MAHONING TWP. — Geisinger physicians, with help from the state Department of Health, continue to search for the source of a bacteria that’s blamed in the deaths of three premature infants since early August.

Epidemiologists from the health department have been at Geisinger Medical Center this week to try to help pinpoint the cause of the Pseudomonas bacteria outbreak that sickened those three infants and five others in the neonatal intensive care unit. Four were treated successfully with antibiotics while one still is undergoing treatment, hospital officials said.

“Our neonatal intensive care unit has never seen a situation involving infections like this,” Dr. Frank Maffei, Geisinger’s chair of pediatrics, said during the news conference on Monday. “Our neonatal intensive care unit has been a cornerstone of our children’s hospital for 25 years. The unit has provided excellent care for the tiniest of babies.”

He said the deaths of the three infants may have been the result of infection complications. The infections are limited to the medical center’s NICU. 

“This is a very common bacteria and is present in very different places and is often very harmless,” Maffei said. “But it can cause disease in very fragile patients. Premature and tiny babies are among our most fragile.”

Geisinger officials said they are taking all precautions as they search for the source of the Pseudomonas bacteria and how it infected the vulnerable infants. The medical center also will divert pregnant women who are likely to deliver in under 32 weeks gestation and infants delivered less than 32 weeks gestation to other facilities, said Dr. Rosemary Leeming, GMC’s chief medical officer. Families of infants currently in the unit have the option of transferring their children to a facility in the Geisinger system or to an outside facility.

Officials said the NICU care teams are working with families to come up with the best and safest solutions for the care of infants currently in the Geisinger NICU. Leeming emphasized the medical center’s NICU remains open to care for babies born after 32 weeks gestation.

Seven of the infants infected with the bacteria were born at under 26 weeks, one under 27 weeks. A full-term child is born at 39 to 40 weeks.

Maffei said infants born after 32 weeks are less vulnerable and require less invasive treatment, such as the insertion of tubes. 

 

Expert floats theories

Lawrence F. Muscarella, PhD, an independent safety expert from Montgomeryville, Montgomery County, observed that possible sources of a Pseudomonas outbreak can be medical tubing or catheters, or a solution or nutrient, such as those used for irrigation or feeding in the NICU.

Dr. Muscarella is president of LFM Healthcare Solutions, LLC, an independent quality improvement and health care safety company that he founded in 2013, according to its website.

Muscarella says that these types of infections, while rare, can arise when affected infants are unwittingly exposed to a particular type of medical equipment, or if one particular health care worker was in contact with only those infants. That is one of the first things investigators look at, according to Dr. Janet Stout, president and director of Special Pathogens Laboratory Inc., Pittsburgh, an internationally-recognized expert on Legionnaires’ disease and other waterborne pathogens.

Dr. Mark Shelly, Geisinger’s director of infection prevention and control, said on Monday it was too soon to tell where the contamination came from. Tests of the water supply and surfaces inside the NICU tested negative for the bacteria, hospital officials said.

Shelly said the information he has suggests the infection came from outside the NICU. Regardless, hospital staff has increased chlorination, done extra cleaning and changed processes.

Muscarella theorized that the bacteria also could have originated from a person’s hands visiting the hospital from the outside although this is less likely, or from a medical device that was reused after it was cleaned, disinfected and rinsed with water in another department. “I’m just speaking hypothetically,” he said.

Dr. Muscarella says that identifying the root causes of such infections is crucial to public health. “Doing so prevents additional infections and improves hospital safety nationwide,” he added.“It could be water in that department,” he said. “I’m just speaking entirely hypothetically.”

He also suggested it could have been equipment contaminated in manufacturing or a feeding solution mixed in the NICU.

Nate Wardle, a Department of Health (DOH) spokesman, said this was the first outbreak of Pseudomonas bacteria in Pennsylvania in 2019.

Wardle said Geisinger is taking all necessary precautions to try to prevent any additional exposures.

Hospital officials said they are continuing to work closely with DOH and the Centers for Disease Control and Prevention (CDC) to investigate and eradicate the bacteria.

 

Strains widely found

According to the CDC, Pseudomonas infection is caused by strains of bacteria found widely in the environment; the most common type causing infections in humans is called Pseudomonas aeruginosa. 

“Serious Pseudomonas infections usually occur in people in the hospital and/or with weakened immune systems,” the CDC states on its website. “Infections of the blood, pneumonia, and infections following surgery can lead to severe illness and death in these people.

“However, healthy people can also develop mild illnesses with Pseudomonas aeruginosa, especially after exposure to water. Ear infections, especially in children, and more generalized skin rashes may occur after exposure to inadequately chlorinated hot tubs or swimming pools. Eye infections have occasionally been reported in persons using extended-wear contact lenses.”

In hospitals, where the most serious infections occur, Pseudomonas can be spread on the hands of health care workers or by equipment that gets contaminated and is not properly cleaned, the CDC said. 

“Outside the hospital, avoid hot tubs or pools that may be poorly maintained, and keep contact lenses, equipment and solutions from becoming contaminated.”

An estimated 51,000 health care-associated Pseudomonas aeruginosa infections occur in the United States each year. More than 6,000, or 13 percent, of these are multidrug-resistant, with roughly 400 deaths per year attributed to these infections.

GMC’s NICU treats 600 to 700 babies a year, according to Maffei.

A hotline has been established for anyone with questions. The hotline numbers are 570-214-9087 and 570-214-9088.

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