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A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious Pathogens
Published on: June 7, 2017
Serratia marcescens outbreak in a neonatal intensive care unit associated with contaminated handwashing sinks
Qiaozhi Guo1, Xiaopeng Zhao2, Jingxiang Ma1
1Hospital Infection Control Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
Purpose:
This article describes the origin of a S. marcescens outbreak in a neonatal intensive care unit (NICU).
Materials And Methods:
A retrospective case-control study including 12 S. marcescens-positive and 22 S. marcescens-negative neonates in the NICU was performed to identify the source of the outbreak. S. marcescens isolates were collected during the outbreak and analyzed using whole-genome sequencing (WGS). IQ-Tree software, BEAST2 software package and SCOTTI software were used to construct a phylogenetic tree and a propagation path map.
Results:
The index case occurred on February 21st and outbreak ended on March 9th, 2021, affecting a total of 12 neonates (2 with S. marcescens infection and 10 with S. marcescens colonization). Multivariate logistic regression identified that the distance of <0.8 m between the bed unit and the sink (odds ratio [OR], 20.50; 95 % confidence interval [CI], 1.09-384.86), a large number of rotating nurses within a week (OR 2.58, 95 % CI, 1.09-6.11) and use of humidification water in the incubator (OR 189.70, 95 % CI, 2.76-13027.31) were significant increased risk factors for S. marcescens infection or colonization in the outbreak. WGS sifted out a predominant clone between contaminated handwashing sinks and patients, suggesting that cross-transmission was involved in the dissemination of S. marcescens.
Conclusion:
Contaminated handwashing sinks can be a communication intermediary of S. marcescens infection or colonization of neonates in the NICU. A distance of <0.8 m between the bed unit and the sink, and a large number of rotating nurses might play important roles in this outbreak. Attention should be paid to sinks contamination and contact transmission to prevent outbreaks.
Insights
Contaminated sinks spread Serratia marcescens in NICUs. Close bed-to-sink distance and rotating nurses increase risk. Proper sink hygiene is crucial for preventing neonatal infections.
Area of Science:
- Healthcare epidemiology
- Infectious disease control
- Neonatal care
Background:
- Neonatal intensive care units (NICUs) are vulnerable to hospital-acquired infections.
- Serratia marcescens (S. marcescens) outbreaks pose significant risks to vulnerable neonates.
- Identifying outbreak origins is critical for effective infection control.
Purpose of the Study:
- To investigate the origin and transmission dynamics of a S. marcescens outbreak in a NICU.
- To identify risk factors associated with S. marcescens infection or colonization in neonates during the outbreak.
Main Methods:
- Retrospective case-control study of S. marcescens-positive and -negative neonates.
- Whole-genome sequencing (WGS) of S. marcescens isolates.
- Phylogenetic analysis and propagation path mapping using specialized software.
Main Results:
- The outbreak affected 12 neonates between February and March 2021.
- Key risk factors included proximity of beds to sinks (<0.8m), high nurse rotation, and incubator humidification water.
- WGS identified a predominant clone linking contaminated sinks to patients, indicating cross-transmission.
Conclusions:
- Contaminated handwashing sinks serve as a transmission vector for S. marcescens in NICUs.
- Sink proximity and staff mobility are significant factors in S. marcescens outbreaks.
- Enhanced attention to sink disinfection and contact precautions is vital for prevention.
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