Serratia Marcescens Outbreak in a Paediatric Oncology Unit Traced to Contaminated Chlorhexidine

McAllister, Tim A.; Lucas, Carol; Mocan, H; Liddell, R.; Gibson, Brenda; Hann, Ian; Platt, D. J.

doi:10.1177/003693308903400506

Cited by 42 publications

(20 citation statements)

References 23 publications

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“…Disinfectants are supposedly better at killing environmental organisms than detergent-based agents, but some pathogens are able to survive exposure to specific biocides (152). Both multidrug-resistant S. marcescens and extremely drug-resistant strains of K. pneumoniae have demonstrated increasing tolerance to chlorhexidine (153,154). Other cleaning fluids can become contaminated with Gram-negative bacilli during use, with some formulations apparently encouraging acquisition of resistance elements by Gram-negative organisms (126,155).…”

Section: Contamination Of Cleaning Equipment and Liquidsmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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Section: Contamination Of Cleaning Equipment and Liquidsmentioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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“…Outbreaks have been noted in neonatal and pediatric ICUs (4, 14, 18, 21, 28, 41, 60, 63, 74, 76, 88, 94, 95, 116, 133, 137, 150 , 198, 204, 215, 228, 239, 249, 250, 269, 270, 275, 309, 313, 338, 366, 393, 396, 400, 423), neonatal nurseries/units and special care baby units (7,100,156,190,238,275,310,359,362,387,423), pediatric oncology units (258), and maternity wards/hospitals (35,48).…”

Section: S Marcescensmentioning

confidence: 99%

“…Outbreaks of sepsis/bacteremia (4,18,74,88,116,157,215,238,258,310,341,359,362,423), meningitis (74,88,116,157,362,423), conjunctivitis (74,88,116), UTIs (116), respiratory tract infections (74,88,116,285,359), and wound infections (362) due to S. marcescens have all been described for pediatric patients since the series of infections described by McCormack and Kunin in 1966 (259). Conjunctivitis appears to be more common in pediatric population outbreaks in hospitals than in adult populations.…”

Section: S Marcescensmentioning

confidence: 99%

“…From these pediatric nosocomial infection studies, many environmental sources or point sources have been found as reservoirs for S. marcescens, including hands of health care workers and exposure to health care workers (14,156,198,249,267,362,393,396,423), contaminated breast milk, formula, and breast pumps (133,156,204,274,393), contaminated parenteral nutrition (18), an infected neonate as the index patient or colonization of hospitalized infants (28,63,100,148,238,269,270,275,338,362,400), equipment such as incubators (28,198), laryngoscopes (95,204), suction tubes, soap dispensers (52), and waste jars (393), air conditioning ducts (387), contaminated hand brushes (7), contaminated disinfectants and soap (14,52,76,258,313,396), cotton wool pads (137), multidose nebulizer dropper bottles (215), and multidose medications (133).…”

Section: S Marcescensmentioning

confidence: 99%

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Serratia Infections: from Military Experiments to Current Practice

2011

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SUMMARY Serratia species, in particular Serratia marcescens , are significant human pathogens. S. marcescens has a long and interesting taxonomic, medical experimentation, military experimentation, and human clinical infection history. The organisms in this genus, particularly S. marcescens , were long thought to be nonpathogenic. Because S. marcescens was thought to be a nonpathogen and is usually red pigmented, the U.S. military conducted experiments that attempted to ascertain the spread of this organism released over large areas. In the process, members of both the public and the military were exposed to S. marcescens , and this was uncovered by the press in the 1970s, leading to U.S. congressional hearings. S. marcescens was found to be a certain human pathogen by the mid-1960s. S. marcescens and S. liquefaciens have been isolated as causative agents of numerous outbreaks and opportunistic infections, and the association of these organisms with point sources such as medical devices and various solutions given to hospitalized patients is striking. Serratia species appear to be common environmental organisms, and this helps to explain the large number of nosocomial infections due to these bacteria. Since many nosocomial infections are caused by multiply antibiotic-resistant strains of S. marcescens , this increases the danger to hospitalized patients, and hospital personnel should be vigilant in preventing nosocomial outbreaks due to this organism. S. marcescens , and probably other species in the genus, carries several antibiotic resistance determinants and is also capable of acquiring resistance genes. S. marcescens and S. liquefaciens are usually identified well in the clinical laboratory, but the other species are rare enough that laboratory technologists may not recognize them. 16S rRNA gene sequencing may enable better identification of some of the less common Serratia species.

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“…285,339 Occasional outbreaks of nosocomial infections have been traced to contaminated solutions of chlorhexidine. [346][347][348][349] Resistance to chlorhexidine has also been reported. 350 …”

Section: Chlorhexidinementioning

confidence: 99%