1. Line, Tube, and Hand Hygiene

2. vulnerable guests  relative immunodeficiency  frequent instrumentation  need for invasive procedures

3. Other guests?

4.  gram-positive cocci [MRSA, CONS, and vancomycin-resistant Enterococcus faecium (VREF) are multidrug resistant (MDR)]  Gram-negative bacilli [MDR gram-negatives]

5. Infections in the NICU  device use  Central line–associated bloodstream infections (CLABSIs),  ventilator-associated pneumonia (VAP),  catheter-associated urinary tract infections (CA-UTIs)

6.  Minimizing use  antiseptic and antimicrobial impregnated catheters  meticulous care during their insertion and maintenance  Hand hygiene

7. HAND HYGIENE  Reservoirs: GI,nares, nasopharynx, respiratory tract, skin  Fingernails: artificial nails, fungal nail bed disease, long natural nails [ESBL-producing K pneumoniae, P aeruginosa]

8. Factors influencing adherence to hand-hygiene practice  Male sex  Wearing gowns/gloves  High number of opportunities for hand hygiene per hour of patient care  Handwashing agents cause irritation and dryness  Sinks are inconveniently located/shortage of sinks

9. Factors influencing adherence to hand-hygiene practice  Lack of soap and paper towels  Understaffing/overcrowding  Not thinking about it/forgetfulness  No role model from colleagues or superiors  Lack of institutional priority for hand hygiene

11. high rate of CLABSIs  relative immunodeficiency of LBWs  frequent insertion of multiple catheters  repeated catheter access  the need for catheter use for extended periods

12. STRATEGIES TO PREVENT CLABSI  adequate numbers of nursing staff  infection prevention and control programs  development and implementation of a catheter insertion checklist, and education of HCPs about proper maintenance of catheter sterility  appropriate education and training  Catheter insertion kits and carts  adequate laboratory support  IT

13. Before, during, after  Hand hygiene  Maximal sterile barrier:a mask, cap, sterile gown, and sterile gloves worn by all  The patient should be covered with a large sterile drape  disinfection before accessing the catheter  Removing nonessential CVCs  number of infections per 1000 catheter days

14. STRATEGIES TO PREVENT CA- UTIS  Definition?  Limiting catheter use  minimizing the duration  use gloves, a drape, a sterile or antiseptic solution, a single-use packet of sterile lubricant jelly  maintained in a sterile, continuously closed drainage system

16. VAP  Opiate treatment for sedation  Frequent endotracheal suctioning  Reintubation  NICU design and staffing

17. Protective barriers  Anatomic barriers  cough reflexes,  tracheobronchial secretions,  mucociliary lining,  Cell mediated and humoral immunity,  the phagocytic system of the alveolar macrophages and neutrophils