Vigilância national healthcare safety network: Histórico de 5 anos de surtos ocorridos em uma unidade de terapia intensiva Neonatal

Abstract

Nosocomial infections, so-called Healthcare Associated Infections (HAI), occur when patients are hospitalized for over 48 hours. HAI are associated with higher hospital costs and longer length of stay. Moreover, in epidemiology, an abnormal increase in number of infection or colonization cases is called an outbreak. This problem is frequently found in Neonatal Intensive Care Unit (NICU). Due to usually long length of stay and exposure to numerous risk factors, infection outbreaks in NICUs are inevitable from time to time, in spite of precautions. Gram-negative bacteria are especially a source of concern, since they have high virulence and may cause clinical and infectious complications. Objective: This study aims to investigate the occurrence of outbreaks in a university hospital NICU located in the state of Minas Gerais, Brazil, from January 2013 to December 2017. Methods: This study was performed by a nursing student during internship at Hospital Infection Control Committee (HICC). Documents from HICC of the Clinical Hospital, Federal University of Uberlândia (HC/UFU) were used, including epidemiological surveillance NHSN forms, memos that describe the outbreaks, tests results of the related newborn babies, and electronic records of outbreaks. Results: Four outbreaks were registered in the period of five years considered in the study. The first identified outbreak took place in 2013 and affected six newborn babies with bloodstream infection caused by etiological agent Pantoea agglomerans. The second one occurred between November 2014 and March 2015, when six newborn babies were affected by Acinetobacter baumannii with no predominant infection site, as well as the third outbreak, which took place in 2015 and involved 10 newborn babies infected by the same agent A. baumanni. The last identified outbreak occurred in 2016 and was caused by Pseudomonas aeruginosa, in which colonization was predominant and 13 newborn babies were affected. There were no records of outbreaks in 2017. Conclusion: After epidemiological research, four outbreaks were found, being Gram-negative bacteria involved in all of them, which highlights their importance as the cause of problems in the hospital NICU. The most affected newborns were premature infants and babies with low birthweight. Even though there were few cases, carbapenem-resistant organisms (CRO) were found and appeared as a problem in the studied NICU.