Nosocomial Outbreak of Candida albicans Sternal Wound Infections following Cardiac Surgery Traced to a Scrub Nurse

From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting > 165 min (11/15 vs. 20/45; odds ratio [OR], 5.0; 95% confidence interval [CI], 1.5-16.3) or exposure to first scrub nurse A (15/15 vs. 22/45; OR, infinity; 95% CI, 2.5, infinity). Molecular typing of 5 case-patient C. albicans isolates revealed a common strain. Nurse A had a history of recurrent vaginal infections responding to topical antifungal agents; however, cultures of multiple samples from nurse A, beginning 3 weeks after the last infected patient's surgery, failed to yield C. albicans. Following her voluntary transfer from cardiac surgery, no additional infections of case-patients were detected. This study demonstrates the utility of combining epidemiologic methods and molecular typing in investigating C. albicans infection clusters and suggests that a common exogenous source can be responsible for C. albicans surgical wound infections.