title: Serratia marcescens outbreak in a neonatal intensive care unit: crucial role of implementing hand hygiene among external consultants.
abstract: BACKGROUND
  Serratia marcescens represents an important pathogen involved in hospital acquired infections. Outbreaks are frequently reported and are difficult to eradicate. The aim of this study is to describe an outbreak of Serratia marcescens occurred from May to November 2012 in a neonatal intensive care unit, to discuss the control measures adopted, addressing the role of molecular biology in routine investigations during the outbreak.
  
  
  METHODS
  After an outbreak of Serratia marcescens involving 14 neonates, all admitted patients were screened for rectal and ocular carriage every two weeks. Extensive environmental sampling procedure and hand sampling of the staff were performed. Antimicrobial susceptibility pattern and molecular analysis of isolates were carried out. Effective hand hygiene measures involving all the external consultants has been implemented. Colonized and infected babies were cohorted. Dedicated staff was established to care for the colonized or infected babies.
  
  
  RESULTS
  During the surveillance, 65 newborns were sampled obtaining 297 ocular and rectal swabs in five times. Thirty-four Serratia marcescens isolates were collected: 11 out of 34 strains were isolated from eyes, being the remaining 23 isolated from rectal swabs. Two patients presented symptomatic conjunctivitis. Environmental and hand sampling resulted negative. During the fifth sampling procedure no colonized or infected patients have been identified. Two different clones have been identified.
  
  
  CONCLUSIONS
  Ocular and rectal colonization played an important role in spread of infections. Implementation of infection control measures, involving also external specialists, allowed to control a serious Serratia marcescens outbreak in a neonatal intensive care unit.
authors.affiliation: Department of Health Sciences, University of Florence, Viale Pieraccini 23, 50139, Florence, Italy. carlotta.montagnani@unifi.it.|Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. carlotta.montagnani@unifi.it.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Montagnani
authors.affiliation: Department of Health Sciences, University of Florence, Viale Pieraccini 23, 50139, Florence, Italy. priscilla.cocchi@unifi.it.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Cocchi
authors.affiliation: Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. l.lega@meyer.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Lega
authors.affiliation: Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. s.campana@meyer.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Campana
authors.affiliation: Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. k.biermann@meyer.it.
authors.forename: Klaus Peter
authors.initials: KP
authors.lastname: Biermann
authors.affiliation: Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. c.braggion@meyer.it.
authors.forename: Cesare
authors.initials: C
authors.lastname: Braggion
authors.affiliation: Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy. pecilep@aou-careggi.toscana.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pecile
authors.affiliation: Department of Health Sciences, University of Florence, Viale Pieraccini 23, 50139, Florence, Italy. elena.chiappini@unifi.it.|Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. elena.chiappini@unifi.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.affiliation: Department of Health Sciences, University of Florence, Viale Pieraccini 23, 50139, Florence, Italy. maurizio.demartino@unifi.it.|Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. maurizio.demartino@unifi.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.affiliation: Department of Health Sciences, University of Florence, Viale Pieraccini 23, 50139, Florence, Italy. luisa.galli@unifi.it.|Anna Meyer Children's University Hospital, Viale Pieraccini 23, 50139, Florence, Italy. luisa.galli@unifi.it.
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
mesh_terms: D003253:Consultants; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D063373:Hand Hygiene; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control; D007363:Intensive Care Units, Neonatal; D007558:Italy / Q000453:epidemiology; D008297:Male; D016868:Serratia Infections / Q000453:epidemiology* / Q000517:prevention & control; D012706:Serratia marcescens / Q000302:isolation & purification*