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A Cluster of Group A Streptococcal Infections in a Skilled Nursing Facility—the Potential Role of Healthcare Worker Presenteeism
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Nov 07 2016
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Source: J Am Geriatr Soc. 64(12):e279-e284.
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Details:
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Alternative Title:J Am Geriatr Soc
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Personal Author:
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Description:OBJECTIVES
To determine the extent of a group A streptococcus (GAS) cluster (2 residents with invasive GAS (invasive case-patients), 2 carriers) caused by a single strain (T antigen type 2 and M protein gene subtype 2.0 (T2, emm 2.0)), evaluate factors contributing to transmission, and provide recommendations for disease control.
DESIGN
Cross-sectional analysis and retrospective review.
SETTING
Skilled nursing facility (SNF).
PARTICIPANTS
SNF residents and staff.
MEASUREMENTS
The initial cluster was identified through laboratory notification and screening of SNF residents with wounds. Laboratory and SNF administrative records were subsequently reviewed to identify additional residents with GAS, oropharyngeal and wound (if present) swabs were collected from SNF staff and residents to examine GAS colonization, staff were surveyed to assess infection control practices and risk factors for GAS colonization, epidemiologic links between case-patients and persons colonized with GAS were determined, and facility infection control practices were assessed.
RESULTS
No additional invasive case-patients were identified. Oropharyngeal swabs obtained from all 167 SNF residents were negative; one wound swab grew GAS that was the same as the outbreak strain (T2, emm 2.0). The outbreak strain was not identified in any of the 162 staff members. One of six staff members diagnosed with GAS pharyngitis worked while ill and had direct contact with invasive case-patients within a few weeks before their onset of symptoms. Additional minor breaches in infection control were noted.
CONCLUSION
Sick healthcare workers may have introduced GAS into the SNF, with propagation by infection control lapses. “Presenteeism,” or working while ill, may introduce and transmit GAS to vulnerable in SNF populations. Identification of an invasive GAS case-patient should trigger a prompt response by facilities to prevent further transmission and workplace culture, and policies should be in place to discourage presenteeism in healthcare settings.
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Subjects:
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Source:
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Pubmed ID:27996105
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Pubmed Central ID:PMC5742861
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Volume:64
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Issue:12
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