Long before the coronavirus pandemic began, other infectious disease threats lurked in hospitals and continue to do so. That’s why infectious disease specialist Aaron Milstone is vigilant about washing his hands as he sees patient after patient in the neonatal intensive care unit (NICU). He also regularly dons isolation gowns, masks, and gloves. His clinician colleagues — other doctors, nurses, trainees, and technicians — all take these precautions as well, steps they’re rigorously taught in training to prevent the transfer of germs that can make their young patients sick. However, he says, there’s one prominent group of frequent visitors to the NICU who do not meticulously undertake these safety measures: parents.
“We educate healthcare workers on infection prevention, track events, give them data and make action plans, but we’re not even reminding parents about washing their hands,” Milstone says.
“We know parents are reservoirs about introducing infections to their children, but we don’t usually treat parents with the same rigor that we do healthcare workers.”
Staphylococcus aureus, a bacterial species that harmlessly affects about a third of most adults, can be devastating to babies with weak immune systems, he explains. Studies show that up to 3.7% of very low birthweight babies in NICUs get S. aureus infections during their stay, and up to a quarter of these young patients die.
But a new study led by Milstone and published in the Jan. 28, 2020 Journal of the American Medical Association, shows how effective treating NICU parents can be for reducing their potential to unwittingly introduce infection. Employing a quick and painless intervention, providers in the Johns Hopkins NICU significantly cut infection rates of S. aureus transferred directly from parents.
Over a four-year period, from November 2014 to December 2018, the researchers screened parents whose babies were admitted to the Johns Hopkins NICU to see if they were carriers for S. aureus. If either or both tested positive, the researchers genotyped their bacteria and then randomized both parents to one of two groups: The “intervention” group participants were instructed to put antibiotic ointment in their noses — a common site that these bacteria colonize — and to wipe their hands with antibiotic-impregnated cloths before they entered the NICU. The “control” group placed petroleum jelly in their noses and wiped their hands with soap cloths. Parents were unaware of which group they were assigned to.
When Milstone and his colleagues analyzed the data, they found that about 58% of babies who developed S. aureus infections caught them from their parents, evident because the genotypes of the strains matched. However, babies whose parents were in the intervention group had about half the rates of S. aureus infections caught from parents as those in the control group — a testament to the effectiveness of this simple prophylactic treatment, Milstone says.
Over the years, he and his team have developed a number of other seemingly simple but powerfully protective interventions that can cut infection rates in these very young and vulnerable patients, he adds. They’ve published studies showing that having parents and other care providers bathe pediatric ICU babies using a special antibiotic solution, rather than regular soap, can cut blood-borne infections by a third. He and his team have further cut infections by screening all NICU babies for not only methicillin resistant S. aureus (a strain commonly known as MRSA, which is resistant to a common antibiotic used to treat these infections), but also for susceptible strains of S. aureus, which kill three times as many pediatric patients each year. They also screen all the clinicians who treat PICU and NICU babies. Babies and providers who test positive receive nasal antibiotic ointment.
Milstone says that he and his team will continue to search for ways to incrementally bring his patients’ hospital-acquired infection rates as close to zero as possible.
“For me, the most rewarding part of these strategies is not having to tell a family, ‘I’m sorry, your kid got a hospital onset infection, a surgical site infection, or a blood-borne infection.’ I don’t want to have to apologize to families for infections that potentially are preventable.”