Hand Hygiene (HH) Related Outbreak in a Pediatric hospital: a history of good HH strategy related with an outbreak due to inappropriate environmental cleaning/disinfection
F Ortega-Riosvelasco, P A Mejía-Rosales, I S Pérez-Campos, A E Gamiño-Arroyo, A C Guerrero-Díaz, M Medina-Pelcastre, J A Pérez-León, A Cruz-Córdova, I Parra-Ortega, F J Prado-GalbarroAbstract
Background
Health-care Associated Infections (HAIs) represent a big burden on the health care system, with a subsequent increase in morbidity, hospital stay, medication/procedures, intensive care unit admissions, mortality, costs, etc. In order to avoid this important complication, a great number of Infection Prevention and Control (IPC) strategies has to be stablished daily, such as standard and transmission based precautions, the multimodal hand hygiene strategy, preventive bundles, active surveillance, etc., among others.
Methods
We analyzed an outbreak of Serratia marcescens infections, observed in association with surgical interventions at a tertiary care pediatric hospital. All cases that meet the outbreak definition were included and analyzed, meeting the clinical and epidemiological criteria to be included. Environmental cultures were obtained and compared with the patient’s culture results.
Results
A total of 6 patients that meet clinical and epidemiological criteria were included, 5 of them with identification of infection with S. marcescens. Age range varied from 1 month, to 18 years of age, 50% were male female. Initially, a pseudo-outbreak was identified due to the diversity of wards involved [Surgical Intensive Care Unit (2), Oncology Surgery (1), Orthopedics (1), Neurosurgery (1), and Gastroenterology (1)], with non-related procedures (e.g. renal transplant, tumor resection, removal of surgical prosthetics, intraventricular devices, etc.). During the intensive study of this outbreak, environmental cultures were taken in every operating room (OR) involved (5), no environmental isolate of S. marcescens were found in the ORs, however S. marcescens was found in the sink faucet in front of the ORs involved, where all the surgeons practice proper hand hygiene before surgery. Pulsed Field Electrophoresis Gel was performed to determinate clonal identity between S. marcescens isolates (pending).
Conclusion
We describe an outbreak related with the most important strategy to prevent HAIs: Hand Hygiene. This puts in the scope that even in a hospital with proper programs of IPC, if environmental cleaning/disinfection is affected, we can continue propagating HAIs in good clinical practice scenarios. After this outbreak, surveillance of environmental cleaning was encouraged.