title: Outbreak of Serratia marcescens postoperative infection traced to barbers and razors.
abstract: BACKGROUND
  Fourteen postoperative infections caused by Serratia marcescens were detected in patients on the neurosurgical wards and spinal surgery ward of a 2640-bed hospital between 26th December 2012 and 5th June 2013.
  
  
  OBJECTIVE
  To investigate the source of the outbreak, identify risk factors and implement infection control measures.
  
  
  METHODS
  Cultures were collected from healthcare workers and potential environmental sources. S. marcescens isolates were characterized by antibiotic susceptibility testing and pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was performed to identify the risk factors.
  
  
  RESULTS
  The outbreak involved 14 patients, five of whom required more than one surgical procedure. S. marcescens was isolated from cerebrospinal fluid, brain tissue, sputum and other secretions. S. marcescens was also cultured from samples taken from the hands of two barbers and their razors. Exposure to the two barbers [odds ratio (OR) 78.0, P < 0.0001] and wound drainage (OR 4.889, P = 0.028) were risk factors. Pre-operative shaving by the barbers was the only independent risk factor (OR 78.0, P < 0.0001). Isolates of S. marcescens from patients, barbers and razors were indistinguishable by PFGE and antibiotic susceptibility pattern. The outbreak ended after removal of the implicated barbers, extensive re-inforcement of infection control procedures and re-education.
  
  
  CONCLUSIONS
  These results underscore the risk of postoperative infection associated with pre-operative wet shaving.
authors.affiliation: Department of Pharmacy, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Department of Pharmacology, Medical College of Qingdao University, Qingdao, Shandong, China.
authors.forename: P
authors.initials: P
authors.lastname: Leng
authors.affiliation: Department of Nosocomial Infection Control, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
authors.forename: W L
authors.initials: WL
authors.lastname: Huang
authors.affiliation: Department of Orthopaedics and Traumatology, Yantai Yuhuangding Hospital, Affiliated to Qingdao University Medical College, Yantai, Shandong, China.
authors.forename: T
authors.initials: T
authors.lastname: He
authors.affiliation: Department of Joint Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shangdong, China.
authors.forename: Y Z
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Department of Joint Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shangdong, China. Electronic address: zhhaining@hotmail.com.
authors.forename: H N
authors.initials: HN
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D012189:Retrospective Studies; D016868:Serratia Infections / Q000453:epidemiology*; D012706:Serratia marcescens / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Barbers; Postoperative outbreaks; Razor; Serratia marcescens