title: Survey of neonatal unit outbreaks in North London: identifying causes and risk factors.
abstract: BACKGROUND
  This survey was undertaken after a number of neonatal unit (NNU) outbreaks were reported to the North London health protection teams (HPTs).
  
  
  OBJECTIVE
  To determine the diversity of the outbreaks, ascertain potential sources and contributing factors, and identify the investigative procedures followed and control measures implemented.
  
  
  METHODS
  Using a structured questionnaire, information from the HPT database was collected for all NNU outbreaks reported between January 2010 and February 2011.
  
  
  RESULTS
  Ten outbreaks were identified from seven hospitals in 14 months. There was one para-influenza outbreak, seven Staphylococcus aureus [including six meticillin-resistant S. aureus (MRSA)] outbreaks, and two Gram-negative outbreaks. Potential sources of transmission identified for the MRSA outbreaks were healthcare worker (HCW)-assisted transmission (N = 2) and mother-to-baby transmission with onward HCW-assisted transmission (N = 3). An environmental source with onward HCW-assisted transmission was documented for one of the Gram-negative outbreaks. Interventions included patient screening and enhanced cleaning (N = 10), isolating/cohorting affected neonates (N = 9), barrier nursing (N = 6), staff movement restrictions (N = 5), hand hygiene audits (N = 4), staff screening (N = 4), household contact screening (N = 3) and environmental sampling (N = 3). Potential contributing factors included inadequate staffing levels, cluttered unit, inadequate sterilization of communal milk-expressing equipment and inappropriate follow-up of MRSA results.
  
  
  CONCLUSIONS
  This survey determined the diversity of NNU outbreaks in North London, and highlighted the importance of a multi-faceted approach to outbreak control. These data will assist in the development of clinical standards for the prevention, control and reporting of NNU outbreaks, and guidance for best practice in NNUs.
authors.affiliation: Public Health Laboratory London, Public Health England, London, UK. Electronic address: Kerry.williams1@nhs.net.
authors.forename: K
authors.initials: K
authors.lastname: Williams
authors.affiliation: Health Protection Services Colindale, Public Health England, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: North East and North Central London Health Protection Team, Public Health England, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Turbitt
authors.affiliation: North West London Health Protection Team, Public Health England, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Seng
authors.affiliation: Microbiology Services Colindale, Public Health England, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Cookson
authors.affiliation: Public Health Laboratory London, Public Health England, London, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Patel
authors.affiliation: Public Health Laboratory London, Public Health England, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Manuel
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D063373:Hand Hygiene; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal; D008131:London / Q000453:epidemiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents
keywords: Neonatal unit; Outbreak