocomial infections also register increased morbidity rates (Townsend & Wenzel, 1981, p. 75). Meningitis infection may for example result in multiple morbidities later in life, which include mental retardation, cerebral palsy, visual impairment and seizure disorders among others.
Indirectly, the high rates of nosocomial infections have prevailed upon governments and individual health institutions across the world to be proactive in finding ways through which the infections can be brought down (Newsby, 2008, p. 221, Pawa, anil et al, 1997, p. 297, Kurlat et al 1995). This is because the high infection rates lead to high use of medical resources and also increases the cost of health care. In 2002 for example, the NICU in Carle foundation Hospital, in an attempt to reduce the nosocomial infections, initiated reforms that sought to encourage good hygiene practices among care givers in order to reduce the rates of infection (Stratton, et al 2003, Lam, 2004, p. 567).
Conclusion
Nosocomial infections are the only downside to NICU, which in the last few decades has helped save the lives of countless babies who are born prematurely or with very low-birth weights (McNab & Blackman 1998, p197, Cavalcante et al 2006). As observed in the risk factors, most of the predisposing factors in the environment contributing to the high rates of the nosocomial infections can be avoided if basic hygiene is observed (Won et al, 2004, p. 745, Stowoski, 2008). Such include washing hands between handling different babies in order to reduce contact transmission of pathogens. The nursing staff and those offering care to the NICU patients should wear masks in order to reduce the chances of infections through the air (Hendrik et al, 2005, p. 415). The doctors should also evaluate the neonates and when necessary reduce their dependence on invasive medical equipment such as catheters, feeding tubes and others in order to reduce their chances of infection through such devices. In other words, the neonates should only use the equipment when necessary to avoid prolonged use.
Overall however, the issue of nosocomial infections, their prevalence and how the intensity of the infections can be reduced has been a pertinent question in the minds of medics ever since NICU became an integral part of neo-natal healthcare (Min-kyoung, 2008, p. 9). There are no definite ways through which the entire healthcare system can handle the different challenges arising from the nosocomial infections. Different NICUs will therefore have to find their homegrown intervention that reduces the rates of infections in their respective areas of jurisdiction.
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