Table 1.

Potentially Better Practices for Preventing Nosocomial Infection

Handwashing
Meticulous attention to handwashing, with regular monitoring and surveillance of handwashing practice, and reporting of compliance.
Nutrition
Hyperalimentation solution should not be altered after preparation.
Begin enteral feedings as early as possible.
Reduce exposure to intralipid and hyperalimentation.
Promote the use of human milk; ensure proper collection and storage.
Skin care
Establish a skin care protocol for all neonates <1000 g, the goals of which are to promote skin maturation and to prevent skin breakdown.
Reduce laboratory testing, which requires venipuncture or heelstick.
Develop a systematic approach to intravenous therapy, which reduces the frequency and number of skin punctures for placement of an intravenous catheter.
Diagnosis
Minimum sample size for a blood culture should be 1 mL per aerobic culture bottle.
Two samples of 1 mL each, in 2 culture bottles are preferred.
Develop a method to distinguish true infection from a contaminated culture.
Respiratory care
Minimize intubation days.
Minimize the interruption of the ventilator-endotracheal tube circuit.
Vascular access
Minimize the use of central lines. When central lines are used, minimize the frequency of daily entries, and the duration of use.
Place central lines prospectively when intravenous therapy will be of long duration.
Establish sound policies and procedures for line care and access; regularly monitor compliance.
Unit culture
Promote developmentally supportive care, with an emphasis on minimal handling.
Develop and maintain a culture of cooperation and teamwork that supports and encourages all team members to feel responsible for outcomes.