Outbreak of Serratia Marcescens in the newborn care unit in a local tertiary hospital

ABSTRACT

@#Objectives: This study was performed to investigate the Serratia marcescens outbreak in the Newborn Care Unit of a tertiary hospital. Methods: This is a retrospective, descriptive study. Charts of all neonates with S. marcescens growth in their blood culture were retrieved from the Records Section of the Baguio General Hospital and Medical Center (BHGMC) from July 2002 to July 2003. During the outbreak period, the following interventions were performed 1) orientation and re- orientation of the entire health care team, especially, the staff of the unit on infection control and prevention; 2) aerobic culture of possibly contaminated hands of concerned staff and equipment of both the delivery room and the intensive care unit; 3) closing of the pediatric newborn care unit for general cleaning and disinfection. Results: Of the 132 cases reported to have grown S. marcescens in their blood cultures, 63 (48%) charts were available for review 63% were term; 51% male; 81% were appropriate for gestational age; and 30% had birth weights of 2500 to 2999 grams and delivered via normal spontaneous delivery. The most common reasons for admission were respiratory distress syndrome (5%), multiple congenital anomalies (5%), congenital heart disease (5%), urinary tract infection (5%), severe asphyxia (3%), and pneumonia (3%). The clinical manifestations seen during the first 4 days of life were respiratory distress (51%), poor suck (25%), bleeding (22%), jaundice (6%), sclerema (5%), and vomiting (5%). Blood transfusion (46%), such as fresh frozen plasma and packed red blood cells, was the prevalent invasive procedure done, followed by endotracheal intubation (41%), and umbilical catheterization (38%). Eighteen out of 63 cases died with a case fatality rate of 29%; 28% died of septic shock. S. marcescens showed 100% sensitivity to Piperacillin-Tazobactam, Cefepime, Imipenem, and Meropenem. Environmental cultures showed isolation of S. marcescens from the suction machines used in the aseptic and septic areas of the neonatal intensive care unit. Furthermore, this study showed that the following factors contributed to the occurrence of an outbreak paucity of manpower, lack of equipment and area assigned for the pediatric newborn care unit. Conclusion: This investigation showed that the S. marcescens outbreak in the pediatric newborn care unit has been associated with environmental contamination and breakdown in infection control measures such as overcrowding, understaffing, and other major disruptions of routine nursery care, particularly hand hygiene.