title: Control and outcome of a large outbreak of colonization and infection with glycopeptide-intermediate Staphylococcus aureus in an intensive care unit.
abstract: BACKGROUND
  Glycopeptide-intermediate Staphylococcus aureus (GISA) is emerging as a cause of nosocomial infection and outbreaks of infection and colonization in intensive care units (ICUs). We describe an outbreak of GISA colonization/infection and the ensuing control measures in an ICU and investigate outcomes of the affected patients.
  
  
  METHODS
  We describe an outbreak of GISA colonization and infection that affected 21 patients in a medical ICU at a tertiary care teaching hospital, as well as the measures taken to eradicate the GISA strain.
  
  
  RESULTS
  Recognition of the outbreak was difficult. Infections, all of which were severe, were diagnosed in 11 of 21 patients. Patient isolation and barrier precautions failed when used alone. Addition of a stringent policy of restricted admissions, twice daily environmental cleaning, and implementation of hand decontamination with a hydroalcoholic solution led to outbreak termination. This was associated with increases in workload, despite a marked decrease in the number of admissions.
  
  
  CONCLUSIONS
  This first description of a large outbreak of GISA colonization and infection underlines the importance of routine GISA-strain detection when methicillin-resistant S. aureus is isolated. Outbreak control may be difficult to achieve.
authors.affiliation: Medical-Surgical Intensive Care Unit, Louis-Mourier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France. arnaud.de-lassence@lmr.ap-hop-paris.fr
authors.forename: Arnaud
authors.initials: A
authors.lastname: de Lassence
authors.forename: Nadia
authors.initials: N
authors.lastname: Hidri
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Joly-Guillou
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiery
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Pascale
authors.initials: P
authors.lastname: Lable
authors.forename: Annie
authors.initials: A
authors.lastname: Blivet
authors.forename: Helene
authors.initials: H
authors.lastname: Kalinowski
authors.forename: Yolaine
authors.initials: Y
authors.lastname: Martin
authors.forename: Jean-Patrick
authors.initials: JP
authors.lastname: Lajonchere
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State; D003428:Cross Infection; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D006020:Glycopeptides / Q000494:pharmacology*; D006235:Hand Disinfection / Q000379:methods; D006282:Health Personnel; D006797:Housekeeping, Hospital; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides