Fatal multi-resistant Pseudomonas aeruginosa septicemia outbreak in a neonatal intensive care unit in Trinidad

Between July 2-3, 1998, six infants on the neonatal intensive care unit (ICU) at San Fernando General Hospital died following septicemia with multi-resistant Pseudomonas aeruginosa. All patients were infected with the same strain and all were resistant to gentamicin, tobramycin, piperacillin and ceftazidime. Samples of hand washing liquids from the hands of the neonatal ICU staff were cultured and no P. aeruginosa was detected. Patients' environment and environmental surfaces: latches and interiors of incubators, sink traps and the operating theater environment and suction tubing were cultured, and P. aeruginosa with the same antibiogram was recovered from the suction tubing and the sink trap of the only tap on the neonatal ICU. Following the intervention of the infection control team and their strong re-emphasis on compliance with proper hand washing procedures and sterilization techniques, no cluster of infection with this strain or any other strain of P. aeruginosa were subsequently observed. The infecting strain may have been transferred from the operating theater via a neonate delivered by caesarean section and from this infant to the others by a neonatal health care worker who failed to wash hands properly between patients. This is the first documented fatal P. aeruginosa outbreak described at the San Fernando General hospital.