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Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative

Doris Fischer1, Rolf L Schlößer2, Volkhard A J Kempf3,4

  • 1Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany. doris.fischer@st-vincenz.de.

BMC Infectious Diseases
|May 1, 2019
PubMed
Abstract

Insights

Overcrowding in neonatal intermediate care units did not significantly increase multidrug-resistant gram-negative organism (MDRGN) infections. Diligent staff training and microbiological surveillance are key to preventing nosocomial spread during these periods.

Area of Science:

  • Neonatal Intensive Care
  • Infectious Disease Epidemiology
  • Healthcare Management

Background:

  • Overcrowding in neonatal intensive care units (NICUs) and reduced nurse-to-patient ratios are known risk factors for multidrug-resistant gram-negative organism (MDRGN) spread.
  • Limited data exists on MDRGN transmission in neonatal intermediate care units (NICMUs) for patients weighing over 1500g, especially during periods of overcrowding.
  • This study investigates MDRGN incidence in a level III NICMU during and after a short-term overcrowding period.

Purpose of the Study:

  • To assess the impact of overcrowding on MDRGN incidence in a neonatal intermediate care unit (NICMU).
  • To evaluate the effectiveness of existing infection control measures during periods of increased patient volume.
  • To determine the role of bed-to-bed distance in MDRGN transmission within the NICMU.

Main Methods:

  • Epidemiological data was collected during a 25-day overcrowding period and a 28-day post-overcrowding period on the NICMU.
  • Microbiological surveillance was continuously maintained throughout the study periods.
  • Data was compared to the preceding 12 months of regular bed occupancy (PRAE-OV).

Main Results:

  • Patient numbers increased from 18 to 22 during overcrowding, with a reduced nurse:patient ratio (4:22 vs. 3:18).
  • Cumulative incidence of MDRGN showed no significant variation (4.7% during overcrowding, 2.4% post-overcrowding, vs. 4.8% pre-overcrowding).
  • No septic episodes due to MDRGN occurred during overcrowding or post-overcrowding; one case of potential nosocomial transmission of resistant Enterobacter cloacae was noted.

Conclusions:

  • Prevention of nosocomial MDRGN spread in overcrowded NICMUs relies on staff training and adequate staffing levels.
  • Continuous microbiological surveillance is crucial during periods of overcrowding.
  • The impact of reduced bed-to-bed distance on MDRGN transmission appeared less significant in this specific setting.
Keywords:
Infection controlMicrobiological surveillanceMultidrug-resistant gram-negative bacteriaNeonatal intermediate care unitNurse to patient ratioOvercrowding

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