PseudomonasSurgical-Site Infections Linked to a Healthcare Worker With Onychomycosis

Abstract

AbstractObjective:To determine the etiology ofPseudomonas aeruginosasurgical-site infections following cardiac surgery.Setting:University teaching hospital.Patients:Those with wound cultures that grewP. aeruginosaafter cardiac surgery performed from 1999 to 2001.Methods:Medical records and operating room (OR) records of patients withP. aeruginosacardiac surgical-site infections from 1999 to 2001 were reviewed. Healthcare workers involved with two or more cases were interviewed and examined. Specimens for environmental cultures were obtained from the ORs and cardiac surgical equipment. Cardiac surgery cases were observed and postoperative care and the cleaning of surgical instruments were investigated. OR air handling system records during the epidemic period were reviewed. Molecular fingerprinting of availableP. aeruginosaisolates from infected patients and a healthcare worker was done.Results:There were fiveP. aeruginosacardiac surgical-site infections from January to August 2001, compared with no such infections from 1999 to 2000. All were adult patients. One cardiac surgeon with onychomycosis operated on all five cases. He did not routinely double glove. The involved fingernail grewP. aeruginosa.ThreeP. aeruginosapatient isolates were available for pulsed-field gel electrophoresis; two were identical to the isolate from the involved surgeon's onychomycotic nail. No environmental OR cultures grewP. aeruginosa.The surgeon's culture-positive nail was completely removed. There have been noP. aeruginosasurgical-site infections among cardiac surgery patients since this intervention.Conclusion:At least two cases of a cluster ofP. aeruginosasurgical-site infections resulted from colonization of a cardiac surgeon's onychomycotic nail.