A Cluster of Staphylococcus aureus in Pediatric Cardiac Surgery Leads to Identification of Prevalence of SA Colonization in the Cardiac Surgery Team

Abstract

ISSUE: A cluster of four Staphylococcus aureus (SA) pediatric cardiac surgical site infections (SSIs) was noted within a 2-week period. We evaluated whether staff working in cardiac surgery were colonized with SA and could have transmitted SA to patients. PROJECT: The hands and nares of all staff involved in cardiac surgery (CS) were cultured using standard techniques. This included cardiology staff entering the operating room. In total, 78 staff and 27 environmental cultures were (EC) done. EC included machinery taken into the operating room (OR) and surfaces in two of four ORs. All isolates from both patients and staff were typed using pulsed-field gel electrophoresis (PFGE) to determine if a clonal relationship existed. RESULTS: The prevalence of SA in this population of heathcare workers (HCWs) was 35.9% (28/78): 44% of physicians were colonized, 25% of nurses were colonized, 38% of the physician and surgical assistants were colonized, and 33% of the perfusionists were colonized. Of these, 14.3% of isolates were MRSA (5.1% of samples taken). All patient isolates were unique. Although several HCWs shared isolates, their isolates did not match patient isolates. All HCWs with MRSA were decolonized with mupirocin ointment. Based on these results, investigation was focused on best practice in OR prep and antibiotic prophylaxis. LESSONS LEARNED: By culturing HCWs in CS, we identified a high prevalence of MRSA colonization. Although we did not demonstrate transfer of SA from HCW to patient, HCWs should be aware of the potential increase in MRSA colonization.