The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

PROCESS IMPROVEMENT IN THE NICU.

Denise Haley-Jones, Amar B. Vasu, Zacharia Cherian, Katherine Geiser; Respiratory & Pulmonary Services, Washington Hospital Center, Washington, DC

Background: During July 2008 a sudden increase in the number of babies with positive blood and sputum cultures for the Bacillus species occured. 22 environmental cultures were positive: 12 B. cerus, 5 B. thuringiensis, 5 Bacillus species. A multidisciplinary team was assembled to help isolate and control the spread of infection among the infants in the NICU. Bacillus is a gram positive, spore forming, aerorbic rod consistently found in soil and dust, transmitted by environmental contact. Bacillus Cereus can cause opportunistic infections in the immunocompromised premature hosts. B. cereus has been associated with serious invasive infections and neonatal demise in 1998 and 2001. 7 of our babies were extremely susceptible to the organism requiring antibiotic therapy and prolonged mechanical ventilation. Method: The team suggested several sources of possible contamination. Initially the common areas were the focal point for extreme cleaning. There was no appreciable reduction in positive cultures. Next, infants with positive cultures then had their direct contact respiratory equipment swabbed and re-cultured, again no significant findings. Finally, all of the Drager Babylog 8000 flow sensors and housings that were previously disinfected for re-use were cultured. Results: The inadequately cleaned housing and flow sensors were the culprits. Initially these vital ventilator parts were only cleaned in the nursery by RT staff. Flow sensors were soaked in 70% alcohol for 15 minutes, rinsed in sterile water for 10 minutes, air dried and finally placed in an open bin before being returned to service. By adding the step of sending the sensors to SP for steam sterilization and individual packaging, the growth and spread of B. cereus on the flow sensors was completely stopped by March of 2009. Conclusion: This case analysis strongly suggests that pre-soaking followed by steam sterilization of reused flow sensors will prevent contamination and the spread of B. cereus. Single patient use is always preferred but not always an option. Sponsored Research - None