THE CIRCUMCISION REFERENCE LIBRARY
Hoffman KK.* Weber DJ, Bost R, Rutala WA.
Univ. of North Carolina School of Medicine and UNC Hosps.
Chapel Hill. NC.
In Aug 1998, a 150-bed naval hospital in eastern North Carolina identified an outbreak in the newborn nursery. Cases were newborn males who had undergone a circumcision procedure and post-discharge required antimicrobial treatment for severe pustulous diaper rash. A total of 36 cases were identified from Aug to Jan 1999. All 17 cases that were cultured grew methicillin-sensitive, erythromycin-resistant Staphylococcus aureus. Extensive environmental culturing of the nursery unit and circumcision procedure equipment did not reveal an inanimate reservoir for the S. aureus. Initial infection control measures (Aug) to review aseptic technique and instrument sterilization procedures were ineffective. In Jan additional control measures included enforcement of glove wearing for all diaper changes and limited post-circumcision care to one healthcare worker (HCW) per newborn. In Feb all HCWs (MDs, RNs, LPN and corpmen) were cultured by anterior nasal swabs and hand swab cultures. Fourteen (14) HCWs had positive cultures identified with S. aureus. Pulse field gel electrophoresis (PFGE) were performed on 13 of the 17 case isolates. All 13 case isolates were identical. All 14 HCWs identified with S. aureus were compared to the >13 cases by PFGE, and 3 HCWs (2 RN, 1 LPN) matched identically. One of these HCWs had a chronic cough, and a second had concealed dermatititis. This suggests that these DCWs were disseminators in light of the prolonged nature of the outbreak. Antimicrobial decolonization was instituted for the HCWs and there was one additional case in Mar. In conclusion, HCWs identified by DNA testing may have represented the reservoir of infection in this outbreak.
[CIRP Note: This paper represented by this abstract was presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, Atlanta, March 5-9, 2000.]
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