Prevention of infection in the nursery

Most infants are "sterile" when admitted to the newborn nursery. Rapid colonization of microorganisms in the infant then occurs. Colonization of virulent microorganisms can overwhelm the immature local and systemic immunity of a newborn infant. Cannulae, catheters, and assisted ventilation can bypass these fragile defenses. Effective infection control in the nursery attempts to reduce the exposure of the neonate to harmful microorganisms. Important measures include (1) the reduction of bacterial colonization through appropriate care of the umbilical stump and skin of the patient; (2) handwashing before and after contact with a patient; (3) low nurse-to-patient ratios; (4) cohorting of newborn infants; (5) isolation and cohorting of infected babies; (6) good hygiene among personnel; and (7) use of aseptic technique. Neonatal intensive care units have extraordinarily high infection rates. Most infants are on ventilators. Daily decontamination of respiratory equipment is essential. Regular monitoring of endotracheal cultures is useful, particularly when bacteria that are resistant to multiple antibiotics emerge.