Question

CASE STUDY: Outbreak in the nursery As you read through this case study, you will encounter a series of questions that healthcare workers ask themselves as they determine the cause of the illness. Try to answer each question before going on to the next one. During one year, 12 newborns developed serious Proteus vulgaris infections in a hospital nursery. Six babies had P. vulgaris in their blood, four had meningitis, and two had osteomyelitis; four of the babies died. All of the babies were healthy, full-term babies from normal pregnancies and deliveries. 1. How could newborns be infected with this bacterium that is normally found in the soil, water, and feces? All the babies were in the same nursery and P. vulgaris infections did not occur in any other unit in the hospital. P. vulgaris was not found in the tap water. 2. Now what will you look for? Each infant assigned to the nursery remained in the same bassinet until discharge and three nurses were permanently assigned to the nursery. The nursery was closed for six months for cleaning. When the nursery reopened, three more P. vulgaris infections occurred in newborns. What will you look for now? One nurse (nurse A), working in the night shift, admitted all of the infected newborns. Electronic monitors on the sink and hand-sanitizer recorded 70% less use during the night shift than during the other shifts. Sterile swabs dipped in nutrient broth were rubbed over the fingertips and under the nails of both hands of each nurse. Proteus is one of the most common organisms in the skin microbiome of dogs and is found in moist areas of human skin such as under fingernails. P. vulgaris was cultured from nurse A. 4. What mistake did nurse A make? 3.

Answer 1

1. Proteus vulgaris infection is rare in newborn babies. But in this case 12 newborns developed Proteus vulgaris infection. Six babies had Proteus vulgaris infection because they may be invaded through newborn belly button wound. Four newborn babies get meningitis when Proteus vulgaris travels in the bloodstream to their spinal cord and brain. Two babies had osteomyelitis (an infection in a bone) because infections reached the bone by traveling through the bloodstream. Proteus vulgaris infection can lead to death due to cerebral hemorrhage. In this case two infants died, this may be due to the cerebral hemorrage and the infant died.

2. If all the babies remain in the same nursery with the same nurses, there is a chance to get Proteus vulgaris infection in newly admitted babies.

3. Three more infants got Proteus vulgaris infection when nursery opened after cleaning. This means they got infection from the nurse who have urinary tract infection (UTI) because Proteus vulgaris cause urinary tract infection which is the most common clinical manifestation of Proteus vulgaris infection. They already found that Proteus vulgaris was not found in the tap water. Electronic monitors on the sink and hand sanitisers are less during night shift. So she cannot manintain personal hygiene. They found Proteus vulgaris from skin under the finger nails of Nurse A. So the babies got Proteus vulgaris infection from nurse A.

4. During night shift, electronic monitors on the sink and hand sanitisers are 70% less, So she canot maintain personal hygiene. Without personal hygeine she may cleaned baby's navel, so that babies got infected.