Variation in Visiting and Isolation Policies in Neonatal Units: A U.K. Nationwide Survey

Discordance among Belief, Practice, and the Literature in Infection Prevention in the NICU

This study evaluates practices of infection control in the NICU as compared with the available literature. We aimed to assess providers’ awareness of their institutional policies, how strongly they believed in those policies, the correlation between institution size and policies adopted, years of experience and belief in a policy’s efficacy, and methods employed in the existing literature. An IRB-approved survey was distributed to members of the AAP Neonatal Section. A systematic review of the literature provided the domains of the survey questions. Data was analyzed as appropriate. A total of 364 providers responded. While larger NICUs were more likely to have policies, their providers are less likely to know them. When a policy is in place and it is known, providers believe in the effectiveness of that policy suggesting consensus or, at its worst, groupthink. Ultimately, practice across the US is non-uniform and policies are not always consistent with best available literature. The strength of available literature is adequate enough to provide grade B recommendations in many aspects of infection prevention. A more standardized approach to infection prevention in the NICU would be beneficial and is needed.

Hospital-Acquired Viral Respiratory Tract Infections in the Neonatal Unit: A Comparison with Other Inpatient Groups

BACKGROUND

Hospital-acquired viral respiratory tract infections (VRTIs) cause significant morbidity and mortality in neonatal patients. This includes escalation of respiratory support, increased length of hospital stay, and need for home oxygen, as well as higher healthcare costs. To date, no studies have compared population rates of VRTIs across age groups.

AIM

Quantify the rates of hospital-acquired VRTIs in our neonatal population compared with other inpatient age groups in Nottinghamshire, UK.

METHODS

We compared all hospital inpatient PCR-positive viral respiratory samples between 2007 and 2013 and calculated age-stratified rates based on population estimates.

RESULTS

From a population of 4,707,217, we identified a previously unrecognised burden of VRTI in neonatal patients, only second to the 0-1-year-old group. Although only accounting for 1.3% of the population, half of the infections were in infants <1 year old and neonatal intensive care unit (NICU) patients. Human rhinovirus was the most dominant virus across the inpatient group, particularly in neonatal patients. Despite a two- to three-fold increase in the rate of positive samples in all groups during the colder months (1.1/1,000 October-March vs. 0.4/1,000 April-September), rates in the NICU did not change throughout the year at 4.3/1,000. Pandemic H1N1 influenza rates were 20 times higher in neonatal patients and infants <1 year old.

CONCLUSION

Good epidemiological and interventional data are needed to help inform visiting and infection control policies to reduce transmission of hospital-acquired viral infections to this vulnerable population, particularly during pandemic seasons.

Low Frequency of Viral Respiratory Tract Infections During Family-Centered Neonatal Intensive Care: Results of a Prospective Surveillance Study

Background: Viral respiratory tract infections (VRTI) may cause severe respiratory and sepsis-like symptoms in infants hospitalized in the neonatal intensive care unit (NICU). Little is known about the frequencies of VRTI in relation to visiting policies in the NICU. Objective: Aim of this study was to evaluate the frequency of symptomatic and asymptomatic VRTI in our family-centered NICU. Methods: This was a 12-month, prospective, observational study from February 2018 to January 2019. Infants hospitalized ≥72 h were eligible for the study. To determine the frequency of VRTI, multiplexed point-of-care testing (mPOCT) of symptomatic infants was combined with a weekly screening of all infants. Our 10-bed NICU is 24/7 open to families and visitors. The number of simultaneous visitors is restricted to two per patient. Parents and visitors are instructed in hand hygiene and advised to avoid visits in cases of respiratory illness. Siblings irrespective of age may visit the NICU following a physical check-up. Results Multiplexed point-of-care testing (71 symptomatic episodes) combined with the weekly screening (272 episodes) yielded in 21 positive samples from 2 of the 67 infants enrolled in the study. Both infants were first detected during symptomatic episodes. Rhino-/enterovirus were detected in all cases. Conclusion: Respiratory viruses were detected during symptomatic and asymptomatic episodes but affected <3% of infants enrolled in the study. In our unit, a low frequency of VRTI was attained despite adherence to family integrated care including liberal visiting policies for younger siblings.

Impact of respiratory viruses in the neonatal intensive care unit

OBJECTIVE

To describe the epidemiology and clinical impact of respiratory viruses in a neonatal intensive care unit (NICU).

STUDY DESIGN

We conducted a retrospective observational study of infants with respiratory viruses detected by multiplex reverse-transcriptase PCR from May 2012 to May 2017. The proportion of symptomatic vs. asymptomatic infants and associated morbidity were assessed. The association of infection prevention and control (IP&C) strategies and transmission was ascertained.

RESULTS

Respiratory viruses were detected in 83 infants representing 86 unique episodes during which infants remained asymptomatic in 15 (17%). Of the 71 symptomatic episodes, only 45% were associated with increased respiratory and/or nutritional support. Rhinovirus/enteroviruses were most common (69%) and involved nine of 12 transmission events. IP&C strategies including restricting visitors <12 years of age and screening exposed infants were associated with decreased transmission rates.

CONCLUSIONS

NICU patients can be asymptomatic carriers of respiratory viruses. Identification of such infants is important to prevent transmission in the NICU.