Nursing Care Plan Preterm Infant | Risk for Infection

Nursing diagnosis: Risk for infection may be related to immature immune response, fragile skin, trauma-tized tissues, invasive procedures, environmental exposure (PROM, transplacental exposure).

Desired Outcomes: Be free of signs of infection, for example, temperature instability, lethargy, respiratory distress, purulent drainage/secretions. Maintain negative serum, CSF, urine, and nasopharyngeal cultures with CBC, platelets, and pH level WNL.

Nursing intervention with rationale:
1. Review record of delivery to determine whether resuscitative measures were required, length of rupture of membranes, and presence of chorioamnionitis. Note maternal GBS status and/or other sexually transmitted diseases (STDs) present.
Rationale: Infant who has been resuscitated and has required invasive interventions is especially prone to introduction of pathogens and infection. Maternal factors such as PROM with preterm labor and delivery possibly caused by an infectious process predispose the preterm infant to ascending infection. Early-onset sepsis (occurring within the first 2 days of life) is affected by host defenses and duration of antepartal rupture of membranes. Transplacentally acquired infections (which affect two-thirds of all infected infants) are also a threat.


2. Determine gestational age of fetus, using Dubowitz criteria.
Rationale: Delivery prior to 28–30 weeks’ gestation increases infant’s susceptibility to infection, because of reduced ability of WBCs to destroy bacteria, reduced transfer of IgG (IgG is transported across the placenta primarily in the third trimester), lack of IgA if infant does not receive breast milk, and poorly keratinized skin with ineffective barrier qualities. Note: Infant who suffers from intrauterine growth retardation/restriction is at greater risk for infection.

3. Promote meticulous hand washing by staff, parents, and ancillary workers per protocol. Use antiseptic before assisting with surgical or invasive procedure.
Rationale: Hand washing is the most important practice for preventing cross-contamination and controlling infection in the nursery.

4. Monitor staff and visitors for presence of skin lesions, draining wounds, acute respiratory infections, fever, gastroenteritis, active herpes simplex (oral, genital, or paronychial), and herpes zoster.
Rationale: Transmission of disease to neonate by employees or visitors can occur directly or indirectly.

5. Provide adequate space between infants or between Isolettes or individual units. Use separate isolation rooms and isolation technique, as indicated.
Rationale: Providing 4–6 ft of space between infants helps prevent spread of droplet or airborne infections.

6. Assess infant for signs of infection, such as temperature instability (hypothermia or hyperthermia), lethargy or behavior changes, respiratory distress (apnea, cyanosis, or tachypnea), jaundice, petechiae, nasal congestion, or drainage from eyes or umbilicus.
Rationale: Useful in the diagnosis of infection; body temperature alone is an unreliable means of assessing infection in the preterm infant with impaired inflammatory response and WBC mobilization.

7. Establish a cohort of infants, when possible, and ensure that same nurse cares for the infants grouped together.
Rationale: Infants who are born within the same time frame (usually 24–48 hr), or who are colonized/infected with the same pathogen, may be grouped together until discharge. Such grouping is an important measure in infection control in that it limits the amount of contact of one infant with other susceptible infants or personnel.

8. Use aseptic technique during suctioning. Date the opened solution for humidification, irrigation, or nebulization, and discard after 24 hr. Ensure routine cleaning or replacement of respiratory equipment.
Rationale: Reduces opportunity for introduction of bacteria that could result in respiratory infection.

9. Observe for signs of shock or DIC, such as bradycardia, decreasing BP, temperature instability, listlessness, edema, or erythema of abdominal wall.
Rationale: DIC may occur with gram-negative septicemia.

10. Administer antibiotics IV based on results of culture and sensitivity.
Rationale: Broad-spectrum antibiotic coverage with ampicillin and an aminoglycoside is usually initiated, pending results of culture and sensitivity tests. Indiscriminate or inappropriate use of systemic antibiotics may cause undesirable side effects, foster emergence of resistant bacterial strains, and alter the newborn’s normal flora.