A Prolonged Outbreak ofPseudomonas Aeruginosain a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?

Infection Control and Hospital Epidemiology - Tập 21 Số 2 - Trang 80-85 - 2000
Ronald L. Moolenaar1,2, James M. Crutcher1, Venusto H. San Joaquin3, Lucille V. Sewell3, Isdore Chola Shamputa2, Loretta A. Carson2, Denise Robison3, Lauri Smithee1, William R. Jarvis2
1Acute Disease Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma
2Centers for Disease Control and Prevention, Atlanta, Georgia
3Children's Hospital of Oklahoma, Oklahoma City, Oklahoma

Tóm tắt

AbstractObjectives:To describe an outbreak ofPseudomonas aeruginosabloodstream infection (BSD and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.Design:A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.Setting and Patients:Neonates in the NICU of a university-affiliated children's hospital.Interventions:Improved hand washing and restriction of use of long or artificial fingernails.Results:Of 439 neonates admitted during the study period, 46 (10.5%) acquiredP aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained,P aeruginosawas isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-l and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization withP aeruginosa, but other variables, including exposure to nurse A-2, were not.Conclusion:Epidemiological evidence demonstrated an association between acquiringP aeruginosaand exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands withP aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.

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Infection Control and Hospital Epidemiology

Tập 21 Số 2

80-85

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