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An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible
K Weist1, C Wendt, L R Petersen
1Institute of Hygiene, Free University of Berlin, Germany.
Objective:
To investigate an outbreak of methicillin-susceptible Staphylococcus aureus (MSSA) infections in a neonatal clinic.
Design:
Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.
Setting:
A German 1,350-bed tertiary-care teaching university hospital.
Results:
There was a significant increase in the incidence of pyodermas with MSSA; 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.
Conclusions:
Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomial S. aureus infections of the skin. To our knowledge this source of S. aureus infections has not previously been described.
Insights
Contaminated ultrasound gel spread methicillin-susceptible Staphylococcus aureus (MSSA) infections in a neonatal clinic. Inappropriate hygiene during ultrasounds can cause these nosocomial skin infections.
Area of Science:
- Infectious Disease Epidemiology
- Clinical Microbiology
- Neonatal Care
Background:
- An outbreak of methicillin-susceptible Staphylococcus aureus (MSSA) infections occurred in a neonatal clinic.
- The infections manifested as pyodermas in neonates who were otherwise in good condition.
Purpose of the Study:
- To investigate the source and transmission of the MSSA outbreak.
- To identify risk factors associated with the infections.
Main Methods:
- Prospective chart review and environmental sampling were conducted.
- Genotyping was performed using pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR).
- A case-control study identified potential risk factors.
Main Results:
- A shared ultrasound gel and spatula were identified as the primary sources of MSSA.
- Genotyping confirmed that MSSA strains from neonates and the ultrasound gel were genetically related.
- The attack rate increased significantly during the outbreak period.
Conclusions:
- Inappropriate hygienic practices with ultrasound lubricants can lead to nosocomial Staphylococcus aureus skin infections.
- This study highlights a previously undescribed source of S. aureus transmission in a neonatal setting.