Management of Infection Management of Infection Outbreaks in NICU Outbreaks in NICU Experience in level 3 NICU over 10 years Experience in level 3 NICU over 10 years Dr Sarah Skinner Dr Sarah Skinner Consultant in Neonatal Medicine Consultant in Neonatal Medicine Luton and Dunstable Hospital Luton and Dunstable Hospital The 6th Annual Perinatal Conference A collaboration of the Midlands and East Neonatal and Perinatal Networks Friday 25th January 2013
Transcript
Management of Infection Management of Infection
Outbreaks in NICU Outbreaks in NICU
Experience in level 3 NICU over 10 yearsExperience in level 3 NICU over 10 years
Dr Sarah SkinnerDr Sarah Skinner
Consultant in Neonatal MedicineConsultant in Neonatal Medicine
Luton and Dunstable Hospital Luton and Dunstable Hospital
The 6th Annual Perinatal Conference
A collaboration of the Midlands and East Neonatal and Perinatal Networks
Friday 25th January 2013
Experience in level 3 NICU over 10 yearsExperience in level 3 NICU over 10 years
��OrOr
�� This is what has happened to us….. This is what has happened to us…..
��How this How this will will happen to you happen to you
How I wished we done things differentlyHow I wished we done things differently��How I wished we done things differentlyHow I wished we done things differently
��How we can avoid “reinventing the wheel “ How we can avoid “reinventing the wheel “
and make it easier for those who have to and make it easier for those who have to
face the issue in the future face the issue in the future
��….. …..
Aims Aims
�� Brief overview of history of L+D infection Brief overview of history of L+D infection Outbreaks on NNUOutbreaks on NNU
��How we managed Infection OutbreaksHow we managed Infection Outbreaks
�� Lessons from management of our Lessons from management of our �� Lessons from management of our Lessons from management of our outbreaks outbreaks
��National Picture National Picture
��Clinical Governance /Network Clinical Governance /Network communication issues communication issues
Network imageNetwork image
Putting Infection in local contextPutting Infection in local context
�� L+D NNUL+D NNU
�� 37 cots37 cots
�� 19 ITU/High dependency 19 ITU/High dependency
�� Regional NICU for Regional NICU for
Bedfordshire and Bedfordshire and Bedfordshire and Bedfordshire and
Hertfordshire neonatal Hertfordshire neonatal
network network
�� Higher than average Higher than average
number of very tiny number of very tiny
prems prems
�� New build plannedNew build planned
Neonatal InfectionNeonatal Infection
TB 2004 TB 2004 �� 2004;TB exposure NNU 2004;TB exposure NNU mother and her premature mother and her premature baby died; 80 exposed babies baby died; 80 exposed babies needing screening and treating needing screening and treating none infected none infected
�� All exposed babies and staff All exposed babies and staff remained well remained well
�� Lots of extra clinics and Lots of extra clinics and clinicians time weekends and clinicians time weekends and evenings evenings
�� Phone line set up for parents Phone line set up for parents
Outcome/recommendations;Outcome/recommendations;
�� First Neonatal Outbreak meeting First Neonatal Outbreak meeting
�� Learning experience for us all Learning experience for us all
��Heavy input from public health Heavy input from public health HPAHPA
��CommunicationCommunication needed to be improved needed to be improved
when HIV positive women unwellwhen HIV positive women unwell
“Neonates do NOT cough”“Neonates do NOT cough”
��Coughing women with HIV have TB until Coughing women with HIV have TB until
proved otherwiseproved otherwise
TB recommendations2TB recommendations2
�� ANNP and senior nursing roles vital ANNP and senior nursing roles vital
�� Involvement of local TB services Involvement of local TB services
�� Early lessons in communication with Early lessons in communication with
parents ;letters and directly parents ;letters and directly parents ;letters and directly parents ;letters and directly
��Media interest Media interest
ESBL 2008ESBL 2008
�� 2008 ESBL E coli 2008 ESBL E coli
�� 13 infants infected 2 13 infants infected 2 died 5 unwell and 6 died 5 unwell and 6 carrierscarriers
�� ESBL carriage was ESBL carriage was �� ESBL carriage was ESBL carriage was very long term and very long term and persisted after persisted after discharge .babies discharge .babies with bowel carriage with bowel carriage remained wellremained well
ESBL OutcomeESBL Outcome
�� MediaMedia Interest +Interest +
