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Neonatal unit shut after infection kills baby

A highly feared bacterial infection has killed a premature baby at a downtown Toronto hospital, sparking special hygiene measures and the closing of a neonatal intensive care unit.

The infant died of bacteremia, commonly known as blood poisoning, at Mount Sinai Hospital after acquiring serratia, a particularly harmful pathogen that can cause severe infections in babies, Allison McGeer, the hospital's director of infection control, confirmed in a telephone interview Wednesday.

"This is one of the organisms we really worry about it," Dr. McGeer said. "... This is not an organism you take any chances with."

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In this case, the infant, described as weighing between about one and three pounds (500 and 1,500 grams), succumbed to the infection over the weekend. The gender of the child could not be provided, due to patient confidentiality, said Jodi Salem, the hospital's spokeswoman.

A second baby, who also tested positive for serratia, an organism found fairly commonly in the bowels of adults, is in isolation at Mount Sinai but is not seriously ill.

"It is so awful for new parents, such a tragedy that these babies die," Dr. McGeer said. "It's also extremely hard on the staff who work in the unit because every one of those babies is their baby, too."

The death of the infant, described as very premature, has prompted special infection-control procedures, including improved hand hygiene and the wearing of gowns and gloves in the 54-bed neonatal intensive care unit, which cares for some of the most fragile babies in the province.

Mount Sinai's level 3 neonatal unit, where the most fragile infants are admitted, remained closed last night. Late yesterday afternoon, the hospital reopened level 2 of the neonatal intensive care unit, Dr. McGeer said.

Since Monday, there have been three transfers of patients, including pregnant and new mothers, which would have had to happen anyway as the neonatal care unit is at maximum capacity.

The baby's death is a tragedy for parents who will mourn a lost future.

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But it comes at a time when Mount Sinai plans to renovate its neonatal intensive care unit to fix a problem endemic to many Canadian hospitals: too many sick babies in cramped spaces.

To minimize infection, experts recommend there be 10 feet between incubators.

But hospitals built decades ago, such as Mount Sinai, have only four to five feet between these babies, Dr. McGeer said. Mount Sinai is contemplating whether they should have separate rooms altogether.

From an infection-control point of view, experts recommend babies in neonatal intensive care units be in a single room that is 150 square feet and that all babies be 10 feet apart.

But that design could potentially spell problems for monitoring them as it could be more difficult to provide treatment to them quickly in an emergency.

"There's nothing that happened to this baby where mistakes were made or there were obvious problems in care," said Dr. McGeer, adding that Mount Sinai's rate of hospital-acquired infections is very low.

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"Does that mean when we move to single rooms in our new NICU [neonatal intensive care unit]that wouldn't have been one of the deaths that would happen? I can't tell you that. There's really no way of knowing which of those babies is going to be the baby who doesn't die."

Though it may sound a rare occurrence, hospital-acquired infections are frighteningly common.

They are the fourth-leading cause of death, with 8,000 to 12,000 Canadians dying of them every year, according to Dick Zoutman, physician director of the Community and Hospital Infection Control Association of Canada.

"People die one at a time," Dr. Zoutman said in a telephone interview from Kingston yesterday, "but it's bigger than car accidents, it's bigger than breast cancer, it's bigger than colon cancer. It's huge."

Crucial to minimizing serratia infections is hand hygiene, facility design and adequate space, he said. Though serratia is "not the most common infection, it is the most feared outbreak in neonatal units," Dr. Zoutman said, adding that when it sweeps through neonatal intensive care units, it can cause pneumonia, meningitis and bacteremia, such as in this most recent case.

Treatment is with intravenous antibiotics, which race to stamp out the virulent organism as it travels through the bloodstream. Serratia is known to stimulate an immense immune system reaction: a patient becomes delirious, blood pressure drops and septic shock and organ failure follows.

Dr. Zoutman said much more research needs to take place on hospital-acquired infections, and that the federal government should establish a $10-million-a-year research fund for the next 10 years.

The problems of hospital-acquired infections are "diverse and complex," he said. "But we have an abundance of evidence that a lot of it is preventable."

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