An outbreak of heterogeneous glycopeptide-intermediate Staphylococcus aureus related to a device source in an intensive care unit.

OBJECTIVE

The emergence of Staphylococcus aureus with reduced susceptibility to glycopeptides (glycopeptide-intermediate S. aureus [GISA] and heterogeneous GISA [h-GISA]) leads to intensive care unit (ICU) outbreaks that frequently result in ward closure. We investigated the role of hospital hygiene in the transmission and eradication of an h-GISA outbreak.

DESIGN

The study is a description of an original environmental investigation around a series of 12 cases.

SETTING AND PATIENTS

The outbreak occurred in a 20-bed polyvalent/trauma ICU in a 2,800-bed tertiary care university hospital in France.

INTERVENTIONS

Specimens were obtained for surveillance and diagnostic cultures from all patients in the unit. Surface sampling was also performed. Geographic cohorting, contact isolation, emphasis on adherence to infection control practices, and environmental cleaning were implemented.

RESULTS

Twelve patients with h-GISA infection (n = 5) or colonization (n = 7) were identified. The mean interval between admission and h-GISA detection was 23.6 days (range, 10-89 days), with a median of 16.5 days. Environmental investigation identified an unexpected reservoir, namely, SpO(2) sensors. The outbreak was controlled by a combination of measures, including eradication of this reservoir, avoiding total ward closure.

CONCLUSIONS

Targeted surface sampling helps to secure the environment through active investigation of various reservoirs while maintaining normal activity on the ward. In our study, this method led to the detection of an unsuspected reservoir, the eradication of which helped control the h-GISA epidemic. Further applications of this original investigative procedure should allow confirmation of its relevance and efficiency.