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An outbreak of Serratia marcescens bacteremia after general anesthesia
Michael E Sebert1, Mary Lou Manning, Karin L McGowan
1Division of Immunologic and Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Objective:
To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia.
Design:
A case-control study.
Setting:
A 304-bed, pediatric teaching hospital.
Patients:
Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period.
Results:
Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies.
Conclusions:
Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.
Insights
An outbreak of Serratia marcescens bacteremia in pediatric patients was linked to operating room technicians preparing intravenous fluids. This highlights the need for strict sterile techniques and comprehensive training for all operating room staff.
Area of Science:
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
- Pediatric Patient Safety
Background:
- Serratia marcescens bacteremia is a serious healthcare-associated infection.
- Pediatric patients undergoing general anesthesia are at risk for post-operative infections.
- Investigating outbreaks requires understanding potential sources of contamination.
Purpose of the Study:
- To investigate an outbreak of Serratia marcescens bacteremia in pediatric patients following general anesthesia.
- To identify risk factors and the source of contamination during the outbreak period.
Main Methods:
- A case-control study was conducted at a 304-bed pediatric teaching hospital.
- Twenty-three pediatric patients with S. marcescens bacteremia post-anesthesia were compared to 46 age-matched controls.
- Data collected included patient procedures, staff exposure, and perioperative interventions.
Main Results:
- Patients who developed bacteremia were more likely to have received cefazolin or had central vascular catheters placed.
- The timing of procedures was significantly associated with the shifts of operating room technicians preparing intravenous fluids.
- Contamination was intermittent, linked to breaches in sterile technique during fluid preparation.
Conclusions:
- The outbreak suggests intermittent contamination from breaches in sterile technique, not a single point source.
- Multifunctional operating room personnel preparing intravenous fluids pose unique challenges to infection control.
- Comprehensive training in antisepsis is crucial for operating room staff to prevent such outbreaks.