The basis of bacteriological safety in the neonatal intensive care unit (literature review)

Background. According to world statistics, 7% of patients out of 100 in high-income countries and 15% of patients out of 100 in low- and middle-income countries develop infections related to medical care. As follows from the report of the World Health Organization, one in four cases of hospital sepsis that occurred in the intensive care unit is caused by hospital strains. On average, one in ten of these patients has a hospital-acquired infection that is fatal. The high-risk group includes patients in intensive care units, including newborns. In 2023, 28973 cases of neonatal infections (including intrauterine infection) were registered in medical organizations of the Russian Federation. The highest rates of neonatal morbidity were recorded in the Sverdlovsk Region (42.2%), the Trans-Baikal Territory (33.0%), the Novosibirsk Region (26.0%), the Chelyabinsk Region (22.4%), the Krasnoyarsk Territory (21.8%) and the Irkutsk Region (21.3%). Thus, infection prevention and control strategies aimed at both patients and their environment are of paramount importance in neonatal intensive care units.

Objective. To summarize current relevant data on the prevention of hospital infections in neonatal intensive care units.

Materials and methods. A literature review was conducted using the MEDLINE database (PubMed) as of December 2024 using keywords and a filter: randomized controlled trial, meta-analysis, systematic review.

Results. This review summarizes the main data on the prevention of hospital infections in neonatal intensive care units. According to the literature, ensuring bacteriological safety in relation to the development of hospital infections depends on many factors: hand hygiene of medical personnel, organization of venous access control, disinfection of medical equipment and premises, compliance with the rules of asepsis and antiseptics when performing invasive manipulations, the introduction of modern approaches in the care of premature infants.

Conclusion. There are many tasks in the intensive care unit that require innovative strategies to ensure the safe care of premature newborns. Joint efforts to standardize the processing of specialized equipment, maintain the cleanliness of the environment, comply with vascular access care protocols, adequate hand hygiene, and the active introduction of parents into newborn care are an integral part of the program aimed at preventing nosocomial infections. Active cooperation between the neonatal intensive care unit and the epidemiological service of the institution will allow us to develop a rational policy for risk management and monitoring of hospital infections.

1. Global Report of the World Organization for Infection Prevention and Control, 2022. (In Russ). URL: https://www.who.int/ru/news/item/06-05-2022-wholaunches-first-ever-global-report-on-infection-prevention-and-control. (дата обращения: 19.12.2024 г.). Текст электронный.

2. Simonsen KA, [et al.] Early-onset neonatal sepsis. Clin. Microbiol. Rev. 2014; 27(1):21–47. DOI: https://doi.org/10.1128/CMR.00031-13

3. Frey HA, Klebanoff МА. The epidemiology, etiology, and costs of preterm birth. Semin. Fetal. Neonatal. Med. 2016; 21(2):68-73. DOI: https://doi.org/10.1016/j.siny.2015.12.011

4. Gebremedhin D. Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia Unmatched Case Control Study. PLOS one. 2016; 11(5):1-10. DOI: https://doi.org/10.3389/fped.2019.00476.2016.

5. Xiao T, [et al.] The analysis of etiology and risk factors for 192 cases of neonatal sepsis Biomed. Res. Int.: 2017; 1:1-6. DOI: https://doi.org/10.1155/2017/8617076

6. Akimkin V.G., Tutelyan A.V., Orlova O.A., Abrosimova O.A., Sycheva N.V., Ovchinnikova V.S., Voskanyan Sh.L., Abramov Yu.E. Infections associated with the provision of medical care (ISMP). Newsletter for 2022 of the Federal State Budgetary Institution of the Central Research Institute of Rospotrebnadzor. p. 55.

7. Osman АН, Darkwah S, Kotey FC, Odoom A, Hotor P. Reservoirs of Nosocomial Pathogens in Intensive Care Units. A Systematic Review. Environmental Health Insights. 2014; 18: 16. DOI: https://doi.org/10.1177/11786302241243239.

8. Dancer SJ, Adam CE, Smith J, Pichon B, Kearns A. Tracking Staphylococcus aureus in the intensive care unit using whole-genome sequencing. J Hosp Infect. 2019;103(1):13-20. DOI: https://doi.org/10.1016/j.jhin.2019.04.016.

9. Borghesi A, Stronati M. Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp. Infect. 2008; 68(4):293-300. DOI: https://doi.org/10.1016/j.jhin.2008.01.011

10. O’Grady NP, Alexander M, Burns LA, [et al.]. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9): 162-93. DOI: https://doi.org/10.1067/mic.2002.129427.

11. Quach C, Milstone AM, Perpeˆte C, [et al.]. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream infections. Infect Control Hosp Epidemiol. 2014;35(2):158-63. DOI: https://doi.org/10.1086/674862.

