International Journal of Healthcare Simulation

Background:

Neonates in intensive care are vulnerable to colonisation and invasive infections from multi-resistant gram-negative bacteria [1]. In 2021 our neonatal unit (NNU) fell victim to an ESBL-Klebsiella outbreak. An outbreak control plan was formulated that included education; hand-hygiene and cleaning auditing; cohorting infants; mass screening infants and environment; and reduction of equipment in clinical areas. Our NNU has an active multidisciplinary simulation programme. Simulation is an effective educational tool to increase competence of healthcare providers [2]. We wanted to use simulation to highlight the ease of transmission of particles from a colonised infant.

Methods:

The simulation involved a preterm 28-week infant corrected to 35-week gestation with numerous desaturation episodes. The baby was known to be colonised with pseudomonas. A ‘monitored’ low-fidelity manikin was placed in a cot in an isolation room. Candidates were unaware that the manikin was covered with ultraviolet powder. The manikin had numerous desaturation and bradycardic episodes necessitating airway and breathing support, clinical assessment, and septic screen. The spread of powder was assessed afterwards with a black-light.

Results:

The simulation lasted just 8 minutes. There were exemplary unprompted infection-prevention measures with appropriate handwashing and personal protective equipment. Despite this the powder spread to staff facemasks, stethoscope, resuscitation equipment, patient trolley, and monitor.

Conclusion:

This demonstrated the ease of transmission of particles to other surfaces despite adherence to infection prevention policies. Most striking was the transmission to candidates’ facemasks which are not routinely changed, and could be a potential risk of carriage of microbes to other infants.

References

1. Patel SJ, Green N, Clock SA, Paul DA, Perlman JM, Zaoutis T, Ferng YH, Alba L, Jia H, Larson EL, Saiman L. Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit. J Pediatric Infect Dis Soc. 2017;6(3):227–230.

2. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A. Training and simulation for patient safety. BMJ Quality & Safety. 2010;19(Suppl 2):i34–43.