Abstract
Methods We conducted an outbreak investigation and performed a molecular typing of the outbreak strains with pulsed-field gel electrophoresis (PFGE). In addition, we reviewed PubMed and the Outbreak Database for MRSA outbreaks related to hydrotherapy or other bathing activities. Results Four patients acquired nosocomial MRSA during the 4-week outbreak period. Environmental sampling revealed the presence of MRSA in the bathtub used for hydrotherapy. The environmental and the patients' isolates showed an indistinguishable restriction pattern in the PFGE. Subsequent discontinuation of bathing stopped the outbreak. The literature search found 9 MRSA outbreak reports related to bathing activities or hydrotherapy. Conclusion The epidemiologic outbreak investigation together with the molecular findings suggests monoclonal spread of MRSA due to surface contamination of the bathtub. After enhancing the disinfection and cleaning process accompanied by staff training with respect to hand hygiene, no further cases occurred. Standardized and best practice cleaning and disinfection protocols are crucial, especially in critical facilities such as hydrotherapy units. Regular environmental sampling is helpful to monitor these processes and to detect potential contamination.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for infections in patients both inside and outside of the hospital and causes outbreaks
Two of the patients came from the same surgical ward; the third patient was located on the tertiary burn unit, and the fourth patient was on an internal medicine ward at the time point of MRSA detection. e third case triggered the outbreak investigation
Nosocomial MRSA acquisition on the burn unit became apparent as the ward has only 6 patient beds and a tight microbiological monitoring. e analysis of movements and treatment data showed that the first 3 patients were repeatedly treated in the same bathtub immediately prior to their first MRSA findings
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for infections in patients both inside and outside of the hospital and causes outbreaks. We demonstrate the characteristics and control of a MRSA outbreak related to a carbon dioxide hydrotherapy bathtub. Environmental sampling revealed the presence of MRSA in the bathtub used for hydrotherapy. E literature search found 9 MRSA outbreak reports related to bathing activities or hydrotherapy. E epidemiologic outbreak investigation together with the molecular findings suggests monoclonal spread of MRSA due to surface contamination of the bathtub. Depending on the extent of the underlying lesions, only a body part can be treated or the entire patient may be exposed to the carbon dioxide. During this treatment, bacteria from the patient’s microbiome There are some reports addressing contaminated hydrotherapy equipment as a (point) source of nosocomial spread of bacteria [6, 7]
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