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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

Published online by Cambridge University Press:  02 January 2015

Brigitte Lemyre ,
Wenlong Xiu ,
Nicole Rouvinez Bouali ,
Janet Brintnell ,
Jo-Anne Janigan ,
Kathryn N. Suh  and
Nicholas Barrowman
Brigitte Lemyre*
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
Wenlong Xiu
Affiliation:
Department of Neonatology, Fujian Provincial Maternity and Children Health Hospital, Fujian Province, China
Nicole Rouvinez Bouali
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
Janet Brintnell
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
Jo-Anne Janigan
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
Kathryn N. Suh
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
Nicholas Barrowman
Affiliation:
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
*
Division of Neonatology, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada ([email protected])
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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.

Design.

Retrospective chart review.

Setting.

A 24-bed, university-affiliated, inborn level 3 NICU.

Participants.

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.

Interventions.

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).

Conclusion.

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.

Infect Control Hosp Epidemiol 2012;33(1):29-33

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 1 , January 2012 , pp. 29 - 33
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. Lin, PW, Stoll, BJ. Necrotising enterocolitis. Lancet 2006;368(9543):1271–1283.Google Scholar
2. Neu, J, Walker, WA. Necrotizing enterocolitis. N Engl J Med 2011;364(3):255–264.CrossRefGoogle ScholarPubMed
3. Schnabl, KL, Van Aerde, JE, Thomson, AB, Clandinin, MT. Necrotizing enterocolitis: a multifactorial disease with no cure. World J Gastroenterol 2008;14(14):2142–2161.Google Scholar
4. Tyson, JE, Kennedy, KA, Lucke, JF, Pedroza, C. Dilemmas initiating enteral feedings in high risk infants: how can they be resolved? Semin Perinatol 2007;31(2):61–73.Google Scholar
5. Wendelboe, AM, Smelser, C, Lucero, CA, McDonald, LC. Cluster of necrotizing enterocolitis in a neonatal intensive care unit: New Mexico, 2007. Am J Infect Control 2010;38(2):144–148.Google Scholar
6. Boccia, D, Stolfi, I, Lana, S, Moro, ML. Nosocomial necrotising enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr 2001;160(6):385–391.Google Scholar
7. Bagci, S, Eis-Hubinger, AM, Franz, AR, et al. Detection of astrovirus in premature infants with necrotizing enterocolitis. Pediatr Infect Dis J 2008;27(4):347–350.Google Scholar
8. Recommended Standards for Newborn ICU Design. Report of the Seventh Consensus Conference on Newborn ICU Design, Committee to Establish Recommended Standards for Newborn ICU. http://www.nd.edu/ñicudes/stan%203.html. Published 2007. Accessed July 25, 2011.Google Scholar
9. Walsh, MC, Kliegman, RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986;33(1):179–201.Google Scholar
10. Murgas Torrazza, R, Neu, J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol 2011;31(suppl 1):S28–S34.Google Scholar
11. Hunter, CJ, Upperman, JS, Ford, HR, Camerini, V. Understanding the susceptibility of the premature infants to necrotizing enterocolitis (NEC). Pediatr Res 2008;63(2):117–123.Google Scholar
12. Sharma, R, Garrison, RD, Tepas, JJ III, et al. Rotavirus-associated necrotizing enterocolitis: an insight into a potentially preventable disease? J Pediatr Surg 2004;39(3):453–457.Google Scholar
13. Stuart, RL, Tan, K, Mahar, JE, et al. An outbreak of necrotizing enterocolitis associated with norovirus genotype GII.3. Pediatr Infect Dis J 2010;29(7):644–647.Google Scholar
14. Scheifele, DW, Bjornson, GL, Dyer, RA, Dimmick, JE. Delta-like toxin produced by coagulase-negative staphylococci is associated with neonatal necrotizing enterocolitis. Infect Immun 1987;55(9):2268–2273.Google Scholar
15. Mai, V, Young, CM, Ukhanova, M, et al. Fecal microbiota in premature infants prior to necrotizing enterocolitis. PLoS ONE 2011;6(6):e20647.Google Scholar
16. de La Cochetiere, MF, Piloquet, H, Des Robert, C, Darmaun, D, Galmiche, JP, Rozé, JC. Early intestinal bacterial colonization and necrotizing enterocolitis in premature infants: the putative role of Clostridium . Pediatr Res 2004;56(3):366–370.Google Scholar