Abstract :
BACKGROUND: A neonate born in our hospital was discharged from the newborn nursery after a 20-day length of stay. The infant was readmitted 7 days later to pediatric intensive care unit (ICU). Within 8 hours, the DFA was positive from a NP swab for Bordetella pertussis. We concluded that due to the incubation period of B. pertussis, the baby was potentially exposed during the initial hospitalization. As a result, we began an investigation to determine possible exposures and the source case in the newborn nursery.
METHODS: Time was a critical factor in our plan to notify parents and staff of possible exposure and offer prophylactic antibiotics. Several meetings with administration and our local health department were held to determine an action plan. Because many of the potentially exposed infants were Hispanic, all communication was delivered in English and Spanish. A call center was set up, and phone calls to parents began within 6 hours of the positive culture; followed by certified letters. The local health department ran a special weekend clinic to provide antibiotic prophylaxis to all 188 infants potentially exposed. We had meetings with our newborn nursery team to determine the magnitude of the exposure to staff, and to investigate whether we could determine the source case. Due to feeding issues, the infant was in close contact with virtually every staff member and volunteer in our newborn nursery.
RESULTS: During our investigation, we identified over 300 healthcare workers (HCWs) and 188 infants who were potentially exposed. HCWs were evaluated by occupational health; 200 were given prophylaxis. NP swabs were performed on 17 HCWs who met our case definition. Of those tested, none were positive for B. pertussis. Because of our rapid response to this case, infants potentially exposed within the incubation period received prophylactic antibiotics at the health department or their physicianʹs office. No additional cases of B. pertussis were attributed to this occurrence. The original source case was not determined.
LESSONS LEARNED: The Hispanic radio station needed a hard copy of the information immediately to avoid confusion and incorrect information. Information by phone call and fax were sent to private physicianʹs offices to ensure information was received. Policies concerning employees working while ill and newborn nursery visitation needed revision. Because the newborn nursery is frequently at maximum capacity, a second newborn nursery was subsequently opened for overflow.
