Not Just Little Adults: Two Outbreaks in Nicus and Lessons Learned

Session Description: Neonatal Intensive Care Units (NICUs) across the country vary significantly, operating either as specialized units within pediatric hospitals or as part of adult-focused hospitals. These differences include but are not limited to a wide variety in level of care, subspecialty presence, and physical structure of the units. For an effective infection prevention program, it is crucial to understand how these factors influence infection and outbreak risks in the NICU setting. This session will explore the NICU-specific factors critical for managing and controlling outbreaks. The presentation will begin with an overview of why neonates are more susceptible to infections, emphasizing differences in their pathophysiology compared to adults, including their integumentary, respiratory, and immune systems. Following this background, the session will cover two distinct outbreak case studies from different NICUs: an outbreak of methicillin-resistant Staphylococcus aureus and a rhinovirus outbreak. These case studies will highlight pediatric-specific considerations that infection prevention and neonatal care teams need to address during an outbreak either from a bacterial pathogen spread via contact transmission or a virus spread via a combination of contact and droplet transmission. The discussion will focus on how infections present in neonates versus adults, differences in testing protocols, and criteria for isolation removal. Additionally, the session will address environmental factors relevant to NICU outbreaks, including the physical layout, visitation policies, and equipment considerations. Finally, the session will cover the mitigation steps taken to stop the outbreaks along with the ongoing monitoring steps to prevent subsequent recurrences. Understanding these elements is essential for effectively managing infection risks and ensuring the safety of vulnerable neonate patients.