Infection Control in Neonatal and Pediatric Intensive Care Units

There are meaningful differences and similarities in the prevalence, associated risks, and prevention of healthcare-associated infections (HAI) in pediatric/neonatal intensive care units (ICUs) when compared to adult care areas. For the prevention of central line-associated blood stream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), many pediatric hospitals use the successful insertion and maintenance bundles developed by the Solutions for Patient Safety (SPS) collaborative as well as other complementary initiatives including the utilization of line teams and midlines. Control mechanisms beyond contact isolation for multidrug-resistant organisms, such as methicillin resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and multidrug-resistant Gram-negative bacilli, include the growing adoption of daily chlorhexidine bathing typically for children above a certain weight and/or age, and antibiotic stewardship programs. The national reporting of pediatric ventilator-associated pneumonia (VAP) is transitioning to the newer pediatric ventilator-associated events (PedVAE) definition with pediatric ICUs able to utilize either and neonatal ICUs using only PedVAE. Thus far there are no well-established PedVAE prevention bundles. Hospital-acquired respiratory infections occur in nearly one in every 1000 pediatric patient days. Screening via viral testing is typically limited to only symptomatic patients and visitors. Besides employing the Centers for Disease Control and Prevention’s recommended precautions for infected patients, many pediatric hospitals strategically place alcohol-based sanitizers and cough-etiquette posters, ban young visitors during the viral season, and encourage staff influenza vaccination. Nosocomial diarrheal illnesses, typically secondary to Clostridioides difficile and rotavirus, account for 15–35% of all pediatric hospital-acquired infections. Prevention strategies for both infections include patient isolation, contact precautions, and pathogen appropriate hand washing and room cleaning techniques. Pediatric cardiac patients besides having higher central line and ventilator days per ICU admission, those with delayed sternal closure have increased rates of surgical sites infection causing many hospitals to develop sternal wound care prevention protocols.