Outbreaks in neonatal intensive care units -: They are not like others

Background: Outbreaks of health care-associated infections in neonatal intensive care units (NICUs) are frequent and have received more attention in medical literature than outbreaks from other types of intensive care units (ICUs). The objective of this systematic review was to identify differences between outbreaks of health care-associated infections in NICUs and other ICUs as reported to date in the medical literature. Methods: Screening the outbreak database (http://www.outbreak-database.com), a systematic comparison of outbreaks was performed with the following categories: causing pathogen, type of infection, sources identified, and measures taken to stop the outbreak. Results: Two hundred and seventy-six outbreaks were reported from NICUs and 453 from other ICU types. Enterobacteriaceae were significantly more often responsible for NICU outbreaks, whereas nonfermenting bacteria are more frequently identified in other ICU types. On average, 23.9 patients and 1.8 health care workers were involved in NICU outbreaks. Average mortality in NICU outbreak was 6.4 % (1.5 newborns on average). In 48.6 % of NICU outbreaks the authors were unable to identify the sources compared with 38.0% in other ICU outbreaks. The most important infection control measures were significantly more often implemented in NICUs than in other ICUs. Conclusions: Systematic outbreak analysis is essential for gaining insights into the control of NICU outbreaks.