An outbreak of methicillin resistant Staphylococcus aureus on a burn unit:potential role of contaminated hydrotherapy equipment

Objective: To report a multi-institution outbreak caused by a single strain of methicillin-resistant Staphylococcus aureus (MRSA). Outbreak: Between S eptember 19 and November 20, 1996 an index case and five secondary cases of nosocomial MRSA occurred on a 26 bed adult plastic surgery/burn unit (PSBU ) at a tertiary care teaching hospital. Between November 11 and December 23 , 1996, six additional cases were identified at a community hospital. One o f the community hospital cases was transferred from the PSBU. All strains w ere identical by pulsed-field gel electrophoresis. MRSA may have contribute d to skin graft breakdown in one case, and delayed wound healing in others. Patients required 2 to 226 isolation days. Control Measures: A hand held s hower and stretcher for showering in the hydrotherapy room of the PSBU were culture positive for the outbreak strain, and the presumed means of transm ission. Replacement of stretcher showering with bedside sterile burn wound compresses terminated the outbreak. The PSBU was closed to new admissions a nd transfers out for I I days during the investigation. Seven of 12 patient s had effective decolonization therapy. Conclusion: Environmental contamina tion is a potential source of nosocomial MRSA transmission on a burn unit. Notification among institutions and community care providers of shared pati ents infected or colonized with an antimicrobial resistant microorganism is necessary. (C) 2001 Elsevier Science Ltd and ISBI. All rights reserved.