�� Litigation Litigation several parents several parents
�� No evidence of contamination of any NICU No evidence of contamination of any NICU surfaces including outside of incubators surfaces including outside of incubators
No direct evidence of staff to patient spread but No direct evidence of staff to patient spread but �� No direct evidence of staff to patient spread but No direct evidence of staff to patient spread but in the absence of other evidence this was the in the absence of other evidence this was the presumed method of infection presumed method of infection
�� Good use of Good use of communicationcommunication letters to parents letters to parents and direct 1 to 1 meetings with CD and chief and direct 1 to 1 meetings with CD and chief nurse for all affected babies nurse for all affected babies
�� Parents sue over E.coli outbreakParents sue over E.coli outbreak
�� Families are suing a hospital where two Families are suing a hospital where two
babies died following an E.coli babies died following an E.coli
outbreak after it emerged that staff may outbreak after it emerged that staff may outbreak after it emerged that staff may outbreak after it emerged that staff may
have spread the infection by not have spread the infection by not
washing their hands.washing their hands.
ESBL; RecommendationsESBL; Recommendations
�� Stop all visitors Stop all visitors
including including
grandparents and grandparents and
siblingssiblings
�� Gloves and gowns Gloves and gowns
when handling all when handling all
babies (this is not the babies (this is not the
regional neonatal regional neonatal
network policy ) network policy )
ESBL Recommendations 2ESBL Recommendations 2
��Regular screening of inpatients stool Regular screening of inpatients stool
sample since weekly (resulted in apparent sample since weekly (resulted in apparent
increase incidence initially now stabilised )increase incidence initially now stabilised )
�� Second line antibiotics changed to include Second line antibiotics changed to include �� Second line antibiotics changed to include Second line antibiotics changed to include
Merepenum for a period of time until Merepenum for a period of time until
ESBL Recommendations 3ESBL Recommendations 3�� Improved surveillance for bacterial infection to Improved surveillance for bacterial infection to pick up outbreaks early pick up outbreaks early
�� Daily email to all nicu consultants and senior Daily email to all nicu consultants and senior nurse very effective nurse very effective
�� Staffing improvements with increased nursing Staffing improvements with increased nursing time for infection control and increased senior time for infection control and increased senior time for infection control and increased senior time for infection control and increased senior nursing time /matron post nursing time /matron post
�� Change all taps to sensor tapsChange all taps to sensor taps
�� New sinks New sinks
�� Earlier involvement of Trust executive teamEarlier involvement of Trust executive teamrecommended recommended
�� Media TrainingMedia Training needed needed
National surveillance study of extended spectrum β National surveillance study of extended spectrum β
lactamase (ESBL) producing organism infection in lactamase (ESBL) producing organism infection in
neonatal units of england and wales neonatal units of england and wales S MitraS Mitra11, ,
35 units(26%) had had ESBL isolated in the last 2 years 16
surface only 19 invasive infections
Only 10 declared an outbreak
11% units screen regularly for ESBL but
26% don’t isolate Baby if ESBL found
Lack of knowledge of outbreaks in other hospitals
Pseudomonas 2009Pseudomonas 2009
�� Regular stool sampling Regular stool sampling with daily alerts to NNU with daily alerts to NNU team detected small team detected small increase in the number of increase in the number of patients on NNU with patients on NNU with pseudomonas in stool pseudomonas in stool pseudomonas in stool pseudomonas in stool
�� Further investigation Further investigation found pseudomonas in found pseudomonas in water in newly fitted water in newly fitted sensor taps sensor taps
�� Reported via Datix risk Reported via Datix risk event system event system
L+D L+D �� Enhanced infection control Enhanced infection control measures continuedmeasures continued
�� Use of alcohol gelUse of alcohol gel after after washing hands with hand washing hands with hand wash wash
