Deborah Tuttle

Premedication for intubation in neonates

Editor—We were very interested in the recent papers by Bhutada et al 1and Whyte et al 2 on the use of premedication for semielective intubation in neonates. It is now well accepted that term and preterm neonates tolerate awake intubation poorly, often exhibiting hypoxia, bradycardia, and systemic and intracranial hypertension during nasotracheal or orotracheal intubation.3 4 Analgesia and sedation are still used infrequently in nurseries for intubation and other “routine”, but invasive, therapeutic …

Prolonged early antibiotic use and bronchopulmonary dysplasia in very low birth weight infants.

OBJECTIVE The objective of the article is to determine if > 48 hours of antibiotic treatment during the 1st week of life is associated with subsequent isolation of bacteria from the endotracheal tube (ETT), and an increased risk of bronchopulmonary dysplasia (BPD). STUDY DESIGN Retrospective cohort study of very low birth weight infants. Routine weekly surveillance ETT cultures were obtained to monitor bacterial colonization in all intubated infants. Risk factors for BPD were assessed using unadjusted and multivariable analyses. RESULTS In the study sample (n = 906), infants with BPD (n = 182) were more likely to have received > 48 hours antibiotic treatment (31 vs. 14%, p < 0.01) and have a resistant gram-negative bacilli in ETT (7 vs. 2%, p = 0.0001) compared with infants without BPD. Treatment with > 48 hours of antibiotics remained associated with BPD (adjusted odds ratio, 2.2; 95% confidence interval, 1.4-3.5) after controlling for confounding variables. CONCLUSIONS Antibiotic duration > 48 hours in the 1st week of life was associated with subsequent BPD and the presence of resistant bacteria in routine ETT cultures.

A Network Model of Hand Hygiene: How Good Is Good Enough to Stop the Spread of MRSA?

BACKGROUND Simulation models have been used to investigate the impact of hand hygiene on methicillin-resistant Staphylococcus aureus (MRSA) transmission within the healthcare setting, but they have been limited by their ability to accurately model complex patient-provider interactions. METHODS Using a network-based modeling approach, we created a simulated neonatal intensive care unit (NICU) representing the potential for per-hour infant-infant MRSA transmission via the healthcare worker resulting in subsequent colonization. The starting prevalence of MRSA colonized infants varied from 2% to 8%. Hand hygiene ranged from 0% (none) to 100% (theoretical maximum), with an expected effectiveness of 88% inferred from literature. RESULTS Based on empiric care provided within a 1-hour period, the mean number of infant-infant MRSA transmissible opportunities per hour was 1.3. Compared to no hand hygiene and averaged across all initial colonization states, colonization was reduced by approximately 29%, 51%, 67%, 80%, and 86% for the respective levels of hygiene: 24%, 48%, 68%, 88%, and 100%. Preterm infants had a 61% increase in MRSA colonization, and mechanically ventilated infants had a 27% increase. CONCLUSIONS Even under optimal hygiene conditions, horizontal transmission of MRSA is possible. Additional prevention paradigms should focus on the most acute patients because they are at greatest risk. Infect Control Hosp Epidemiol 2017;38:945-952.

Spatial and environmental correlates of organism colonization and infection in the neonatal intensive care unit

ObjectiveTo examine organism colonization and infection in the neonatal intensive care unit as a result of environmental and spatial factors.Study designA retrospective cohort of infants admitted between 2006 and 2015 (n = 11 428), to assess the relationship between location and four outcomes: methicillin-resistant Staphylococcus aureus (MRSA) colonization; culture-confirmed late-onset sepsis; and, if intubated, endotracheal tube colonization with Pseudomonas aeruginosa or Klebsiella pneumonia. Independent risk factors were identified with mixed-effects logistic regression models and Moran’s I for spatial autocorrelation.ResultAll four outcomes statistically clustered by location; neighboring colonization also influenced risk of MRSA (p < 0.05). For P. aeruginosa, being in a location with space for more medical equipment was associated with 2.61 times the odds of colonization (95% CrI: 1.19, 5.78).ConclusionExtrinsic factors partially explained risk for neonatal colonization and infection. For P. aeruginosa, infection prevention efforts at locations with space for more equipment may lower future colonization.

Evaluating a neonatal intensive care unit MRSA surveillance programme using agent-based network modelling

BACKGROUND Surveillance for meticillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) is a commonplace infection prevention strategy, yet the optimal frequency with which to monitor the unit is unknown. AIM To compare various surveillance frequencies using simulation modelling. METHODS One hundred NICU networks of 52 infants were simulated over a six-month period to assess MRSA transmission. Unit-wide surveillance occurred every N weeks where N={1,2,3,4}, and was compared with the current NICU policy of dynamic surveillance (i.e. weekly when at least one positive screen, otherwise every three weeks). For each surveillance period, colonized infants received a decolonization regimen (56% effective) and were moved to isolation rooms, if available. FINDINGS As the surveillance frequency increased, the mean number of MRSA-colonized infants decreased, from a high of 2.9 (four-weekly monitoring) to a low of 0.6 (weekly monitoring) detected per episode. The mean duration of colonization decreased from 307 h (four-weekly monitoring) to 61 h (weekly monitoring). Meanwhile, the availability of isolation rooms followed an inverse relationship: as surveillance frequency increased, the availability of isolation rooms decreased (61% isolation success rate for four-weekly monitoring vs 49% success rate for weekly monitoring). The dynamic policy performed similar to a biweekly programme. CONCLUSIONS An effective MRSA surveillance programme needs to balance resource availability with potential for harm due to longer colonization periods and opportunity for development of invasive disease. While more frequent monitoring led to greater use of a decolonization regimen, it also reduced the likelihood of isolation rooms being available.

Endotracheal Intubation in Awake Versus Sedated Premature Infants: A Randomized, Double Blind, Placebo-Controlled Trial

Endotracheal Intubation in Awake Versus Sedated Premature Infants: A Randomized, Double Blind, Placebo-Controlled Trial

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit due to Construction Related Water Line Alterations † 1485

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit due to Construction Related Water Line Alterations † 1485

Neonatal Neutropenia Associated With Preeclampsia Does Not Increase the Risk for Culture Proven Sepsis † 1462

Neonatal Neutropenia Associated With Preeclampsia Does Not Increase the Risk for Culture Proven Sepsis † 1462

Epidemiology of a Vancomycin Resistant Enterococcal Outbreak in the Neonatal Intensive Care Unit |[dagger]| 1466

Epidemiology of a Vancomycin Resistant Enterococcal Outbreak in the Neonatal Intensive Care Unit † 1466