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Researchers have traced the cause of a bacterial infection outbreak in
a newborn intensive care unit (ICU) to the hands of healthcare workers.
Pseudomonas aeruginosa, a well-known cause of infections
acquired in newborn ICUs, usually resides in sinks and respiratory-therapy
devices, and only rarely have outbreaks been linked to hands.
The authors tested 25 possible sources of the bacteria
after nine infants were infected with Pseudomonas aeruginosa in August
1998. In addition, a total of 49 infants had shown evidence of Pseudomonas
during 1997 and 1998.
The authors also tested the hands of healthcare
workers who came in contact with any infants hospitalized in the ICU during
that period.
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None of the environmental specimens were found
to be contaminated with the bacteria.
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However, the hands of 10 out of the 165 healthcare
workers tested were contaminated.
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One week later, only three of the 10 healthcare
workers were still positive for the bacteria when retested.
Interestingly, the source of a majority of the infections
in the infants was traced to a single healthcare worker, who carried the
same strain of the bacteria as that infecting most of the infants. Researchers
determined that being cared for by this healthcare worker increased the
infants' chances of being infected by more than 41 times.
Based on these findings,
the authors suggest that the hands of healthcare workers be tested early
in any outbreak investigation. "Underlying conditions such as (outer
ear infections or fungal nail infections) may be associated with persistent
carriage of P. aeruginosa on the hands of healthcare workers and should
be detected and eradicated," they conclude.
The New England Journal
of Medicine September 7, 2000;343:695-700.
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