28. Role of UV Light in the Control of a MRSA Outbreak in a Pediatric Hospital in México.
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Background: MRSA infections substantially increase mortality and hospitalization costs. Outbreaks can have a great impact in healthcare institutions. UV light disinfection reduces MRSA in surfaces and may contribute to outbreak control.

Methods: We describe a MRSA outbreak in a 371-bed pediatric referral hospital in México. Active, hospital-wide surveillance of healthcare associated infections is routinely performed. Kirby-Bauer method was employed to identify MRSA phenotype according to CLSI 2017. PFGE genotyping was performed on all nosocomial MRSA isolates. UV-C light was applied in two 5-minute cycles with the UVDI UV360TM device in the operating room (OR).

Results: The MRSA attack rate increased from 0.02 to 0.14/100 discharges (from 2 cases per year to 5 cases in January-May 2017). Simultaneously, the surgical site infection (SSI) rate increased from 0.6 to 1.6/100 surgeries. Four out of five MRSA cases had surgery or central-line insertion in the OR less than 2 weeks before infection. Hand hygiene and antibiotic prophylaxis were reviewed and improved. Weekly UV-C light disinfection in the OR was implemented. Nasal swabs collected from all surgeons, anesthesiologists and OR nurses (N=120) were negative for MRSA. High touch surface sampling revealed MRSA on anesthesia machines. OR cleaning and disinfection were reviewed and nasal swabs collected from technicians responsible for anesthesia equipment; 2/19 resulted positive for MRSA and nasal mupirocin was prescribed. Nevertheless, there were 3 additional cases (including 1 death) from June to September 2017, all with a history of exposure to the OR. On August, the frequency of UV-C disinfection was increased (M-F). In September, anesthesia machine disinfection was improved. All MRSA isolates from patients, technicians and surfaces were clonally related (r= 0.97062)(Fig. 1). Remarkably, there were no MRSA cases when the OR had been disinfected with UV-C less than 24 hours before the procedure. There have been no other MRSA cases since October 2017 until now (May 2018) (Fig. 2).

Conclusion: MRSA nasal colonization of maintenance technicians and contamination of anesthesia equipment were associated with a MRSA outbreak. UV-C light disinfection, together with standard interventions, was effective in achieving outbreak control.

Daniela De La Rosa Zamboni, MSC1, Almudena Laris González, MD1, Juan Xicohtencatl Cortes, PHD2, Sara Ariadna Ochoa Pérez, PHD2, Víctor Edmundo Fuentes García, MD3, Diana Moyao Garcia, MD3, Eric Ochoa Hein, MD4, Israel Parra Ortega, MSC5, María Isabel Franco Hernandez, MD5, Ariadnna Del Carmen Cruz Córdova, PhD6 and German Alberto Venegas Esquivel, MD7, (1)Departament of Hospital Epidemiology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, (2)Departament of Laboratory of Intestinal Bacteriology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, (3)Departament of Anesthesiology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, (4)Departament of Hospital Epidemiology Healthcare-Associated Infection Research, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (5)Departament of Clinical Laboratory, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, (6)Intestinal Bacteriology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, (7)Departament of Infectious Disease, Hospital Infantil de México Federico Gómez, Mexico City, Mexico

Disclosures:

D. De La Rosa Zamboni, None

A. Laris González, None

J. Xicohtencatl Cortes, None

S. A. Ochoa Pérez, None

V. E. Fuentes García, None

D. Moyao Garcia, None

E. Ochoa Hein, None

I. Parra Ortega, None

M. I. Franco Hernandez, None

A. D. C. Cruz Córdova, None

G. A. Venegas Esquivel, None

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