Read part one of this blog post here.
Viral Outbreaks in the NICU
Though the majority of NICU infections are bacterial, nosocomial viral infections have been widely reported, including outbreaks of syncytial virus (RSV), influenza H1N1, rotavirus, adenovirus, enterovirus, and norovirus.
COVID-19 aside, respiratory viral infections (RVIs) strike newborns particularly hard and, according to Austrian researchers, are “more prevalent in the NICU than previously considered.”
RVIs are likely underdiagnosed, the authors assert, as many NICUs don’t routinely test for viral pathogens in symptomatic patients. Respiratory viral infections are a leading cause of mortality among newborns and often are detected only late in the course of illness.
The hospital costs of RVIs are particularly high. A 6-year study of a NICU in Nottingham, UK, found that compared to uninfected newborns, infected NICU patients spent far longer in the hospital — 76 days compared to 41 days — and in-hospital care costs were significantly higher, £49,664 compared to £22,155.
Infected NICU staff are often the source of viral outbreaks, especially influenza infection.
Newborns, of course, cannot be vaccinated, and annual vaccination rates among the healthcare workers who care for these patients are alarmingly low.
An H1N1 influenza outbreak in a Greek NICU, for example, was traced to the nursing staff, just 15% of whom were vaccinated.
“Nosocomial influenza can cause considerable morbidity, especially in high-risk neonates,” the authors wrote, “and is readily transmissible in the NICU setting by unvaccinated staff members.”
Viral infection spreads quickly in the NICU. A norovirus outbreak at Texas Children’s Hospital, traced to one newborn, began spreading within 24 hours and within two weeks had afflicted 28 babies, along with 12 staff members, who had to be furloughed.
Disinfecting the NICU Air, Safely and Quietly
Hand hygiene has long been the cornerstone of hospital infection prevention, in the NICU and elsewhere, and healthcare workers are striving to be even more meticulous in the COVID era. Yet hundreds of studies demonstrate that over the decades, compliance has been, in the words of the World Health Organization, “abysmally low.”
Surface cleaning, too, has been augmented since the emergence of SARS-CoV-2 but inevitably falls short, as airborne pathogens continually settle on medical equipment, floors, clothing, and healthcare workers’ hands.
“It is impossible to operate [NICU] environments in complete sterility,” a University of California team reported. The infants themselves, the adults who care for them, the equipment required for their care — all represent “fertile vectors for microbial transmission.”
Though stringent cleaning protocols for NICU surfaces have been in place for years, infections rates remain stubbornly high.
“It is tempting to speculate that more potent cleaning techniques or agents will lead to further decreases in nosocomial infections,” the researchers concluded, but reality may be otherwise. “Future improvement may require innovative approaches.”
Among the most effective innovations is ultra-low-energy plasma technology by Novaerus, now deployed in NICUs and COVID wards worldwide. Easily installed on the wall, a shelf, or a rolling stand, Novaerus devices quickly destroy airborne viral, bacterial, and fungal particles.
For example, lab tests found the company’s most powerful unit can reduce the airborne load of MS2 Bacteriophage, a virus used as a surrogate for SARS-CoV-2, by 99.99% in just 15 minutes. The technology decimates MRSA load just as thoroughly and quickly.
Dis-infecting air in the NICU, as well as other wards and common areas, is imperative, as study after study points to hospital infection spread via aerosolization. A Japanese team, for example, reported on an outbreak of Bacillus cereus in its NICU, concluding the bacteria spread via the airflow of the ventilation system. Numerous studies have detected MRSA and Clostridicum difficile in hospital air.
As for SARS-CoV-2, air-sampling studies have detected viral RNA in hospital hallways and in rooms where healthcare workers changed their clothing, prompting the World Health Organization to finally agree with scientists worldwide that aerosol transmission of COVID-19 cannot be ruled out.
In a year-long study of an American NICU, a team of environmental engineers noted in PLOS One: “Hospital hygiene protocols may undervalue the potential importance of the airborne transmission route.”
Throughout hospitals, but especially in the NICU, ultra-low-energy plasma technology is an important addition to ventilation and filtration. Whereas conventional filters capture only large particles, Novaerus units destroy the smaller and deadlier ones.
Novaerus units run continuously and quietly, a benefit given the adverse effect of noise on the heart rates and respiratory systems of preterm or very low birth weight infants.
The technology is safe to operate around even the smallest, most medically fragile NICU patients, unlike other air-sanitation methods that can produce harmful byproducts.
Novaerus technology not only helps prevent infection but also mitigates newborns’ exposure to chemicals such as volatile organic compounds (VOCs) and particulate matter. Lacking the protective buffer of the womb, research suggests, newborns in the NICU are exposed to chemicals that may permanently alter neurobehavioral outcomes.
Air quality in the NICU may have a “significant impact on their long-term development,” note researchers at the Icahn School of Medicine at Mount Sinai in New York City, who are conducting the first study of air quality in neonatal intensive care.
Infants admitted to the NICU often stay for long periods, putting them at elevated risk for contracting an infection. The average length of stay for a term or near-term infant with surgical or respiratory issues is about 15 days; the length of stay for preterm infants born at 26 weeks’ gestation is more than 2 months.
Throughout their stay, it is imperative that their infection risk is reduced by stringent hand hygiene, effective surface cleaning, and 24/7 air dis-infection.
Microbes accumulate 24 hours a day, as visitors, staff, and medical devices come and go. Healthcare workers’ hands and NICU equipment cannot be cleaned continually, but with the installation of Novaerus technology, the air in the NICU can.