a1 Département d'Hygiène Hospitalière, Centre Hospitaller Régional Universitaire de Montpellier, Montpellier, France
a2 Unité Mixte de Recherche 5119 (Université Montpellier 2, Centre National de la Recherche Scientifique [CNRS], Institut de Recherche pour le Développement [IRD], Institut Français de Recherche pour l'Exploitation de la Mer [IFREMER], Université Montpellier 1), équipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
a3 Département d'Anesthésie et Réanimation A, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
a4 Service de Médecine du Travail, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
a5 Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
Objective. The emergence of Staphylococcus aureus with reduced susceptibility to glycopeptides (glycopeptide-intermediate S. aureus [GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.
Design. The study is a description of an original environmental investigation around a series of 12 cases.
Setting and Patients. The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.
Interventions. Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.
Results. Twelve patients with h-GISA infection (n = 5) or colonization (n = 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10–89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO2 sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.
Conclusions. Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.
Infect Control Hosp Epidemiol 2012;33(2):167-174
(Received May 16 2011)
(Accepted October 11 2011)