An Outbreak Investigation of Neonatal Sepsis Caused by Multi-drug Resistant Klebsiella Bacteria

Abstract

On 19 January 2016, Infectious Control Unit, Yala Hospital, was notified by a pediatrician about 3 cases of neonatal sepsis with multi-drug resistant at neonatal intensive care unit (NICU). The surveillance and rapid response teams from Preventive Medicine and Infectious Control Units jointly investigated the incident during 19 January - 17 February 2016, with the objectives to confirmed diagnosis and outbreak, to identify the source of outbreak and to implement control and prevention measures by finding more neonatal sepsis patients, performing environmental survey, collecting microbiological cultures from environment and observing behaviors of healthcare provides. It was found that there was confirmed outbreak of neonatal sepsis caused by Klebsiella pneumoniae in the NICU. There were altogether 5 cases of neonatal sepsis with multi-drug resistant. The transmission was found to be contamination from the environment such as feeding utensils especially during milk preparation for neonatal feeding. Strict control and prevention measures were implemented in the NICU based on the SHIP model. Participatory assessment and problem solving process among all members had resulted in continuation of practice. After 7 days of the implementation of control and prevention measures in the NICU, there was no additional case. Monitoring milk preparation and formula feeding processes had revealed some practices at risk of pathogen transmission. To reduce the risk, milk preparation and milk bottle cleaning were separated from the NICU, and moved to nutrition unit of the hospital. Integrated formula feeding preparation process was also developed to reduce the risk of disease transmission and contamination in order to achieve maximum benefit for the patients.