<i>Pseudomonas</i>Surgical-Site Infections Linked to a Healthcare Worker With Onychomycosis

Mermel, Leonard A.; McKay, Maria; Dempsey, Jane; Parenteau, Stephen

doi:10.1086/502125

Cited by 35 publications

(19 citation statements)

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“…This may at first seem difficult to explain, since S. brevicaulis grows vigorously in culture and a single viable cell is enough to start a culture, while PCR may require a somewhat larger amount of material as a template. Fungus-killing bacteria, known to occur abundantly in distal areas of onychomycosis-affected nails, may be responsible for the lack of outgrowth in at least some cases (25,32,53).…”

Section: Discussionmentioning

confidence: 99%

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

et al. 2006

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A novel strategy for the molecular identification of fungal agents of onychomycosis (including Trichophyton rubrum) has been designed based on the use of species-specific and universal primers in conjunction with a commercial kit that allows the extraction of DNA directly from the nail specimens. The microsatellite marker T1, which is based on a (GT)n repeat, was applied for the species-specific identification of Trichophyton rubrum. To evaluate how often Scopulariopsis spp. are detected in nail specimens, a second primer pair was designed to amplify specifically a 336-bp DNA fragment of the 28S region of the nuclear rRNA gene of S. brevicaulis and closely related species. Other fungal species were identified using amplification of the internal transcribed spacer (ITS) region of the rRNA gene, followed by restriction fragment length polymorphism analysis or sequencing. In addition, polyacrylamide gel separation of the T1-PCR product allowed subtyping of T. rubrum strains. We studied 195 nail specimens (the "nail sample") and 66 previously collected etiologic strains (the "strain sample") from 261 onychomycosis patients from Bulgaria and Greece. Of the etiologic agents obtained from both samples, T. rubrum was the most common organism, confirmed to be present in 76% of all cases and serving as the sole or (rarely) mixed etiologic agent in 199 of 218 cases (91%) where the identity of the causal organism(s) was confirmed. Other agents seen included molds (6% of cases with identified etiologic agents; mainly S. brevicaulis) and other dermatophyte species (4%; most frequently Trichophyton interdigitale). Simultaneous infections with two fungal species were confirmed in a small percentage of cases (below 1%). The proportion of morphologically identified cultures revealed by molecular study to have been misidentified was 6%. Subtyping revealed that all but five T. rubrum isolates were of the common type B that is prevalent in Europe. In comparison to microscopy and culture, the molecular approach was superior. The PCR was more sensitive (84%) than culture (22%) in the nail sample and was more frequently correct in specifically identifying etiologic agents (100%) than microscopy plus routine culture in either the nail or the strain samples (correct culture identifications in 96% and 94% of cases, respectively). Using the molecular approach, the time for diagnosing the identity of fungi causing onychomycosis could be reduced to 48 h, whereas culture techniques generally require 2 to 4 weeks. The early detection and identification of the infecting species in nails will facilitate prompt and appropriate treatment and may be an aid for the development of new antifungal agents.

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Section: Discussionmentioning

confidence: 99%

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

et al. 2006

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“…A common misconception among healthcare professionals is that surgical scrubbing before surgery and use of sterile gloves eliminate their hands as a potential source of a surgical site infection. However, operative site contamination transmitted from the hands of healthcare professionals despite adhering to scrubbing protocols has been reported [18]. Interestingly, evaluation of hand-scrubbing materials has shown a loss of efficacy more than 3 hours from the initial cleaning [10].…”

Section: Introductionmentioning

confidence: 99%

Do Longer Surgical Procedures Result in Greater Contamination of Surgeons’ Hands?

