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SCALDED SKIN SYNDROME IN NICU Sue Hetticher, MT(ASCP), CIC Nancy Turner R.N., MSN, PHN Audra Deveikis, M.D. Antoine Soliman, M.D. Stephanie Figueroa MSN, RNC-NIC

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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

Conclusion

The Staff is empowered to remind others

of hand hygiene violations

Staff dermatitis must be reported to Employee

Health