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An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit
Stefan Weber1, Loreen A Herwaldt, Louise-Anne Mcnutt
1Department of Internal Medicine University of Iowa College of Medicine, Iowa City, USA.
Insights
An outbreak of Staphylococcus aureus surgical-site infections in pediatric cardiothoracic surgery was investigated. Decolonization of healthcare workers carrying the epidemic strain successfully halted further infections.
Area of Science:
- Infectious Diseases
- Epidemiology
- Molecular Biology
Background:
- Surgical-site infections (SSIs) pose a significant risk in pediatric cardiothoracic surgery.
- Identifying the source of outbreaks is critical for preventing further patient harm.
Purpose of the Study:
- To investigate an outbreak of Staphylococcus aureus SSIs within a pediatric cardiothoracic surgery service.
- To identify the source and transmission dynamics of the epidemic strain.
Main Methods:
- A case-control study was conducted.
- Molecular typing (e.g., DNA fingerprinting) was employed to identify carriers of the epidemic strain among healthcare workers.
- Epidemiologic data collection and analysis were performed.
Main Results:
- Three pediatric patients acquired SSIs caused by a single S. aureus strain.
- The epidemic strain was prevalent among operating room (25%) and nursing unit (11%) staff.
- Molecular typing and case-control analysis identified specific healthcare workers, including a surgeon and perfusionist, carrying the strain.
Conclusions:
- The S. aureus epidemic strain disseminated widely among healthcare staff caring for pediatric cardiothoracic surgery patients.
- Decolonization protocols for identified carriers effectively stopped the outbreak, with no new cases reported.
- A combination of traditional epidemiologic methods and molecular typing was essential for outbreak resolution.
Objective:
To investigate an outbreak of Staphylococcus aureus surgical-site infections.
Design:
Case-control study.
Setting:
Pediatric cardiothoracic surgery service of a tertiary-care university medical center.
Method:
Molecular typing was used to identify healthcare workers who carried the epidemic strain.
Results:
Three children acquired surgical-site infections caused by a single strain of S. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P = .01). A case-control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not grow S. aureus.
Conclusions:
Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.