Serratia marcescens outbreak in a neonatal intensive care unit: crucial role of implementing hand hygiene among external consultants

Abstract

BackgroundSerratia marcescens represents an important pathogen involved in hospital acquired infections. Outbreaks are frequently reported and are difficult to eradicate. The aim of this study is to describe an outbreak of Serratia marcescens occurred from May to November 2012 in a neonatal intensive care unit, to discuss the control measures adopted, addressing the role of molecular biology in routine investigations during the outbreak.MethodsAfter an outbreak of Serratia marcescens involving 14 neonates, all admitted patients were screened for rectal and ocular carriage every two weeks. Extensive environmental sampling procedure and hand sampling of the staff were performed. Antimicrobial susceptibility pattern and molecular analysis of isolates were carried out. Effective hand hygiene measures involving all the external consultants has been implemented. Colonized and infected babies were cohorted. Dedicated staff was established to care for the colonized or infected babies.ResultsDuring the surveillance, 65 newborns were sampled obtaining 297 ocular and rectal swabs in five times. Thirty-four Serratia marcescens isolates were collected: 11 out of 34 strains were isolated from eyes, being the remaining 23 isolated from rectal swabs. Two patients presented symptomatic conjunctivitis. Environmental and hand sampling resulted negative. During the fifth sampling procedure no colonized or infected patients have been identified. Two different clones have been identified.ConclusionsOcular and rectal colonization played an important role in spread of infections. Implementation of infection control measures, involving also external specialists, allowed to control a serious Serratia marcescens outbreak in a neonatal intensive care unit.

A Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening

“…It was not possible to close the unit or limit patient admissions, not even temporarily, although the literature suggests that is fairly common practice (). However, solutions similar to ours have also been reported . According to earlier studies, S. marcescens can spread uncontrollably and contaminate the environment and instruments such as nursing equipment, ventilators and breastmilk .…”

“…Several outbreaks of S. marcescens in NICUs have been reported, with the duration ranging from several months to years (). This study describes an outbreak in a Finnish NICU, which was rapidly managed with hospital hygienic interventions and education.…”

Depth and Well Type Related to Groundwater Microbiological Contamination

“…The antimicrobial resistance profiles of the isolates were similar to those of microorganisms isolated from clinical samples [35,36,37] and the environment-hospital-environment dissemination of these microorganisms should be considered. The presence of E. coli in water indicated the existence of contamination from sewage, which could increase the chance that antibiotic-resistant pathogens could be transmitted via this route [38].…”

Serratia marcescens Outbreak in a Neonatal Intensive Care Unit: New Insights from Next-Generation Sequencing Applications

“…marcescens is ubiquitous in the environment, and previously identified sources of contamination included the hands of health care workers, medical devices, soap, sinks, and milk (2)(3)(4). Although environmental sampling occasionally led to the isolation of S. marcescens, the source of contamination remained unidentified in most outbreaks (5,6). In NICUs, S. marcescens gastrointestinal carriage was identified as a potential reservoir (5,7) and was associated with greater prematurity, use of antibiotics, and mechanical ventilation (7).…”

“…Although environmental sampling occasionally led to the isolation of S. marcescens, the source of contamination remained unidentified in most outbreaks (5,6). In NICUs, S. marcescens gastrointestinal carriage was identified as a potential reservoir (5,7) and was associated with greater prematurity, use of antibiotics, and mechanical ventilation (7).…”