Implementing Oral Candidiasis Protocol Beyond Pharmaceutical Intervention in the NICU

Infants in the NICU are at an increased risk for developing opportunistic infections, such as oral candidiasis, due to their immature immune systems. These infections have the potential to become systemic and increase morbidity and mortality1. Candida albicans, the predominant cause of oral candidiasis, can thrive on the surfaces of pacifiers even without a nutritive medium2. There is currently no protocol for decolonization of oral objects, especially pacifiers, beyond standard practices upon the diagnosis of oral candidiasis in the UUH NICU.

Implementing Oral Candidiasis Protocol Beyond Pharmaceutical Intervention in the NICU Ashlinn Neff BSN Student University of Utah College of Nursing I. Background • Infants in the NICU are at an increased risk for developing opportunistic infections, such as oral candidiasis, due to their immature immune systems. • These infections have the potential to become systemic and increase morbidity and mortality1. • Candida albicans, the predominant cause of oral candidiasis, can thrive on the surfaces of pacifiers even without a nutritive medium2. • There is currently no protocol for decolonization of oral objects, especially pacifiers, beyond standard practices upon the diagnosis of oral candidiasis in the UUH NICU. III. Proposed Intervention IV. Measurement V. Stakeholders • UUH NICU Nurses should perform decolonization practices on both bottles and pacifiers upon each use following the diagnosis of oral candidiasis. The Evidence: • Candida albicans is able to grow on the surfaces of pacifiers without a nutritive medium2. • Decolonization with 3.5% neutral detergent, 2.5% sodium hypochlorite, and 15 minutes of boiling water were all found to eliminate Candida albicans from pacifiers entirely2. • Efficacy of the protocol can be evaluated by comparing past Candida albicans infections, where only antifungal medications and standard procedures were used, to Candida albicans infections where pacifier decolonization protocol was implemented. • Infection rates and recovery times can be compared to evaluate efficacy of the new pacifier decolonization protocol. Top 3 Stakeholders: 1. NICU Nurses 2. Patients/Parents 3. Chief Nursing Executive Potential Barrier: • This subject has a limited number of trials testing and supporting the efficacy of decolonizing pacifiers and would require more research. Figure 1 – Reduction of C. albicans utilizing 4 different methods of colonization2. VI. References 1. Tinoco-Araujo, J. E., Araújo, D. F., Barbosa, P. G., Santos, P. S., & Medeiros, A. M. (2013). Invasive candidiasis and oral manifestations in premature newborns. Einstein (São Paulo), 11(1), 71–75. https://doi.org/10.1590/s167945082013000100013 2. Lopes, D. F., Fernandes, R. T., Medeiros, Y., & Apolonio, A. C. (2019). Disinfection of pacifier focusing on Candida albicans. Clinical Pediatrics, 58(14), 1540–1543. https://doi.org/10.1177/0009922819875541 II. PICOT Question • For infants in the NICU that develop oral candidiasis, would implementing decolonization protocols for oral objects, especially pacifiers, improve infection treatment compared to antifungal administration only? This work was supported by the University of Utah Office of Undergraduate Research. Ashlinn Neff, BSN Student University of Utah College of Nursing [e-mail]