Hosseini

Mundis

Eastlack

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background A surgical site infection is a substantial cause of complications in patients. Different methods are being used to decrease surgical site infections; however, these infections still can cause complications, especially in patients undergoing longer operations ([ 3 hours). There is evidence that the efficacy of the scrubbing material fades after 3 hours. However, we do not know the longevity of hand cleanliness after application of scrubbing materials in a long operation. It can be postulated that if the surgeon's scrubbed hands are recolonized after a certain time, they may serve as a progressive source of contamination during surgery. Questions/purposes We asked: (1) Is there a correlation between surgical duration and hand contamination at the end of surgery? (2) At what point during surgery does hand contamination reach or exceed prescrub levels? Methods Three spine surgeons using the same scrubbing technique and materials consisting of chlorhexidine gluconate 1% solution and ethyl alcohol 61% w/w were enrolled in our study. Between December 2014 and April 2015, spine procedures of 3 hours or more, which were the One of the authors (PH) received funding from The San Diego Spine Foundation for this study. One of the authors certifies that he (BAA) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Nuvasive (San Diego, CA, USA), K2M (Leesburg, VA, USA), and DePuy Synthes (West Chester, PA, USA), and Ellipse (Aliso Viejo, CA, USA); an amount of USD 100,000 to 1000,000 from Nuvasive (San Diego, CA, USA); an amount of less than USD 10,000 from Ellipse (Aliso Viejo, CA, USA), Kspine (Leesburg, VA, USA), International Spine Study Group (Brighton, CO, USA), Nuvasive (San Diego, CA, USA), and K2M (Leesburg, VA, USA); Growing Spine Foundation (Milwaukee, WI, USA), San Diego Spine Foundation (San Diego, CA, USA), Scoliosis Research Society (Milwaukee, WI, USA), and Society of Lateral Access Surgery (San Diego, CA, USA). One of the authors certifies that he (GMM) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,000 to 1,000,000 from Nuvasive (San Diego, CA, USA); an amount of less than USD 10,000 from K2M (Leesburg, VA, USA), Medicrea (Lyon, France), Misonix (Farmingdale, NY, USA), International Spine Study Group Foundation (Brighton, CO, USA), Society of Lateral Access Surgery (San Diego, CA, USA), Scoliosis Research Society (Milwaukee, WI, USA), and San Diego Spine Foundation (San Diego, CA, USA). One of the authors certifies that he (RE) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD10,000 from Globus Medical (Audubon, PA, USA), Aesculap/B. Braun (Center Valley, PA, USA), DePuy (West Chester, PA, USA), Johnson & Johnson Company (New Brunswick, NJ, USA), Eli Lilly (Indianapolis, IN, USA), Synthes (West Chester, PA, USA), DiFusion (Georgetown, TX, USA), Inv...

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“…162 A cardiac surgeon with onychomycosis became the source of an outbreak of SSIs due to P. aeruginosa, possibly facilitated by not routinely practising double gloving. 523 One outbreak of SSIs even occurred when surgeons who normally used an antiseptic surgical scrub preparation switched to a nonantimicrobial product. 524 Despite a large body of indirect evidence for the need of surgical hand antisepsis, its requirement before surgical interventions has never been proven by a randomized, controlled clinical trial.…”

Section: Issues Raised By the Surveymentioning

confidence: 99%

“…A cluster of P. aeruginosa SSIs resulted from colonization of a cardiac surgeon's onychomycotic nail. 523 A growing body of evidence suggests that wearing artificial nails may contribute to the transmission of certain health care-associated pathogens. HCWs who wear artificial nails are more likely to harbour Gram-negative pathogens on their fingertips than those who have natural nails, both before and after handwashing 154,534,974,975 or handrub with an alcohol-based gel.…”

Section: Fingernails and Artificial Nailsmentioning

confidence: 99%

Hand Hygiene

Longtin¹,

Sax²,

Allegranzi³

et al. 2011

N Engl J Med

108

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PseudomonasSurgical-Site Infections Linked to a Healthcare Worker With Onychomycosis

Abstract: At least two cases of a cluster of P. aeruginosa surgical-site infections resulted from colonization of a cardiac surgeon's onychomycotic nail.

Cited by 35 publications

References 18 publications

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

Do Longer Surgical Procedures Result in Greater Contamination of Surgeons’ Hands?

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