Tab. I.

Measures used in NICU by to control the outbreak of VIM-K. pneumoniae.

a) Early detection and implementation of contact precautions, emphasizing hand hygiene with alcohol solutions. The efficacy of the alcohol solution actually used in neonates was tested with VIM-microorganism recently isolated in our NICU.

b) Cohorting the VIM cases, grouping them in one specific area of the NICU.

c) Cohorting the healthcare workers, especially nurses. In the first month, physicians were also dedicated to the VIM-cases, but after that time, they also cared for other non-VIM patients.

d) Restriction of β -lactam-antibiotic use in neonates and limitation to sensitive antibiotics (according to the antibiogram) if the neonate carried VIM- microorganisms.

e) Flagging the patient’s clinical history with a green-colored page stating the contact precautions, used when the child was taken out of the unit for clinical tests, etc. This same signalling page was used if the child was readmitted to our hospital.

f) Daily body washing used a 0.1%-0.5% aqueous chlorhexidine solution (0.1% in preterm < 4 weeks of life or a term < 2 weeks; in preterm > 4 weeks of life or a term > 2 weeks, chlorhexidine is used at 0.5%).

g) Restriction of number of healthcare workers from other specialties who came to visit neonates.

h) Information sessions for parents and refresher courses for NICU doctors, nurses, assistants, and specialists, held to explain the epidemiological evolution of VIM bacteria and the steps to be taken during each phase.

i) The possible environmental origins of this VIM bacteria outbreak were explored early on, and included sinks, NICU surfaces, disinfectants, eyewashes, echograph-transductors etc., that could be related with the outbreak. Milk from the Dietetary Service, instruments and milk recipients were sampled, and also the water faucets in the NICU were studied fortnightly (between February and March). The samples were taked with swabs immediately before bein immersed in Tood-Hewitt broth.

j) Other measures taken to interrupt the epidemiological evolution of the outbreak were to test the efficacy of disinfectant used on surfaces (double application of diluted quaternary ammonium and isopropyl-alcohol to the same surface) with VIM –microorganisms from our NICU, on a glass-germ-carrier, as previously described [21, 24].