12. Vanzi V., Pitaro R. Skin injuries and chlorhexidine gluconate-based antisepsis in early premature infants: a case report and review of the literature. J Perinat Neonatal Nurs. 2018;32(4):341-50. DOI: https://doi.org/10.1097/JPN.0000000000000334

13. Chapman AK, Aucott SW, Gilmore MM. Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates. J. Perinatol. 2013;33(10):768-71 DOI: https://doi.org/10.1038/jp.2013.61

14. Dijk Y, Bik EM, Hochstenbach-Vernooij S. Management of an outbreak of Enterobacter cloacae in a neonatal unit using simple preventive measures. J Hosp Infect. 2002;51(1):21-6. DOI: https://doi.org/10.1053/jhin.2002.1186

15. World Health Organization PAHO. Decontamination and reprocessing of medical devices for health-care facilities. 2016. [World Health Organization PAHO. Decontamination and reprocessing of medical devices for health-care facilities. 2016.] Available at: https://www.who.int/infectionprevention/publications/decontamination/en/. Accessed December 13, 2024.

16. Ismaeil T. Survival of mechanically ventilated patients admitted to intensive care units. Results from a tertiary care center between 2016-2018. Saudi Med. J. 2019;40(8):781- 788. DOI: https://doi.org/10.15537/smj.2019.8.24447

17. Ogunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review. Antimicrob Resist Infect Control 2020;9(1):81. https://doi.org/10.1186/s13756-020-00747-0

18. Li QF, Xu H, Ni XP, [et al.]. Impact of relocation and environmental cleaning onreducing the incidence of healthcare-associated infection in NICU. World J Pediatr. 2017;13(3):217-21. DOI: https://doi.org/10.1007/s12519-017-0001-1

19. Schulster LM, Arduino MJ, Carpenter J, [et al.]. Guidelines for environmental infection control in health-care facilities. In: Recommendations from the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2004. Accessed December 14, 2024. https://www.cdc.gov/infection-control/media/pdfs/Guideline-Environmental-H.pdf

20. Almadhoob A, Ohlsson A. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst. Rev. 2020; 1(1):Cd010333. https://doi.org/10.1002/14651858.CD010333.pub3

21. Etienne KA, Subudhi CPK, Chadwick PR, [et al.]. Investigation of a cluster of cutaneous aspergillosis in a neonatal intensive care unit. J Hosp Infect. 2011;79(4):344- 8. DOI: https://doi.org/10.1016/j.ahj.2011.06.012

22. Boundy EO, Dastjerdi R, Spiegelman D [et al.]. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137(1): e20152238. DOI: https://doi.org/10.1542/peds.2015-2238

23. Capture the Moment - Early initiation of breastfeeding: The best start for every newborn / UNICEF, WHO. New York: UNICEF; 2018:3-41.

24. Abd-Elgawad М. Oropharyngeal Administration of Mother’s Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. JPEN Jornal of Parenteral and Enteral Nutrition. 2019; 44(1): 99-104. DOI: https://doi.org/10.1002/jpen.1601

25. Rodriguez N, [et al.]. Oropharyngeal administration of mother’s colostrum, health outcomes of premature infants: study protocol for a randomized controlled trial .Trials. 2015; 16(453): 2-14. DOI: https://doi.org/10.1186/s13063-015-0969-6

26. Kamada N., Seo S U, Grace Y. Chen Role of the gut microbiota in immunity and inflammatory disease. Nature Rev. Immunol. 2013; 13(5): 321–35. DOI: https://doi.org/10.1038/nri3430

27. Coşkun D, Günay U. The effects of kangaroo care applied by Turkish mothers who have premature babies and cannot breastfeed on their stress levels and amount of milk production. Journal of Pediatrics Nursing. 2019; 45: 51-56. DOI: https://doi.org/10.1016/j.pedn.2019.09.028

28. El-Farrash RA. Longer duration of kangaroo care improves neurobehavioral performance and feeding in preterm infants: a randomized controlled trial. Pediatr. Res. 2019; 87: 683-88. DOI: https://doi.org/10.1038/s41390-019-0558-6.

29. Darmstadt GL, Saha SK, Ahmed AS, [et al.]. Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream. Pediatr Res. 2007;61(5):588-93. DOI: https://doi.org/10.1203/pdr.0b013e3180459f75

30. Salam RA, Darmstadt GL, Bhutta ZA. Effect of emollient therapy on clinical outcomes in preterm neonates in Pakistan: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2015;100(3):210-5. DOI: https://doi.org/10.1136/archdischild-2014-307157

31. Dunn GL, Tapson H, Davis J, et al. Outbreak of Piv-3 in a neonatal intensive care unit in England. Pediatr Infect Dis J. 2017;36(3):344-5. DOI: https://doi.org/10.1097/INF.0000000000001443

32. Popoola VO, Budd A, Wittig SM. [et al.] Methicillinresistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection preven tion. Infect Control Hosp Epidemiol. 2014;35(4):412-8. DOI: https://doi.org/10.1086/675594.