Korean J Nosocomial Infect Control.  2013 Jun;18(1):26-32. 10.14192/kjnic.2013.18.1.26.

Successful Control of Extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit

Affiliations
  • 1Department of Nursing, Pai Chai University, Daejeon, Korea.
  • 2Department of Nursing, Kyung-in Women's College, Incheon, Korea.
  • 3Division of Infections Disease, Chungnam National University Hospital, Daejeon, Korea. medone@cnuh.co.kr

Abstract

BACKGROUND
Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures.
METHODS
We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire.
RESULTS
The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days.
CONCLUSION
Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.

Keyword

Beta-Lactamases; Infant; Intensive care units; Klebsiella pneumoniae; Newborn

MeSH Terms

Bacteremia
beta-Lactamases
Cross Infection
Delivery of Health Care
Hand
Hand Disinfection
Health Personnel
Humans
Incidence
Incubators
Infant
Infant, Newborn
Infection Control
Intensive Care Units
Intensive Care Units, Neonatal
Intensive Care, Neonatal
Klebsiella
Klebsiella pneumoniae
Pneumonia
Prospective Studies
Stethoscopes
Thermometers
Ventilators, Mechanical
beta-Lactamases

Figure

  • Fig. 1. Outbreak of ESBL-producing K. pneumonia in the neonatal intensive care unit.

  • Fig. 2. The timeline of this study.


Reference

References

1. Jin SS, Kim JH, Hur JK, Kang JH. Molecular epidemiologic analysis of a cluster of Klebsiella Pneumoniae infection in neonatal intensive care unit. Korean J of Pediatr. 2000; 43:477–83.
2. Kwon HJ, Kim SY, Cho CY, Choi YY, Shin JH, Suh SP. Nosocomial infection in neonatal intensive care unit. Korean J of Pediatr. 2002; 45:719–26.
3. Jun NL, Kim MN, Jeong JS, Kim YS, Kim ER, Kim KS. et al. Molecular-epidemiologic study on outbreak of colonization by extended spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. Korean J of Pediatr. 2006; 49:150–6.
4. Kim KA, Shin SM, Choi JH. A nationwide survey on the causative organism of neonatal sepsis in Korea. Korean J of Pediatr. 2002; 45:55–63.
5. Song JH. Clinical features and prognostic factors of Klebsiella pneumoniae sepsis with fatal outcome in early phase of infection in neonatal intensive care unit patients. Keimyung University;2011.
6. French GL, Shannon KP, Simmons N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and β-lactam-β-lactamase inhibitor combinations by hyperproduction of SHV-5 β-Lactamase. J Clin Microbiol. 1996; 34:358–63.
7. Coovadia YM, Johnson AP, Bhana RH, Hutchinson GR, George RC. et al. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreak. J Hosp Infect. 1992; 22:107–205.
8. Abdel-Hady H, Hawas S, El-Daker M, El-Kady R. Extended-spctrum β-Lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatology. 2008; 28:685–90.
9. Wie SH, Kim SY, Kim SI, Kim YR, Yoo JH, Shin WS. et al. Molecular characterization of extended-spectrum β-Lactamase (ESBL) in clinical isolates of Klebsiella pneumoniae. Korean J Nosocomial Infect Control. 2003; 8:83–93.
10. Yoo BH. Status and problem of the neonatal intensive care unit in Korea. J Korean Society Maternal and Child Health. 1997; 1:228–31.
11. Chung MS. Relationship between knowledge and performance of infection control among nurses in the neonatal intensive care unit. Yonsei University. 2002.
12. Lee SH, Jeong JS, Lee SY, Pai HJ, Nah J, Park SJ. et al. Outbreak of nosocomial infection caused by Klebsiella pneumoniae producing extended-spectrum β-Lactamase in a neonatal intensive care unit. Korean J Nosocomial Infect Control. 1997; 2:13–28.
13. Banerjee M, Sahu K, Bhattacharya S, Adhya S, Bhowmick P, Chakraborty P. Outbreak of neonatal septicemia with multidrug resistant Klebsiella pneumoniae. Indian J Pediatr. 1993; 60:25–7.
14. Gastmeier P, Groneberg K, Weist K, Ruden H. A cluster of nosocomial Klebsiella pneumonia bloodstream infections in a neonatal intensive care department: identification of transmission and intervention. Am J Infect Control. 2003; 31:424–30.
Full Text Links
  • KJNIC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr