Pseudomonas - Southmead Hospital

Tuesday, 9 October 2012

Pseudomonas - Southmead Hospital
Statement from Dr Chris Burton, Medical Director, North Bristol NHS Trust

In August a premature baby sadly died in Southmead Hospital neonatal intensive care unit and pseudomonas infection contributed to the death. In light of experience in other neonatal ICUs where this has happened North Bristol NHS Trust immediately put in place measures to review infection control procedures in the unit and minimise the risk to other babies.

One measure has been to screen/test babies on the unit and since the first case, 12 have been found to have pseudomonas bacteria on the skin. On its own this does not cause illness or require treatment but presents a risk if bacteria gets into the blood stream. One baby has had treatment for a minor infection but the others remain well and eight have been discharged home. Three babies with the bacteria on their skin remain in the unit but are being treated in isolation.

Pseudomonas bacteria have been found in the water supply in the neonatal ICU and this is the most common source when similar events have happened in other units.  To minimise the risk to patients, strict infection control measures have been instituted for staff, parents and visitors. Babies are washed in sterile water and the tap water is being filtered to ensure that any pseudomonas bacteria is removed. Other measures that have been adopted include more regular testing and enhanced cleaning regimes.

Whilst these measures have reduced the risk to babies the hospital estates team are reviewing the water supply and considering other work that could be done to reduce the risk of pseudomonas. The actions that we are taking are based on national guidance and we are being supported in this work by the expertise of the Health Protection Agency.

Parents of babies in the unit have been given information about the infection and the reasons that strict precautions are in place. Admissions to the unit have been reduced while this is being resolved.

Statement from the Dr Mark Evans, South West (North) Health Protection Unit, Health Protection Agency

Following the discovery of the bacteria, the HPA has provided advice and support to North Bristol NHS Trust to help protect the health of babies in the unit.

Pseudomonas aeruginosa is commonly found in soil and groundwater and it is a recognised healthcare associated infection that affects people with weakened immune systems.

The people most at risk are those with depleted immune systems such as cancer patients, people with severe burns and premature babies in neonatal units. The bacteria can be spread by contaminated water, inhalation of aerosols (water droplets), touching contaminated surfaces or person to person through poor hand hygiene.

The HPA has provided advice to the trust on measures to reduce the risk to other babies in the unit and we will continue to work with the trust to monitor the situation until confident that the risk has been minimised.

The infection can be treated effectively with antibiotics, especially if treatment is started immediately after confirming the diagnosis.

Issued: 9 October 2012

What is Pseudomonas?

Pseudomonas is the name given to a bacterium (sometimes called a bug or germ), that is commonly found in soil and water. Pseudomonas rarely causes infection in people who are healthy. It sometimes causes infection in people  who are already unwell or who do not have a strong or fully developed immune system.

What kind of infections does Pseudomonas cause?

 Pseudomonas may cause:  

  • Respiratory/chest infections

  • Urinary tract/urine infections

  • Wound infections

  • Infections of the blood

The Pseudomonas bacterium is a relatively common cause of healthcare associated infections (HCAIs).

What can be done to treat these infections/stop infants from getting them?

When an infant in hospital has signs of infection (or gets an infection), a sample is usually collected and sent for testing. The sample may be of urine, blood, lung or other secretions. The test results help hospital staff to decide how to treat the infection. Infections caused by Pseudomonas are treated using an appropriate antibiotic.

Pseudomonas may also be found on the skin of some infants and not necessarily cause infection. This is known as colonisation. Colonisation of Pseudomonas on the skin does not usually require treatment and each case will be assessed by the Doctors on NICU.

If more than one infant gets an infection caused by Pseudomonas bacteria in a hospital ward or unit, a risk assessment is generally completed. Samples of commonly used water/sinks and medical equipment may be collected and tested.

The reason that samples may be collected in these areas is because. Pseudomonas likes to grow in moist environments. It may be necessary to keep infants who have Pseudomonas on their skin or who have developed a Pseudomonas infection in an area where their contact with other infants is limited. This is to ensure that the infection is not spread between infants.

The importance of hand hygiene

Hand hygiene is an important way of preventing and controlling Pseudomonas infection.  Hand washing should be carried out before and after contact with the infant and their environment.

Hands should be wet before applying liquid soap. The soap should be rubbed vigorously into all areas to produce suds/lather.

The hands should be rinsed under running water and dried thoroughly. It is really important to dry your hands properly using the disposable paper towels provided.

Paper towels should be disposed of in the foot operated pedal bins provided. Alcohol hand-rubs should also be used after hand washing with soap and water.

After applying the alcohol hand-rub, hands should be rubbed together, covering all areas, until the hands are dry.

The application of the alcohol hand-rub will ensure that should there be any trace of Pseudomonas in the water used for hand washing is eradicated. Nursing staff will show you how to use handrubs properly.