title: An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment.
abstract: OBJECTIVE
  To report a multi-institution outbreak caused by a single strain of methicillin-resistant Staphylococcus aureus (MRSA).
  Between September 19 and November 20, 1996 an index case and five secondary cases of nosocomial MRSA occurred on a 26 bed adult plastic surgery/burn unit (PSBU) at a tertiary care teaching hospital. Between November 11 and December 23, 1996, six additional cases were identified at a community hospital. One of the community hospital cases was transferred from the PSBU. All strains were identical by pulsed-field gel electrophoresis. MRSA may have contributed to skin graft breakdown in one case, and delayed wound healing in others. Patients required 2 to 226 isolation days.
  
  
  METHODS
  A hand held shower and stretcher for showering in the hydrotherapy room of the PSBU were culture positive for the outbreak strain, and the presumed means of transmission. Replacement of stretcher showering with bedside sterile burn wound compresses terminated the outbreak. The PSBU was closed to new admissions and transfers out for 11 days during the investigation. Seven of 12 patients had effective decolonization therapy.
  
  
  CONCLUSIONS
  Environmental contamination is a potential source of nosocomial MRSA transmission on a burn unit. Notification among institutions and community care providers of shared patients infected or colonized with an antimicrobial resistant microorganism is necessary.
authors.affiliation: Infection Control Unit, Health Sciences Centre, MS673, 820 Sherbrook Street, Manitoba, R3A 1R9, Winnipeg, Canada
authors.forename: J M
authors.initials: JM
authors.lastname: Embil
authors.forename: J A
authors.initials: JA
authors.lastname: McLeod
authors.forename: A M
authors.initials: AM
authors.lastname: Al-Barrak
authors.forename: G M
authors.initials: GM
authors.lastname: Thompson
authors.forename: F Y
authors.initials: FY
authors.lastname: Aoki
authors.forename: E J
authors.initials: EJ
authors.lastname: Witwicki
authors.forename: M F
authors.initials: MF
authors.lastname: Stranc
authors.forename: A M
authors.initials: AM
authors.lastname: Kabani
authors.forename: D R
authors.initials: DR
authors.lastname: Nicoll
authors.forename: L E
authors.initials: LE
authors.lastname: Nicolle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000628:therapy*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000295:instrumentation*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D016106:Methicillin Resistance; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*