Screening for Pseudomonas aeruginosa in NICU: does it help reduce infection in neonates?

Pseudomonas aeruginosa (PA) is an environmental organism known to cause overwhelming infection in very premature infants. In recent years, it has become increasingly common practice to screen neonates for PA colonization particularly in units where neonates have developed overwhelming infection with PA or cross-infection has occurred. Following a cluster of babies infected and colonised with PA over a short time period in 2012 in the Neonatal Intensive Care Unit (NICU) at North Bristol NHS Trust, neonatal PA screening was introduced on a weekly basis and continued long after the period of increased incidence had resolved.
The value of screening neonates for PA was subsequently assessed with regard to 1) its role in predicting the risk of developing severe PA infection in neonates and 2) directing infection control practice. Between August 2012 and September 2015, babies admitted to NICU were routinely screened in skin sites (as for MRSA screens) for PA colonization on admission and weekly thereafter, using standard laboratory culture methodology. Environmental samples from NICU were tested for the presence of PA. Variable Number Tandem Repeat (VNTR) typing was performed on strains of PA from babies and the environment. Data on all PA strains cultured from infants and the environment was collated and analysed.
None of the neonates with positive PA screens subsequently developed PA infection. There was no VNTR strain evidence supporting direct cross-infection from the environment or other babies. Screening was discontinued in the NICU at NBT in September 2015.

Dr Elizabeth Darley, North Bristol NHS Trust