00:00 Outbreaks in the neonatal intensive care unit, while they are not very commonplace
00:04 based on statistics in the public domain internationally, when they do occur they
00:09 can be devastating. In 2017 a case study of NICU outbreaks was done by a professor
00:14 of microbiology, infectious diseases and immunology and of pediatrics at the
00:19 University of Montreal Dr. Caroline Quachetan and assistant professor at
00:24 John Hopkins University in the United States
00:27 neonatologist Dr. Juliet Johnson. The study examined English, French and German
00:33 literature during the period of 2015 to 2017. It found that 39 outbreaks in NICUs
00:39 were reported with gram-negative bacteria causing most of them and ESBL
00:44 producing organisms being the most frequent resistant mechanism. A source of
00:50 outbreak was not identified in 33% of the cases. Although there are several
00:55 bacteria that can pose danger and death to premature babies and neonates, let's
01:00 zone in on some of the outbreaks that were related to ESBL Klebsiella pneumoniae
01:04 and serratia marcescens which are two of three bacteria that have been found in
01:09 the outbreak in the NICU at the Port of Spain General Hospital. They are as
01:13 follows. Germany 2013 to 2014 serratia marcescens cause bacteremia conjunctivitis
01:19 which can progress to serious bloodstream infection. The source of the
01:24 spread was not identified. Germany 2009 to 2012 ESBL Klebsiella pneumoniae. The
01:32 source was not identified. Turkey 2013 ESBL Klebsiella pneumoniae cause
01:38 bacteremia or bloodstream infection meningitis and urinary tract infections.
01:43 The source of the spread was not described. Norway 2008 to 2009 ESBL
01:50 Klebsiella pneumoniae cause bacteremia. The source of the spread was
01:54 contaminated breast milk. Ecuador 2013 to 2014 serratia marcescens cause
02:01 bacteremia conjunctivitis and surgical site infections. The source of the spread
02:06 was an index case being transferred from another facility. China had three
02:12 separate outbreaks one in 2014 and two in 2015 from ESBL Klebsiella pneumoniae
02:18 and CRE Klebsiella pneumoniae. This cause bacteremia, respiratory problems, UTIs
02:25 and bacterial colonization. The sources of spread were an index case being
02:30 transferred from another facility and contaminated incubator water. The source
02:36 was not identified for one of the outbreaks. From the case study many of
02:41 the outbreaks lasted for a number of months spanning from one year into the
02:45 next. Regionally Jamaica in 2015 experienced a
02:50 NICU outbreak relating to ESBL Klebsiella pneumoniae that led to the
02:54 deaths of 18 babies in June of that year. One medical publication states that
03:00 Klebsiella pneumoniae has the potential to survive in a NICU setting for more
03:05 than three years and can re-emerge despite infection control measures. It
03:10 cites what it calls primary reservoirs for the bacteria as patients accounting
03:15 for 48.9 percent, health care workers 25.5 percent and contaminated sinks at 13.8
03:24 percent. Meanwhile other medical experts suggest that cell phones can be a
03:28 mechanism for contamination as well as hospital equipment for example feeding
03:33 tubes. In terms of infection control measures that have been triggered when
03:38 outbreaks occur they are multifaceted. Professor Quash Tan and Dr. Johnson's
03:44 side that strict hand hygiene is to be practiced by staff and parents.
03:48 Sanitizing and disinfecting, transition to single-use products where possible,
03:53 patient isolation, the discontinuation of kangaroo K and cohorting which is
03:59 confining affected patients to one area of 4k. Under staffing is stated as a risk
04:05 during outbreaks especially for premature babies and during these
04:09 periods staff to patient ratio is increased. Continuous swabbing is also
04:14 another mechanism. In rare cases of prolonged or severe outbreaks where IPC
04:20 measures fail to work there has been the actioning of temporary or permanent
04:25 ward closure in some places. The identification and strain typing of
04:30 bacteria are said to be an important tool during outbreaks as it can help
04:34 health care providers trigger the appropriate response but a gold standard
04:39 test for outbreak investigations, pulsed field gel electrophoresis is highlighted
04:44 as labor-intensive requiring a lot of analytical expertise. While the experts
04:50 point an extension of active surveillance cultures in babies
04:53 underneath 1500 grams or 1.3 pounds this can be an economic challenge for low
05:00 resource countries. As it pertains to attempting to identify a source swabbing
05:05 of a range of hospital equipment forms part of the process. Babies and their
05:10 parents are also swabbed. Alicia Boucher TV6 News
05:16 [BLANK_AUDIO]
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