Standard Precautions effectively control CPE outbreak in a regional neonatal unit
Mrs Joanna Harris1, Mrs Julie Rieck, Dr Joanne Morris
1Illawarra Shoalhaven Local Health District, Wollongong, Australia
Background
Carbapenemase-Producing Enterobacterales (CPE) cause protracted neonatal unit (NNU) outbreaks. Accepted management strategies recommend Contact Precautions.
On admission to a tertiary hospital a neonate discharged from a regional NNU after a 3-day admission was identified as colonised with CPE. This presentation describes the success of Standard Precautions in halting the outbreak.
Actions
An outbreak management protocol focussing on Standard Precautions was implemented. This involved observational infection prevention and control auditing, education to staff and families, enhanced environmental cleaning and disinfection, and microbiological screening of neonates and selected possible environmental reservoirs, with genotyping of CPE isolates. Empiric antimicrobial prescribing protocols were altered, and strong nursing and medical leadership was apparent.
The neonate screening program has been adopted as business as usual for this unit to facilitate prompt identification of re-emergence.
Results
Twenty-six Contacts were identified and 22 screened. Eight colonised neonates were identified. Isolates were a genetically undistinguishable strain of E. cloacae. The same strain was isolated from a handwash basin drain. A related CPE E. coli was isolated from a second handwash basin.
The outbreak was declared over after 49 days when no further acquisitions of CPE were identified amongst two new cohorts of neonates, and no further environmental isolates were found. None of the colonised neonates developed CPE infection. The unit remained open to admissions throughout the outbreak.
Conclusion
In this setting, CPE transmission between neonates and an identified environmental reservoir was effectively halted by the adoption of a horizontal infection prevention and control strategy founded on Standard Precautions.
Biography:
Joanna has extensive experience in infection prevention and control nursing practice having worked in the UK before moving to Australia in 2007. She has published several peer-reviewed papers on topics as varied as community prevalence of MRSA, headlice, and listeria risk. The ethics of infection prevention and control practice is a particular area of interest and Joanna is committed to improving the experience of infection prevention and control practice for patients and health professionals alike.