title: Outbreak of community-acquired methicillin-resistant Staphylococcus aureus skin infections among health care workers in a cancer center.
abstract: BACKGROUND
  The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) soft tissue infections is rising. However, CA-MRSA outbreaks among health care workers (HCWs) are rarely reported. We describe 3 clusters of CA-MRSA soft tissue infections among HCWs and the subsequent transmission to a patient.
  
  
  METHODS
  The first cluster of boils occurred in 4 employees who worked in the ambulatory treatment clinic (area A) and 1 patient (PA1) who frequently visited area A. Three employees (EA1, EA2, and EA3) and PA1 had positive cultures. Twelve employees in 2 geographically separate diagnostic imaging areas (areas B and C) reported recent or current boils of whom EB1, EB2, EB3, and EC1 had positive cultures. Molecular subtyping using pulse-field gel electrophoresis (PFGE) was performed on all 8 isolates and confirmed by the Centers for Disease Control and Prevention laboratory.
  
  
  RESULTS
  Relatedness of the MRSA strain was confirmed by PFGE in 7 of 8 isolates. Only EB3 was not related to the prototype CA-MRSA strain. All 7 related MRSA strains contained the typical genetic organization of staphylococcal cassette chromosome (SCC)-mec type IVa plus genes encoding Panton-Valentine Leukocidin. EB3's strain contained SCC-mec type II and was Panton-Valentine Leukocidin negative. A total of 171 questionnaires was sent. Nine of the 85 HCWs who responded reported a recent or current history of boils. Infection control conducted an education program for employees in areas A, B, and C.
  
  
  CONCLUSIONS
  Early identification and control of CA-MRSA infections among HCWs is important to limit horizontal transmission to patients. Future efforts should include educational programs and guidelines for reporting and treating HCWs with MRSA infections.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Christelle
authors.initials: C
authors.lastname: Kassis
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Perego
authors.forename: Tanya
authors.initials: T
authors.lastname: Dvorak
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Hulten
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Frenzel
authors.forename: Georgia
authors.initials: G
authors.lastname: Thomas
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
mesh_terms: D000046:Academic Medical Centers; D017714:Community-Acquired Infections / Q000453:epidemiology*; D004196:Disease Outbreaks; D005667:Furunculosis / Q000453:epidemiology* / Q000382:microbiology; D006282:Health Personnel; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D013781:Texas / Q000453:epidemiology