Health care–associated infections in the NICU have serious consequences, including increased mortality, morbidity, hospital length of stay, and cost of care. Prevention of health care–associated infections is crucial for the survival and neurodevelopment of vulnerable infants and is an indication of quality of care. Although trials have been conducted with probiotics, prebiotics, synbiotics, immunoglobulins, and lactoferrin to boost immunity in preterm infants with immature immune systems, the most efficacious measures are hand hygiene and the use of maternal breast milk. Prevention of health care–associated infections is not simple. It requires constant vigilance, attention to detail, and meticulous aseptic technique, all the time, every time. The decline in certain health care–associated infections such as central line–associated bloodstream infections shows that this can be accomplished, and what was once considered inevitable can be prevented.

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