Preventing neonatal sepsis: Evidence-based approach for level 2 and 3 units

Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. The incidence and outcome of these infections are determined by the degree of immaturity of the neonatal immune system, invasive procedures involved, the aetiological agent and its antimicrobial susceptibility pattern and, above all, infection control policies practiced by the unit. The interventions to prevent these health care associated infections are based on strategies that interrupt the transmission of organism to the newborn (hand ‘degerming’, optimal spacing and staffing, disinfection of equipments, maintaining environmental hygiene and skin antisepsis), improving the host defenses (early introduction of breast milk feeds, use of probiotics, cutaneous oil application and avoiding drugs that impair hosts defenses), and by promoting the judicious use of antimicrobials. Most significantly, it is important to change the culture of the neonatal intensive care units so that physicians, nurses, and other staff members are aware of the importance of infection control, in particular, hand washing, limited use of invasive devices, and prudent use of antimicrobial agents.