pediatrics
Neonatal Hospital Acquired Infection
Special care nurseries and neonatal ICUs
Prevention of colonization and infection in special care nurseries requires provision of sufficient space and personnel. In intensive care, multipatient rooms should provide 120 square ft (about 11.2 square m)/infant and 8 ft (about 2.4 m) between incubators or warmers, edge-to-edge in each direction. A nurse:patient ratio of 1:1 to 1:2 is required. In intermediate care, multipatient rooms should provide 120 square ft (about 11.2 square m)/infant and 4 ft (about 1.2 m) between incubators or warmers, edge-to-edge in each direction. A nurse:patient ratio of 1:3 to 1:4 is required. Proper techniques are required, particularly for placement and care of invasive devices and for meticulous cleaning and disinfection or sterilization of equipment. Active monitoring of adherence to techniques is essential. Formal evidence-based protocols for inserting and maintaining central catheters have significantly decreased the rate of central line-associated bloodstream infection. Similarly, a group of procedures and protocols that reduce healthcare-associated pneumonia in the neonatal ICU have been identified; these include staff education and training, active surveillance for healthcare-associated pneumonia, raising the head of an intubated neonate's bed 30 to 45°, and providing comprehensive oral hygiene. Placing the neonate in a lateral position with the endotracheal tube horizontal with the ventilator circuit also may be helpful. (See also current Centers for Disease Control and Prevention [CDC] guidelines for the prevention ofS. aureus infections[2020] andCLABSI[2022] in the neonatal ICU.) 