Investigation of a healthcare-associated infection in Bethal hospital, Mpumalanga province, South Africa, July to August 2025
1
1 Communicable Disease Control, Mpumalanga Department of Health, Mbombela, South Africa
2
2 South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Division of the National Health Laboratory Services, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3092
ABSTRACT
BACKGROUND:
Serratia marcescens is a Gram-negative bacillus frequently implicated in healthcare-associated infections and notable for multidrug resistance. Between June and August 2025, an unusual cluster of S. marcescens infections was detected in the male medical ward of a district hospital in Gert Sibande District, Mpumalanga Province. An investigation was conducted to identify potential sources of infection and assess infection prevention and control (IPC) practices.
METHODS:
A retrospective descriptive review of clinical and laboratory records was conducted for patients with laboratory-confirmed S. marcescens infection. Environmental swabs were collected from frequently touched surfaces and shared equipment. IPC practices were assessed using a structured checklist focusing on personal protective equipment (PPE) use, patient isolation, and cleaning and disinfection procedures.
RESULTS:
Four confirmed cases were identified. The index patient was transferred from a local correctional facility, and another patient had an extended hospital stay, suggesting possible shared exposure. Three patients (75%) presented with respiratory tract infections, while one (25%) developed a wound infection during hospitalisation. Environmental sampling detected Gram-negative rods in 25% of swabs and Bacillus species in 60%, indicating inadequate cleaning practices. The IPC assessment revealed multiple gaps, including inconsistent use of PPE, failure to isolate the index patient, and poor environmental hygiene. Due to non-functional showers, a stainless steel basin was used for patient bathing and shared among multiple patients without disinfection between uses. There was no documented deep-cleaning schedule, routine cleaning was limited, and high-touch items such as patient files and cardiac tables were not disinfected between uses. The case fatality rate was 50%.
CONCLUSIONS:
This investigation identified a healthcare-associated cluster of S. marcescens infections linked to prior exposure in a correctional facility, environmental contamination, and IPC deficiencies. Strengthening surveillance, ensuring consistent PPE use, isolating high-risk patients, and improving environmental cleaning and disinfection practices are critical to preventing future outbreaks.
Serratia marcescens is a Gram-negative bacillus frequently implicated in healthcare-associated infections and notable for multidrug resistance. Between June and August 2025, an unusual cluster of S. marcescens infections was detected in the male medical ward of a district hospital in Gert Sibande District, Mpumalanga Province. An investigation was conducted to identify potential sources of infection and assess infection prevention and control (IPC) practices.
METHODS:
A retrospective descriptive review of clinical and laboratory records was conducted for patients with laboratory-confirmed S. marcescens infection. Environmental swabs were collected from frequently touched surfaces and shared equipment. IPC practices were assessed using a structured checklist focusing on personal protective equipment (PPE) use, patient isolation, and cleaning and disinfection procedures.
RESULTS:
Four confirmed cases were identified. The index patient was transferred from a local correctional facility, and another patient had an extended hospital stay, suggesting possible shared exposure. Three patients (75%) presented with respiratory tract infections, while one (25%) developed a wound infection during hospitalisation. Environmental sampling detected Gram-negative rods in 25% of swabs and Bacillus species in 60%, indicating inadequate cleaning practices. The IPC assessment revealed multiple gaps, including inconsistent use of PPE, failure to isolate the index patient, and poor environmental hygiene. Due to non-functional showers, a stainless steel basin was used for patient bathing and shared among multiple patients without disinfection between uses. There was no documented deep-cleaning schedule, routine cleaning was limited, and high-touch items such as patient files and cardiac tables were not disinfected between uses. The case fatality rate was 50%.
CONCLUSIONS:
This investigation identified a healthcare-associated cluster of S. marcescens infections linked to prior exposure in a correctional facility, environmental contamination, and IPC deficiencies. Strengthening surveillance, ensuring consistent PPE use, isolating high-risk patients, and improving environmental cleaning and disinfection practices are critical to preventing future outbreaks.
| eISSN: | 2654-1459 |
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