Staphylococcus Scalded Skin Syndrome Outbreak in the Neonatal Intensive Care Unit

Abstract

BACKGROUND In August of 2017, Infection Prevention was notified of a single case of Staphylococcus Scalded Skin Syndrome (SSSS) in the Level III Neonatal Intensive Care Unit (NICU), followed by few more cases (in September) of infants with localized blisters and severe exfoliation of the skin. An SSSS outbreak was identified in the NICU where expert resources and public health guidance was consulted to stop transmission and find the source. Four months went by with no additional cases. Then in February of 2018, a second outbreak was identified with NICU patients showing SSSS symptoms and/or carrying the toxin producing Methicillin Susceptible Staph aureus (MSSA) strain. Thorough investigation was conducted during both outbreaks by testing healthcare personnel (HCP), NICU patients, and healthcare equipment. METHODS Weekly MSSA surveillance was conducted during both outbreaks on NICU patients, and any new admissions to the NICU. MSSA screening was also done on all NICU and ancillary personnel. Any positive MSSA healthcare workers (HCWs) were decolonized immediately and placed on work restrictions till they had a negative screening. Pulsed-field gel electrophoresis (PFGE) was used to identify the outbreak MSSA Cluster A strain. RESULTS PFGE results showed a total of six symptomatic and seven asymptomatic patients colonized with MSSA Cluster A strain in the first outbreak; and three symptomatic and six asymptomatic MSSA Cluster A colonized NICU patients in the second outbreak. Regardless of colonization status, all NICU patients went through weekly decolonization with Chlorohexidane (CHG) bathing and mupirocin. CONCLUSIONS Although no common source was linked to the outbreaks, competency-based Personal Protective Equipment (PPE) and Hand Hygiene (HH) training, increasing infection control practices, changing to hospital laundered scrubs and improving environmental cleaning practices prevented further transmission of SSSS in the NICU.