Characterization of a Klebsiella pneumoniae Outbreak in Surgical Therapy and Strategies for its Control in a 3rd Level Pediatric Hospital

Background

Bloodstream infections (BSIs) are one of the most important health-care associated infections (HAIs), with great implication in prolonging hospitalizations, increase in morbidity and mortality and in costs. During March 2024, the increased occurrence of possibly related cases of BSIs was observed in the surgical therapy service, it was identified as an outbreak, and it was monitored to characterize it and take control measures.

Methods

A retrospective analysis was performed with data collected from electronic medical records of the detected cases. The variables studied were sex, venipuncture position, days of catheter placement, underlying disease, days of hospitalization, surgical procedure performed, symptoms and their onset, bacteriological isolation, and factors associated with surgical procedures.

Results

In this outbreak, 4 cases of BSIs due to Klebsiella pneumoniae were identified, 75% had enzymatic resistance mechanisms, 75% were men. The total exposed population was 45 patients, with an attack rate of 8.9%, 75% of the catheters corresponded to jugular venous accesses, the mean duration of CVC installation was 14.25 ± 7.2 days and the duration until removal was 12 ±7.8 days. The mean hospital stay was 89.75 days, (range of 26-155 days). Fever was present in 100% of cases, leukocytosis in 50%, tachycardia in 75%, diaphoresis in 25%, and erythema at the CVC placement site in 25%.

The findings were: poor cleaning, failure of the laminar flow hood and autoclave, excessive foot traffic in the area, misuse of protective equipment, and accumulated unused equipment.

The following interventions were carried out to control the outbreak: catheter removal, hand washing, taking environmental cultures, reinforcing adherence to hand hygiene, monitoring and training in placement and management of central access, timely removal of vascular access, implementing the “no touch” technique, paired sampling, eliminating the use of master solutions, limiting access to non-essential personnel, application of disinfection with UV-C light, periodic cleaning of the gasometer, changing the product collection cart, and monitoring the use of multidose medication.

Conclusions

BSIs are highly related to the days of hospital stay and the time the catheter is in place, usually occurring on day 7 of the start of its placement.

Although there was not only one cause of the outbreak, but different factors were also found that were predisposing to its presence, so we deduced that they were attributable to routine room processes; therefore, the multidisciplinary actions carried out by epidemiology controlled the outbreak.