Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 7, Number 2—April 2001
THEME ISSUE
4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
Prevention is Primary

"Cloud" Health-Care Workers

Robert J. SherertzComments to Author , Stefano Bassetti, and Barbara Bassetti-Wyss
Author affiliations: Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

Main Article

Table 2

Hospital group A streptococcal outbreaks suggesting airborne transmission by asymptomatic health-care workers

Reference Health-care worker Source of GASa,b Patient population Infected patients (no.)
McKee (14,15) Attendant Rectum Gynecologic 11
Schaffner (16) Anesthesiologist Rectum Surgical 20
Berkelman (17) OR nurse Vagina Surgical 10
Mastro (18) OR technician Scalp Surgical 20

aGAS air cultures were all positive
bGAS = Group A Streptococcus, OR = operating room

Main Article

References
  1. Sherertz  RJ, Marosok  RD, Streed  SA. Infection control aspects of hospital employee health. In: RP Wenzel, editor. Prevention and Control of Nosocomial Infections. Baltimore: Williams & Wilkins; 1987. p. 295-332.
  2. Decker  MD, Schaffner  W. Nosocomial diseases in healthcare workers spread by the airborne or contact routes (other than tuberculosis). In: Mayhall CG, editor. Hospital epidemiology and infection control. Baltimore: Williams & Wilkins; 1996. p. 859-82.
  3. Garner  JS; Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. CDC Hospital Infections Program Guidelines and Recommendations. 1997 Feb 18. Available from: URL:www.cdc.gov/ncidod/hip/ISOLAT/isolat.htm.
  4. Lambert  HJ. Epidemiology of a small pertussis outbreak in Kent County, Michigan. Public Health Rep. 1965;80:365–9. DOIPubMedGoogle Scholar
  5. Kurt  TL, Yeager  AS, Guenette  S, Dunlop  S. Spread of pertussis by hospital staff. JAMA. 1972;221:264–7. DOIPubMedGoogle Scholar
  6. Linneman  CC Jr, Ramundo  N, Perlstein  PH, Minton  SD, Englender  GS. Use of pertussis vaccine in an epidemic involving hospital staff. Lancet. 1975;2:540–3. DOIPubMedGoogle Scholar
  7. Addis  DG, Davis  JP, Meade  BD, Burstyn  DG, Meissner  M, Zastrow  JA, A pertussis outbreak in a Wisconsin nursing home. J Infect Dis. 1991;164:704–10. DOIPubMedGoogle Scholar
  8. Christie  CD, Gover  AM, Wilke  MJ, Marx  ML, Reising  SF, Hutchinson  NM. Containment of pertussis in the regional pediatric hospital during the Greater Cincinnati epidemic of 1993. Infect Control Hosp Epidemiol. 1995;16:556–63. DOIPubMedGoogle Scholar
  9. Nouvellon  M, Gehanno  J, Pestel-Caron  M, Weber  C, Lemeland  J, Guiso  N. Usefulness of pulse-field gel electropheresis in assessing nosocomial transmission of pertussis. Infect Control Hosp Epidemiol. 1999;20:758–60. DOIPubMedGoogle Scholar
  10. Jenkinson  D, Pepper  JD. A search for subclinical infection during a small oubreak of whooping cough: implications for clinical diagnosis. J R Coll Gen Pract. 1986;36:547–8.PubMedGoogle Scholar
  11. Krantz  I, Alestig  K, Trollfors  B, Zackrisson  G. The carrier state in pertussis. Scand J Infect Dis. 1986;18:121–3. DOIPubMedGoogle Scholar
  12. Hewlett  EL. Bordetella species. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone: 2000. p. 2414-21.
  13. Aintablian  N, Walpita  P, Sawyer  MH. Detection of Bordetella pertussis and respiratory syncytial virus in air samples from hospital rooms. Infect Control Hosp Epidemiol. 1998;19:918–23. DOIPubMedGoogle Scholar
  14. McKee  WM, di Caprio  JM, Roberts  CE Jr, Sherris  JC. Anal carriage as the probable source of a streptococcal epidemic. Lancet. 1966;2:1007–9. DOIPubMedGoogle Scholar
  15. McIntyre  DM. Epidemic of Streptococcus pyogenes puerperal and postoperative sepsis with unusual carrier site - anus. Am J Obstet Gynecol. 1968;101:308–14.PubMedGoogle Scholar
  16. Schaffner  W, Lefkowitz  LB, Goodman  JS, Koenig  MG. Hospital outbreak of infection with group A streptococci traced to an asymptomatic anal carrier. N Engl J Med. 1969;280:1224–5. DOIPubMedGoogle Scholar
  17. Berkelman  RL, Martin  D, Graham  DR, Mowry  J, Freisem  R, Weber  JA, Streptococcal wound infections caused by a vaginal carrier. JAMA. 1982;247:2680–2. DOIPubMedGoogle Scholar
  18. Mastro  TD, Farley  TA, Elliott  JA, Facklam  RR, Perks  JR, Hadler  JL, An outbreak of surgical wound infections due to group A streptococcus carried on the scalp. N Engl J Med. 1990;323:968–72. DOIPubMedGoogle Scholar
  19. White  A. Relation between quantitative nasal cultures and dissemination of staphylococci. J Lab Clin Med. 1961;58:273–7.PubMedGoogle Scholar
  20. Huijsmans-Evers  AG. Results of routine tests for the detection of dispersers of Staphylococcus aureus. Archivum Chirurgicum Neerlandia. 1978;30:141–50.PubMedGoogle Scholar
  21. Bethune  DW, Blowers  R, Parker  M, Pask  EA. Dispersal of Staphylococcus aureus by patients and surgical staff. Lancet. 1965;1:480–3. DOIPubMedGoogle Scholar
  22. Hill  J, Howell  A, Blowers  R. Effect of clothing on dispersal of Staphylococcus aureus by males and females. Lancet. 1974;2:1131–3. DOIPubMedGoogle Scholar
  23. Hare  R, Thomas  CGA. The transmission of Staphylococcus aureus. BMJ. 1956;2:840–4. DOIPubMedGoogle Scholar
  24. Hare  R, Mackenzie  DM. The source and transmission of nasopharyngeal infections due to certain bacteria and viruses. BMJ. 1946;1:865–70. DOIPubMedGoogle Scholar
  25. Duguid  JP, Wallace  AT. Air infection with dust liberated from clothing. Lancet. 1948;2:845–9. DOIPubMedGoogle Scholar
  26. Ehrenkranz  NJ. Person-to-person transmission of Staphylococcus aureus. Quantitative characterization of nasal carriers spreading infection. N Engl J Med. 1964;271:225–30. DOIPubMedGoogle Scholar
  27. Rammelkamp  CH Jr, Mortimer  EA Jr, Wolinsky  E. Transmission of streptococcal and staphylococcal infections. Ann Intern Med. 1964;60:753–8.PubMedGoogle Scholar
  28. Mortimer  EA, Wolinsky  E, Gonzaga  AJ, Rammelkamp  CH. Role of airborne transmission in staphylococcal infections. BMJ. 1966;1:319–22. DOIPubMedGoogle Scholar
  29. Nobel  WC. The dispersal of staphylococci in hospital wards. J Clin Pathol. 1962;15:552–8. DOIPubMedGoogle Scholar
  30. Shooter  RA, Smith  MA, Griffiths  JD, Brown  MEA, Williams  REO, Rippon  JE, Spread of staphylococci in a surgical ward. BMJ. 1958;1:607–13. DOIPubMedGoogle Scholar
  31. Hare  R, Cooke  EM. Self-contamination of patients with staphylococcal infections. BMJ. 1961;2:333–6. DOIPubMedGoogle Scholar
  32. Tanner  EI, Bullin  J, Bullin  CH, Gamble  DR. An outbreak of post-operative sepsis due to a staphylococcal disperser. J Hyg (Lond). 1980;85:219–25. DOIPubMedGoogle Scholar
  33. Sherertz  RJ, Reagan  DR, Hampton  KD, Robertson  KL, Streed  SA, Hoen  HM, A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med. 1996;124:539–47.PubMedGoogle Scholar
  34. Belani  A, Sherertz  RJ, Sullivan  ML, Russell  BA, Reumen  PD. Outbreak of staphylococcal infection in two hospital nurseries traced to a single nasal carrier. Infect Control. 1986;7:487–90.PubMedGoogle Scholar
  35. Boyce  JM, Opal  SM, Potter-Bynoe  G, Medeiros  AA. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Ann Intern Med. 1993;17:496–504.PubMedGoogle Scholar
  36. Eichenwald  H, Kotsevalov  O, Fasso  LA. The "cloud baby": an example of bacterial-viral interaction. Am J Dis Child. 1960;100:161–73.PubMedGoogle Scholar
  37. Dunkle  LM, Naqvi  SH, McCallum  R, Lofgren  JP. Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Am J Med. 1981;70:455–8. DOIPubMedGoogle Scholar
  38. Hedberg  K, Ristinen  TL, Soler  JT, White  KE, Hedberg  CW, Osterholm  MT, Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery. Pediatr J Infect Dis. 1990;9:268–73. DOIPubMedGoogle Scholar
  39. Coovadia  YM, Bhana  RH, Johnson  AP, Haffejee  I, Marples  RR. A laboratory-confirmed outbreak of rifampin-methicillin resistant Staphylococcus aureus (MRSA) in a newborn nursery. J Hosp Infect. 1989;14:303–12. DOIPubMedGoogle Scholar
  40. Dancer  SJ, Poston  SM, East  J, Simmons  NA, Noble  WC. An outbreak of pemphigus neonatorum. J Infect. 1990;20:73–82. DOIPubMedGoogle Scholar
  41. Gaynes  R, Marosok  R, Mowry-Hanley  J, Laughlin  C, Foley  K, Friedman  C, Mediastinitis following coronary artery bypass surgery: a 3-year review. J Infect Dis. 1991;163:117–21. DOIPubMedGoogle Scholar
  42. Simon  PA, Chen  RT, Elliott  JA, Schwartz  B. Outbreak of pyogenic abscesses after diphtheria and tetanus toxoids and pertussis vaccination. Pediatr J Infect Dis. 1993;12:368–71. DOIPubMedGoogle Scholar
