title: Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap.
abstract: OBJECTIVE
  To determine the role of nonmedicated soap as a source of Serratia marcescens nosocomial infections (NIs) in hospital units with endemic S marcescens NI and to examine the mechanisms of soap colonization.
  
  
  METHODS
  University-affiliated tertiary-care hospitals.
  
  
  METHODS
  A prospective case-control study and an environmental investigation were performed to assess the relationship between S marcescens NIs in hospital units and S marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers' (HCWs) hands were obtained before and after hand washing with soap.
  
  
  RESULTS
  5 of 7 hospital units with S marcescens NIs had soap bottles contaminated with S marcescens, compared to 1 of 14 other units (P=.006). After hand washing with an S marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated with S marcescens (P<.001).
  
  
  CONCLUSIONS
  Extrinsic contamination of a non-medicated liquid soap by S marcescens resulted in handborne transmission of S marcescens NIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.
authors.affiliation: Comité de Lutte contre les Infections Nosocomiales, Hôpital de la Conception, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Sartor
authors.forename: V
authors.initials: V
authors.lastname: Jacomo
authors.forename: C
authors.initials: C
authors.lastname: Duvivier
authors.forename: H
authors.initials: H
authors.lastname: Tissot-Dupont
authors.forename: R
authors.initials: R
authors.lastname: Sambuc
authors.forename: M
authors.initials: M
authors.lastname: Drancourt
mesh_terms: D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005602:France; D006235:Hand Disinfection; D006801:Humans; D009096:Multi-Institutional Systems; D011446:Prospective Studies; D016868:Serratia Infections / Q000453:epidemiology* / Q000382:microbiology; D012706:Serratia marcescens / Q000302:isolation & purification*; D012915:Soaps
chemical_list: D012915:Soaps