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Nursing Home Outbreak of Invasive Group A Streptococcal Infections Caused by 2 Distinct Strains

Published online by Cambridge University Press:  17 August 2016

Michael C. Thigpen ,
D. Michael Thomas ,
David Gloss ,
Sarah Y. Park ,
Amy J. Khan ,
Vicky L. Fogelman ,
Bernard Beali ,
Chris A. Van Beneden ,
Randall L. Todd  and
Carolyn M. Greene
Michael C. Thigpen*
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia
D. Michael Thomas
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
David Gloss
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Sarah Y. Park
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, Georgia
Amy J. Khan
Affiliation:
Career Epidemiology Field Officer, Division of Public Health Partnerships, National Center for Health Marketing, Atlanta, Georgia Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Vicky L. Fogelman
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Bernard Beali
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Chris A. Van Beneden
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
Randall L. Todd
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, and Nevada State Health Division, Carson City, Nevada
Carolyn M. Greene
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia
*
1600 Clifton Rd., Mailstop E-45, Atlanta, GA 30333 (mthigpen@cdc.gov)
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Abstract

Objective.

To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases.

Design.

Outbreak investigation.

Setting.

A 146-bed nursing home facility in northern Nevada.

Methods.

We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices.

Results.

Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts.

Conclusions.

Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 1 , January 2007 , pp. 68 - 74
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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