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A decrease in the number of cases of necrotizing enterocolitis associated with the enhancement of infection
Brigitte Lemyre1, Wenlong Xiu, Nicole Rouvinez Bouali
1The Ottawa Hospital, Ottawa, Ontario, Canada. blemyre@toh.on.ca
Objective:
Most cases of necrotizing enterocolitis (NEC) are sporadic, but outbreaks in hospital settings suggest an infectious cause. Our neonatal intensive care unit (NICU) experienced an outbreak of methicillin-sensitive Staphylococcus aureus (MSSA). We aimed to assess whether the enhancement of infection prevention and control measures would be associated with a reduction in the number of cases of NEC.
Design:
Retrospective chart review.
Setting:
A 24-bed, university-affiliated, inborn level 3 NICU.
Participants:
Infants of less than 30 weeks gestation or birth weight ≤ 1,500 g admitted to the NICU between January 2007 and December 2008 were considered at risk of NEC. All cases of NEC were reviewed.
Interventions:
Infection prevention and control measures, including hand hygiene education, were enhanced during the outbreak. Avoidance of overcapacity in the NICU was reinforced, environmental services (ES) measures were enhanced, and ES hours were increased.
Results:
Two hundred eighty-two at-risk infants were admitted during the study. Their gestational age and birth weight (mean ± SD) were 28.2 ± 2.7 weeks and 1,031 ± 290 g, respectively. The proportion of NEC was 18/110 (16.4%) before the outbreak, 1/54 (1.8%) during the outbreak, and 4/118 (3.4%) after the outbreak. After adjustment for gestational age, birth weight, gender, and singleton versus multiple births, the proportion was lower in the postoutbreak period than in the preoutbreak period (P < .002).
Conclusion:
Although this observational study cannot establish a causal relationship, there was a significant decrease in the incidence of NEC following implementation of enhanced infection prevention and control measures to manage an MSSA outbreak.
Insights
Enhanced infection control measures significantly reduced necrotizing enterocolitis (NEC) cases during a methicillin-sensitive Staphylococcus aureus (MSSA) outbreak in a neonatal intensive care unit (NICU). This suggests improved hygiene protocols can lower NEC incidence in vulnerable infants.
Area of Science:
- Neonatalogy
- Infectious Disease Epidemiology
- Hospital Infection Control
Background:
- Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in premature infants.
- While often sporadic, NEC outbreaks in neonatal intensive care units (NICUs) suggest infectious etiologies.
- An outbreak of methicillin-sensitive Staphylococcus aureus (MSSA) occurred in a level 3 NICU.
Purpose of the Study:
- To evaluate the impact of enhanced infection prevention and control (IPC) measures on NEC incidence.
- To determine if intensified IPC strategies could mitigate NEC cases during an MSSA outbreak.
Main Methods:
- Retrospective chart review of infants admitted to a 24-bed university-affiliated NICU.
- Inclusion criteria: infants < 30 weeks gestation or birth weight ≤ 1,500 g.
- Interventions included enhanced hand hygiene, reinforced avoidance of NICU overcapacity, and increased environmental services (ES) measures and hours.
Main Results:
- A total of 282 at-risk infants were admitted between January 2007 and December 2008.
- NEC incidence was 16.4% before the outbreak, 1.8% during, and 3.4% after.
- Adjusted analysis showed a significant reduction in NEC proportion post-outbreak (P < .002).
Conclusions:
- Enhanced IPC measures were associated with a significant decrease in NEC incidence.
- While causality cannot be definitively established in this observational study, findings support the effectiveness of IPC in managing NEC outbreaks.
- These results highlight the importance of robust infection control protocols in NICUs to prevent NEC.
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