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Bacterial outbreak shuts Toronto neonatal unit
Outbreak forces Women's College Hospital to close its doors to vulnerable infants
UNNATI GANDHI

TORONTO -- A serious bacterial infection has shut down Toronto's largest neonatal intensive care unit, and it could last weeks, putting severe strain on a system that is already at maximum capacity.

Women's College Hospital, where the region's most vulnerable premature babies are cared for, this week stopped accepting high-risk pregnancy transfers, as well as preemies born at other hospitals, after an outbreak of methicillin-sensitive Staphylococcus aureus could not be contained.

"[The closing] means that mothers will have to be transferred to other cities, out of province, even out of country to Buffalo," Mary Vearncombe, director of infection control at Women's College and at Sunnybrook Health Sciences Centre, told The Globe and Mail yesterday, referring to a period in 2005 when several Ontario mothers-to-be were sent to the United States because of an overall shortage of neonatal intensive-care space.

"The neonatal intensive-care system is at capacity all the time. So when you take an element of the system out, then somebody is really going to feel the pinch."

Dr. Vearncombe said the outbreak was partly caused by extremely crowded conditions -- the perfect breeding ground for the spread of infection -- at the neonatal intensive care unit.

The unit's 41 beds and surrounding medical equipment in the decades-old building are each squeezed into just 30 square feet of space, which is less than a third of the recommended minimum of 100 square feet.

NICU staff at Women's College noticed the first case of staph infection in early January. It spread, and a number of preventive measures -- including separating infected and healthy babies and having NICU staff wear gloves and gowns at all times -- were put into place.

That didn't work, and an emergency closing was the only option.

"You always have to balance off which is the bigger risk," Dr. Vearncombe said. "Is it a bigger risk to admit babies to the unit when the outbreak is going on? Or is it a bigger risk to say we're not going to admit babies to the unit knowing that mothers are going to be sent somewhere else?"

The 41 babies remain at the hospital, but hospital staff have cleared the NICU rooms to clean them out.

Premature babies are extremely vulnerable to infections that are often harmless to full-term babies; Staphylococcus aureus is a spherical bacterium commonly found on the skin or in the nose of a healthy person.

Many infants at Women's College, as small as 500 grams, have developed abscesses, pneumonia, eye infections and blood infections. No deaths have been reported, and Dr. Vearncombe would say only that "several" babies have infections.

Ontario Ministry of Health spokesman A. G. Klei said the ministry was aware of the closing of the NICU, and that all babies in the unit would be tested.

Asked about increasing unit capacity, he said: "We're working very closely with partners in the health-care system to bring about a more effective and innovative health-care system. We've already worked with several hospitals to approve projects that expand neonatal intensive care across Ontario."

One of those projects involved Sunnybrook Health Sciences Centre and Women's College Hospital, which had been amalgamated in the 1990s. As far back as the late 1990s, Ontario's hospital-restructuring commission recommended Women's College move its perinatal facility to the Sunnybrook Hospital site and expand. The recommendation was never adopted.

Then, in 2005, Sunnybrook announced that it would dramatically increase the size of its emergency department as part of a reorganization in which Women's College, a cramped facility built decades ago, returned to being a separate entity.

During that announcement, details were revealed about plans to include a state-of-the-art, expanded birthing and neo-natal intensive care unit at Sunnybrook, handling 4,250 births a year. It currently handles about 280.

Dr. Vearncombe says the opening will be "a lot later than" the target date of 2008.

"I started working for Women's College in 1984 and they were talking about getting a new NICU then. Still waiting," she said. "Crowding makes infection control a lot more difficult, so we are all looking forward to that new unit."

Michael Marrin, a neonatologist at McMaster Children's Hospital in Hamilton, said the Women's College closing will likely send other neonatal units across the province scrambling.

"It's going to put pressure on both the obstetric and neonatal units," he said, adding that the Hamilton facility will try to accommodate as many mothers and babies as it can. "But the fact of the matter is, our absolute first priority has to be the safety of the patients we already have under our care."

The closing of 41 beds at Women's College is significant because the province has only about 200 "Level 3" beds, which are for premature babies who need the most monitoring and care.

"Most neonatal intensive care units would plan to run at about an 80-per-cent occupancy averaged over the year."

He said the province needs to be pushed to open more "Level 2" beds because babies who don't necessarily need intensive care are occupying the spots in NICUs because they have nowhere else to go.

http://www.cbc.ca/canada/toronto/story/2007/03/09/infection-neonatal-070309.html