Group A Strep in a Nursing Home
Dana Buckalew (1 PM Micro) found this alarming case study from the most recent issue of Morbidity Mortality Weekly Report, detailing a breakout of a nasty infectious disease in a nursing home facility here in Pennsylvania.
Group A Streptococcus (GAS) infections are transmitted by person-to-person contact or through respiratory droplets that pass from one person to another. The passing of GAS infections can colonize in throats of children and adults who show no symptoms of the disease causing severe invasive infections. Cases can be categorized by invasive, meaning GAS is found in a normally sterile location, or noninvasive. Symptoms can include skin redness, swelling, fever, upper respiratory symptoms, and infected discharge. Infection prevention practices must take place in order to prevent severe morbidity and mortality among vulnerable populations.
The Pennsylvania Department of Health was notified of three confirmed cases of GAS infection in a nursing facility on September 29. 2010. An investigation was conducted in the facility to identify all cases and construct solutions to prevent further infections. They determined that during October 12, 2009 through September 22, 2010, two people had died due to this infection. Also, ten people from the facility had noninvasive infections while thirteen others had invasive infections. These numbers represent one of the largest invasive GAS outbreaks in a nursing facility. Residents and staff were then tested to identify carriers of the infection and those who tested positive were then given antibiotics. The Department of Health then observed hand hygiene practices among the staff and provided education on infection prevention to the staff.
More than half were of the GAS patients were males and 48% were African American ranging between 31 to 97 years of age. A total of 436 people were screened for GAS and where they obtained cultures from different sites for each patient. One resident had positive GAS infection from his or her catheter while four staff members tested positive through oropharyngeal culture findings. All carriers received antibiotics which helped to decolonize the infection and remained absent for 48 hours to let the antibiotics kick in entirely.
There were a variety of prevention practices that were not being performed to standards in the facility. The facility lacked recommended hand-hygiene resources and even stopped producing refills for the sanitizing devices. Sinks were not located in central areas for easy patient and nursing access. During the treatment of infectious wounds, materials were moved from room to room throughout the facility and contact precaution signs were not enforced. After training and audits of prevention practices were performed, the facility improved 70%.
The Pennsylvania Department of Health conducted a matched case-control study to identify associations between risk factors and GAS infection. The case-patients consisted of invasive and noninvasive patients at the facility. The control subjects consisted of residents selected at random showing no evidence of positive GAS symptoms. The control subjects were matched 3:1 to case-patients indicating that GAS case-patients were more likely to obtain the infection due to their treatment in the facility.