title: Serratia marcescens outbreak in a neonatal intensive care unit related to the exit port of an oscillator.
abstract: OBJECTIVE
  To interrupt transmission of Serratia marcescens colonization in a neonatal intensive care unit and determine the source of ongoing transmission.
  
  
  METHODS
  Multidisciplinary outbreak investigation and simulation of droplet generation by a high-frequency oscillator using fluorescent dye.
  
  
  METHODS
  Level III neonatal intensive care unit.
  
  
  METHODS
  Very low birth weight premature infants with respiratory failure.
  
  
  METHODS
  Infection control interventions, pulsed-field gel electrophoresis of isolates to determine relatedness, and construction of a scavenging system to capture the circuitry condensate expelled by the oscillator exit port.
  
  
  RESULTS
  Affected infants were housed in the same geographic site. Serratia marcescens isolates were indistinguishable or closely related using pulsed-field gel electrophoresis. Fluorescent droplet splatter from the circuitry, generated when no containment device covered the exit valve, was visible up to 49 in (107.8 cm) from the source.
  
  
  CONCLUSIONS
  Implementation and adherence to infection control measures is essential to prevent transmission of opportunistic pathogens among ventilated infants. Oscillators can generate droplets that travel farther than 1 m from the source.
authors.affiliation: Department of Infection Prevention and Control Services, IWK Health Center, Halifax, Canada.
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Macdonald
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Langley
authors.forename: Tim
authors.initials: T
authors.lastname: Mailman
authors.forename: Kimberley
authors.initials: K
authors.lastname: Allain
authors.forename: George
authors.initials: G
authors.lastname: Nelson
authors.forename: Lydia
authors.initials: L
authors.lastname: Hatton
authors.forename: Timothy
authors.initials: T
authors.lastname: Sanford
authors.forename: Ken
authors.initials: K
authors.lastname: George
authors.forename: David
authors.initials: D
authors.lastname: Hancock
authors.forename: Dora
authors.initials: D
authors.lastname: Stinson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mulvey
mesh_terms: D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D009864:Ontario / Q000453:epidemiology; D009991:Oscillometry / Q000295:instrumentation*; D011159:Population Surveillance / Q000379:methods; D016868:Serratia Infections / Q000453:epidemiology*; D012706:Serratia marcescens / Q000302:isolation & purification*