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A Hospital-wide Outbreak of Serratia marcescens, and Ishikawa's "Fishbone" Analysis to Support Outbreak Control

Luzia Vetter1, Guido Schuepfer, Stefan P Kuster

  • 1Department of Hospital Infection Control, Lucerne Cantonal Hospital, Lucerne, Switzerland (Ms Vetter and Drs Schuepfer and Rossi); and Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland (Dr Kuster).

Quality Management in Health Care
|January 20, 2016
PubMed

Insights

A Serratia marcescens outbreak in a surgical intensive care unit was controlled by identifying contamination on a transesophageal echocardiography probe and improving surface disinfection. Quality management tools aided this investigation.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Quality Management in Healthcare

Background:

  • Nosocomial outbreaks pose significant risks in healthcare settings, particularly in intensive care units.
  • Serratia marcescens is an opportunistic pathogen frequently associated with healthcare-associated infections.
  • Cardiac surgical patients are a vulnerable population susceptible to nosocomial infections.

Purpose of the Study:

  • To investigate and control a Serratia marcescens outbreak in a surgical intensive care unit.
  • To identify the sources and contributing factors of the nosocomial outbreak.
  • To evaluate the effectiveness of standardized outbreak investigation combined with quality management tools.

Main Methods:

  • Standardized outbreak investigation steps (US Centers for Disease Control and Prevention).
  • Systemic quality management approach utilizing Ishikawa "fishbone" analysis.
  • Microbiological assessment of respiratory samples and equipment, including transesophageal echocardiography probes.
  • Reengineering of surface disinfection protocols and disinfectant logistics.

Main Results:

  • Serratia marcescens was identified as the causative agent in respiratory samples from surgical intensive care unit patients.
  • Contamination was detected on a transesophageal echocardiography probe used during cardiac surgery.
  • Insufficient surface disinfection, due to multiple factors, was identified as a key contributing issue.
  • Reengineering disinfectant procurement and logistics led to effective outbreak control.

Conclusions:

  • Standardized outbreak investigation is crucial for identifying healthcare-associated infections.
  • Quality management tools, such as fishbone analysis, enhance the effectiveness of outbreak investigations.
  • Addressing equipment contamination and optimizing disinfection processes are vital for controlling Serratia marcescens outbreaks.
  • Comprehensive reengineering of disinfectant supply chain management was critical for successful outbreak containment.

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