关于产房和新生儿病房感染控制的文献(陆续增加中)

David

The Lancet Infectious Diseases
Review

Volume 8, Issue 1, January 2008, Pages 19-31

Infection control in paediatrics
儿科感染控制综述
Klara M Posfay-Barbe MDa, Prof Danielle M Zerr MDb and Prof Didier Pittet MDc, ,

aChildren's Hospital of Geneva, University of Geneva Hospitals, Geneva, Switzerland

bDepartment of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, WA, USA

cInfection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland


Available online 24 December 2007.

Summary
Infection control has a particularly important role in paediatric hospitals and must take into account the specificity of the needs and environment of the paediatric patient. Children are susceptible to infections that are prevented in older patients by vaccination or previous natural exposure. Consequently, the nosocomial pathogens and most common health-care-associated infection sites in children differ from those observed among adults. The immunological naivety of young children, especially neonates, translates into an enhanced susceptibility to many infections with important health consequences as well as higher rates and longer duration of microorganism shedding. In particular, respiratory virus infections, rotavirus, varicella zoster virus, and pertussis represent persistent challenges in children's hospitals. Specific factors such as the use of breastmilk, toys, or therapy animals are associated with an increased risk for health-care-associated infections. We review the emergence of antimicrobial-resistant organisms and strategies to prevent health-care-associated infections in the paediatric setting.

桂花香

谢DAVID的文献，期待更多的内容...

David

ediatrics. 2007 Sep;120(3):650-65. Links
Infection prevention and control in pediatric ambulatory settings.
儿科门诊的感染预防和控制指南
American Academy of Pediatrics Committee on Infectious Diseases.
Since the American Academy of Pediatrics published a statement titled "Infection Control in Physicians' Offices" (Pediatrics. 2000;105[6]:1361-1369), there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated annually, and enforced. The standard precautions for hospitalized patients from the Centers for Disease Control and Prevention, with a modification from the American Academy of Pediatrics exempting the use of gloves for routine diaper changes and wiping a well child's nose or tears, are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration to take precautions to identify and protect employees who are likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of standard precautions include hand hygiene (ie, use of alcohol-based hand rub or hand-washing with soap [plain or antimicrobial] and water) before and after every patient contact; implementation of respiratory hygiene and cough-etiquette strategies for patients with suspected influenza or infection with another respiratory tract pathogen to the extent feasible; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices and evaluation and implementation of needle-safety devices; appropriate use of personal protective equipment such as gloves, gowns, masks, and eye protection; and appropriate sterilization, disinfection, and antisepsis.

David

Hosp Infect. 2008 Sep;70(1):7-14. Epub 2008 Jul 16. Links
Investigation of an outbreak of Enterobacter cloacae in a neonatal unit and review of the literature.
新生儿病房阴沟肠杆菌暴发调查和文献复习
Dalben M, Varkulja G, Basso M, Krebs VL, Gibelli MA, van der Heijden I, Rossi F, Duboc G, Levin AS, Costa SF.
Hospital das Clínicas, University of São Paulo, Department of Infectious Diseases, São Paulo, Brazil.
Enterobacter cloacae has emerged as an important pathogen in neonatal units, with several outbreaks of infection being reported. The aim of this study was to investigate an outbreak of sepsis due to E. cloacae in a neonatal unit and to review the literature. A retrospective cohort study was conducted in which cases were compared with all newborns hospitalised for more than 48h in the neonatal intensive care unit (NICU). Cohorting of infected patients and work reorganisation were implemented. Pulsed-field gel electrophoresis was performed. The retrospective cohort included the six cases and 13 control patients that had been in the NICU during April 2006. Univariate analysis showed that the use of dobutamine was significantly associated with infection (P=0.036) and that enteral feeding was a protective factor (P=0.02). Multivariate analysis did not find any independent risk factor. Bed occupancy rate in March 2006 was 109.6%, indicating overcrowding. PFGE identified indistinguishable patterns among isolates from all six newborns. PubMed and OVID was search from 1 January 1983 to 15 January 2008 for papers including the terms 'E. cloacae', 'outbreaks', 'clusters' in combination with 'neonate', 'newborn', and 'infant'.We found 26 reports of outbreaks due to E. cloacae in neonate patients: sixteen (52%) were bloodstream infection outbreaks, of which two (12.5%) were related to multiple-dose medications. The source for our outbreak was not identified. Reinforcement of hygiene practices, restrictions on new admissions and the establishment of single-dose medications helped to control the outbreak.

