title: An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus.
abstract: OBJECTIVE
  To investigate an outbreak of methicillin-susceptible Staphylococcus aureus (MSSA) infections in a neonatal clinic.
  
  
  METHODS
  Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.
  
  
  METHODS
  A German 1,350-bed tertiary-care teaching university hospital.
  
  
  RESULTS
  There was a significant increase in the incidence of pyodermas with MSSA; 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.
  
  
  CONCLUSIONS
  Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomial S. aureus infections of the skin. To our knowledge this source of S. aureus infections has not previously been described.
authors.affiliation: Institute of Hygiene, Free University of Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Weist
authors.forename: C
authors.initials: C
authors.lastname: Wendt
authors.forename: L R
authors.initials: LR
authors.lastname: Petersen
authors.forename: H
authors.initials: H
authors.lastname: Versmold
authors.forename: H
authors.initials: H
authors.lastname: Rüden
mesh_terms: D016022:Case-Control Studies; D003151:Community Health Centers; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D005782:Gels; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D010406:Penicillins / Q000494:pharmacology; D016133:Polymerase Chain Reaction; D011711:Pyoderma / Q000209:etiology* / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000209:etiology* / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification* / Q000472:pathogenicity; D014463:Ultrasonography / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D004269:DNA, Bacterial; D005782:Gels; D010406:Penicillins; D008712:Methicillin