Keeping Vulnerable Children Safe from Pertussis Preventing Nosocomial Pertussis Transmission in the Neonatal Intensive Care Unit

2009 ◽  
Vol 30 (11) ◽  
pp. 1084-1089 ◽  
Author(s):  
Amy L. Greer ◽  
David N. Fisman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Booster Vaccination ◽  
The United States ◽  
Base Case ◽  
Vaccination Strategies ◽  
The Impact

Objective.To examine the impact of different acellular pertussis booster vaccination strategies on the probability of a nosocomial pertussis outbreak occurring and the distribution of outbreak sizes observed for each intervention strategy.Setting.Neonatal intensive care unit.Methods.We developed a stochastic, agent-based simulation model to examine the impact of booster vaccination strategies for pertussis on health care-related transmission.Results.Our results demonstrate that healthcare worker booster vaccination decreases the probability of secondary transmission from 49% (base case, no boosting) to 2% (if 95% of healthcare workers are boosted) and decreases final outbreak size. Boosting family caregivers did not have a clinically significant impact on nosocomial disease transmission.Conclusion.The provision of booster vaccine to healthcare workers in the neonatal intensive care unit substantially reduces the risk of hospital-centered pertussis outbreaks in a manner that enhances the health of hospitalized children. A formal health economic analysis of this finding is currently under way. Policies to protect patient safety in pediatric facilities should include compliance with the United States Advisory Committee on Immunization Practices, which recommends provision of pertussis booster vaccination to healthcare workers.

scholarly journals The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System

2020 ◽  
Vol 37 (10) ◽  
pp. 1022-1030 ◽  
Author(s):  
Ian Griffin ◽  
Farah Benarba ◽  
Caryn Peters ◽  
Yinka Oyelese ◽  
Tom Murphy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Jersey ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
The United States ◽  
Labor And Delivery ◽  
Hospital System ◽  
Novel Coronavirus ◽  
The Impact

Objective Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). Materials and Methods Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. Discussion Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. Results COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. Conclusion Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. Key Points

scholarly journals Mothers and fathers in NICU: The impact of preterm birth on parental distress

2016 ◽  
Vol 12 (4) ◽  
pp. 604-621 ◽  
Author(s):  
Chiara Ionio ◽  
Caterina Colombo ◽  
Valeria Brazzoduro ◽  
Eleonora Mascheroni ◽  
Emanuela Confalonieri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Birth ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Post Partum ◽  
Event Scale ◽  
Mothers And Fathers ◽  
Negative Feelings ◽  
The Impact

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers’ responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

scholarly journals Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Caroline Quach ◽  
Aaron M. Milstone ◽  
Chantal Perpête ◽  
Mario Bonenfant ◽  
Dorothy L. Moore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Adverse Events ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
The Impact

Background.Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

One-Week versus 2-Day Ventilator Circuit Change in Neonates with Prolonged Ventilation: Cost-Effectiveness and Impact on Ventilator-Associated Pneumonia

2014 ◽  
Vol 36 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Shih-Ming Chu ◽  
Mei-Chin Yang ◽  
Hsiu-Feng Hsiao ◽  
Jen-Fu Hsu ◽  
Reyin Lien ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Ventilator Circuit ◽  
Mechanical Ventilators ◽  
Prolonged Intubation ◽  
The Impact

ObjectiveTo investigate the impact of 1-week ventilator circuit change on ventilator-associated pneumonia and its cost-effectiveness compared with a 2-day change.DesignAn observational cohort study.SettingA tertiary level neonatal intensive care unit in a university-affiliated teaching hospital in Taiwan.PatientsAll neonates in the neonatal intensive care unit receiving invasive intubation for more than 1 week from July 1, 2011, through December 31, 2013.InterventionWe investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort.Measurements and Main ResultsA total of 361 patients were maintained on mechanical ventilators for 13,981 days. The 2 groups did not differ significantly in any demographic characteristics. The rate of ventilator-associated pneumonia was comparable between the 2-day group and the 7-day group (8.2 vs 9.5 per 1,000 ventilator-days, P=.439). The durations of mechanical ventilation and hospital stay, and rates of bloodstream infection and mortality, were also comparable between the 2 groups. Switching from a 2-day to a 7-day change policy would save our neonatal intensive care unit a yearly sum of US $29,350 and 525 working hours.ConclusionDecreasing the frequency of ventilator circuit changes from every 2 days to once per week is safe and cost-effective in neonates requiring prolonged intubation for more than 1 week.Infect Control Hosp Epidemiol 2014;00(0): 1–7

Control of an Outbreak of Pandrug-ResistantAcinetobacter baumanniiColonization and Infection in a Neonatal Intensive Care Unit

2007 ◽  
Vol 28 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Pei-Chun Chan ◽  
Li-Min Huang ◽  
Hui-Chi Lin ◽  
Luan-Yin Chang ◽  
Mei-Ling Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Control Measures ◽  
Positive Culture Result ◽  
Mode Of Transmission

