590. Reduction of Endotracheal Colonization by Gram-Negative Bacilli in a Neonatal Intensive Care Unit Through Use of a Novel Drain Cover

Abstract

BackgroundSplash and aerosolization from sink drains are a source of contamination, particularly by Gram-negative bacilli (GNB), in healthcare facilities. Neonatal Intensive Care Unit (NICU) outbreaks of infection due to GNB have been attributed to NICU sinks. Recent studies found that a dome-shaped drain cover placed in sinks in an adult ICU prevented dispersal of sink drain bacteria to the environment and hands of healthcare providers. Our NICU routinely performs weekly surveillance cultures of all endotracheal tubes (ETT) and has previously reported a correlation of ETT colonizing organisms with bacteria isolated from blood in late onset sepsis. Our objective was to determine whether the use of a drain cover in every sink in a level III 72 bed NICU could lead to a decrease in the isolation of GNB in the ETTs of hospitalized infants.MethodsAll 34 sink drains and basins in an open layout NICU were cultured. Drain covers were then installed and replaced on a routine basis. Weekly endotracheal tube cultures were performed for all intubated infants.ResultsPrior to implementation of drain covers, the most common GNBs cultured from ETTs were, in order, E. cloacae, Klebsiella spp., Acinetobacter spp., and S. maltophilia. The most common organisms isolated from sinks were, in order, P. aeruginosa, Acinetobacter spp. and S. maltophilia. An unusual species, Acinetobacter ursingii, was common in both sinks and endotracheal tubes. Before and after the implementation of drain covers, the median time to first isolation of a GNB was 14 and 17 days, respectively. Prior to draining cover implementation, there were 31 new GNB isolates during 700 ventilator days (rate of 44.3/1000 ventilator days) among infants with any positive ETT cultures. Post drain cover there were 26 new GNB isolates during 900 ventilator days (rate of 28.9/1000 ventilator days). There was a shift in microbial species isolated from ETTs with Klebsiella spp. and S. marcescens predominating after implementation of drain covers.ConclusionThe use of a novel drain cover in the sinks in a NICU can reduce the frequency of GNB colonizing the ETTs of patients and can lengthen the time to first positivity. Mitigating sinks as a reservoir for GNB may reduce the likelihood of these bacteria infecting a vulnerable population.Disclosures All authors: No reported disclosures.