Korean J healthc assoc Infect Control Prev.  2023 Jun;28(1):29-35. 10.14192/kjicp.2023.28.1.29.

Current Status and Issues of Infection Control in the Neonatal Intensive Care Units

Affiliations
  • 1Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea

Abstract

Very-low-birthweight infants (VLBWIs) are at increased risk of developing healthcare-acquired infections because of their immunological immaturity and the frequent use of invasive procedures. Healthcare-acquired infections are associated with increased length of stay, mortality, and significant morbidities in VLBWIs. Numerous issues with infection control in Korea’s neonatal intensive care units (NICUs) have come to light as a result of the Ewha Womans University Mokdong Hospital incident on December 16, 2017, such as the shortages in manpower and facilities and the lack of standardized protocols and systemic supervision by the infection control tower. Although many issues have been improved in recent years, the shortage and considerable center-to-center disparity of manpower, including well-trained neonatal nurses and neonatologists for effective infection control in the NICUs, still remain unresolved. This study reviewed the current status and several issues of infection control in the NICUs in Korea, focusing on structural factors such as the shortage and center-to-center disparity of medical personnel.

Keyword

Healthcare-associated infection; Infection control; Neonatal intensive care units

Reference

1. Haslam DB. Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. 2019. Healthcare-acquired infections. Nelson textbook of pediatrics. 21st ed. Elsevier;Philadelphia: p. 1005–8.
2. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. 1996; Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 129:63–71. DOI: 10.1016/S0022-3476(96)70191-9. PMID: 8757564.
Article
3. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. 2002; Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 110(2 Pt 1):285–91. DOI: 10.1542/peds.110.2.285. PMID: 12165580.
Article
4. Boghossian NS, Page GP, Bell EF, Stoll BJ, Murray JC, Cotten CM, et al. 2013; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr. 162:1120–4. 1124.e1. DOI: 10.1016/j.jpeds.2012.11.089. PMID: 23324523. PMCID: PMC3633723.
5. Lee SM, Chang M, Kim KS. 2015; Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in Korea. J Korean Med Sci. 30 Suppl 1:S67–74. DOI: 10.3346/jkms.2015.30.S1.S67. PMID: 26566360. PMCID: PMC4641066.
Article
6. Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR, et al. 1998; Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Infect Dis J. 17:593–8. DOI: 10.1097/00006454-199807000-00004. PMID: 9686724.
7. Downey LC, Smith PB, Benjamin DK Jr. 2010; Risk factors and prevention of late-onset sepsis in premature infants. Early Hum Dev. 86(Suppl 1):7–12. DOI: 10.1016/j.earlhumdev.2010.01.012. PMID: 20116186. PMCID: PMC2889164.
Article
8. Hentges CR, Silveira RC, Procianoy RS, Carvalho CG, Filipouski GR, Fuentefria RN, et al. 2014; Association of late-onset neonatal sepsis with late neurodevelopment in the first two years of life of preterm infants with very low birth weight. J Pediatr (Rio J). 90:50–7. DOI: 10.1016/j.jped.2013.10.002. PMID: 24148798.
Article
9. Lee SK, Shah PS, Singhal N, Aziz K, Synnes A, McMillan D, et al. Canadian EPIQ Study Group. 2014; Association of a quality improvement program with neonatal outcomes in extremely preterm infants: a prospective cohort study. CMAJ. 186:E485–94. DOI: 10.1503/cmaj.140399. PMID: 25135927. PMCID: PMC4162801.
Article
10. Statistics Korea. Statistical database: population. https://kosis.kr/index/index.do. (Updated on 11 April 2023).
11. Lee JH, Noh OK, Chang YS. 2019; Neonatal outcomes of very low birth weight infants in Korean Neonatal Network from 2013 to 2016. J Korean Med Sci. 34:e400. DOI: 10.3346/jkms.2019.34.e40. PMID: 30718992. PMCID: PMC6356024.
Article
12. Ministry of Health. Short-term policies for safety management in NICU. https://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=343655. (Updated on 24 January 2018).
