Dr Margaret Broom1, Mrs Melanie Rosin1, Mrs Janine McEwan1, Ms Wendy Beckingham3, Mrs Penny Maher1
1Department of Women,.Youth and Children, Centenary Hospital for Women and Children, Woden, Australia,
2Australian Catholic University, Dickson, Australia,
3Canberra Hospital and Health Service (Infection Prevention and Control), Woden, Australia
Introduction: The prevalence of Vancomycin-resistant enterococci (VRE) colonisation has increased in Neonatal Intensive Care Units (NICU) over the past 5 years. Studies reporting 12-39% colonisation rates in their NICU population. In March 2017 the Canberra NICU clinical team were alerted that an infant transferred to local SCN was colonised for VRE. Further investigation identified a 20% colonisation rate in the NICU highlighting the need to review current cleaning processes and protocols.
Methods: A VRE working group (VWG) was established, membership included: medical, nursing, infection control and biomedical staff. The VWG met weekly and undertook a systematic review of NICU cleaning processes and protocols. Factors reviewed include: the layout of the clinical environment and equipment, staff education, cleaning responsibilities and cleaning products.
Results The VWG highlighted the following gaps: complexity of delineation of cleaning responsibilities and methods due to NICU footprint, product misuse, adherence to standard precautions and hand hygiene practice. The VWG developed and initiated a comprehensive package of interventions. Strategies implemented consisted of: updating protocols and facilitating staff (clinical and cleaning) education, weekly surveillance of environmental cleaning, testing of new cleaning products as well as positive feedback for improved outcomes. Isolation of colonisated infants and comprehensive infection control measures were initiated across the NICU. A weekly infant VRE swab protocol was implemented. No positive cultures were reported eight weeks post event.
Conclusion: Infants colonised with VRE are at risk of developing systemic infection emphasising the importance of continuing education, maintenance of cleaning standards and hand hygiene practices.
Dr Margaret Broom leads nursing research the Neonatal Intensive Care and Special Care Units of the Centenary Hospital for Women and Children in Canberra, Australia. Margaret has worked in the NICU for over 20 years and was a member of the working group described in this project.