Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence.
BACKGROUND
Fourteen patients in the pediatric cardiac intensive care unit (CICU) had > or =1 positive culture for a single strain of Serratia marcescens from April through December 1995 (study period).


OBJECTIVE
To identify risk factors for S marcescens infection or colonization in a pediatric CICU.


METHODS
Retrospective case-control study. Assessment of CICU infection control practices and patient exposure to CICU health care workers (HCWs). Epidemiologic-directed cultures of the environment and HCWs' hands were obtained.


METHODS
Pediatric CICU.


METHODS
Fourteen patients in the pediatric CICU had > or =1 positive culture for a single strain of S marcescens from April through December 1995 (study period). CICU patients who did not have S marcescens infection or colonization during the study period were randomly selected as controls.


RESULTS
A case patient was more likely than a noncase patient to have exposure to a single HCW (odds ratio [OR], 19.5; 95% CI, 2.6-416; P<.003); however, this association was not adequately explained by epidemiologic or microbiologic studies. Interviews suggested that during the outbreak period, handwashing frequency among HCWs might have been reduced because of severe hand dermatitis.


CONCLUSIONS
A combination of factors, including breaks in aseptic technique, reduced frequency of handwashing among HCWs before and between caring for patients, decreased attention to infection control practices, and environmental contamination may have indirectly contributed to this S marcescens infections outbreak.
Manning
M L
ML
Infection Control Department, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Archibald
L K
LK
Bell
L M
LM
Banerjee
S N
SN
Jarvis
W R
WR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006235:Hand Disinfection / Q000379:methods / Q000592:standards; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000592:standards; D015278:Intensive Care Units, Pediatric; D008297:Male; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology; D016017:Odds Ratio; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D016868:Serratia Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D012706:Serratia marcescens; D011795:Surveys and Questionnaires