�� Stop using tap water to wash Stop using tap water to wash babiesbabies and with nappy change and with nappy change babiesbabies and with nappy change and with nappy change
�� Nappy change water not to be Nappy change water not to be disposed in sinks disposed in sinks
�� Taps changed back to Taps changed back to elbow elbow operated operated
�� Bacterial filters placed on the Bacterial filters placed on the outflow of each tap outflow of each tap
�� Infection control transfer letter Infection control transfer letter for discharges out to other for discharges out to other hospitals hospitals
��Week 2 unwell respiratory and septic Week 2 unwell respiratory and septic ��Week 2 unwell respiratory and septic Week 2 unwell respiratory and septic
deterioration deterioration
��Cystic lung changes Cystic lung changes
��One baby had skin abcess One baby had skin abcess
PVL Staphylococcus areus PVL Staphylococcus areus
detecteddetected
�� Possibility of PVL Staphylococcus raisedPossibility of PVL Staphylococcus raised
�� Samples from both babies sent to Samples from both babies sent to reference laboratory reference laboratory
�� Antibiotic management changed Antibiotic management changed �� Antibiotic management changed Antibiotic management changed Clindamycin and Linesolid Clindamycin and Linesolid
�� Babies received intravenous Babies received intravenous Immunoglobulin 2 doses in 48 hours Immunoglobulin 2 doses in 48 hours
��Cultures confirmed PVL strain Cultures confirmed PVL strain Staphylococcus Areus in Both babies Staphylococcus Areus in Both babies
PVL OutcomePVL Outcome
�� Unit full closed to outside Unit full closed to outside admissions admissions
�� Parents informed ; Parents informed ; Mother discharging Mother discharging caesarean wound for 10 caesarean wound for 10 caesarean wound for 10 caesarean wound for 10 days not responded to days not responded to flucloxacillin .GP has just flucloxacillin .GP has just changed her to another changed her to another antibiotic antibiotic
�� Wound swab grew PVLWound swab grew PVL
�� Both babies had Both babies had previously had kangaroo previously had kangaroo care care
PVL investigationPVL investigation
�� Twins parents nose and groin swabTwins parents nose and groin swab
�� All NNU staff and labour ward staff who All NNU staff and labour ward staff who
had had contact with mum swabbedhad had contact with mum swabbedhad had contact with mum swabbedhad had contact with mum swabbed
�� All babies who were on the unit since time All babies who were on the unit since time
of twins positive results swabbed of twins positive results swabbed
Initial ResultsInitial Results
�� Mother of twins positive PVLMother of twins positive PVL
�� 2 other babies born on the same day also PVL 2 other babies born on the same day also PVL
positive on nose and groin swab .bed space positive on nose and groin swab .bed space
close to the index twins. Both babies remained close to the index twins. Both babies remained close to the index twins. Both babies remained close to the index twins. Both babies remained
well well
�� NICU ;104 staff screened 26 staph carriers 3 NICU ;104 staff screened 26 staph carriers 3
PVL (all carriers were different type than twins) PVL (all carriers were different type than twins)
�� Treated at home as per MRSATreated at home as per MRSA
�� Stay off clinical duties until repeat swab Stay off clinical duties until repeat swab
negative negative
�� Long time off sick leave as proved very Long time off sick leave as proved very �� Long time off sick leave as proved very Long time off sick leave as proved very
resistant to treatment resistant to treatment
Baby carriersBaby carriers
��Decontamination as per MRSA Decontamination as per MRSA
PVL recommendationsPVL recommendations
�� Restricted visiting ;Restricted visiting ;parents onlyparents only
�� Limited admissions to luton booked Limited admissions to luton booked
�� Enhanced hand hygieneEnhanced hand hygiene
�� Isolated and barrier nursed infected Isolated and barrier nursed infected Isolated and barrier nursed infected Isolated and barrier nursed infected
�� PVL added temporarily to nnu screeningPVL added temporarily to nnu screening on on admission and for existing babies admission and for existing babies
�� New New parental health questionnaireparental health questionnaire introducedintroduced
�� Letters to all parents of babies on the unitLetters to all parents of babies on the unit
�� Press report released Press report released
Other infection incidentsOther infection incidents
�� Staff /Family member with chicken poxStaff /Family member with chicken pox
��Norovirus Norovirus
�� Seasonal and pandromic influenza Seasonal and pandromic influenza
MRSAMRSA��MRSAMRSA
��RSV RSV
Infection in NNU ;putting outbreaks Infection in NNU ;putting outbreaks
into contextinto contextSignificant positive blood cultures Dec 2008-Dec 2009 incusive
2%
2%
5% 2%
2%
2%
ESBL E Coli
E COLI
Group B Streptococcus
Streptococcus sanguis2%
4%
2%
2%
2%
2%
2%
2%
2%
67%
Acinetobacter lowoffii
Enterobacter cloacae
strep faecalis
Pseudomonas. aeruginosa
Acinetobacter lowoffii
Streptococcus agalactiae
Candida tropicalis
heamophilus Influenza
Enterobacter aerogenes
staphylococcus areus
Staph Epi
National PictureNational Picture
�� Largely not clear Largely not clear
�� Limited awareness between units of Limited awareness between units of
issues even very locally issues even very locally
�� All neonatal units have infection outbreaks All neonatal units have infection outbreaks �� All neonatal units have infection outbreaks All neonatal units have infection outbreaks
but not all are formally reported but not all are formally reported
��When it does get into the paper the When it does get into the paper the
reporting can be unpleasant and reporting can be unpleasant and
20112011Independent review of the incidents of Pseudomonas Infection in Neonatal Units in Independent review of the incidents of Pseudomonas Infection in Neonatal Units in
Northern Ireland; The regulation and quality improvement authority report March 2012Northern Ireland; The regulation and quality improvement authority report March 2012
��Northern Ireland ;5 NICU providing ITU Northern Ireland ;5 NICU providing ITU
care and 2 only providing scbu care care and 2 only providing scbu care
��Nov 2011 3 babies in 1 unit unwell Nov 2011 3 babies in 1 unit unwell ��Nov 2011 3 babies in 1 unit unwell Nov 2011 3 babies in 1 unit unwell
pseudomonas infection in blood ; 2 died pseudomonas infection in blood ; 2 died
��Unit screening confirmed 2 further babies Unit screening confirmed 2 further babies
�� Jan 2012 3Jan 2012 3rdrd unit 3 colonised babiesunit 3 colonised babies
�� Jan 2012 4Jan 2012 4thth unit 2 colonisedunit 2 colonised
Recommendations NIRecommendations NI
�� Sterile water to wash all babies in neonatal care Sterile water to wash all babies in neonatal care
�� No tap water to defrost human milkNo tap water to defrost human milk
�� Advice re water testing protocols Advice re water testing protocols
�� Sink cleaning guidance Sink cleaning guidance
�� No water for cleaning incubators ;wipes No water for cleaning incubators ;wipes �� No water for cleaning incubators ;wipes No water for cleaning incubators ;wipes
�� Hand hygiene auditsHand hygiene audits
�� Pseudomonas should be an alert organism in Pseudomonas should be an alert organism in NICU . 1 case should prompt water check in NICU . 1 case should prompt water check in areas baby has been nursed areas baby has been nursed
�� Surveillance arrangements need improvingSurveillance arrangements need improving
DOH guidanceDOH guidanceWater sources and potential Pseudomonas Aeruginosa contamination of taps Water sources and potential Pseudomonas Aeruginosa contamination of taps
and water systems march 2012 and water systems march 2012
�� Water safety plansWater safety plans;;�� includes advice on water sampling how ,when and includes advice on water sampling how ,when and how to interpret results how to interpret results
�� What to do in the event of a pseudomonas in What to do in the event of a pseudomonas in water contamination problem in units with at risk water contamination problem in units with at risk patientspatientspatientspatients�� Filter water or use from a safe sourceFilter water or use from a safe source
�� Use of alcohol hand rub Use of alcohol hand rub
�� Sterile water for baby top and tail Sterile water for baby top and tail
�� Cleaning equipment use single use if possible and Cleaning equipment use single use if possible and use detergent wipes rather than water for incubator use detergent wipes rather than water for incubator cleaninf cleaninf
Out break managementOut break management
1.1. Confirm an outbreak Confirm an outbreak
2.2. Arrange and infection control /outbreak Arrange and infection control /outbreak
meeting meeting
3.3. Decide who needs to be there Decide who needs to be there 3.3. Decide who needs to be there Decide who needs to be there
