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Officials Look for Source of Infection in Closed Toronto Neonatal Care Unit

Posted on: Thursday, 31 May 2007, 18:00 CDT

By NOOR JAVED

TORONTO (CP) - A neonatal care unit at Mount Sinai Hospital remained closed Thursday, days after a highly feared bacterial infection killed a premature baby and left hospital officials searching for the source of the pathogen.

A two-week-old premature infant died of blood poisoning over the weekend after acquiring serratia, an organism found naturally in the bowels of adults, but that can lead to severe infections in babies.

Four others babies in the level 3 unit, where high-risk infants are admitted, tested positive for serratia, but had not shown symptoms of infection Thursday.

Dr. Allison McGeer, director of infection control at the hospital, said the health of the "palm-sized" babies was being closely monitored.

"This is an organism we worry a lot about," McGeer said. "While we see it quite commonly found in the gut of adults, and even some infants ... in premature neonates it can cause very severe infection very quickly."

While serratia is detected in the ward almost once a year, McGeer said, the last time the infection resulted in a fatality was more than three years ago. Officials worked Thursday to determine how the bacteria, transmitted by touch, was able to spread so quickly.

"We look for any medication, equipment, places in the unit where serratia might be growing that could be an ongoing source for me to pick up on my hands and transfer to babies," McGeer said, adding that occasionally the bacteria could also come from an ill staff member.

"There are bunch of things we look for, but we don't usually don't find them. You can't keep all the bacteria out."

The difficult decision to close two of the hospital's three neonatal wards came Monday amid concerns that until the infection was contained, it could be passed on to newly admitted patients. The level 2 ward of the neonatal intensive care unit was reopened Wednesday.

"We will keep the ward closed until we are convinced when we bring new babies in, we are not putting them at risk," McGeer said.

Despite the closure, the ward has admitted a small number of new patients needing critical care into the 34-bed unit in the last few days. The remaining overflow of patients is being diverted to two other hospitals in the city.

"We haven't had to send any mothers and babies out of province yet," McGeer said, noting the hospital has been forced to exercise that option in the past due to overcrowding.

But experts say the closure of even one ward can tip the fine balance that exists between neonatal units in the region.

"There is a very tight network of neonatal units in the province that function like an integrated one, and if they have to close one, that decision is never taken lightly," said Dr. Dick Zoutman, a physician-director of the Community and Hospital Infection Control Association of Canada.

With chronic overcrowding and limited resources plaguing most neonatal units, the closure of such wards seems to have occurred more frequently in recent years, he said.

"Neonatal units that were built three decades ago were built to house a certain number of newborns and suddenly are housing twice as many," said Zoutman, who works as a physician at Kingston General Hospital.

Zoutman said it is difficult to completely stop the spread of hospital-acquired infections because of the lack of research on the subject.

"We don't know how make infections zero, and in order to reduce them to the lowest level possible, we definitely need more research funding to get there."

Source: Canadian Press

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