Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-15T03:40:50.374Z Has data issue: false hasContentIssue false
  • English
  • Français

Serratia Marcescens Outbreak Associated With Extrinsic Contamination of 1% Chlorxylenol Soap

Published online by Cambridge University Press:  02 January 2015

Lennox K. Archibald ,
Ann Corl ,
Bhavesh Shah ,
Myrna Schulte ,
Matthew J. Arduino ,
Sonia Aguero ,
Donna J. Fisher ,
Barbara W. Stechenberg ,
Shailen N. Banerjee  and
William R. Jarvis
Lennox K. Archibald*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (CDC)
Ann Corl
Affiliation:
Atlanta, Georgia, and Baystate Medical Center, Springfield, Massachusetts
Bhavesh Shah
Affiliation:
Atlanta, Georgia, and Baystate Medical Center, Springfield, Massachusetts
Myrna Schulte
Affiliation:
Atlanta, Georgia, and Baystate Medical Center, Springfield, Massachusetts
Matthew J. Arduino
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (CDC)
Sonia Aguero
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (CDC)
Donna J. Fisher
Affiliation:
Atlanta, Georgia, and Baystate Medical Center, Springfield, Massachusetts
Barbara W. Stechenberg
Affiliation:
Atlanta, Georgia, and Baystate Medical Center, Springfield, Massachusetts
Shailen N. Banerjee
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (CDC)
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention (CDC)
*
Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E-55, 1600 Clifton Rd, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To determine risk factors for Serratia marcescens infection or colonization, and to identify the source of the pathogen and factors facilitating its persistence in a neonatal intensive-care unit (NICU) during an outbreak.

Design:

Retrospective case-control study; review of NICU infection control policies, soap use, and hand-washing practices among healthcare workers (HCWs); and selected environmental cultures.

Setting:

A university-affiliated tertiary-care hospital NICU.

Patients:

All NICU infants with at least one positive culture for S marcescens during August 1994 to October 1995. Infants who did not develop S marcescens infection or colonization were selected randomly as controls.

Results:

Thirty-two patients met the case definition. On multivariate analysis, independent risk factors for S marcescens infection or colonization were having very low birth weight (<1,500 g), a patent ductus arteriosus, a mother with chorioamnionitis, or exposure to a single HCW. During January to July 1995, NICU HCWs carried their own bottles of 1% chlorxylenol soap, which often were left standing inverted in the NICU sink and work areas. Cultures of 16 (31%) of 52 samples of soap and 1 (8%) of 13 sinks yielded S marcescens. The 16 samples of soap all came from opened 4-oz bottles carried by HCWs. DNA banding patterns of case infant, HCW soap bottle, and sink isolates were identical.

Conclusions:

Extrinsically contaminated soap contributed to an outbreak of S marcescens infection. Very-low-birth-weight infants with multiple invasive procedures and exposures to certain HCWs were at greatest risk of S marcescens infection or colonization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 10 , October 1997 , pp. 704 - 709
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gorbach, SL, Bartlett, JG, Blacklow, NR. Infectious Diseases. Philadelphia, PA: WB Saunders Co; 1992.Google Scholar
2. Yu, VL. Serratia marcescens: historical perspective and clinical review. N Engl J Med 1979;300:887–893.CrossRefGoogle ScholarPubMed
3. Villarino, ME, Jarvis, WR, O'Hara, C, Bresnahan, J, Clark, N. Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit. J Clin Microbiol 1989;27:2433–2436.CrossRefGoogle Scholar
4. Nakashima, AK, McCarthy, MA, Martone, WJ, Anderson, RL. Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic. J Clin Microbiol 1987;25:1014–1018.CrossRefGoogle ScholarPubMed
5. Sautter, RL, Mattman, LH, Legaspi, RC. Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution. Infect Control 1984;5:223–225.CrossRefGoogle ScholarPubMed
6. Ehrenkranz, NJ, Bolyard, EA, Wiener, M, Cleary, TJ. Antibiotic-sensitive Serratia marcescens infections complicating car-diopulmonary operations: contaminated disinfectant as a reservoir. Lancet 1980;2:1289–1292.Google Scholar
7. McNaughton, M, Mazinke, N, Thomas, E. Newborn conjunctivitis associated with triclosan 0.5% antiseptic intrinsically contaminated with Serratia marcescens . Canadian Journal of Infection Control 1995;10:7–8.Google ScholarPubMed
8. Barry, MA, Craven, DE, Goularte, TA, Lichtenberg, DA. Serratia marcescens contamination of antiseptic soap containing tri-closan: implications for nosocomial infection. Infect Control 1984;5:427–430.Google Scholar
9. Morse, LJ, Schonbeck, LF. Hand lotions-a potential nosocomial hazard. N Engl J Med 1968;278:376–378.CrossRefGoogle ScholarPubMed
10. Sanford, JP. Disinfectants that don't. Ann Intern Med 1970;72:282–283.Google Scholar
11. Dixon, RE, Kaslow, RA, Mackel, DC, Fulkerson, CC, Mallison, GF. Aqueous quaternary ammonium antiseptic and disinfectants: use and misuse. JAMA 1976;236:2415–2417.Google Scholar
12. Richardson, DK, Gray, JE, McCormick, MC, Workman, K, Goldmann, DA. Score for neonatal acute physiology: a physiologic severity index for neonatal intensive care. Pediatrics 1993;91:617–623.Google Scholar
13. Maslow, JN, Slutsky, AM, Arbeit, RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology, Principles and Applications. Washington, DC: American Society for Microbiology; 1993.Google Scholar
14. Petersen, NJ, Collins, DE, Marshall, JH. A microbiological assay technique for hands. Health Laboratory Science 1973;10:18–22.Google ScholarPubMed
15. Byers, KE, Durbin, LJ, Simonton, BM, Anglim, AM, Adal, KA, Farr, BM. Environmental contamination with vancomycin-resistant Enterococcus faecium (VRE). In: Program of the Fifth Annual Meeting of the Society of Hospital Epidemiology of America, San Diego, CA; 04 1995; P18. Abstract 17.Google Scholar
16. Centers for Disease Control and Prevention. Guideline for Handwashing and Hospital Environmental Control, 1985. Atlanta, GA: US Department of Health and Human Services, 1985.Google Scholar