Lesions requiring wound management in a central tertiary neonatal intensive care unit

Background:Most of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin.Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage.This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management,and to assess the most common skin injuries and wounds,and their aetiology.Methods:Data were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31,2012 and January 31,2013.Information about gestational age,sex,birth weight,area of involvement,wound aetiology,and therapy were collected.Results:Among the 211 neonates observed,wound management was required in 10 cases of diaper dermatitis,7 epidermal stripping,6 extravasation injuries,5 pressure ulcers,1 surgical wound and infection,1 thermal burn,and 5 other lesions.Conclusions:International guidelines in neonatal wound care practice are not available,and further research concerns are clearly needed.Dressings and antiseptic agents should be chosen with great care for application to neonates,with particular attention to the prevention of adverse events in this sensitive population.Team work among dermatologists,neonatologists and nurses is crucial for the successful treatment of neonates.

Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit

Background:Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates.At our Neonatal Intensive Care Unit (NICU),the presence of these bacteria became so threatening in 2011 that immediate intervention was required.Methods:This study was conducted during a nearly two-year period consisting of three phases:retrospective (9 months),educational (3 months) and prospective (9 months).Based on retrospective data analysis,a complex management plan was devised involving the introduction of the INSURE protocol,changes to the antibiotic regimen,microbiological screening at short intervals,progressive feeding,a safer bathing protocol,staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients.During these intervals,a total of 355 patients were monitored.Results:Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples).In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients;P=0.029) and infected (3/167 patients;P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients.There was a decrease in the average number of patientdays (from 343.72 to 292.44 days per months),though this difference is not significant (P=0.058).During the prospective period,indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day,P<0.001).Conclusion:Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.