Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence
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Published on: February 23, 2014
M L Manning1, L K Archibald, L M Bell
1Infection Control Department, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Insights
A Serratia marcescens outbreak in a pediatric cardiac intensive care unit was linked to reduced handwashing by healthcare workers (HCWs). Breaks in aseptic technique and environmental contamination also contributed to the S marcescens infections.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Hospital infection control
Background:
- An outbreak of Serratia marcescens occurred in a pediatric cardiac intensive care unit (CICU) between April and December 1995.
- Fourteen patients developed infection or colonization with a single strain of S. marcescens during the study period.
Purpose of the Study:
- To identify risk factors associated with Serratia marcescens infection or colonization in a pediatric CICU.
- To investigate the contributing factors to the S. marcescens outbreak.
Main Methods:
- A retrospective case-control study was conducted.
- Infection control practices and patient exposure to healthcare workers (HCWs) were assessed.
- Environmental and HCW hand cultures were obtained.
Main Results:
- Patients with S. marcescens were more likely to have exposure to a single HCW (OR, 19.5).
- Interviews suggested reduced handwashing frequency among HCWs due to hand dermatitis during the outbreak.
- Breaks in aseptic technique and environmental contamination were also implicated.
Conclusions:
- Reduced handwashing frequency among HCWs, potentially due to hand dermatitis, was a significant factor.
- Breaks in aseptic technique and environmental contamination likely contributed to the S. marcescens outbreak.
- Enhanced infection control practices are crucial in pediatric CICUs to prevent such outbreaks.
Background:
Fourteen patients in the pediatric cardiac intensive care unit (CICU) had > or =1 positive culture for a single strain of Serratia marcescens from April through December 1995 (study period).
Objectives:
To identify risk factors for S marcescens infection or colonization in a pediatric CICU.
Methods:
Retrospective case-control study. Assessment of CICU infection control practices and patient exposure to CICU health care workers (HCWs). Epidemiologic-directed cultures of the environment and HCWs' hands were obtained.
Setting:
Pediatric CICU.
Patients:
Fourteen patients in the pediatric CICU had > or =1 positive culture for a single strain of S marcescens from April through December 1995 (study period). CICU patients who did not have S marcescens infection or colonization during the study period were randomly selected as controls.
Results:
A case patient was more likely than a noncase patient to have exposure to a single HCW (odds ratio [OR], 19.5; 95% CI, 2.6-416; P<.003); however, this association was not adequately explained by epidemiologic or microbiologic studies. Interviews suggested that during the outbreak period, handwashing frequency among HCWs might have been reduced because of severe hand dermatitis.
Conclusions:
A combination of factors, including breaks in aseptic technique, reduced frequency of handwashing among HCWs before and between caring for patients, decreased attention to infection control practices, and environmental contamination may have indirectly contributed to this S marcescens infections outbreak.
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