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.

Two outbreaks of Flavobacterium meningosepticum type E in a neonatal intensive care unit.

Two separate outbreaks due to Flavobacterium meningosepticum type E occurred in a neonatal intensive care unit in March-April and July 1975. The first outbreak involved all five infants in the unit. Two infants developed meningitis, one had bacteremia, and two were colonized. During the second outbreak, five of seven infants were colonized but none developed disease. The upper respiratory tract was colonized first in most instances, and the organism persisted at this site for a mean of 17.3 days. Duration of colonization was more prolonged in infants receiving antibiotics than in untreated infants. Extensive environmental surveillance failed to demonstrate a reservoir, however, F. meningosepticum was recovered from three nasoendotracheal tubes and from an aerosol tube before colonization of four infants. The organism was resistant to most antimicrobial colonization of four infants. The organism was resistant to most antimicrobial agents tested and developed resistance to others during the treatment course of one infant. Although F. meningosepticum was not recovered from cultures of transport vehicles, several other gram-negative bacteria were isolated and were also resistant to multiple antibiotics.