873 - Clusters of Postpartum Group A Streptococcus (GAS) Infections on a Labor and Delivery (L&D) Unit June-October 2019

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Presenting Author(s)

Michael Haden

Assistant Professor
The Ohio State University
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CL

Christina Liscynesky

Assistant Professor of Internal Medicine
The Ohio State Univiersity Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Nora Colburn

Assistant Professor of Medicine; Medical Director of Clinical Epidemiology, Ross Heart Hospital
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JS

Justin Smyer

Director
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
IG

Iahn Gonsenhauser

Chief Quality & Patient Safety Officer
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Kimberly Malcolm

Infection preventionist
The Ohio State University Wexner Medical Center
Circleville, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MI

Michelle M. Isley

Associate Professor
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MH

Michele Hardgrow

Nurse Manager
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PP

Preeti Pancholi

Professor - Clinical
The Ohio State University College of Medicine
Columbus, OH
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KT

Keelie E. Thomas

Lead Medical Laboratory Scientist
The Ohio State University Wexner Medical Center
Blacklick, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AC

Anita Cygnor

Director of Nursing Department of Women and Infants
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HT

Heather Tabor

Nurse Manager
The Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BB

Brynn Berger

Epidemiologist
Columbus Public Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
OA

Oluseun Aluko

Public Health Program Manager/ Outbreak Response Coordinator
Columbus Public Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EK

Elizabeth Koch

Outbreak Response Director
Columbus Public Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NT

Naomi E. Tucker

Director, Office of Infectious Disease Investigation
Columbus Public Health
Hilliard, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Eric Brandt

Laboratory Scientist 3
Ohio Department of Health
Reynoldsburg, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KC

Katie Cibulskas

Infectious Disease Epidemiologist
None
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KF

Kelsey Florek

Bioinformatician
Wisconsin State Laboratory of Hygiene
Madison, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Marika C. Mohr

Healthcare-Associated Infections Coordinator
Ohio Department of Health
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SD

Shandra R. Day

Assistant Professor - Clinical
Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: GAS can cause severe postpartum infections and may be transmitted from colonized healthcare workers (HCWs).

Methods: Two cases of GAS bacteremia following vaginal delivery were identified on the L&D unit June-July 2019 (Cluster 1), prompting a carrier-disseminator investigation. Two additional cases were identified September-October 2019 (Cluster 2), followed by an additional 3 cases late October 2019, all of whom delivered on the same night (Cluster 3).
All patients and HCWs were evaluated for GAS risk factors and screened for colonization via throat, vaginal and perirectal cultures. During Clusters 1 and 2, only HCWs with patient contact were screened, but this was expanded to the entire unit in October after Cluster 3 was identified. All GAS colonized HCWs were provided chemoprophylaxis and rescreened 7-10 days after treatment to ensure eradication. GAS isolates from patients and HCWs were analyzed by whole genome sequencing (WGS).

Results: During Cluster 1 a total of 43 HCWs were screened and HCWA was colonized at all three sites. In Cluster 2, nine HCWs were screened; HCWA was negative at that time but HCWB was colonized in the throat only. Patient 3 was confirmed to be community acquired by pulsed-field gel electrophoresis, patient 4 was closely related by WGS. A new policy was instituted that required all HCWs present at delivery to wear gowns, gloves, masks, eye protection, and to undergo infection prevention education and practice review. Following Cluster 3, all HCWs on the unit were screened (681 total). HCWA was again positive at all 3 sites and two additional HCWs were found to be colonized with the outbreak strain on throat swab only. Isolates from patients 1, 2, 4, 5, 6, 7 and the 4 HCWs were identified as subtype emm 28 and all closely related by WGS (figure 1). A household contact of HCWA was colonized with the outbreak strain as well.Figure 1

Conclusion: A carrier-disseminator investigation identified clusters of nosocomial postpartum GAS infections involving 6 patients, 4 HCWs and a HCW household contact that were highly related based on WGS. The outbreak strain of GAS was likely spread amongst HCWs via ping pong transmission on the unit. Transmission to patients was halted with implementation of strict infection prevention measures and mass screening and chemoprophylaxis of all colonized HCWs.