Bacterial invasive infections in a neonatal intensive care unit: a 13 years microbiological report from an Italian tertiary care centre.

INTRODUCTION: To evaluate the aetiology of neonatal invasive diseases (positive cultures from blood or cerebrospinal fluid, CSF) due to bacteria other than coagulase-negative staphylococci in a large tertiary care centre and compare with results of surveillance cultures. METHODS: Retrospective analysis of microbiological data of children admitted in neonatal intensive care unit (NICU) of a large tertiary care centre from 2005 to 2018. RESULTS: 230 bacterial strains, 223 from blood and 7 from CSF, respectively, were detected as cause of invasive infections, while 152 were detected in surveillance cultures. Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated pathogen both in invasive infections (18%) and colonizations (23%) followed by Escherichia coli (16% on invasive disease and 20% of colonizations). Other common bacteria include Enterococcus faecalis and Streptococcus agalactiae for invasive disease and methicillin-resistant Staphylococcus aureus in colonizations. Invasive infection was due to a pathogen detected in surveillance cultures in 33% of cases. In more than 50% of invasive diseases the identified pathogen was not present in surveillance cultures. CONCLUSIONS: The high percentage of invasive infections due to bacteria not previously identified in surveillance cultures raises doubts about the efficiency of this procedure and highlights the need to search for alternative infection sources. This finding and the high prevalence of invasive infections due to nosocomial pathogens such as Staphylococcus aureus could be the result of horizontal transmission between patients through the hands of health care professionals, emphasizing once again the importance of applying stringent hand hygiene procedures and isolation standards.

Behaviours monitoring and infection control in neonatal intensive care unit: how to improve ourselves?

INTRODUCTION: Healthcare-associated infections are important events in neonatal intensive care unit.Hand hygiene is considered one of the most important procedures to control these complications. METHODS: Healthcare workers procedures for patient's approaching were directly monitored from February to April 2018 in the Neonatal Intensive Care Unit of Istituto Giannina Gaslini, Genoa, Italy.Number and type of total contacts with patients or "patient unit" (e.g.: ventilator, monitor, isolette) were recorded as well as errors related to lack of hand hygiene after and before performing procedures. RESULTS: A total of 1,040 actions were observed on patient or patient unit: 560 actions by nursing staff, 240 by residents and 240 by consultants. The most common misbehaviour was the "double touch" in nursing staff (30%), "glasses, hair or nose" in residents (35%), and "double touch" and "glasses hair or nose" in consultants (25% and 23% respectively). CONCLUSIONS: Extemporaneous contact is the more frequent potential "high risk" moment for transmission of healthcare associated infections in NICU.

Neonatology and the caesarean section.

The origins of the use of the Caesarean section date far back in human history. Traces of this procedure can be found in Greek mythology and in the history of Ancient Rome. Many documents about the history of religion make reference to a delivery from the abdomen.