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Maryland Department of Health and Mental Hygiene
Larry Hogan, Governor - Boyd Rutherford, Lt. Governor - Van Mitchell, Secretary

November 18, 2016

Ron Laxton, DNP, RN

Senior Vice President Clinical Services & Chief Nurse Executive
Dimensions Healthcare System
Cheverly, MD 20785

Dear Dr. Laxton,

Attached please find the DHMH interim final recommendations in response to the outbreak at the
Prince Georges Hospital Center neonatal intensive care unit. We have developed these
recommendations in consultation with the CDC as noted in our meeting on November 10; these
recommendations could need modification based on the results of either the upcoming
environmental sampling results or additional surveillance findings.

We have specifically identified those items that need to be implemented prior to reopening the unit.
Some of these might have already been implemented.

In addition to the specific recommendations in the interim document, we have the following general
recommendations to optimize infection prevention and control at PGHC:

Water Management General Comments

There is no evidence-based remediation that will rid an aged plumbing system of accumulated
biofilm. Therefore, the best intervention is to raise awareness of how the hospitals tap water is

Infection Prevention Staffing

DHMH recommends additional staffing for infection prevention, consisting at least of:
(1) One additional senior certified infection preventionist to ensure consistent on-site
presence at PGHC;
(2) One staff member trained in epidemiology and data management, dedicated to
surveillance activities; and
(3) Adequate data entry personnel to enter data from central line audits and other
surveillance/auditing activities.
In the interim, before permanent staff is hired, ensure that there is adequate capacity (internally or
externally) to address any infection issues that arise that cannot be immediately addressed by
existing staff.

Administrative Recommendations
Both DHMH and CDC identified a need for increased inclusion of input from Infection Control,
Environmental Services and Facilities Management in the hospitals approach to quality, patient

201 W. Preston Street Baltimore, Maryland 21201

Toll Free 1-877-4MD-DHMH TTY/Maryland Relay Service 1-800-735-2258
Web Site: www.dhmh.maryland.gov
safety, and infection prevention/control. We recommend that PGHC enhance staffing and strengthen
the administrative structures to facilitate input from these 3 entities, and encourage regular
communication and a strong partnership between these entities and the Quality Management

We appreciate your continued efforts in addressing these important issues. If you have any
questions, please contact us.

Thank you,

Lucy Wilson, MD, ScM

Chief, Center for Surveillance, Infection Prevention and Outbreak Response
Prevention and Health Promotion Administration
Maryland Department of Health and Mental Hygiene
201 W. Preston St, 3rd Floor
Baltimore, MD 21201