Waterbirths: regional audit of infection control practices

Waterbirths are increasingly being offered as an option, although concerns about associated infection risks have been expressed. We undertook an audit of current practice in our region to help formulate an infection control policy. Questionnaires were sent to the Infection Control Nurses at 16 centres, with a request for completion in conjunction with the Infection Control Doctor. Fourteen (88%) centres responded, 11 of which carried out waterbirthing. Eight had permanent on-site pools, of which five were permanently plumbed in and provided with separate water inlets and outlets. All eight centres had infection control policies for waterbirthing. Six policies included care of the pool using detergent and disinfectant (chlorine-releasing compounds) and two using detergent alone. In none of the centres were the mothers tested for blood-borne viruses. Six centres collected data on infection in mother or child, and two carried out regular microbiological testing of pools. Infection control policies for waterbirths should include instructions for pool maintenance and decontamination, for prevention of legionella, for universal precautions and for use of personal protective equipment. Post-natal surveillance of mothers and babies is required in order to ascertain infection rates.

Neutropenic enterocolitis associated with Clostridium tertium

A 15 year old boy being treated for relapsed acute lymphoblastic leukaemia developed severe diarrhoea and abdominal pain which worsened despite empirical antibiotic treatment. A right hemicolectomy was performed. The caecum and ascending colon showed changes typical of neutropenic enterocolitis. Clostridium tertium was isolated from faeces, blood cultures, and from the resected gut wall, with no evidence of other organisms capable of causing such a condition. As far as is known, this is the first reported case in which neutropenic enterocolitis has been associated with well documented C tertium infection, an organism previously described as a cause of bacteraemia in neutropenic patients.

Clostridium tertium septicemia in patients with neutropenia

Eighteen adult patients with hematologic malignancy developed bacteremia due to Clostridium tertium while neutropenic. Fifteen had accompanying abdominal pain, colonic bleeding, or diarrhea, and three had perianal cellulitis. Fourteen recovered with antibiotic therapy alone; no patient was treated by surgery. C. tertium is an unusual Clostridium because it is resistant to many beta-lactam antibiotics and to metronidazole but is susceptible to vancomycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. It is possible that use of third-generation cephalosporins (cefotaxime, ceftizoxime, ceftazidime) for treating febrile episodes in the absence of any selective intestinal decontamination with trimethoprim-sulfamethoxazole or ciprofloxacin may have resulted in selection for C. tertium in our patients.