A five year outbreak of methicillin-susceptible Staphylococcus aureus phage type 53,85 in a regional neonatal unit

Abstract

Article ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. SUMMARYWe identified a 5-year outbreak of a methicillin-susceptible Staphylococcus aureus (MSSA) strain, affecting 202 babies on a neonatal unit, by routine weekly phage typing all S. aureus isolates. Multiple staged control measures including strict emphasis on hand hygiene, environmental and staff surveillance sampling, and application of topical hexachlorophane powder failed to end the outbreak. S. aureus PT 53,85 (SA5385) was found on opened packs of Stomahesive2, used as a neonatal skin protectant. Only following the implementation of aseptic handling of Stomahesive, and the use of topical mupirocin for staff nasal carriers of SA5385, and for babies colonized or infected with S. aureus, did the isolation rate of SA5385 decline. DNA fingerprinting indicated that 95 % of SA5385 isolates were clonal. In itro death rates of SA5385 on Stomahesive with human serum were significantly lower than on Stomahesive alone (P l 0n04), and on cotton sheet with serum (P l 0n04), highlighting the potential of this material as a survival niche. Phage typing remains a valuable, inexpensive and simple method for monitoring nosocomial MSSA infection.

Staphylococcus aureus epidemic in a neonatal nursery: a strategy of infection control

“…It is interesting to note that, unlike other epidemics reported in the literature [1,5,8,12,13], the measures adopted were very effective in controlling the outbreak, which decreased and gradually died out. Wilcox [13] reported a neonatal epidemic that lasted 5 years; however, no systematic cohorting was carried out. It is difficult to ascertain which measure was the most effective since different steps were taken almost simultaneously.…”

“…The old Nursery was then abandoned, and a new one was created after the epidemic. Obviously, the other measures adopted, including conscientious accurate hand washing [4], skin cleaning with an alcohol-based product [4] or diluted solution of hexachlorophene [13], the use of disposable gloves [6], and the eradication of S. aureus in colonized personnel with topical application of mupirocin to the nose two to three times a day for 5 days [2,9], were of great importance. The fact that no neonate was seriously affected by the S. aureus infection is, in our opinion, due to the effective follow up control on all of the discharged neonates who were seen at least once after being discharged from the hospital.…”

“…Chromosomal DNA analysis by pulsed-field gel electrophoresis (PFGE) Preparation of chromosomal DNA Chromosomal DNA was prepared following the method reported by Trzcinski et al [12] and Wilcox et al [13] with some modifications. From each isolate one colony of S. aureus was suspended in 10 ml of Trypticase soy broth and incubated overnight at 37°C with shaking.…”

“…In the hospital setting it can be the cause of various infections, ranging from relatively mild infections of the skin and soft tissues to life-threatening sepsis, pneumonia, and toxic shock syndrome [13]. Outbreaks are facilitated by the propensity of the micro-organism to develop resistance to multiple antibiotics, thereby making containment of the epidemic strain particularly difficult [7,12].…”

Medical Adhesives and Patient Safety

“…For example, pectin-based adhesive skin barrier sheets were implicated in a 5-year outbreak of S aureus in a neonatal unit in the United Kingdom. 71 In addition, outbreaks of cutaneous Rhizopus infection have been reported with the use of adhesive products such as polyethylene tape, 72 ostomy pouches, 73 and elasticized adhesive dressings used over surgical wounds. 67,68 Cases of cutaneous mucormycosis associated with the use of temperature probes and monitoring electrodes in neonates have also been reported.…”