Clinical assay of N-duopropenide alcohol solution on hand application in newborn and pediatric intensive care units: Control of an outbreak of multiresistant Klebsiella pneumoniae in a newborn intensive care unit with this measure

Outbreaks of gram-negative colonization (generally by antibiotic-resistant enterobacteria) are common in newborn intensive care units (NICUs), and con trol methods are not always effective, We studied the effectiveness of an a lcohol solution of N-duopropenide (NDP) in vivo (germicidal effect on flora of teams in the NICU and the pediatric intensive care unit. vs handwashing with nonantiseptic soap) and its effect on the control of a multiresistant (MR) Klebsiella pneumoniae outbreak in our NICU that had persisted for 13 months, despite the use of classic control measures. For educational purpos es, we also performed 4 prevalence studies of microbial hand flora in NICU staff (two before and two after introducing NDP). The alcohol solution of N DP was highly germicidal in vivo, destroying microorganisms better than cla ssic handwashing on the hands of 69 health care staff of our NICU and PICU. The flora in both units was reduced from an average of 63% to an average o f 95%. Application of this disinfectant to the hands of health care workers after handling newborns helped to eliminate the MR Klebsiella strain in ou r NICU, (relative risk compared with the period preceding use of the disinf ectant: 8.6, with 95% confidence intervals, 4.8-145.5). Four prevalence stu dies of hand microbial contamination, before and after NDP introduction in the NICU, showed a significant reduction of enterobacteriaceae, mainly MR K pneumoniae, in health care workers. In conclusion, NDP in alcohol was very effective in vivo. It proved to be a useful complementary measure to handw ashing and reduced exogenous microorganism transmission in a unit with a he avy patient-care workload.