  43. Nakashima  AK, Allen  JR, Martone  WJ, Plikaytis  BD, Stover  B, Cook  LN, Epidemic bullous impetigo in a nursery due to a nasal carrier of Staphylococcus aureus: role of epidemiology and control measures. Infect Control. 1984;5:326–31.PubMedGoogle Scholar
  44. Hoeger  PH, Elsner  P. Staphylococcal scaled skin syndrome: transmission of exfoliatin-producing Staphylococcus aureus by an asymptomatic carrier. Pediatr Infect Dis J. 1988;7:340–2. DOIPubMedGoogle Scholar
  45. Richardson  JF, Quoraishi  AH, Francis  BJ, Marples  RR. Beta-lactamase-negative, methicillin-resistant Staphylococcus aureus in a newborn nursery: report of an outbreak and laboratory investigations. J Hosp Infect. 1990;16:109–21. DOIPubMedGoogle Scholar
  46. Back  NA, Linnemann  CC Jr, Pfaller  MA, Staneck  JL, Morthland  V. Recurrent epidemics caused by a single strain of erythromycin-resistant Staphylococcus aureus. The importance of molecular epidemiology. JAMA. 1993;270:1363–4. DOIPubMedGoogle Scholar
  47. Chowdhury  MN, Kambal  AM. An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit. J Hosp Infect. 1992;22:299–305. DOIPubMedGoogle Scholar
  48. Walter  CW, Kundsin  RB, Brubaker  MM. The incidence of airborne wound infection during operation. JAMA. 1963; 908–13.PubMedGoogle Scholar
  49. Venezia  RA, Harris  V, Miller  C, Peck  H. san Antanio M. Investigation of an outbreak of methicillin-resistant Staphylococcus aureus in patients with skin disease using DNA restriction patterns. Infect Control Hosp Epidemiol. 1992;13:472–6. DOIPubMedGoogle Scholar
  50. Trilla  A, Nettleman  MD, Hollis  RJ, Fredrickson  M, Wenzel  RP, Pfaller  MA. Restriction endonuclease analysis of plasmid DNA from methicillin-resistant Staphylococcus aureus: clinical application over a three-year period. Infect Control Hosp Epidemiol. 1993;14:29–35. DOIPubMedGoogle Scholar
  51. Payne  RW. Severe outbreak of surgical sepsis due to Staphylococcus aureus of unusual type and origin. BMJ. 1967;4:17–20. DOIPubMedGoogle Scholar
  52. Allen  KD, Anson  JJ, Parsons  LA, Frost  NG. Staff carriage of methicillin-resistant Staphylococcus aureus (EMRSA 15) and the home environment: a case report. J Hosp Infect. 1997;37:74–5.PubMedGoogle Scholar
  53. Williams  REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev. 1963;27:56–71.PubMedGoogle Scholar
  54. Haley  RW, Bregman  DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis. 1982;145:875–85. DOIPubMedGoogle Scholar
  55. Reagan  DR, Doebbeling  BN, Pfaller  MA, Sheetz  CT, Houston  AK, Hollis  RJ, Elimination of coincident S. aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med. 1991;114:101–6.PubMedGoogle Scholar
  56. Waldvogel  FA. Staphylococcus aureus (including toxic shock syndrome). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. New York: Churchill Livingston; 1995. p. 1754-77.
  57. Hamre  D, Connelly  AP Jr, Procknow  JJ. Virologic studies of acute respiratory disease in young adults. Am J Epidemiol. 1966;83:238–49.PubMedGoogle Scholar
  58. Bassetti  S, Bassetti-Wyss  B, D'Agostino  R, Gwaltney  JM, Pfaller  MA, Sherertz  RJ. "Cloud adults" exist: airborne dispersal of Staphylococcus aureus associated with a rhinovirus infection [Abstract #115]. 38th Annual Meeting of the Infectious Diseases Society of America; Sept 7-10 2000; New Orleans, Louisiana.
  59. Nichol  KP, Cherry  JD. Bacterial-viral interrelations in respiratory infections of children. N Engl J Med. 1967;277:667–72. DOIPubMedGoogle Scholar
  60. Gwaltney  JM, Sande  MA, Austrian  R, Hendley  JO. Spread of Streptococcus pneumoniae in families. Relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J Infect Dis. 1975;132:62–8. DOIPubMedGoogle Scholar
  61. Harrison  LH, Armstrong  CW, Jenkins  SR, Harmon  MW, Ajello  GW, Miller  GB Jr, A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med. 1991;151:1005–9. DOIPubMedGoogle Scholar
  62. Gwaltney  JM, Hayden  FG. The nose and infection. Ed. by. In: Proctor DF, Andersen I, editors. The nose: upper airway physiology and the atomspheric environment. Amsterdam: Elsevier Biomedical Press; 1982. p.399-422.

Main Article

Page created: May 10, 2011
Page updated: May 10, 2011
Page reviewed: May 10, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external