David

Hosp Infect. 2008 Apr;68(4):293-300. Epub 2008 Mar 7. Links
Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit.
新生儿ICU预防医院感染的策略
Borghesi A, Stronati M.
Neonatal Intensive Care Unit, Fondazione IRCCS-Policlinico San Matteo, Pavia, Italy. alessandroborghesi@yahoo.it
Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. Prevention of healthcare-associated infections is based on strategies that aim to limit susceptibility to infections by enhancing host defences, interrupting transmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. Several strategies are available and include: hand hygiene practices; prevention of central venous catheter-related bloodstream infections; judicious use of antimicrobials for therapy and prophylaxis; enhancement of host defences; skin care; and early enteral feeding with human milk.

David

urr Opin Pediatr. 2006 Apr;18(2):101-6. Links
Strategies for prevention of nosocomial sepsis in the neonatal intensive care unit.
新生儿ICU预防医院获得性败血症的策略
Saiman L.
Columbia University, Department of Pediatrics, Division of Infectious Diseases, New York 10032, USA. LS5@columbia.edu
PURPOSE OF REVIEW: Infants hospitalized in the neonatal intensive care unit, particularly preterm infants, have very high rates of nosocomial sepsis (also referred to as late onset sepsis or healthcare-associated sepsis). Today's preventive strategies for nosocomial sepsis focus on augmenting the immunologic and functional immaturities of premature infants and ameliorating the risks of extrinsic factors by the use of prophylactic antibiotics and best clinical practices. RECENT FINDINGS: Topical emollients improved neonatal skin condition, but were associated with an increased risk of nosocomial bacterial sepsis and coagulase negative staphylococcal infections, and thus should not be used in extremely-low-birth-weight infants. Single-center studies have shown that probiotics containing anaerobic bacteria may reduce the rate of necrotizing enterocolitis, the severity of necrotizing enterocolitis, and/or bacterial sepsis. Single-center studies have shown that prophylactic fluconazole reduces the rates of invasive candidiasis and/or colonization of extremely-low-birth-weight infants. Quality improvement projects to improve adherence to appropriate hand hygiene and best practices for central venous catheter insertion and maintenance can reduce rates of nosocomial sepsis. SUMMARY: The safety and efficacy of probiotics and prophylactic fluconazole require large multicenter trials. Quality improvement initiatives, however, can be performed now and can reduce the rates of nosocomial sepsis in the neonatal intensive care unit.

David

emin Neonatol. 2002 Aug;7(4):325-33. Links
Preventing nosocomial bloodstream infection in very low birth weight infants.
低出生体重儿医院血流感染的预防
Edwards WH.
Nosocomial sepsis is a frequent complication of caring for very low birth weight infants and incidence varies substantially among centres. Many cases are preventable. An organized approach to understanding the epidemiology of nosocomial sepsis within a unit, and implementing evidence-based practices can successfully reduce the incidence. Diagnostic accuracy is important to limit excess empiric antibiotic therapy. Instituting a hand hygiene program of education, monitoring, and consideration of waterless hand disinfectants to avoid hand transmission of organisms is essential. An emphasis on early achievement of enteral nutrition, preferably with human milk is important to reduce unnecessary exposure to central catheters and parenteral nutrition. Use of maximum sterile barrier precautions by personnel trained and skilled in central catheter insertion, followed by meticulous care in preventing catheter hub contamination will reduce the incidence of catheter related sepsis. Ultimately, the culture of the NICU needs to shift from a focus on early detection of infection to one of prevention. Copyright 2002 Elsevier Science Ltd.

Mr.beauty

太感谢了，非常需要这样的文章