a1 Leeds Public Health Laboratory, Bridle Path, York Road, Leeds LS15 7TR
a2 Staphylococcus Reference Laboratory, Hospital and Respiratory Infection Division, PHLS Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT
a3 Ashford Public Health Laboratory, The William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent TN24 0LZ
This report describes a double outbreak of staphylococcal scalded skin syndrome (SSSS) in which two distinct tetracycline-resistant strains of Staphylococcus aureus producing different exfoliative toxins were involved. In the first phase the daytime staff of the delivery unit and eczematous skin conditions in midwives were implicated as the probable source. In the second phase a source within a post-natal ward was suggested with local cross-infection. In the final phase both sources were epidemiologically linked to cases of SSSS. Because early discharge was the policy of the unit many cases presented in the community rather than in the hospital.
Confirmation of epidemiological findings was provided by additional laboratory studies. Two distinct strains of S. aureus could be defined, differing in phage-typing patterns, the exfoliative toxin produced, plasmid profile, cadmium resistance and bacteriocin production. Strict care in hand washing with a chlorhexidine-containing detergent was an important control measure.
(Accepted September 04 1993)