Relation between nursing procedures, other local characteristics and transmission of enteric bacteria in neonatal wards

Faecal colonization patterns were studied in 22 neonatal special care units ( N = 953 babies) using a novel method for typing of Escherichia coli, Klebsiella spp. and Enterobacter spp. isolates. Sporadic strains of E. coli (found in only one infant in a ward) were taken to indicate natural colonization, whereas local spread of E. coli strains or colonization with sporadic or spreading strains of Klebsiella spp. and Enterobacter spp. was regarded as abnormal (non-maternal) colonization. All apparent risk factors for abnormal neonatal colonization with enteric bacteria identified were modifiable (ward size, staff work load, antibiotic policy, hygienic precautions). Another encouraging finding was that variables harder to modify (crowding, intensity of care) appeared to be unimportant in influencing neonatal colonization patterns with such bacteria.