Objective.To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR)Acinetobacter baumanniiin a 7-day-old neonate who developed PDRA. baumanniibacteremia that was presumed to be the iceberg of a potential outbreak.Design.Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.Setting.A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.Interventions.Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDRA. baumanniiisolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.Results.One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDRA. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDRA. baumanniiin 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDRA. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.Conclusions.In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDRA. baumanniiwas suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDRA. baumannii.

scholarly journals Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 755
Author(s):  
Laura Polloni ◽  
Francesco Cavallin ◽  
Elisabetta Lolli ◽  
Rossana Schiavo ◽  
Martina Bua ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Parental Stress ◽  
Neonatal Intensive Care ◽  
Physical Contact ◽  
Psychological Wellbeing ◽  
Depression Symptoms ◽  
Parental Role ◽  
The Impact

The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor superimposed on pre-existing high distress in parents of infants admitted to the neonatal intensive care unit (NICU). This study aimed to investigate the psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four parents of 25 inpatients of the Padua University Hospital NICU were included from June 2020 to February 2021. At 7–14 days postpartum parents completed the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire measuring parental COVID-19 related stress. About one third of parents reported extreme/high stress and a relevant negative impact on parenthood experience. Less time (82%) and less physical contact (73%) with infants due to COVID-19 preventive measures were the most frequent negative factors. Higher COVID-19 related parental stress was positively associated with anxiety, depression, NICU parental stress, stress related to NICU environment, and parental role alterations. Depression symptoms, stress related to infant condition and parental role alterations were higher in mothers. The pandemic affected parental emotional and relational wellbeing directly through additional stress due to COVID-19 concerns and indirectly through the impact of restrictions on the experience of becoming parents.

scholarly journals Association of Maternal, Obstetric and Neonatal Variables on the Use of Bronchial Hygiene Maneuvers and Impact on Morbidity, Mortality and Survival in Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Lucio Flavio Garcia Rodrigues ◽  
Emerson Souza Da Rocha ◽  
Isabelle Coelho da Silva ◽  
Luciana de Fátima da Costa Moraes ◽  
Laura Maria Tomazi Neves ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Referral Hospital ◽  
Risk Of Death ◽  
Terapia Intensiva ◽  
The Impact ◽  
And Child Health ◽  
Respiratory Variables

Abstract Objective: To analyze whether maternal, obstetric, anthropometric data of the neonate and respiratory variables influence the use of BHMs in neonates admitted to the NICU. In addition, to evaluate the impact of the applicability of this type of technique on the morbidity, mortality and survival of these neonates. Methods: Retrospective, quantitative study with descriptive and inferential analysis. Initially, the sample consisted of 599 medical records. The study involved newborns of both sexes admitted to the Neonatal Intensive Care Unit (NICU) of the tertiary referral hospital at maternal and child health, during 2017. The respiratory variables, maternal, obstetric, data of the neonate, morbidity and mortality were selected. Results: BHMs were associated with neonates whose mothers had a number of pregnancies ≥ 3 or newborns who had cephalic presentation at the time of delivery. In addition, there are particularities among neonates who receive this intervention, such as higher capillary glycemia, lower head circumference and occurrence of jaundice. The technique was not related to prematurity factors, such as pregnancy time ≤ 24 weeks, or respiratory factors, such as apnea, flapping of the nose wing, cyanosis and intercostal retraction. However, the use of the BHMs increases neonatal survival and reduces the mortality. Conclusion: The BHMs use is determined by maternal, obstetric and neonatal variables, being determinant to reduce the risk of death and increase the survival in NICU. RESUMO Objetivo: Analisar se dados maternos, obstétricos, antropométricos e variáveis respiratórias influenciam o uso de BHMs em neonatos internados em UTIN. Além disso, avaliar o impacto da aplicabilidade desse tipo de técnica na morbimortalidade e sobrevida desses neonatos. Métodos: Estudo retrospectivo, quantitativo com análise descritiva e inferencial. Inicialmente, a amostra era composta por 599 prontuários. O estudo envolveu recém-nascidos de ambos os sexos internados na Unidade de Terapia Intensiva Neonatal (UTIN) do hospital terciário de referência em saúde materno-infantil, durante 2017. Foram selecionadas as variáveis respiratórias, maternas, obstétricas, dados do neonato, morbimortalidade.Resultados: os BHMs foram associados a neonatos cujas mães tiveram um número de gestações ≥ 3 ou recém-nascidos que apresentaram apresentação cefálica no momento do parto. Além disso, existem particularidades entre os neonatos que recebem essa intervenção, como aumento da glicemia capilar, menor perímetro cefálico e ocorrência de icterícia. A técnica não foi relacionada a fatores de prematuridade, como tempo de gestação ≤ 24 semanas, ou fatores respiratórios, como apneia, batimento da asa nasal, cianose e retração intercostal. Porém, o uso dos BHMs aumenta a sobrevida neonatal e reduz a mortalidade. Conclusão: O uso de BHMs é determinado por variáveis maternas, obstétricas e neonatais, sendo determinante para reduzir o risco de óbito e aumentar a sobrevida em UTIN.

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