We read with interest the article by K Ganesan et al 1 about using prophylactic oral Nystatin to prevent fungal colonisation and invasive fungaemia. We strongly support this practice especially in preterm babies who are on broad spectrum antibiotics.

It is interesting to know if the authors discovered any other bacterial organisms apart from candida in there routine surveillance swabs. We in our unit in Royal Oldham hospital (large District Hospital 16 neonatal level 2 Cots) not only swab babies but also there microenvironment, toys and religious items left in incubators and cots. In a recent random safety study we found 16 items in 10 cots, surveillance swabs taken form them revealed scanty growth of skin organisms in 7, scanty to moderate growth of coliforms in 3 and scanty growth of staphylococci in 1. It is interesting to note that none of these environmental swabs demonstrated any fungal colonisation. In view of the above study findings we follow a ‘No soft toys or religious items in cots/incubators policy’ along with the enforcement of strict hand washing policy.

Prophylactic nystatin could be the way forward to prevent fungal colonisation but what about colonisation from other bacterial organisms?. The age old saying ‘Prevention is better than cure’ stands true in our fight against infection and hence the need to maintain a clean microenvironment in the neonatal unit.