4.4. Decide on immediate clinical Decide on immediate clinical
management for affected babiesmanagement for affected babies
5.5. Are there any implications for staff ?Are there any implications for staff ?
�� Is this a Serious Incident ? (SI previously Is this a Serious Incident ? (SI previously
SUI)SUI)
Route Cause analysisRoute Cause analysis
�� Time frames Time frames
�� Patient movement and adjacencies Patient movement and adjacencies
Staff movement and staffing levels Staff movement and staffing levels �� Staff movement and staffing levels Staff movement and staffing levels
�� Shared equipment Shared equipment
�� Environmental issues Environmental issues
Local investigationLocal investigation
�� Takes time Takes time
��May need staff to work extra hours ; how May need staff to work extra hours ; how
is this paid for ?is this paid for ?
�� Effect on morale of staff on unit Effect on morale of staff on unit �� Effect on morale of staff on unit Effect on morale of staff on unit
�� Parental support Parental support
Communication strategyCommunication strategy
�� Immediate to parents of affected babies ;face to Immediate to parents of affected babies ;face to
face clinical team on duty face clinical team on duty
�� Parents of other children on unit letters Parents of other children on unit letters
�� Keep a record of which parents have been told Keep a record of which parents have been told �� Keep a record of which parents have been told Keep a record of which parents have been told
�� Inform Staff members in NNU and wider hospital Inform Staff members in NNU and wider hospital
�� Keep electronic file of lettersKeep electronic file of letters from previous from previous
incidents saves time incidents saves time
�� Local GPsLocal GPs
�� Public ; reactive v Public ; reactive v proactive press statementproactive press statement
Communication 2Communication 2�� Phone advice line for large outbreaks Phone advice line for large outbreaks
�� Use your hospital media service Use your hospital media service
�� Consider formal Consider formal media trainingmedia training .The press can .The press can be difficult to manage ,papers,radio, Tv .It helps be difficult to manage ,papers,radio, Tv .It helps to be prewarned to be prewarned
�� Neonatal network Neonatal network
�� Transport teamTransport team
�� Any hospital baby may be transferred to Any hospital baby may be transferred to subsequently subsequently
�� BAPM ??BAPM ??
