Abstract
In January 2008, we investigated a cluster of neonates with bullous impetigo in a hospital of northern Thailand in order to control the outbreak and identify a potential source of the infection. We reviewed medical records and working timetables of healthcare workers (HCWs) and conducted a case-control study. We performed an environmental study and took bacteriological samples from HCWs and equipments. According to our case definitions, we identified 16 confirmed cases and 14 probable cases. The attack rate was 42%. Most cases had skin blisters (28 cases) followed by pustules (five cases) and exfoliation (three cases). The location of the lesion was the trunk (17 cases), neck (14 cases) or armpits (nine cases). Nineteen cases had symptoms onset after discharge from hospital. Median age at onset was 4 days. The strain isolated from an infected newborn shared the same phage type as the contaminated equipment. Insufficient hand hygiene was an observed risk behaviour of HCWs and visitors. Exposure to a nasal carrier of Staphylococcus aureus (adjusted OR: 80.3, 95% CI: 4.8 - 1350.3) and ward sharing with a symptomatic case (adjusted OR: 35.6, 95% CI: 1.9 - 654.7) increased the risk of acquiring the infection. The outbreak ended abruptly after implementation of hand hygiene practices and equipment cleaning.
Highlights
Bullous impetigo is a superficial bacterial skin infection, mainly affecting infants and small children, usually caused by Staphylococcus aureus which can lead to severe illness in the form of staphylococcal scalded skin syndrome (SSSS), septicaemia, or pneumonia [1,2]
In this report we describe an outbreak of the staphylococcal bullous impetigo occurring in a district hospital in northern Thailand between 11 and 27 January 2008
Sixty (84.5%) out of 71 neonates were physically examined again from 25 January to 27 January 2008, of which we identified a total of 30 cases: 16 confirmed and 14 probable cases
Summary
Bullous impetigo is a superficial bacterial skin infection, mainly affecting infants and small children, usually caused by Staphylococcus aureus which can lead to severe illness in the form of staphylococcal scalded skin syndrome (SSSS), septicaemia, or pneumonia [1,2]. Newborn infants are prone to skin infection due to the vulnerability of their skin [3]. Thai Ministry of Public Health included nosocomial infections in mandatory reporting in 1982 [8]. The prevalence of nosocomial infections in Thailand was 11.7% in 1988, it diminished to 7.4% in 1992, to 6.4% in 2001 and slightly increased to 6.5% in 2006 [9]. Most hospitals in Thailand have targeted surveillance systems in place for high risk population such as intensive care patients, post-surgery patients and patients with invasive devices. Staff shortage and high workload are the main problems in tackling nosocomial infections in Thailand [10-12]
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