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An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-Susceptible Staphylococcus Aureus

Published online by Cambridge University Press:  02 January 2015

Klaus Weist ,
Constanze Wendt ,
Lyle R. Petersen ,
Hans Versmold  and
Henning Rüden
Klaus Weist*
Affiliation:
Institute of Hygiene, Free University of Berlin, Germany
Constanze Wendt
Affiliation:
Institute of Hygiene, Free University of Berlin, Germany
Lyle R. Petersen
Affiliation:
Robert Koch Institute, German Ministry of Health, Berlin, Germany
Hans Versmold
Affiliation:
Department of Pediatrics, University Hospital Benjamin Franklin, Free Universität Berlin, Germany
Henning Rüden
Affiliation:
Institute of Hygiene, Free University of Berlin, Germany
*
Institut für Hygiene, Freie Universität Berlin, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 27, 12203 Berlin, Germany
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Abstract

Objective:

To investigate an outbreak of methicillin-susceptible Staphylococcus aureus (MSSA); infections in a neonatal clinic.

Design:

Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.

Setting:

A German 1,350-bed tertiary-care teaching university hospital.

Results:

There was a significant increase in the incidence of pyodermas with MSSA 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip-joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.

Conclusions:

Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomial S aureus infections of the skin. To our knowledge this source of S aureus infections has not previously been described.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 12 , December 2000 , pp. 761 - 764
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Maguire, GC, Nordin, J, Myers, MG, Koontz, FP, Hierholzer, W, Nassif, E. Infections acquired by young infants. Am J Dis Child 1981;135:693–698.Google ScholarPubMed
2.Scheckler, WE, Peterson, PJ. Nosocomial infections in 15 rural Wisconsin hospitals—results and conclusions from 6 months of comprehensive surveillance. Infed Control 1986;7:397–402.Google Scholar
3.Weliver, RC, McLaughlin, S. Unique epidemiology of nosocomial infection in a children's hospital. Am J Dis Child 1984;138:131–135.Google Scholar
4.Harbarth, S, Pittet, D. Identification and management of infectious outbreaks in the critical care unit. Curr Opin Crit Care 1996;2:352–360.CrossRefGoogle Scholar
5.Wu, SX, Tang, J. Epidemiologic study of neonatal subcutaneous gangrene caused by multi-resistant Staphylococcus aureus. Acta Paediatr Scand 1989;78:222–227.Google Scholar
6.Archibald, LK, Corl, AShah, B, Schulte, M, Arduino, MJ, Aguero, S, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chloroxylenol soap. Infect Control Hosp Epidemiol 1997;18:704–709.Google Scholar
7.Camargo, LF, Strabelli, TM, Ribeiro, FG, Iwahashi, ER, Ebaid, M, Filho, HH. Epidemiological investigation of an outbreak of coagulase-negative Staphylococcus primary bacteremia in a newborn intensive care unit. Infect Control Hosp Epidemiol 1995;16:595–596.CrossRefGoogle Scholar
8.Haddad, Q, Sobayo, EI, Basit, OBARotimi, VO. Outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. J Hosp Infect 1993;23:211–221.Google Scholar
9.Kacica, MA, Horgan, MJ, Preston, KE, Lepow, M, Venezia, RARelatedness of coagulase-negative staphylococci causing bacteremia in low-birthweight infants. Infect Control Hosp Epidemiol 1994;15:658–662.Google Scholar
10.Wiswell, TE, Curtis, J, Dobek, AS, Zierdt, CH. Staphylococcus aureus colonization after neonatal circumcision in relation to device used. J Pediatr 1991;119:302–304.Google Scholar
11.Gooch, JJ, Britt, EM. Staphylococcus aureus colonization and infections in newborn nursery patients. Am J Dis Child 1978;132:893–896.Google Scholar
12.Kampf, G, Weist, K, Swidzinski, S, Kegel, M, Rüden, H. Comparison of screening methods to identify methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1997;16:301–307.CrossRefGoogle ScholarPubMed
13.Witte, W, Cuny, C, Zimmermann, O, Rüchel, R, Höpken, M, Fischer, R, Wagner, S. Stability of genomic DNA fragment patterns in methicillin resistant Staphylococcus aureus (MRSA) during the course of intra- and inter-hospital spread. Eur J Epidemiol 1994;10:1–6.Google Scholar
14.Struelens, M, members of the European Study Group on Epidemiological Markers (ESGM) of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). Consensus guidelines for appropriate use and evaluation of microbial epidemiologic typing systems. Clin Microbiol Infect 1996;2:2–11.Google Scholar
15.Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PAMurray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction pattern produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
16.van Belkum, AKluytmans, J, van Leeuwen, W, Bax, R, Quint, W, Peters, E, et al. Multicenter evaluation of arbitrarily primed PCR for typing of Staphylococcus aureus strains. J Clin Microbiol 1995;33:1537–1547.CrossRefGoogle ScholarPubMed
17.Jernigan, JATitus, MG, Gröschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.Google Scholar
18.Becks, VE, Lorenzoni, NM. Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: a possible link to contaminated hand lotion. Am J Infect Control 1995;23:396–398.Google Scholar
19.Long, SS, Swenson, RM. Development of anaerobic fecal flora in healthy newborn infants. J Pediatr 1977;91:298–301.Google Scholar
20.Mackenzie, AJohnson, W, Heyes, B, Norrish, B, Jamieson, FA prolonged outbreak of exfoliative toxin A-producing Staphylococcus aureus in a newborn nursery. Diagn Microbiol Infed 1995;21:69–75.CrossRefGoogle Scholar
21.Mumford, F, Hindes, R, Given, LNosocomial Xanthomonas meningitis/ventriculitis. Am J Infect Control 1993;21:85. Abstract.Google Scholar
22.Gaillot, O, Maruejouls, C, Abachin, E, Lecuru, F, Arlet, G, Simonet, M, et al. Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum β-lactamases, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol 1998;36:1357–1360.CrossRefGoogle ScholarPubMed
23.Muradali, D, Gold, WLPhillips, AWilson, S. Can ultrasound probes and coupling gel be a source of nosocomial infection in patients undergoing sonography? An in vivo and in vitro study. Am J Roentgenol 1995;164:1521–1524.Google Scholar