BackgroundThe occurrence of a respiratory syncytial virus (RSV) outbreak in a Neonatal Intensive Care Unit (NICU) is related to unfavorable outcomes, as this infection can lead to respiratory distress and death in premature in infants. Report the successful control of an outbreak that occurred in April 2010 in a NICU.MethodsAfter the index case, of 18 premature infants placed in the same room 10 infants were infected. Of those 10, 6 developed mild to moderate respiratory symptoms, 4 persisted asymptomatic and no death occurred. Contact and respiratory precautions were rapidly initiated, the infants were cohorted in 3 different rooms and palivizumab was administered to all contacts.ResultsThe outbreak was controlled and no new cases were subsequently indentified.ConclusionStandard infection control measures plus palivizumab prophylaxis were efficient in rapid control of the outbreak.
BACKGROUND: Group B streptococcus (GBS) is one of the principal agents of neonatal early onset sepsis (EOS). OBJECTIVE: To evaluate the incidence of GBS colonization and neonatal EOS due to GBS and to describe the compliance of an institutional protocol. METHODS: From January 2007 to December 2010 we conducted a retrospective cohort study to evaluate the incidence of maternal GBS colonization in high risk pregnant women. A protocol was implemented to determine anal/vaginal GBS colonization of all women at 22 to 37 weeks of pregnancy and all patients that presented the following risk factors. Intrapartum antibiotic prophylaxis (IAP) was administered according to the Centers for Disease Control and Prevention (CDC) guidelines. From January 2009 to December 2010, data from the medical records of all newborns at the NICU were also collected to identify the incidence of newborns whose mothers were screened as indicated by the protocol. RESULTS: A total of 4,797 high risk pregnant women were included. The incidence of maternal GBS colonization was 23%. The incidence of neonatal EOS due to GBS was 0.09/1000 live births and a 50% mortality rate. Information regarding GBS maternal colonization was available for 91% of the neonates admitted to the NICU. CONCLUSIONS: The maternal GBS colonization rate was similar to that described in the literature. Information regarding maternal GBS colonization was available to the majority of neonates, which is essential for management of this high risk population. The strategy of surveillance of high risk pregnant women can provide a useful and feasible strategy.
Background: Following the first reports of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the 1970s, several measures to prevent its transmission were introduced in hospitals. However, controversy continues regarding the best approach to prevent and control MRSA, especially in neonatal intensive care units (NICUs). Objective: To report the reduction of colonization and primary central venous catheter–related bloodstream infection (CRBSI) caused by MRSA through surveillance, decolonization, and adoption of best practices in intravenous catheter care. Methods: Quasi-experimental, nonrandomized, before-and-after intervention study conducted in a 70-bed NICU in a private maternity hospital in Brazil. Period studied comprehended between August 2018 and May 2019 (period 1 - preintervention) and June to December 2019 (period II - postintervention). At the end of period 1, several measures were implanted to control and prevent colonization and CRBSI in the unit. The following measures were implemented: incentive to hand hygiene; best practices training on medication preparation and central catheter manipulation; systematic screening of colonized patients with nasal and umbilical swabs; contact precautions for colonized newborn (NB); contact precautions for twins of a colonized NB even when they had a negative swab; decolonization of patients with nasal mupirocin and chlorohexidine (oral preparation) for oral hygiene; concurrent linen change at the end of the patient’s decolonization; decolonization of parents of colonized siblings with chlorohexidine bath and nasal mupirocin; environmental organization; intensification of cleaning and disinfection of equipment and articles; cohort of patients and workers; isolation and precautions compliance audit; professional investigation and decolonization and universal chlorhexidine bath for newborns. Results: In periods I and II, the positivity rates of the collected swabs were 4.14% and 0.75% (P < .0001), respectively, with a peak of positivity of 11.8% in January. Also, 12 episodes of CRBSI were documented in period I (incidence, 2.9%) versus no episode in period 2, with a significant difference in incidence rate between the 2 periods (P = .002). Conclusion: The innovative measures were effective for eradicating the outbreak when instituted together with recognized good practices. In an outbreak scenario is difficult to define the isolated impact of each measure, although, parents’ decolonization to prevent the colonization of other siblings and contact precautions for twins of colonized NB seemed to improve the results.Funding: NoneDisclosures: None
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