CDC updating guidelines for group A strep
HICPAC considering employee health guidelines
The following draft guidelines for investigating group A Streptococcus outbreaks in hospitals are being discussed by the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee (HICPAC). Drafted as part of an employee health guideline still under consideration, the recommendations are subject to further review and revision by the CDC and HICPAC.
* Patient-to-Personnel Transmission: Pharyngeal and skin infections are the most common group A streptococcal infections. However, clusters of invasive group A streptococcal infections, including the toxic shock-like syndrome (TSLS), have been recognized. Secondary spread and illness (including TSLS, cellulitis, lymphangitis, and pharyngitis) in hospital personnel have occurred following direct contact by personnel with secretions from infected patients. To prevent patient-to-personnel transmission of group A streptococci, personnel should wash their hands thoroughly after each patient contact, wear gloves when contact with potentially contaminated secretions is anticipated, and wear gowns when soiling with infective material is likely.
* Personnel-to-Patient Transmission: Sporadic outbreaks of surgical wound infections or postpartum infections caused by group A streptococci have been associated with carriers among operating room or delivery room personnel. The main reservoirs of group A streptococci in implicated carriers are the pharynx, the skin, the rectum, and the female genital tract. Direct contact and airborne spread are the major modes of transmission of this organism in these settings.
Since surgical wound infections or postpartum infections due to group A streptococci occur infrequently, any isolate from cases should be saved for possible serotyping should an outbreak ensue. The occurrence of 2 or more cases should prompt an epidemiologic investigation and a search for a carrier-disseminator. Isolates obtained from personnel and patients should be serotyped to determine strain relatedness. Ideally, only personnel who are epidemiologically linked to cases should have cultures of skin lesions, pharynx, rectum, and vagina, and if positive, should be removed from patient contact until treatment is completed and follow-up cultures are negative. In situations in which epidemiologic studies could not establish any links between cases and personnel, however, the identification of a carrier-disseminator may be facilitated by culturing all personnel associated with cases and by culturing the operating room environment. Routine screening of personnel for group A streptococcal carriage in the absence of cases of nosocomial infection is not recommended.
Because experience is limited regarding the treatment and follow-up of personnel-carriers implicated in outbreaks of surgical wound infections due to group A streptococci, and because carriage of the organism by a health care worker may be recurrent over long periods of time, treatment and follow-up of these personnel-carriers should be individualized. *
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