Preventionof of infection Infection in in thethe NNUNNU

Preventionof of infection Infection in in thethe NNUNNU • Prevention A regional approach • A regional approach

Northern Ireland population 1. 8 M

Main Units: all carry out intensive care • • • Belfast Jubilee 3 deaths 2 infections 9 col Altnagelvin (Derry) 1 death 2 inf 2 col Craigavon 1 death 3 col Antrim 2 col Ulster 25 babies involved

Pseudomonas bacteraemias • 2 babies in St John’s • One transferred to SCRH • Another became infected in SCRH • One of the babies in St John’s dies Is this relevant to Dundee and BGH?

What should SCRH do?

• • Treat infected babies Isolate infected babies Screen all babies Screen taps Screen water supplies Screen other intensive care areas? Call Incident Management Team

Communicate • • Parents Health Board Press Each other • Videolinked conference

Who helps clinicians? • • • No-one? Parents? Each other? Managers? Psychologists?

Incident Management Team • • • Senior Paediatrician/Neonatologist Senior Nurse Senior Bacteriologist Senior Public Health Official Senior Chair Senior Manager Senior Press officer Health Protection Scotland Partnership

The Paediatrician’s Day • • Meet with night staff Meet with Day staff Delegate ward round to trainees Take queries from managers Take queries from trainees Attend videoconference (3 hours) Meet with parents 7. 30 pm begin day’s work

SCRH • One baby (previously infected with Ps) is transferred in from Kirkcaldy for a surgical procedure. On return to Kirkcaldy collapses and dies. • One baby born in Perth spends one night in Dundee and is transferred to SCRH. Dies of Pseud pneumonia.

Pseudomonas aeruginosa • • Dundee strain BGH strain: find one colonised baby SCRH strain: three babies die Kirkcaldy strain: one baby transferred to SCRH has died. Baby after procedure in Edinburgh has also died

What is an outbreak? What is an infection?

Recommendations Work as a formal MCN Develop Communications plan Many recommendations for builders, plumbers ? get rid of heat-sensor taps Weekly health protection alert bulletin Avoid over-crowded unit Develop joint agreements about repatriation Plans to support staff Sterile water for topping and tailing? Ensure transport systems are ideal No tap water for defrosting milk Guidance on cleaning sinks Guidance on cleaning incubators Ensure adequate isolation facilities Independent validation of hand hygiene audits Ps Aerug should be an alert organism

Recognise stress