An Epidemic of Bullous Impetigo Arising From a Central Admission-Observation Nursery

An epidemic of discrete exfoliative skin lesions associated with group II staphylococci was recognized in infants recently discharged from a newborn nursery unit. Bacteriologic surveillance of infants discharged from the nursery indicated a recent increase in colonization of infants with this organism. Nasal cultures from personnel and environmental cultures failed to reveal the source of the epidemic. Isolation of the organism from two infants discharged home directly from the admission-observation nursery suggested that the epidemic was being perpetuated by a reservoir of infection among infants in this central nursery. Following a change in the location of this nursery, with physical separation of all new admissions from previously colonized infants, there was an immediate and significant decrease in colonization with the epidemic strain of staphylococcus. Closing of the entire admitting nursery and converting to a cohort system was associated with a total disappearance of the epidemic strain.