An outbreak of influenza A in a neonatal intensive care unit.

OBJECTIVES: Investigation of an outbreak of influenza A in a neonatal intensive care unit (NICU) with examination of risk factors for infection and outcomes. DESIGN: Retrospective cohort study of infants admitted to the unit during the outbreak period. Prospective survey of NICU staff and mothers of infants in the cohort study. SETTING: Level III nursery in a university-affiliated tertiary referral center. RESULTS: Nineteen infants in the NICU were infected with influenza A There were six symptomatic cases and one death who had evidence of virus-associated hemophagocytic syndrome at autopsy. Amantadine prophylaxis was offered to the NICU staff, and amantadine therapy was given to five of the six symptomatic infants. Mechanical ventilation, gestational age, birth weight, Clinical Risk Index for Babies score, and twin pregnancy were associated with acquisition of influenza A on univariate analysis. Mechanical ventilation (odds ratio [OR], 6.2; P=.02) and twin pregnancy (OR, 7.0; P=.04) remained as significant risk factors for infection on multiple logistic regression analysis. Only 15% of respondents to the NICU staff survey were vaccinated against influenza. There was no association between a history of an influenza-like illness during pregnancy and acquisition of influenza A by infants of mothers who responded to the maternal survey (OR, 0.91; P=1.0). CONCLUSIONS: Influenza A is an important pathogen in the neonatal population and is readily transmissible in the NICU setting.

Streamlining the physician credentialing process.

It is not anticipated that the demand for physician credentialing information will lessen. Organizations will have to become more cost-efficient in the way that the credentialing process is managed. The use of a uniform application and the emergence of CVOs can help streamline the process. Additional methods for implementing cost reductions and avoiding duplication of efforts in the area of physician credentialing will result as competition increases in the managed care arena.

Bacillus species pseudobacteremia following hospital construction.

A 13-fold increase (0.08 to 1.05%) in the isolation rate of Bacillus species from in-patient blood cultures led to the investigation of pseudobacteremia over a four-month period. Data on blood isolates (BACTEC NR 660, bottle types 6A and PEDS) of Bacillus species were compiled between July and October 1993. BACTEC bottles, as well as their plastic lids and rubber septa (representing 20% of stored bottles), and alcohol swabs, iodine preparation pads and butterfly collection systems were cultured. Air plates inside the BACTEC 660 instrument were cultured, as well as swabs of both the BACTEC needles and the interior of the BACTEC handling area. To investigate carry-over contamination, sterile BACTEC bottles were tested immediately following bottles containing Bacillus species. Growth of Bacillus species was obtained from 16% of the plastic lids and 1.3% of the rubber septa. No growth was obtained from other cultures. The outbreak coincide with construction on a driveway of the hospital over the area where BACTEC bottles were stored. Upon completion of construction in November 1993, the isolation of Bacillus species returned to baseline. No pseudobacteremia isolates occurred in areas where the trained intravenous team was assigned. In conclusion, hospital construction leading to airborne spread of Bacillus species may cause Bacillus species pseudobacteremia, and failure to disinfect blood culture bottles adequately may predispose to such an outcome.

Bacterial colonization of tunneled right atrial catheters in pediatric oncology: a comparison of sterile saline and bacteriostatic saline flush solutions.

In a double-blind, randomized controlled trial, children with malignant diseases had their tunneled right atrial catheters flushed with either sterile saline or bacteriostatic saline, once per week for 26 weeks. There was no significant difference in the rates of catheter colonization between the two groups, which did differ, however, in terms of the time from entry into the study to the first infective event (64 +/- 34 days vs. 146 +/- 27 days; p less than 0.001). This was strongly suggestive of a seasonal effect, as all of the colonizations in the bacteriostatic saline group were delayed until the summer months. We conclude that the use of a bacteriostatic saline flush solution for tunneled right atrial catheters is beneficial in efforts to prevent catheter colonization.

A review of staphylococcal colonization and infection rates in a family-centred maternity unit 1979-89.

The usefulness of routine bacteriological surveillance of newborns in a family-centred maternity unit is explored. Colonization and infection rates were reviewed for a 10 year period. This review demonstrated a correlation between infection and colonization rates only when the colonization rate with Staphylococcus aureus was greater than 40%. The ability of this unit in the last years of the review to maintain a colonization rate of less than 25% enabled the practice to be discontinued and replaced with random point prevalence determinations, and has provided a method for researching various nursery practices. This review looks at the cost of monitoring Staph aureus colonization and summarizes some of the current practices in this unit.