Management of a Burkholderia cepacia outbreak in a Neonatal Intensive Care Unit.

Management of a Burkholderia cepacia outbreak in a Neonatal Intensive Care Unit.

Jacqueline Meyer¹, Susan Ryan¹, Rachael Purcell^1,2,3,4, Norelle Sherry^5,6, Rhonda L Stuart^1,7,8, ,

¹Infection Prevention Monash Health, Clayton, Victoria, Australia
²Health Informatics Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
³Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
⁴Bioinformatics Group, Centre for Health Analytics, Royal Children’s Hospital, Melbourne, Victoria, Australia
⁵Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
⁶Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
⁷Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
⁸South East Public Health Unit, Clayton, Victoria, Australia









Introduction
Burkholderia cepacia complex (BCC) are gram-negative bacteria found in soil and water with optimal growth temperature 30-37 ⁰C. It forms biofilms, can survive months in water and extended periods on polyvinylchloride.

We describe the management of a BCC outbreak in a Neonatal Intensive Care Unit (NICU), potentially related to contaminated plumbing. NICU water temperature is regulated at 35-38 ⁰C to comply with safety standards and delivered through polyvinylchloride pipes, providing environmental conditions perfect for BCC growth. During CPE screening in 2021, BCC was incidentally found in hand hygiene basin taps and faeces of two neonates. Six monthly disinfection and thermal flushes were implemented. In 2022, a neonate with a BCC bloodstream infection was identified in a room with a tap which was previously colonised.

Method
Investigation included microbiological screening of taps, genomic sequencing of all positive cultures and mapping of patient placement.

Results
BCC was isolated from 2 patient room taps and one breast pump cleaning sink tap. Genomic sequencing suggested a common source of the outbreak.

Infection prevention strategies included cleaning and disinfecting contaminated taps and applying tap bacterial filters. When unsuccessful, thermal flushing and aerator changes implemented in 2021, were increased to monthly, with weekly microbiological testing. The frequency of flushing and testing lengthened over time, to determine optimal control.

No additional BCC infections have been detected and no positive screening results have been recorded since September 2022.

Conclusion
Controlling a BCC outbreak, although challenging, was achieved through tap cleaning, thermal flushing and surveillance. Ongoing monitoring continues.

Biography

Jacky Meyer has been working in Infection Prevention at Monash Health since 2014. She has a background in both adult and paediatric Intensive Care nursing, having worked in Australia the UK, and Fiji. She has a keen interest in outbreak management & investigation, Infection Prevention education and research.

Susan Ryan has 35 years of nursing experience, with lead roles in Critical Care and Infection Prevention at Monash Health. This year she has taken on the role of Infection Prevention Site Lead at the new Victorian Heart Hospital. She has a keen interest in Infection Prevention research and quality improvement.