Introduction. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for infections in patients both inside and outside of the hospital and causes outbreaks. Here, we demonstrate the characteristics and control of a MRSA outbreak related to a carbon dioxide hydrotherapy bathtub. Methods. We conducted an outbreak investigation and performed a molecular typing of the outbreak strains with pulsed-field gel electrophoresis (PFGE). In addition, we reviewed PubMed and the Outbreak Database for MRSA outbreaks related to hydrotherapy or other bathing activities. Results. Four patients acquired nosocomial MRSA during the 4-week outbreak period. Environmental sampling revealed the presence of MRSA in the bathtub used for hydrotherapy. The environmental and the patients’ isolates showed an indistinguishable restriction pattern in the PFGE. Subsequent discontinuation of bathing stopped the outbreak. The literature search found 9 MRSA outbreak reports related to bathing activities or hydrotherapy. Conclusion. The epidemiologic outbreak investigation together with the molecular findings suggests monoclonal spread of MRSA due to surface contamination of the bathtub. After enhancing the disinfection and cleaning process accompanied by staff training with respect to hand hygiene, no further cases occurred. Standardized and best practice cleaning and disinfection protocols are crucial, especially in critical facilities such as hydrotherapy units. Regular environmental sampling is helpful to monitor these processes and to detect potential contamination.

中文翻译：

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用于二氧化碳水疗的污染浴缸引起的 MRSA 爆发的流行病学和分子学调查及文献回顾。

简介。耐甲氧西林金黄色葡萄球菌(MRSA) 是医院内外患者感染的原因，并导致疾病暴发。在这里，我们展示了与二氧化碳水疗浴缸相关的 MRSA 爆发的特征和控制。方法。我们进行了暴发调查，并使用脉冲场凝胶电泳 (PFGE) 对暴发菌株进行了分子分型。此外，我们审查了 PubMed 和爆发数据库中与水疗或其他沐浴活动相关的 MRSA 爆发。结果. 4 名患者在 4 周的暴发期间获得了院内 MRSA。环境采样显示用于水疗的浴缸中存在 MRSA。环境和患者的分离物在 PFGE 中显示出无法区分的限制模式。随后停止洗澡阻止了疫情的爆发。文献检索发现了 9 篇与沐浴活动或水疗相关的 MRSA 暴发报告。结论. 流行病学暴发调查和分子发现表明，由于浴缸表面污染导致 MRSA 的单克隆传播。在加强消毒和清洁流程，同时对员工进行手部卫生培训后，没有再发生病例。标准化和最佳实践的清洁和消毒方案至关重要，尤其是在水疗设备等关键设施中。定期进行环境采样有助于监控这些过程并检测潜在的污染。