title: Postoperative Serratia marcescens wound infections traced to an out-of-hospital source.
abstract: From 25 August to 28 September 1994, 7 cardiovascular surgery (CVS) patients at a California hospital acquired postoperative Serratia marcescens infections, and 1 died. To identify the outbreak source, a cohort study was done of all 55 adults who underwent CVS at the hospital during the outbreak. Specimens from the hospital environment and from hands of selected staff were cultured. S. marcescens isolates were compared using restriction-endonuclease analysis and pulsed-field gel electrophoresis. Several risk factors for S. marcescens infection were identified, but hospital and hand cultures were negative. In October, a patient exposed to scrub nurse A (who wore artificial fingernails) and to another nurse-but not to other identified risk factors-became infected with the outbreak strain. Subsequent cultures from nurse A's home identified the strain in a jar of exfoliant cream. Removal of the cream ended the outbreak. S. marcescens does not normally colonize human skin, but artificial nails may have facilitated transmission via nurse A's hands.
authors.affiliation: California Department of Health Services, and School of Public Health, University of California, Berkeley 94704, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Passaro
authors.forename: L
authors.initials: L
authors.lastname: Waring
authors.forename: R
authors.initials: R
authors.lastname: Armstrong
authors.forename: F
authors.initials: F
authors.lastname: Bolding
authors.forename: B
authors.initials: B
authors.lastname: Bouvier
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: A W
authors.initials: AW
authors.lastname: Reingold
authors.forename: M
authors.initials: M
authors.lastname: McQuitty
authors.forename: S M
authors.initials: SM
authors.lastname: Philpott
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: S B
authors.initials: SB
authors.lastname: Werner
authors.forename: L S
authors.initials: LS
authors.lastname: Tompkins
authors.forename: D J
authors.initials: DJ
authors.lastname: Vugia
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009726:Nurses; D016868:Serratia Infections / Q000209:etiology*; D012706:Serratia marcescens / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000209:etiology*