The mode of transmission is presumed to be airborne. Surgical and obstetric patients are particularly vulnerable to infection because broken cutaneous or mucosal barriers facilitate invasive infection after exposure. To prevent additional nosocomial GAS infections, enhanced surveillance and limited epidemiologic investigation are warranted following one episode of nosocomial GAS infection on a surgical or obstetric ward. After identification of a patient with postoperative or postpartum GAS, medical and laboratory records should be reviewed to identify other infections, and isolates from infected patients should be stored and surveillance heightened to identify additional episodes. When an episode of postoperative or postpartum GAS is identified, limited HCW screening should be undertaken.
Most nosocomial transmission is traced to carriers involved in direct patient care.
For a postpartum GAS-infected patient, screening should include all HCWs present at the delivery and those who performed vaginal examinations before delivery. For a postoperative GAS-infected patient, screening should include all HCWs present in the operating room during the procedure and those who changed dressings on open wounds. Screening of HCWs should include culture of the nares, throat, vagina, rectum, and skin. HCWs may return to work pending culture results. Any HCW culture-positive for GAS should refrain from patient care for the first 24 hours of antimicrobial treatment.