1. 

Moodley P, Coovadia YM, Sturm AW. Intravenous glucose preparation as the source of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infections in the neonatal unit of a regional hospital in KwaZulu-Natal. S Afr Med J. 2005 Nov;95(11):861-4.

Department of Medical Microbiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

In the last week of May 2005, staff at Mahatma Gandhi Memorial Hospital in KwaZulu-Natal realised that many babies in the high-care nursery ward had bloodstream infections involving Klebsiella pneumoniae bacteria. Attempts to identify a common source of infection failed. The ward was therefore closed and new babies needing high care were admitted to another empty ward. Despite this, babies still became infected. This resulted in a request for assistance from the Department of Medical Microbiology of the Nelson R Mandela School of Medicine. A search for common factors through case history studies of the 26 infected babies showed that blood cultures of the babies remained positive despite the administration of appropriate antibiotics. Different options that could explain this were investigated. The organism was found in intravenous glucose preparations used for multiple dosing. Unopened vials of the same medication were sterile. The nursery was found to lack proper hand-wash facilities and to be overcrowded and understaffed. Reinforcement of hand hygiene and a ban on the multiple dosing of medicines stopped the outbreak. In conclusion, this outbreak resulted from a combination of factors among which lack of hand hygiene and multiple dosing of an intravenous glucose preparation were most significant.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

13960 .  Earsing KA, Hobson DB, White KM. Best-practice protocols: preventing central line infection. Nurs Manage. 2005 Oct;36(10):18-24.

13961.  Jensen PA, Lambert LA, Iademarco MF, Ridzon R; CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005 Dec 30;54(17):1-141.

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Therapy:

13974.     Chudleigh J, Fletcher M, Gould D. Infection control in neonatal intensive care units. J Hosp Infect. 2005 Oct;61(2):123-9.

13975.  O'Neill JK, Rust P, Knight D, Ricketts DM. Greens could be bad for you: a study of the inappropriate use of theater greens. South Med J. 2005 Oct;98(10):1053-4.  

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