Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains.
In the course of a hospital management takeover, a microbial outbreak took place in a tertiary neonatal intensive care unit (NICU). Here, we characterize the outbreak and its management. About 4 months prior to takeover, there was a sharp increase in positive isolates for MSSA and multidrug-resistant organisms (MDROs). Simultaneously, the nursing staff sick leave rate increased dramatically which directly correlated with the number of infection/colonization per week (r2= 0.95, p = 0.02). During the following months we observed several peaks in positive isolates of methicillin-sensitive staphylococcus aureus (MSSA), MDROs and subsequently a vancomycin-resistant enterococcus (VRE) outbreak. Interventional outbreak management measures were only successful after substantial recruitment of additional nursing staff. None of the VRE, but 44% (n = 4) of MDRO and 32% (n = 23) of MSSA colonized infants developed symptomatic infections (p = 0.02). Among the latter, 35% suffered from serious consequences such as osteomyelitis. The most important risk factors for colonization-to-infection progression were low gestational age and birth weight. Nursing staff fluctuation poses a substantial risk for both bacterial colonization and infection in neonates. Comprehensive outbreak management measures are only successful if adequate nursing staff is available. Non resistant strains account for most neonatal infections - possibly due to their limited perception as being harmful.
HELIOS University Medical Center Wuppertal, Department of Pediatrics and Neonatology, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany.
Kai O
KO
Hensel
Department of Neonatology, University Hospital Essen, Germany.
Rhea
R
van den Bruck
Robert-Koch Institute, Wernigerode, Germany.
Ingo
I
Klare
HELIOS University Medical Center Wuppertal, Department of Pediatrics and Neonatology, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany.
Michael
M
Heldmann
HELIOS University Medical Center Wuppertal, Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Germany.
Beniam
B
Ghebremedhin
EKO Children' Hospital, Oberhausen, Witten/Herdecke University, Germany.
Andreas C
AC
Jenke
D000328:Adult; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D019468:Disease Management; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007363:Intensive Care Units, Neonatal; D008297:Male; D009740:Nursing Staff; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus