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High prevalence of S. aureus carriage in HCWs contributed to outbreak
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A recent outbreak of Staphylococcus aureus surgical site infections after cardiovascular surgery at a Toronto hospital was associated with a high prevalence of S. aureus carriage among health care workers.
The outbreak occurred from January 2009 to March 2010, when 38 patients developed an S. aureus surgical site infection. Pulsed-field gel electrophoresis showed that the outbreak involved three different strains of S. aureus, two of which were methicillin-sensitive and one that was methicillin-resistant. The researchers conducted a retrospective case-control study to identify risk factors contributing to the outbreak.
Twelve of the 38 cases were attributed to MRSA, of which nine were associated with the MRSA outbreak clone. There were 14 cases of MSSA that were attributed to the two MSSA outbreak clones. Twelve of the cases did not have an outbreak clone and three did not undergo typing. Among the 256 health care workers who were tested, 74 were colonized with S. aureus, of whom 21 were carrying one of the outbreak strains.
The researchers observed that there was suboptimal compliance with infection control policies, such as hand hygiene and routine practices. There were also noncompliance issues with the processes in the operating room, such as a lack of preoperative chlorhexidine showers, hair clipping inside the operating room, improper timing of preoperative antimicrobial prophylaxis and unnecessary traffic flow in the operating room.
Previous cardiac surgery and longer procedure duration were associated with S. aureus surgical site infections.
“Suboptimal compliance with standard infection control practices was likely a contributing factor in the transmission of the outbreak strains,” the researchers wrote. “Furthermore, the feasibility of implementing preoperative screening for S. aureus and decolonizing positive patients is being explored with the cardiac surgery team.”
Disclosure: The researchers report no relevant financial disclosures.
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