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Managing and preventing outbreaks of Gram-negative infections in UK neonatal units
  1. Mark Anthony1,
  2. Alison Bedford-Russell2,
  3. Tracey Cooper3,
  4. Carole Fry4,
  5. Paul T Heath5,
  6. Nigel Kennea6,
  7. Maureen McCartney7,
  8. Bharat Patel8,
  9. Tina Pollard9,
  10. Mike Sharland5,
  11. Peter Wilson10
  1. 1Oxford University Hospitals NHS Trust, Headington, Oxford, UK
  2. 2Neonatal Unit, Birmingham Women's NHS Foundation Trust, Birmingham, UK
  3. 3Department of Infection Prevention and Control, Queen Marys Hospital, Sidcup, Kent, UK
  4. 4Department of Health, Wellington House, London, UK
  5. 5Department of Child Health, St Georges Hospital Medical School, University of London, London, UK
  6. 6Neonatal Unit, St. George's Hospital, London, UK
  7. 7Department of Public Health, Public Health Agency, Belfast, UK
  8. 8Microbiology Services Division, Public Health England, Barts Health NHS Trust, London, UK
  9. 9Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  10. 10Department of Clinical Microbiology and Virology, UCLH NHS Foundation Trust, London, UK
  1. Correspondence to Dr Mark Anthony, Department of Neonatology, John Radcliffe Hospital, Oxford OX3 9DU, UK; mark.anthony{at}orh.nhs.uk

Abstract

De novo guidance on the management of Gram-negative bacteria outbreaks in UK neonatal units was developed in 2012 by a Department of Health, England Antimicrobial Resistance and Healthcare Associated Infection working group. The recommendations included activation of an organisational response and establishing a control team when an outbreak is suspected; screening for the specific organism only during an outbreak; undertaking multidisciplinary reviews of cleaning routines, hand hygiene and Gram-negative bacteria transmission risks; considering deep-cleaning; cohorting colonised and infected babies preferably but not necessarily in isolation cubicles; and considering reducing beds or closing a unit to new admissions as a way of improving spacing and staff:patient ratios until the outbreak is under control. The group advised establishing mechanisms to communicate effectively across the network; informing parents of the outbreak as early as possible, and providing prewritten ‘infection outbreak’ information sheets. For prevention of outbreaks, the group advised meeting national staffing and cot-spacing requirements; following a Water Action Plan; using infection reduction care bundles and benchmarking; and introducing breast milk early and limiting antibiotic use.

  • Infectious Diseases
  • Neonatology

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