Ultra-sonic nebulizers as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in a university tertiary care hospital.

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred on a head and neck surgical (HNS) ward of a university hospital in Amsterdam. The outbreak lasted from May 2000 until November 2000, and MRSA spread to two intensive care units. Amplified fragment length polymorphism analysis indicated that a single clone was responsible for the outbreak. Phage-typing indicated that this clone was of a type that was uncommon in The Netherlands. Strict isolation of patients, according to the Dutch national guidelines, was instituted. During the outbreak, surveillance culture specimens, from patients, healthcare workers, and the environment, were obtained at regular intervals. MRSA was found in the dust filters of nebulizers through which air from the room was filtered and subsequently humidified. These nebulizers were used to humidify tracheostomies. The dust filters were not maintained according to the guidelines. Restricted use and cleaning and disinfection of all ultra-sonic nebulizers led to termination of the outbreak. The outbreak illustrates that to terminate transmission of outbreak strains of MRSA, meticulous measures are necessary, which not only include strict isolation precautions, but also decontamination of the environment. In addition, it demonstrates the necessity of adhering to cleaning and disinfection guidelines for all medical and nursing equipment used in the hospital.

Infection control in the Netherlands.

A survey was made by the Dutch association of infection control practitioners (VHIG) concerning the organization of infection control in Dutch hospitals and the activities of its members. The results are reported and compared with recent American studies. A comparison is made between a group of infection control technicians (ICTs) who were not nurses and a group of nurses (ICNs), working in infection control. Although the ICT has significantly more daily contacts with the hospital microbiologist and is more often secretary to the infection control committee and the ICN visits the outpatient department significantly more often, the other activities in their practice are essentially the same. From this study we conclude that either an ICT or an ICN can adequately function as an infection control practitioner in the Netherlands.