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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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