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NICU Outbreaks

NICU Outbreaks. Nawaf M. Al-Dajani. Disclosure. Infection Components. Host. Environment. Organisms. MRSA. Infection Rates in NICUs. Up to 6-38 (25%) per 100 admissions. 8.9 to 62 per 1000 patient days. No. approved antibiotics. Outbreak:

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NICU Outbreaks

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  1. NICU Outbreaks Nawaf M. Al-Dajani

  2. Disclosure

  3. Infection Components Host Environment Organisms

  4. MRSA

  5. Infection Rates in NICUs • Up to 6-38 (25%) per 100 admissions. • 8.9 to 62 per 1000 patient days.

  6. No. approved antibiotics

  7. Outbreak: An excess over the usual level of a disease within geographic area in certain period. • Epidemic curve: • Base line data:

  8. Preventable Nosocomial infection • Inevitable

  9. What to do during outbreak? A - Prepare for investigation: - Develop knowledge about investigation techniques. - Review similar outbreak. - Team assembly. B - Confirm outbreak existence: - Case definition. - Case finding. - Early control measures. - Report to public health. - Appropriate consultations.

  10. Outbreak investigation cont… C - Verify diagnosis of reported cases: - Agent - Disease nature - Specimens D - Search for additional cases: E - Characterize cases of disease: - Time - Place - Person - Graph F - Formulate hypothesis: - Source - Epi curve

  11. Cont… G - Test hypothesis: H - Evaluate control measures efficacy: I - Review current practice: J- Communicate findings:

  12. Examples • MRSA outbreak BCCH, Vancouver. • 1999, 33 cases were identified in NICU. • Task force team assembled. • Effective IC measures implemented. • Enhanced surveillance. • Isolation and cohorting.

  13. Weekly surveillance Glove & gown d/c’d Al-Dajani et al, IDSA 2006

  14. Vanco stopped Daily tubing replacement

  15. KAAUH • Eight cases of persistent CoNS in 1 wk. • Associated with thrombocytopenia. • One term baby? • Different allocations. • High dose of vancomycin +/- rifampin. • Worsening clinical condition. • One has PICC. • What to do??

  16. ?common source • TPN might be ? • Culture from TPN sent. • Guess what? • Three +ve for CoNS. • TPN d/c’d for 5 days. • Sepsis well controlled. • No more new cases.

  17. ESBL-KP • Klebsiella pneumonia outbreak • Macrae et al, J Hosp Infect 2001; 49: 183-92 • Outbreak control group. • Closed to transfer. • Cohort not feasible. • Hand hygiene etc… • Screening. • Antibiotic changed • But outbreak continued???

  18. NICU closed. • Satellite unit opened. • Screen all new comers. • Outbreak over.

  19. Cont… • Klebsiella pneumonia sepsis > 50%, 2001, PIDJ, 05. • 88/115 had clinical sepsis, MR 51%. • 24 pt develop sepsis in < 24hr, K-P 73%, ESBL 58%. • Reviewing their IC practice. • IVF prepared at bed side. • Inadequate hand hygiene & aseptic tech. • Cultures from IVF (65%) revealed KP. • Standard IC precautions improved sepsis rate & MR.

  20. Take home messages • Team work. • Epi-curve. • Think of the source. • Reinforce IC measures. • Appropriate allocation. • Review antibiogram. • Re-evaluate efficacy of IC. • Prevention vs therapy

  21. Thank You

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