Ramasethu Jayashree
Division of Neonatal Perinatal Medicine, Department of Pediatrics, MedStar Georgetown University Hospital, Washington DC, 20007 USA.
Matern Health Neonatol Perinatol. 2017 Feb 13;3:5. doi: 10.1186/s40748-017-0043-3. eCollection 2017.
Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more resistant strains.
医院获得性感染威胁着入住新生儿重症监护病房婴儿的生存及神经发育结局，并增加了护理成本。早产儿尤其脆弱，因为他们经常接受侵入性操作，依赖中心静脉导管输送营养，依靠呼吸机进行呼吸支持。预防医院感染是保障患者安全的关键要务，而且始终需要采取多学科方法。没有捷径可走。接触患者前后的手部卫生是最重要的措施，然而，对这一简单措施的依从性可能不尽人意。与普通肥皂或含抗菌剂的肥皂相比，含酒精的洗手液对许多微生物有效且高效。使用母乳是降低感染率的另一项低成本且简单的措施。通过使用益生菌、益生元及合生元来复制母乳抗感染特性的努力取得了不同程度的成功，目前正在进行乳铁蛋白的试验，乳铁蛋白是初乳中大量存在的一种铁结合乳清蛋白。使用外源性免疫球蛋白来提高早产儿免疫球蛋白水平的尝试尚未显示能显著降低医院感染率。在过去十年中，通过从导管插入到维护的每一个细节都予以精心关注，导管相关感染的发生率有所改善，一些中心报告此类感染率为零。其他医院感染，如呼吸机相关性肺炎和金黄色葡萄球菌感染仍然是问题，多重耐药菌的暴发继续造成灾难性后果。感染的管理基于新生儿病房及社区中的微生物情况，需要进行靶向治疗以控制疾病，同时又不会导致产生更多耐药菌株。
