SCALDED
SKIN
SYNDROME
IN NICUSue Hetticher, MT(ASCP), CIC
Nancy Turner R.N., MSN, PHN
Audra Deveikis, M.D.
Antoine Soliman, M.D.
Stephanie Figueroa MSN, RNC-NIC
Background
• Staphylococcal scalded skin syndrome (SSSS) is an exfoliating skin condition caused by Staphylococcal aureus (S.aureus) predominated by desquamation and blistering.
• In March 2015, an outbreak of SSSS was identified in the
Neonatal Intensive Care Unit (NICU) in five infants.
Methods
• Four Cases
• premature extremely low birth weight (ELBW) (<1000 g) infants
• 107 bed Level III NICU
• developed skin breakdown 8-21 days after birth.
• A 5th case was identified
• 23 day old full term infant with NICU stay for rule out sepsis who developed umbilical infection
Methods
• Exposure was defined as being in the same room or pod as an identified case
• Actions included cohorting and contact isolation of cases.
• A multidisciplinary team was assembled to address this issue
and interrupt transmission.
• An exposure enhanced surveillance among all infants for new skin breakdown began
• Nasal & axilla swab testing for S.aureuswas performed on all infants
Methods continued
exposed in the same NICU pod as the SSSS infants.
• 4% Chlorhexidine Gluconate (CHG) hand scrub was …
Methods continued
implemented for 1st scrub ….
of the day....
for all staff.
• Screening of healthcare workers (HCW) for Staph colonization was
performed (nares swab)
• 28% (48/171) of staff were colonized with S.aureus
HCWs with S.aureus were prescribed mupirocin
nasal decolonization and CHG showers for 5 days.
Results
• One colonized HCW was observed not hand washing due to dermatitis
• Seven isolates exhibited indistinguishable chromosomal patterns strains, confirmed by pulse field-gel electrophoresis (PFGE), Figure 1.
Results continued
Includes the 5 infants and 2 HCWs
Two HCWs were identified who may have contributed to the transmission of S.aureus in the NICU.
Conclusion
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