title: Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward.
abstract: BACKGROUND
  Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings and have been documented in surgical, obstetrics and gynaecology, and burns units. The environment may serve as a reservoir and facilitate transmission via contaminated equipment.
  
  
  OBJECTIVE
  To describe the investigation and control of an outbreak of healthcare-associated GAS infection on an ear, nose and throat (ENT) ward in a tertiary referral centre.
  
  
  METHODS
  Two patients with laryngeal cancer developed invasive GAS infection (bacteraemia) with associated tracheostomy wound cellulitis within a 48 h period. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, healthcare worker screening and sampling of patient curtains. Immediate control measures included source isolation, a thorough rolling clean with a chlorine-based disinfectant and hydrogen peroxide decontamination of patient equipment.
  
  
  RESULTS
  Prospective patient screening identified one additional patient with carriage of GAS from a tracheostomy wound swab. Staff screening identified one healthcare worker who acquired GAS during the outbreak and who subsequently developed pharyngitis. Environmental sampling demonstrated that 10 out of 34 patient curtains on the ward were contaminated with GAS and all isolates were typed as emm-1.
  
  
  CONCLUSIONS
  This is the first outbreak report to demonstrate patient curtains as potential source for GAS cross-transmission, with implications in relation to hand hygiene and frequency of laundering. Based on this report we recommend that during an outbreak of GAS infection all patient curtains should be changed as part of the enhanced decontamination procedures.
authors.affiliation: Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Mahida
authors.affiliation: Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Beal
authors.affiliation: Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Trigg
authors.affiliation: Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Vaughan
authors.affiliation: Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK. Electronic address: tim.boswell@nuh.nhs.uk.
authors.forename: T
authors.initials: T
authors.lastname: Boswell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D006235:Hand Disinfection / Q000379:methods; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D062606:Tertiary Care Centers
keywords: Group A streptococcus; Healthcare-acquired infection; Infection control; Outbreak