Edwards William H
Department of Pediatrics, Children's Hospital at Dartmouth, One Medical Center Drive, Lebanon, New Hampshire 03756, USA.
Semin Neonatol. 2002 Aug;7(4):325-33. doi: 10.1016/s1084-2756(02)99125-6.
Nosocomial sepsis is a frequent complication of caring for very low birth weight infants and incidence varies substantially among centres. Many cases are preventable. An organized approach to understanding the epidemiology of nosocomial sepsis within a unit, and implementing evidence-based practices can successfully reduce the incidence. Diagnostic accuracy is important to limit excess empiric antibiotic therapy. Instituting a hand hygiene program of education, monitoring, and consideration of waterless hand disinfectants to avoid hand transmission of organisms is essential. An emphasis on early achievement of enteral nutrition, preferably with human milk is important to reduce unnecessary exposure to central catheters and parenteral nutrition. Use of maximum sterile barrier precautions by personnel trained and skilled in central catheter insertion, followed by meticulous care in preventing catheter hub contamination will reduce the incidence of catheter related sepsis. Ultimately, the culture of the NICU needs to shift from a focus on early detection of infection to one of prevention.
医院感染性败血症是极低出生体重儿护理中常见的并发症，各中心的发病率差异很大。许多病例是可以预防的。采用有组织的方法来了解单位内医院感染性败血症的流行病学情况，并实施循证实践，可成功降低发病率。诊断准确性对于限制过度的经验性抗生素治疗很重要。开展一项包括教育、监测以及考虑使用无水手部消毒剂以避免手部传播病原体的手卫生计划至关重要。强调尽早实现肠内营养，最好是母乳喂养，对于减少不必要的中心静脉导管和肠外营养暴露很重要。由经过培训且熟练掌握中心静脉导管插入技术的人员采取最大无菌屏障预防措施，随后在预防导管接头污染方面进行精心护理，将降低导管相关败血症的发病率。最终，新生儿重症监护病房的文化需要从专注于感染的早期检测转变为预防。
