Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain

Abstract

Inadequate infection control and improper wound-care practices likely led to this 28-month-long outbreak of severe infections in a skilled nursing facility. Whole genome sequencing and phylogenetic analysis suggested that intrafacility transmission of a single highly transmissible GAS strain was responsible for the outbreak in facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.

A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control

“…Fifteen studies reported outbreaks caused by bacteria [15-17, 20, 22, 24, 27, 32-39] and 22 studies were outbreaks by viruses [14,18,19,21,23,25,26,[28][29][30][31][40][41][42][43][44][45][46][47][48][49][50]. The largest number of a single pathogen was influenza viruses [40][41][42][43][44][45], followed by group A streptococcus (GAS) [17,20,24,37,38]. The most affected site was respiratory tract (n = 12) [32, 35, 36, 39-45, 48, 50], followed by gastrointestinal (GI) tract (n = 10) [14,16,23,26,27,31,33,46,47,49].…”

“…Three studies analyzed the data of multiple outbreaks of viral gastroenteritis and influenza-like illness that occurred in multiple facilities for a certain period of time [14,46,48]. The outbreaks in 23 studies affected both the residents and HCWs [14,20,22,23,25,26,29,31,33,[35][36][37][38][39][40][41][43][44][45][46][47][48][49], and the outbreaks of 14 studies affected only the residents [15-19, 21, 24, 27, 28, 30, 32, 34, 42, 50].…”

“…The most frequently observed problem was suboptimal hand hygiene, followed by personal protective equipment (PPE), and cleaning and disinfection. Investigation for the GAS outbreak in the study by Nanduri et al [37] revealed that hand hygiene compliance among employees was 14-25%. Additionally, poor hand hygiene became a more critical factor that facilitated the transmission of acute gastroenteritis, particularly in LTCFs having close living conditions with frequent close contact between the staff and dependent residents [31].…”

“…Additionally, poor hand hygiene became a more critical factor that facilitated the transmission of acute gastroenteritis, particularly in LTCFs having close living conditions with frequent close contact between the staff and dependent residents [31]. Issues related to PPE had been addressed including inappropriate use of glove and improper storage of PPE [20,24,30,31,34,37]. There were reports indicating the potential to cross-contamination by not-changing gloves between residents or by storage of PPE in the room of the index case [31,34].…”

“…There were reports indicating the potential to cross-contamination by not-changing gloves between residents or by storage of PPE in the room of the index case [31,34]. Breaches in disinfection and cleaning of the environment and equipment were associated with many outbreaks, most of them were GAS [20,37,38] or hepatitis B and C outbreaks [28,30]. Three reports of GAS outbreaks found lapses in wound care practice such as inconsistent cleaning and disinfection [20,37,38].…”