Poor hand washing causes NICU epidemic
Nurse probably carried infection from pet dog
The case of a nurse who failed to wash her hands properly before entering a neonatal intensive-care unit, resulting in at least 24 neonates acquiring a yeast infection, emphasizes the need to educate health care workers about following basic infection control procedures.
An outbreak of Malassezia pachydermatis between Oct. 17, 1993, and Jan. 18, 1995, at the Dartmouth-Hitchcock Medical Center in Lebanon, NH, was investigated to identify risk factors for colonization and infection. Investigators collected cultures from infants, health care workers, and from the HCWs' pets, because the organism has been associated with otitis externa in dogs.1
Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. Symptoms range from diaper rash to painful thrush, and in severe cases can damage the brain, kidneys, eyes, and liver. Researchers led by U.S. Centers for Disease Control and Prevention investigators defined a case patient as any infant in the intensive care nursery who had a positive culture for M. pachydermatis during the 15-month outbreak period.
Fifteen infants met the case definition: eight with bloodstream infections, two with urinary tract infections, one with meningitis, and four with asymptomatic colonization. Nine additional infants, one HCW, and 12 of the HCWs' pet dogs at home had positive cultures for M. pachydermatis. Three of the 12 dogs had patterns of restriction-fragment-length polymorphisms that were identical to all 15 case patients, the nine additional colonized infants, and one HCW.
One nurse, identified only as Nurse A, seemed to have had contact with all but one of the symptomatic infants, but Nurse A tested negative for the yeast infection and had no pets. Another nurse, Nurse C, was the only HCW who tested positive, but investigators say one or more of the nurses probably introduced the infection into the nursery on their hands. The organism persisted in the nursery through patient-to-patient transmission.
"Careful hand washing by health care workers on reporting to work and before and after all contacts with patients is essential" to preventing outbreaks of pet-associated infections in a nursery, the researchers say.
In an editorial accompanying the investigators' report, experts state: ". . . health care workers must wash their hands after handling animals and before providing care to patients. Proper hand washing remains the cornerstone of infection control, whether the pathogens originate in humans or animals."2
References
1. Chang HJ, Miller HL, Watkins N, et al. An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers' pet dogs. N Engl J Med 1998; 338:706-711.
2. Marcus LC, Marcus E. Nosocomial zoonoses (Editorial). N Engl J Med 1998; 338:757-759.
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