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Kim, Chung, and Sohn: Successful Control of Extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit
Original Article

Korean J Nosocomial Infect Control 2013;18(1):26-32.

Published online: 5 January 2013

DOI: https://doi.org/10.14192/kjnic.2013.18.1.26

Successful Control of Extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit

Mi Ja Kim1, Kil Soo Chung2, Kyung Mok Sohn3

Department of Nursing, Pai Chai University, Daejeon, Korea

Daejeon, Department of Nursing, Kyung-in Women's College, Daejeon, Korea

Incheon, Division of Infections Disease, Chungnam National University Hospital, Daejeon, Korea

Correspondence: Kyung Mok Sohn, Division of Infections Disease, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea Tel: 042-280-8080, Fax: 042-280-8880 E-mail: medone@cnuh.co.kr

Received 21 November 2012       Accepted 8 April 2013

Copyright © 2013 Korean Society for Nosocomial Infection Control

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures.

Methods

We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire.

Results

The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days.

Conclusion

Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.

Keywords: Beta-Lactamases, Infant, Intensive care units, Klebsiella pneumoniae, Newborn

References

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Fig. 1.
Outbreak of ESBL-producing K. pneumonia in the neonatal intensive care unit.
kjnic-18-26f1.tif
Fig. 2.
The timeline of this study.
kjnic-18-26f2.tif
Table 1.
Knowledge of multidrug-resistant gram-negative bacilli
Question related to knowledge of multidrug-resistant gram-negative bacilli Pre-intervention (N=45) Post-intervention (N=45) P value
N (%) N (%)
Knowledge 25 (55.6) 43 (95.6) <0.001
The types 30 (66.6) 33 (73.3) <0.001
Surveillance 23 (51.1) 38 (84.4) 0.001
Isolation precautions 39 (86.7) 45 (100) 0.011
The need for isolation room 31 (68.9) 44 (97.8) <0.001
The need for wearing the gowns 26 (57.8) 41 (91.1) <0.001
  Mean±SD Mean±SD  
The application of isolation precautions 3.93±0.889 4.84±0.475 <0.001
Importance of infection control 4.58±0.499 4.73±0.495 0.142
Importance of hand hygiene 4.78±0.420 4.89±0.318 0.161
The need for nurses in charge 4.07±0.863 4.96±0.208 <0.001
Table 2.
Knowledge & compliance of hand hygiene (%)
Category Knowledge
 Compliance
Pre-intervention Post-intervention P value Pre-intervention Post-intervention
(N=45) (N=45) N (%) N (%)
IV injection 75.6 84.4 0.292 19 (90.0) 20 (100)
Sampling (BST, ABGA, blood culture etc.) 68.9 97.8 <0.001 41 (97.6) 29 (100)
IV prepare (fluid mix etc.) 71.1 86.7 0.071 45 (83.3) 14 (100)
Suction 71.1 82.2 0.213 54 (50.0) 58 (100)
Ambu-bagging 57.8 84.4 0.005 5 (80.0) 6 (100)
Dressing 75.6 100 <0.001 27 (70.4) 18 (100)
G-tube keep/nutrition infusion 71.1 100 <0.001 8 (87.5) 14 (92.9)
Diaper change 75.6 82.2 0.438 80 (60.0) 77 (100)
Light contact (X-ray, ultrasonic photography, examination etc.) 75.6 93.3 0.020 242 (85.9) 246 (92.8)
Total 77.5 91.3 <0.001    
Table 3.
Number (%) of ESBL K. pneumoniae isolated from environmental culture
Category Pre-intervention
 Post-intervention
May June July August
No. of environmental culture 416 455 408 427
No. of microorganisms isolates 37 79 11 16
Overall microorganisms isolation rates (%) 8.89 17.36 2.70 3.75
No. of ESBL K. pneumoniae isolates 1 13 3 0
ESBL K. pneumoniae isolation rates (%) 0.24 2.86 0.74 0

Abbreviation: ESBL, Extended-spectrum beta-lactamase-producing.

Table 4.
Number (%) of ESBL K. pneumoniae isolated from clinical specimens of patients
Category Specimen Pre-intervention
 Post-intervention
May   June   July   August  
No. of micro-organisms isolates   56   99   94   87  
No. of K. pneumoniae isolates   18   37   33   17  
No. of ESBL K. pneumoniae isolates S   4   2   2   0
  U 17 5 31 11 29 25 11 10
  B   8   18   2   1
ESBL K. pneumoniae isolation rates (%)   30.4   31.3   30.9   12.6  

Abbreviations: S, Sputum; U, Urine; B, Blood.

Table 5.
Comparison of central line-associated bloodstream infection before and after the intervention
Category Pre-intervention Post-intervention
Central line days 1,540 1,714
No. of central line-associated bloodstream infection caused 3 0
by ESBL K. pneumoniae    
Overall central line-associated bloodstream infection 1.30 0
by ESBL K. pneumoniae/1,000 device-days    
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