Outbreak of Sternal Surgical Site Infections Due toPseudomonas aeruginosaTraced to a Scrub Nurse with Onychomycosis

Вспышка инфекций области хирургического вмешательства в области грудины, вызванных Pseudomonas aeruginosa, связанная с операционной медицинской сестрой, страдавшей онихомикозом
Shelly McNeil, Lisbeth Nordstrom‐Lerner, Preeti Malani, Marcus Zervos, Carol A. Kauffman
2001-08-01

Pseudomonas aeruginosamedian sternotomyonychomycosispulsed-field gel electrophoresissurgical site infections
From 19 February 1999 through 31 October 1999, 16 (8.6%) of 185 patients who underwent median sternotomy developed infections with Pseudomonas aeruginosa. Seven patients had mediastinitis, 5 had deep sternal wound infection, 2 had superficial sternal wound infection, 1 had prosthetic valve endocarditis, and 1 had sepsis. Pulsed-field gel electrophoresis confirmed that all 13 isolates that were available for typing were the same strain. Cultures of hand specimens identified 1 nurse from whom the same strain of P. aeruginosa was repeatedly isolated; the nurse had been in contact with all 16 infected patients. Investigation revealed that the nurse had severe onycholysis and onychomycosis of the right thumbnail. Cultures of samples of this nail's subungual region and of multiple cosmetic products from the nurse's home yielded the identical P. aeruginosa strain. This outbreak of surgical site infections due to P. aeruginosa was caused by wound contamination from the thumbnail of this nurse, despite her appropriate use of latex surgical gloves.
1
Among 185 median sternotomy patients, 16 (8.6%) developed Pseudomonas aeruginosa surgical site infections, including mediastinitis, deep or superficial sternal infections, endocarditis, and sepsis.
2
Pulsed-field gel electrophoresis showed that all 13 available patient isolates belonged to the same P. aeruginosa strain.
3
The identical strain was repeatedly recovered from a scrub nurse who had contact with all 16 infected patients.
4
The nurse had severe onycholysis and onychomycosis, and the outbreak strain was isolated from the thumbnail’s subungual region and multiple household cosmetic products.
5
The outbreak was attributed to wound contamination from the nurse’s thumbnail despite appropriate use of latex surgical gloves.

Pseudomonas aeruginosa sternal surgical site infections in patients undergoing median sternotomy

The outbreak source and transmission mechanism, specifically wound contamination from a scrub nurse’s onycholytic, onychomycotic thumbnail despite latex glove use

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2001-08-01
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Shelly McNeil
Lisbeth Nordstrom‐Lerner
Preeti Malani
Marcus Zervos
Carol A. Kauffman
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