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A Prolonged Outbreak of Pseudomonas Aeruginosa in a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?

Published online by Cambridge University Press:  02 January 2015

Ronald L. Moolenaar ,
J. Michael Crutcher ,
Venusto H. San Joaquin ,
Lucille V. Sewell ,
Lori C. Hutwagner ,
Loretta A. Carson ,
Denise A. Robison ,
Lauri M.K. Smithee  and
William R. Jarvis
Ronald L. Moolenaar*
Affiliation:
Acute Disease Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma Centers for Disease Control and Prevention, Atlanta, Georgia
J. Michael Crutcher
Affiliation:
Acute Disease Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma
Venusto H. San Joaquin
Affiliation:
Children's Hospital of Oklahoma, Oklahoma City, Oklahoma
Lucille V. Sewell
Affiliation:
Children's Hospital of Oklahoma, Oklahoma City, Oklahoma
Lori C. Hutwagner
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Loretta A. Carson
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Denise A. Robison
Affiliation:
Children's Hospital of Oklahoma, Oklahoma City, Oklahoma
Lauri M.K. Smithee
Affiliation:
Acute Disease Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma
William R. Jarvis
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop D-18, Atlanta, GA 30333
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Abstract

Objectives:

To describe an outbreak of Pseudomonas aeruginosa bloodstream 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%) acquired P 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 aeruginosa was 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 with P aeruginosa, but other variables, including exposure to nurse A-2, were not.

Conclusion:

Epidemiological evidence demonstrated an association between acquiring P aeruginosa and 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 with P aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 2 , February 2000 , pp. 80 - 85
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Pittet, D, Harbarth, SJ. The intensive care unit. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 4th ed. Philadelphia, PA: Lippincott-Raven Publishers; 1998:381–402.Google Scholar
2.Pollack, M. Pseudomonas aeruginosa. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:1980–2003.Google Scholar
3.Hospital Infections Program, Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1997, issued May 1997. A report from the NNIS System. Am J Infect Control 1997;25:477–487.Google Scholar
4.Climo, MW, Pastor, A, Wong, ES. An outbreak of Pseudomonas aeruginosa related to contaminated urodynamic equipment. Infect Control Hosp Epidemiol 1997;18:509–510.Google Scholar
5.Farmer, JJ III, Weinstein, RA, Zierdt, CH, Brokopp, CD. Hospital outbreaks caused by Pseudomonas aeruginosa: importance of serogroup OU. J Clin Microbiol 1982;16:266–270.CrossRefGoogle Scholar
6.Rudnick, JR, Beck-Sague, CM, Anderson, RL, Schable, B, Miller, JM, Jarvis, WR. Gram-negative bacteremia in open-heart-surgery patients traced to probable tap-water contamination of pressure-monitoring equipment. Infect Control Hosp Epidemiol 1996;17:281–285.Google ScholarPubMed
7.Chang, HJ, Miller, HL, Watkins, N, Arduino, MJ, Ashford, DA, Midgely, G, et al. An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers' pet dogs. N Engl J Med 1998;338:706–711.CrossRefGoogle Scholar
8.Passaro, DJ, Waring, L, Armstrong, R, Bolding, F, Bouvier, B, Rosenberg, J, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992–995.CrossRefGoogle Scholar
9.Doring, G, Horz, M, Ortelt, J, Grupp, H, Wolz, C. Molecular epidemiology of Pseudomonas aeruginosa in an intensive care unit. Epidemiol Infect 1993;110:427–436.Google Scholar
10.Widmer, AF, Wenzel, RP, Trilla, A, Bale, MJ, Jones, RN, Doebbeling, BN. Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a health care worker. Clin Infect Dis 1993;16:372–376.Google Scholar
11.Pottinger, J, Burns, S, Manske, C. Bacterial carriage by artificial versus natural nails. Am J Infect Control 1989;17:340–344.CrossRefGoogle ScholarPubMed
12.Tenover, FC, Arbeit, RD, Goering, RV, Mickelson, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
13.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:426–439.Google Scholar
14.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
15.Parker, AV, Cohen, EJ, Arentsen, JJ. Pseudomonas corneal ulcers after artificial fingernail injuries. Am J Ophthalmol 1989;107:548–549.Google Scholar
16.File, TM Jr, Tan, JS, Thomson, RB Jr, Stephens, C, Thompson, P. An outbreak of Pseudomonas aeruginosa ventilator-associated respiratory infections due to contaminated food coloring dye—further evidence of the significance of gastric colonization preceding nosocomial pneumonia. Infect Control Hosp Epidemiol 1995;16:417–418.Google Scholar
17. Getting Nailed (transcript). “Dateline NBC.” NBC television. December 1, 1997.Google Scholar
18.AORN Recommended Practices Coordinating Committee. Recommended practices: surgical hand scrubs. AORN J 1990;52:830–836.CrossRefGoogle Scholar