title: Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review.
abstract: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.
authors.affiliation: Department of Paediatrics, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Neylon
authors.forename: Nuala H
authors.initials: NH
authors.lastname: O'Connell
authors.forename: Barbara
authors.initials: B
authors.lastname: Slevin
authors.forename: James
authors.initials: J
authors.lastname: Powell
authors.forename: Regina
authors.initials: R
authors.lastname: Monahan
authors.forename: Liz
authors.initials: L
authors.lastname: Boyle
authors.forename: Dominic
authors.initials: D
authors.lastname: Whyte
authors.forename: Mai
authors.initials: M
authors.lastname: Mannix
authors.forename: Fiona
authors.initials: F
authors.lastname: McElligott
authors.forename: Angela M
authors.initials: AM
authors.lastname: Kearns
authors.forename: Roy K
authors.initials: RK
authors.lastname: Philip
mesh_terms: D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control / Q000706:statistics & numerical data; D007494:Ireland / Q000453:epidemiology; D008297:Male; D015997:Neonatal Screening / Q000295:instrumentation / Q000379:methods; D013206:Staphylococcal Scalded Skin Syndrome / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D013211:Staphylococcus aureus / Q000302:isolation & purification