13. Kim AR, Kim EJ, Kim CS, Park MS, Park JY, Shim GH, et al. 2020; Perspective of nationwide surveillance system for healthcareassociated infection in neonatal intensive care units. Korean J healthc assoc Infect Control Prev. 25:154–6. DOI: 10.14192/kjicp.2020.25.2.154.
Article
14. Korean Society for Healthcare-associated Infection Control. KONIS NICU reports. http://konis.cafe24.com/xe/reports_nicu_y. (Updated on 20 May 2022).
15. Schwab F, Geffers C, Bärwolff S, Rüden H, Gastmeier P. 2007; Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J Hosp Infect. 65:319–25. DOI: 10.1016/j.jhin.2006.12.020. PMID: 17350730.
Article
16. Worth LJ, Daley AJ, Spelman T, Bull AL, Brett JA, Richards MJ. 2018; Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008-2016. J Hosp Infect. 99:55–61. DOI: 10.1016/j.jhin.2017.11.021. PMID: 29222036.
Article
17. Estañ-Capell J, Alarcón-Torres B, Bermúdez JD, Martínez-Rodríguez L, Martínez-Costa C. 2019; Effect of a surveillance system for decreasing neonatal nosocomial infections. Early Hum Dev. 131:36–40. DOI: 10.1016/j.earlhumdev.2019.02.006. PMID: 30825743.
Article
18. Kramer TS, Salm F, Schwab F, Geffers C, Behnke M, Gastmeier P, et al. 2022; Reduction of antibacterial use in patients with very low birth weight on German NICUs after implementation of a mandatory surveillance system. A longitudinal study with national data from 2013 to 2019. J Infect. 85:8–16. DOI: 10.1016/j.jinf.2022.05.009. PMID: 35580752.
Article
19. Korea Disease Control. Infection prevention and control in NICU. https://www.kdca.go.kr/filepath/boardSyview.es?bid=0019&list_no=366743&seq=1. (Updated on 6 April 2020).
20. Health Insurance Review. Reports of quality assessment in NICU. https://www.hira.or.kr/ra/eval/asmWrptPopup.do?evlCd=33&pgmid=HIRAA030004000000. (Updated on 26 May 2022).
21. Hugonnet S, Harbarth S, Sax H, Duncan RA, Pittet D. 2004; Nursing resources: a major determinant of nosocomial infection? Curr Opin Infect Dis. 17:329–33. DOI: 10.1097/01.qco.0000136931.83167.d2. PMID: 15241077.
Article
22. Beltempo M, Blais R, Lacroix G, Cabot M, Piedboeuf B. 2017; Association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections in the NICU. Am J Perinatol. 34:996–1002. DOI: 10.1055/s-0037-1601459. PMID: 28376546.
23. Rogowski JA, Staiger D, Patrick T, Horbar J, Kenny M, Lake ET. 2013; Nurse staffing and NICU infection rates. JAMA Pediatr. 167:444–50. DOI: 10.1001/jamapediatrics.2013.18. PMID: 23549661. PMCID: PMC4972585.
Article
24. Leistner R, Thürnagel S, Schwab F, Piening B, Gastmeier P, Geffers C. 2013; The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates - results of nation-wide cohort study in Germany. Antimicrob Resist Infect Control. 2:11. DOI: 10.1186/2047-2994-2-11. PMID: 23557510. PMCID: PMC3643825.
Article
25. Lee YJ, Lee T, Cho E, Park S, Park CS. 2020; Association of nurse staffing with nosocomial infections of very low-birth-weight infants. J Perinat Neonatal Nurs. 34:E12–8. DOI: 10.1097/JPN.0000000000000475. PMID: 32332450.
Article
26. Kim CG, Kim JS, Bae KS. 2023; Association between nurse staffing levels and rotavirus infection in neonatal intensive care units: a retrospective observational study. Intensive Crit Care Nurs. 74:103314. DOI: 10.1016/j.iccn.2022.103314. PMID: 36153186.
Article
27. Stone PW, Mooney-Kane C, Larson EL, Horan T, Glance LG, Zwanziger J, et al. 2007; Nurse working conditions and patient safety outcomes. Med Care. 45:571–8. DOI: 10.1097/MLR.0b013e3180383667. PMID: 17515785.
Article
28. Tucker J. UK Neonatal Staffing Study Group. 2002; Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Lancet. 359:99–107. DOI: 10.1016/S0140-6736(02)07366-X. PMID: 11809250.
Article
29. Shah PS, Mirea L, Ng E, Solimano A, Lee SK. Canadian Neonatal Network. 2015; Association of unit size, resource utilization and occupancy with outcomes of preterm infants. J Perinatol. 35:522–9. DOI: 10.1038/jp.2015.4. PMID: 25675049.
Article
30. Haley RW, Bregman DA. 1982; The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis. 145:875–85. DOI: 10.1093/infdis/145.6.875. PMID: 7086199.
Article
31. Smith PJ, Brookfield DS, Shaw DA, Gray J. 1984; An outbreak of Serratia marcescens infections in a neonatal unit. Lancet. 1:151–3. DOI: 10.1016/S0140-6736(84)90074-6. PMID: 6140453.
32. Pittet D, Mourouga P, Perneger TV. 1999; Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 130:126–30. DOI: 10.7326/0003-4819-130-2-199901190-00006. PMID: 10068358.
33. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. 2006; An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 355:2725–32. Erratum in: N Engl J Med 2007;356:2660. DOI: 10.1056/NEJMoa061115. PMID: 17192537.
Article
34. Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, et al. 2010; Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ. 340:c309. DOI: 10.1136/bmj.c309. PMID: 20133365. PMCID: PMC2816728.
Article
35. Profit J, Sharek PJ, Kan P, Rigdon J, Desai M, Nisbet CC, et al. 2017; Teamwork in the NICU setting and its association with health care-associated infections in very low-birth-weight infants. Am J Perinatol. 34:1032–40. DOI: 10.1055/s-0037-1601563. PMID: 28395366. PMCID: PMC5798868.
Article
36. Chang YS. 2018; Moving forward to improve safety and quality of neonatal intensive care in Korea. J Korean Med Sci. 33:e89. DOI: 10.3346/jkms.2018.33.e89. PMID: 29441743. PMCID: PMC5811665.
Article
37. Salem MR, Youssef MRL. 2017; Health care providers' perspectives for providing quality infection control measures at the neonatal intensive care unit, Cairo University Hospital. Am J Infect Control. 45:e99–102. DOI: 10.1016/j.ajic.2017.03.013. PMID: 28449919.
Article
38. Yu M. 2011; Work stress, turnover intention and burnout among nurses in neonatal intensive care units. J Korean Acad Nurs Adm. 17:115–26. DOI: 10.11111/jkana.2011.17.1.115.
Article
39. Bea HJ, Kim JE, Bea YH, Kim HJ. 2019; Factors associated with patient safety care activity among nurses in small-medium sized general hospitals. J Korea Acad Ind Coop Soc. 20:118–27.
40. The Korean Pediatric Society. Absence of pediatirc residents and crisis of medical care system. https://www.pediatrics.or.kr/general/notice. (Updated on 9 December 2022).
41. The Korean Society of Neonatology. Current status of medical manpower in Korea's NICU. https://www.neonatology.or.kr. (Updated on 31 December 2022).
42. Sung TJ, Sohn JA, Oh S, Lee JA. 2020; The influence of the variation in sepsis rate between neonatal intensive care units on neonatal outcomes in very-low-birth-weight infants. Sci Rep. 10:6687. DOI: 10.1038/s41598-020-63762-6. PMID: 32317733. PMCID: PMC7174287.
Article
43. Chien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK. Canadian Neonatal Network. 2002; Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J. 21:505–11. DOI: 10.1097/00006454-200206000-00006. PMID: 12182373.
Article
44. Aziz K, McMillan DD, Andrews W, Pendray M, Qiu Z, Karuri S, et al. Canadian Neonatal Network. 2005; Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr. 5:22. DOI: 10.1186/1471-2431-5-22. PMID: 16004613. PMCID: PMC1182378.
Article
45. Shah J, Jefferies AL, Yoon EW, Lee SK, Shah PS. Canadian Neonatal Network. 2015; Risk factors and outcomes of late-onset bacterial sepsis in preterm neonates born at < 32 weeks' gestation. Am J Perinatol. 32:675–82. DOI: 10.1055/s-0034-1393936. PMID: 25486288.
46. Boo NY, Cheah IG. 2016; Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units. Singapore Med J. 57:144–52. DOI: 10.11622/smedj.2016056. PMID: 26996633. PMCID: PMC4800725.
Article
47. Shim JW, Kim MJ, Kim EK, Park HK, Song ES, Lee SM, et al. Committee on Data Collection and Statistical Analysis, the Korean Society of Neonatology. 2013; The impact of neonatal care resources on regional variation in neonatal mortality among very low birthweight infants in Korea. Paediatr Perinat Epidemiol. 27:216–25. DOI: 10.1111/ppe.12033. PMID: 23374067.
Article
Full Text Links
  • KJHAICP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr