DANVILLE, Pennsylvania — Three infants being treated at the neonatal intensive care unit in a central Pennsylvania hospital have died since early August, hospital officials said this week.
Officials at Geisinger Medical Center in Danville said the deaths are possibly due to an increase in a waterborne bacteria that has infected eight infants in the unit, hospital officials said Monday. Eight infants born before 27 weeks were infected with the Pseudomonas bacteria, hospital officials said. Four were successfully treated with antibiotics. One of the eight premature infants infected with the bacteria is still is undergoing antibiotic treatment, hospital officials said Tuesday.
Meanwhile, doctors are continuing their search for the source and cause of the infection.
Geisinger officials said they are taking all precautions as they continue their investigation. They said the Pseudomonas bacteria is not contagious person to person and is common.
Dr. Frank Maffei, Geisinger’s chair of pediatrics, said the deaths of the three infants may have been the result of infection complications. The infections were limited to the medical center’s NICU.
"Our neonatal intensive care unit has never seen a situation involving infections like this," Maffei said during a news conference. "Our neonatal intensive care unit has been a cornerstone of our children's hospital for 25 years. The unit has provided excellent care for the tiniest of babies."
“This is a very common bacteria and is present in very different places and is often very harmless,” Maffei said at the news conference. “But it can cause disease in very fragile patients. Premature and tiny babies are among our most fragile.”
Evangelical Community Hospital in nearby Lewisburg, Pennsylvania has not experienced any such outbreaks in recent memory, hospital spokeswoman Deanna Hollenbach said.
Nate Wardle, a spokesman for the Pennsylvania Department of Health, said Pennsylvania has not had any reports of Pseudomonas bacteria outbreaks this year, but it is also not a reportable condition in Pennsylvania. He said bacteria is fairly rare but normally occurs in health care settings.
Epidemiologists from the state Department of Health were at Geisinger for a second day on Tuesday to try to help hospital officials pinpoint the cause of a bacterial outbreak.
The state officials “will be working with” Geisinger official to determine when it’s appropriate to resume accepting babies born before 32-weeks in the NICU, Wardle said.
Neonatal intensive care units are more prone to these types of outbreaks because premature babies have weaker immune systems, said Dr. Janet Stout, president and director of Special Pathogens Laboratory, Inc., based in Pittsburgh. Stout is an internationally-recognized expert on Legionnaires' Disease and other waterborne pathogens.
Stout said she has been consulted by investigators examining the Geisinger outbreak. One of the early steps involves trying to determine what sort of common factors, like caretakers, were involved in the care of the babies who got sick that weren’t involved in other babies in the NICU who didn’t get sick, she said.
The most recent nearby case comparable to the outbreak at Geisinger that Stout could recall was in Maryland, she said. The NICU at Prince George’s Hospital was closed for four months after pseudomonas bacteria sickened 15 babies, according to the Washington Post.
Geisinger has begun to divert pregnant women who are likely to deliver in under 32 weeks gestation to other facilities, said Dr. Rosemary Leeming, Geisinger's chief medical officer. Families of infants currently in the unit have the option of transferring their children to a facility in the Geisinger system or to an outside facility.
“We have not transferred any infants out of the NICU," Geisinger officials said in a statement issued by spokesman Joseph Stender. "Our NICU care teams are actively working with families to come up with the best and safest solutions for the care of infants currently in the Geisinger NICU."
Leeming emphasized the medical center’s NICU remains open to care for babies born after 32 weeks gestation. Seven of the infants infected with the bacteria were born at under 26 weeks, one under 27 weeks. A full-term child is born at 39 to 40 weeks.
Maffei said infants born after 32 weeks are less vulnerable and require less invasive treatment, such as the insertion of tubes.
“It’s too soon to say where the organism is coming from,” said Dr. Mark Shelly, Geisinger’s director of infection prevention and control, said he expects it will take at least a couple of weeks for him to get the confirmatory information he needs.
Shelly said tests of the water supply and surfaces inside the NICU tested negative for the bacteria, hospital officials said.
The information Shelly has suggests the infection came from outside the NICU. Regardless, hospital staff has increased chlorination, done extra cleaning and changed processes.
When asked, Geisinger also responded that, "There has been absolutely nothing to indicate that the Pseudomonas bacteria was the result of any criminal or negligent behavior. Pseudomonas is common in everyday environments and is spread through contact with the bacteria, but is only dangerous for very fragile populations such as extremely premature infants."