SI procedureSI procedure
�� Trust to inform SHA in writing at 7 and 45 Trust to inform SHA in writing at 7 and 45
days days
�� Final report needed Final report needed
�� Time frame very tight as will need Time frame very tight as will need �� Time frame very tight as will need Time frame very tight as will need
checking by trust board before sending checking by trust board before sending
�� SI report should be shared with the SI report should be shared with the
Neonatal Network /BAPMNeonatal Network /BAPM
LitigationLitigation
�� Sadly increasing Sadly increasing
�� Accurate legible contemporaneous notes Accurate legible contemporaneous notes
needed needed
��Good communication can help prevent Good communication can help prevent ��Good communication can help prevent Good communication can help prevent
��Remember you are not alone and all NNU Remember you are not alone and all NNU
have infections have infections
Key Learning points for meKey Learning points for me
�� Involve trust executive team earlyInvolve trust executive team early
�� Use your hospital media departmentUse your hospital media department
�� Get Public Health input early Get Public Health input early
�� Early good communication with parentsEarly good communication with parents�� Early good communication with parentsEarly good communication with parents
�� Keep copies of old infection related letters you Keep copies of old infection related letters you
will need them again and will kick yourself if you will need them again and will kick yourself if you
have to rewrite have to rewrite
�� Support your staff ,an infection in your prized Support your staff ,an infection in your prized
neonatal unit is very upsetting to us all neonatal unit is very upsetting to us all
�� Work on increasing breast feeding Work on increasing breast feeding
Response to NI pseudomonasResponse to NI pseudomonas
�� 2.Standardised audit tool /RAG rating the 2.Standardised audit tool /RAG rating the
NI NI
NumNum
berber
RecommendationRecommendation Local planLocal plan Action Action
neededneeded
Time Time
frameframe
RAG RAG
RatingRating
11 Sterile water Sterile water
should be used should be used
when washing all when washing all
babies in neonatal babies in neonatal
carecare
All babies in HDU All babies in HDU
and ITU will be and ITU will be
washed in sterile washed in sterile
water and this will water and this will
be used for all be used for all
nappy changes. no nappy changes. no
dirty water to be dirty water to be
disposed of in sinks disposed of in sinks
.Babies in scbu who .Babies in scbu who
are being bathed are being bathed
nonenone currentcurrent greengreen
are being bathed are being bathed
will be bathed in will be bathed in
water from a source water from a source
known never to known never to
have been have been
colonised with colonised with
pseudomonas ( pseudomonas (
delivery suite).bath delivery suite).bath
water will be water will be
disposed of in the disposed of in the
sluicesluice
NumberNumber RecommendatiRecommendati
onon
Local planLocal plan Action Action
neededneeded
Time Time
frameframe
RAG RatingRAG Rating
22 Tap water should Tap water should
not be used during not be used during
the process of the process of
defrosting frozen defrosting frozen
breast milk breast milk
Defrost milk in milk Defrost milk in milk
fridge .If milk is fridge .If milk is
needed more quickly needed more quickly
use sterile water use sterile water
boiled in a dedicated boiled in a dedicated
kettle in the milk kettle in the milk
kitchen kitchen
Buy kettle Buy kettle
Consider Consider
purchase of purchase of
milk warmermilk warmer
Aug Aug
20122012
amberamber
33 Follow water testing Follow water testing
guidance as per guidance as per
DOH march 2012 DOH march 2012
guidance guidance
Estates water action Estates water action
group group
Aug Aug
20122012
amberamber
NumberNumber RecommendatiRecommendati
onon
Local planLocal plan Action neededAction needed Time Time
frameframe
RAG RatingRAG Rating
44 Presentation of Presentation of
water test results water test results
should be should be
standardised across standardised across
the laboratories that the laboratories that
undertake this undertake this
follow testing follow testing
protocolprotocol
estates to coordinate estates to coordinate End End
20122012
amberamber
55 Guidance on Guidance on
cleaning sinks cleaning sinks
should be should be
standard standard
cleaning cleaning
regime for regime for
develop develop
standardised standardised
cleaning cleaning
End 2012End 2012 greengreen
should be should be
reviewed and the reviewed and the
process process
standardised standardised
across all clinical across all clinical
areas areas
regime for regime for
sinks in high sinks in high
risk clinical risk clinical
areas such as areas such as
NNU NNU
cleaning cleaning
procedureprocedure
66 Regional Regional
guidance on the guidance on the
cleaning of cleaning of
incubators and incubators and
other specialist other specialist
