Geisinger infection

Robert Inglis/The Daily Item

Geisinger doctors Mark Shelly, left, Frank Maffei, and Rosemary Leeming, talk about the recent spread of pseudomonas in the NICU at Geisinger in Danville.

HARRISBURG — Epidemiologists from the state Department of Health were at Geisinger Medical Center for a second day on Tuesday to try to help hospital officials pinpoint the cause of a bacterial outbreak blamed for the deaths of three infants in the Neonatal Intensive Care Unit.

The state officials “will be working with” Geisinger official to determine when it’s appropriate to resume accepting babies born before 32-weeks in the NICU, said Nate Wardle, a Department of Health spokesman.

It’s the first outbreak of Pseudomonas bacteria in Pennsylvania in 2019, Wardle said.

Hospitals don’t have to notify the state about individual cases of infection from Pseudomonas bacteria, but they are required to alert the state about outbreaks of the disease.

The Department of Health’s definition of what constitutes an “outbreak” varies by disease, he said, adding that for pseudomonas bacteria infections, it’s considered an outbreak if the facility discovers it’s seeing more cases than normal.

Neonatal intensive care units are more prone to these types of outbreaks because premature babies have weaker immune systems, said Dr. Janet Stout, president and director of Special Pathogens Laboratory, Inc., based in Pittsburgh. Stout is an internationally-recognized expert on Legionnaires’ Disease and other waterborne pathogens.

Because medical professionals recognize the life-threatening danger posed by bacteria like pseudomonas, “every effort is taken to prevent transmission,” she said.

But pseudomonas bacteria can be spread multiple ways, including through skin-to-skin contact, or if medication that is supposed to be sterile has been contaminated, among other ways, she said.

In other cases, humidifiers were found to be the source of the problem, she said.

Stout said she has been consulted by investigators examining the Geisinger outbreak. One of the early steps involves trying to determine what sort of common factors, like caretakers, were involved in the care of the babies who got sick that weren’t involved in other babies in the NICU who didn’t get sick, she said.

Stout said that the one thing she’s confident about is that investigators will pinpoint the cause.

Investigators can analyze samples at the molecular level to determine whether the bacteria that sickened the children was the same as the bacteria found in suspected sources, she said.

“It’s a bit of detective work, and it does take time,” Stout said.

The most recent nearby case comparable to the outbreak at Geisinger that Stout could recall was in Maryland, she said. The NICU at Prince George’s Hospital was closed for four months after pseudomonas bacteria sickened 15 babies, according to the Washington Post.

The last time there was a pseudomonas bacteria outbreak in a hospital in Pennsylvania was in “2016 or 2017,” Wardle said. There was a death caused by that outbreak, Wardle said. The hospital involved in that incident never publicly announced that the outbreak had taken place and Wardle on Tuesday declined to identify which Pennsylvania hospital was involved.

Health Department communications staff also declined repeated requests on Tuesday to make Secretary of Health Dr. Rachel Levine available for an interview to talk about the department’s role in investigating the Geisinger outbreak.

The Department of Health will notify the public of an outbreak of a disease if there’s reason to believe there’s a risk to the public, Wardle said.

Hospitals are not required to publicly announce if they are dealing with outbreaks like the one at Geisinger, he said.

“Facilities do not have a requirement to provide public notification, but often do in order to be transparent,” Wardel said.

Geisinger officials announced Monday that eight infants in the NICU have been sickened due to exposure to the pseudomonas bacteria since August, and three of those babies died. Neither hospital officials, nor the Department of Health officials have indicated how they believe the babies were exposed to the water-borne bacteria.

Tests of the water supply and surfaces inside the NICU tested negative for the bacteria, hospital officials said.

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