Julianne Munro

Canterbury District Health Board

Leave no stone unturned – Learnings from multidrug resistant organism transmission events in a neonatal unit.

Concurrent session:
Overcrowding and understaffing have long been identified as risk factors for multidrug resistant organisms (MDRO) transmission. Neonates requiring specialised care are particularly vulnerable. The ability to control cross infection of MDRO in the overcrowded neonatal environment requires a multi-modal approach. This paper compares risk factors in separate cross infection events of extended spectrum beta-lactase Klebsiella pneumoniae and multidrug methicillin resistant Staphylococcus aureus in a tertiary level neonatal care unit.

Observational reviews by infection prevention and control (IPC) experts were implemented to identify risk factors for the spread of MDROs including: observation of practices, environmental audit, hand hygiene audit and terminal cleaning protocol review. Failure to sustain change led to a second observational review process.

Risk factors for transmission events included overcrowding, short staffing, high acuity, overstocking, lack of dedicated technicians for incubator management and inconsistencies in cleaning and disinfection. A DHB wide change of alcohol-based hand rub lead to significant hand health issues for 27% of neonatal nursing staff. Compliance with 5 Moments Hand Hygiene reduced during this time. A more suitable product for the high hand hygiene compliance required in a neonatal unit was implemented, resulting in no further hand health issues.
Incorrect disinfection practices and entrenched attitudes were identified during observational reviews. These were addressed by changing from a two-step disinfection process to a one-step process with simplified instructions, ongoing education and support.
Practice changes bundles were recommended. These included ongoing hand hygiene audit with feedback to staff, ongoing education regarding cleaning and disinfection, terminal cleaning quick reference guide, and trialling of sticker systems to aid compliance with new measures.

Data gathered, and observational reviews and audits were crucial to the IPC response and halting ongoing cross transmission issues in a neonatal unit.

Julianne has had over 20 years working in Infection Prevention has afforded me with a wide range of experience in a variety of services. These have included community, private services, older persons health and aged care facilities as well as Ministry of Health guideline and education input.  More recently I have been based at Christchurch Hospital campus covering Women and Child’s Health for Canterbury District Health Board. This service includes maternity, gynaecology, paediatrics, Children’s Oncology Unit and neonatal services with a neonatal intensive care unit.
Preventing cross infection of multidrug resistant organisms whilst using a risk -based approach in healthcare settings has been a passion of hers. She has also had significant experience in outbreak management of an assortment of microorganisms.  


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