equipment for equipment for
neonatal care neonatal care
should be should be
introduced introduced
use of use of
cleaning cleaning
wipes in the wipes in the
place of soap place of soap
and water to and water to
clean clean
incubators incubators
to trial wipes as to trial wipes as
advised by advised by
infection control infection control
develop a process develop a process
map for cleaning map for cleaning
incubatorsincubators
End 2012End 2012 greengreen
NumberNumber RecommendatiRecommendati
onon
Local planLocal plan Action neededAction needed Time Time
frameframe
RAG RAG
RatingRating
66 Regional Regional
guidance on the guidance on the
cleaning of cleaning of
incubators and incubators and
other specialist other specialist
equipment for equipment for
neonatal care neonatal care
should be should be
use of use of
cleaning cleaning
wipes in the wipes in the
place of soap place of soap
and water to and water to
clean clean
incubators incubators
To trial wipes as advised To trial wipes as advised
by infection control by infection control
develop a process map develop a process map
for cleaning incubatorsfor cleaning incubators
End End
20122012
greengreen
should be should be
introduced introduced
77 Independent Independent
hand hygiene hand hygiene
audit s should be audit s should be
carried out in a carried out in a
regular basisregular basis
continuecontinue End End
20122012
greengreen
88 expansion of the expansion of the
neonatal unit to neonatal unit to
allow more allow more
circulation space circulation space
around cotsaround cots
New buildNew build redred
RecommendationRecommendation Local planLocal plan Action neededAction needed Time Time
frameframe
RAG RAG
RatingRating
99 Pseudomonas Pseudomonas
should be identified should be identified
as an alert organism as an alert organism
for neonatal intensive for neonatal intensive
and high dependency and high dependency
care /When identified care /When identified
from a sample from a from a sample from a
baby, taps and sinks baby, taps and sinks
should be tested in should be tested in
rooms which have rooms which have
been occupied by been occupied by
Daily alert system in Daily alert system in
place for all positive place for all positive
swab and culture swab and culture
results. All NNU taps results. All NNU taps
tested with monthly tested with monthly
water samples and all water samples and all
babies are screened babies are screened
with stool samples with stool samples
weekly therefore we weekly therefore we
only need to test taps only need to test taps
in the areas that the in the areas that the
baby has been in baby has been in
End 2012End 2012 greengreen
been occupied by been occupied by
that baby since birtthat baby since birthh
baby has been in baby has been in
since the last since the last
negative stool sample negative stool sample
1010 Surveillance Surveillance
arrangements should arrangements should
be established for be established for
pseudomonas pseudomonas
aeruginosa for aeruginosa for
augmented care augmented care
settings including settings including
neonatal care neonatal care
Existing daily alert Existing daily alert
to all NNU to all NNU
consultants and consultants and
senior nurses of senior nurses of
positive swabs positive swabs
and cultures on and cultures on
NNU. Weekly stool NNU. Weekly stool
sample screening sample screening
for Pseudomonas for Pseudomonas
on all babies on on all babies on
NNU.NNU.
End 2012End 2012 greengreen
NumberNumber RecommendatiRecommendati
onon
Local planLocal plan Action neededAction needed Time Time
frameframe
RAG RatingRAG Rating
1111 All regional All regional
organisations organisations
should work to an should work to an
agreed regional agreed regional
protocol for the protocol for the
declaration of declaration of
outbreaksoutbreaks
amberamber
1212 Arrangements for Arrangements for
typing of typing of
availableavailable End 2012End 2012 greengreen
typing of typing of
Psuedomonas Psuedomonas
aeruginosa aeruginosa
should be should be
establishedestablished
1313 Improve Improve
accommodation accommodation
for the purposes for the purposes
of isolation and of isolation and
for cleaning of for cleaning of
equipment in NNU equipment in NNU
. Improve space . Improve space
around each cotaround each cot
New build New build redred
Summary Summary
�� Infection outbreaks are universal Infection outbreaks are universal
�� PrePre--planning can help planning can help
��Communication within and between Communication within and between networks vitalnetworks vital
Reinventing the wheel is a pointless and Reinventing the wheel is a pointless and ��Reinventing the wheel is a pointless and Reinventing the wheel is a pointless and demoralising experience ; why are we so demoralising experience ; why are we so good at it in the NHS ?good at it in the NHS ?
��Neonatal Networks have a vital role in Neonatal Networks have a vital role in preventing wheel reinvention preventing wheel reinvention
