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The Wound Care Team: A New Source of Group A Streptococcal Nosocomial Transmission

Published online by Cambridge University Press:  21 June 2016

Marilyn Felkner ,
Neil Pascoe ,
Kathleen Shupe-Ricksecker  and
Edward Goodman
Marilyn Felkner*
Affiliation:
Texas Department of Health, Austin, Texas
Neil Pascoe
Affiliation:
Texas Department of Health, Austin, Texas
Kathleen Shupe-Ricksecker
Affiliation:
Texas Department of Health, Austin, Texas
Edward Goodman
Affiliation:
Texas Department of Health, Austin, Texas
*
1100 W. 49th St., Austin, TX 78756.marilyn.felkner@tdh.state.tx.us
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Abstract

Background:

In August 2001, the Centers for Disease Control and Prevention (CDC) notified the Texas Department of Health (TDH) of an unusually high number of wounds infected with group A streptococci (GAS) in an acute care facility. The TDH initiated an investigation, ultimately identifying 28 cases of non-pharyngeal, non-community-acquired GAS that had occurred between December 2000 and August 2001 and resulted in 3 deaths and 4 nonfatal cases of invasive disease. Ten specimens were sent to the CDC for emm typing; all isolates were emm type 114. However, the source of the outbreak could not be confirmed through laboratory testing at that time.

Methods:

A case–control study was conducted comparing the 10 case-patients with 52 control-patients with wounds that were not infected with GAS. Age, gender, type of wound, underlying medical conditions, and treatment by the wound care team were examined for association with GAS infection.

Results:

The odds of having wound care team treatment versus not having it were 424.2 (95% confidence interval, 19.0 to 9,495.2) among case-patients when compared with control-patients. No other risk factor showed this magnitude of association.

Conclusions:

This study provided overwhelming epidemiologic evidence that the wound care team was the means of transmission. One year later, when two patients receiving wound care were concurrently diagnosed as having GAS, a member of the wound care team was found to be GAS positive for the matching emm type. This is the first report of a GAS hospital outbreak linked to a wound care team.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 462 - 465
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Anonymous. Nosocomial group A streptococcal infections associated with asymptomatic health-care workers: Maryland and California, 1997. MMWR 1999;48:163–166.Google Scholar
2.Berkelman, RL, Martin, D, Graham, DR, et al. Streptococcal wound infections caused by a vaginal carrier. JAMA 1982;247:2680–2682.Google Scholar
3.Kolmos, HJ, Svendsen, RN, Nielsen, SV. The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes. J Hosp Infect 1997;35:207–214.Google Scholar
4.Mastro, TD, Farley, TA, Elliott, JA, et al. An outbreak of surgical-wound infections due to group A Streptococcus carried on the scalp. N Engl J Med 1990;323:968–972.Google Scholar
5.Paul, SM, Genese, C, Spitalny, K. Postoperative group A beta-hemo-lytic Streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household. Infect Control Hosp Epidemiol 1990;11:643–646.Google Scholar
6.Schaffner, W, Lefkowitz, LB, Goodman, JS, Koenig, MG. Hospital outbreak of infections with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med 1969;280:1224–1225.Google Scholar
7.Viglionese, A, Nottebart, VF, Bodman, HA, Piatt, R. Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks. Am J Med 1991;91(suppl 3B):329S–333S.CrossRefGoogle Scholar
8.Burnett, IA, Norman, P. Streptococcus pyogenes: an outbreak on a burns unit. J Hosp Infect 1990;15:173–176.Google Scholar
9.Freeman, R. Streptococcal infection in a large general hospital. J Clin Pathol 1971;24:300–303.Google Scholar
10.Harkness, GA, Bentley, DW, Mottley, M, Lee, J. Streptococcus pyogenes outbreak in a long-term care facility. Am J Infect Control 1992;20:142–148.Google Scholar
11.Isenberg, HD, Tucci, V, Lipsitz, , Facklam, RR. Clinical laboratory and epidemiologic investigations of a Streptococcus pyogenes cluster epidemic in a newborn nursery. J Clin Microbiol 1984;19:366–370.Google Scholar
12.Lannigan, R, Hussain, Z, Austin, TW. Streptococcus pyogenes as a cause of nosocomial infection in a critical care unit. Diagn Microbiol Infect Dis 1985;3:337–341.Google Scholar
13.Ramage, L, Green, K, Pyskir, D, Simor, AE. An outbreak of fatal nosocomial infections due to group A streptococcus on a medical ward. Infect Control Hosp Epidemiol 1996;17:429–431.CrossRefGoogle ScholarPubMed
14.Schwartz, B, Elliott, JA, Butler, JC. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. Clin Infect Dis 1992;15:277–284.Google Scholar
15.Stamm, WE, Feeley, JC, Facklam, RR. Wound infections due to group A streptococcus traced to a vaginal carrier. J Infect Dis 1978;138:287–292.CrossRefGoogle ScholarPubMed
16.Facklam, R, Beall, B, Efstratiou, A, et al. emm Typing and validation of provisional M types for group A streptococci. Emerg Infect Dis 1999;5:247–253. Available at www.cdc.gov/ncidod/ElD.Google Scholar