title: A decrease in the number of cases of necrotizing enterocolitis associated with the enhancement of infection prevention and control measures during a Staphylococcus aureus outbreak in a neonatal intensive care unit.
abstract: OBJECTIVE
  Most cases of necrotizing enterocolitis (NEC) are sporadic, but outbreaks in hospital settings suggest an infectious cause. Our neonatal intensive care unit (NICU) experienced an outbreak of methicillin-sensitive Staphylococcus aureus (MSSA). We aimed to assess whether the enhancement of infection prevention and control measures would be associated with a reduction in the number of cases of NEC.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A 24-bed, university-affiliated, inborn level 3 NICU.
  
  
  METHODS
  Infants of less than 30 weeks gestation or birth weight ≤ 1,500 g admitted to the NICU between January 2007 and December 2008 were considered at risk of NEC. All cases of NEC were reviewed.
  
  
  METHODS
  Infection prevention and control measures, including hand hygiene education, were enhanced during the outbreak. Avoidance of overcapacity in the NICU was reinforced, environmental services (ES) measures were enhanced, and ES hours were increased.
  
  
  RESULTS
  Two hundred eighty-two at-risk infants were admitted during the study. Their gestational age and birth weight (mean ± SD) were 28.2 ± 2.7 weeks and 1,031 ± 290 g, respectively. The proportion of NEC was 18/110 (16.4%) before the outbreak, 1/54 (1.8%) during the outbreak, and 4/118 (3.4%) after the outbreak. After adjustment for gestational age, birth weight, gender, and singleton versus multiple births, the proportion was lower in the postoutbreak period than in the preoutbreak period (P < .002).
  
  
  CONCLUSIONS
  Although this observational study cannot establish a causal relationship, there was a significant decrease in the incidence of NEC following implementation of enhanced infection prevention and control measures to manage an MSSA outbreak.
authors.affiliation: The Ottawa Hospital, Ottawa, Ontario, Canada. blemyre@toh.on.ca
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lemyre
authors.forename: Wenlong
authors.initials: W
authors.lastname: Xiu
authors.forename: Nicole Rouvinez
authors.initials: NR
authors.lastname: Bouali
authors.forename: Janet
authors.initials: J
authors.lastname: Brintnell
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Janigan
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Suh
authors.forename: Nicholas
authors.initials: N
authors.lastname: Barrowman
mesh_terms: D001724:Birth Weight; D004196:Disease Outbreaks / Q000517:prevention & control*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006235:Hand Disinfection; D006797:Housekeeping, Hospital; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control; D015931:Intensive Care, Neonatal; D008297:Male; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*