Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: A possible link to contaminated hand lotion

This article describes a prolonged outbreak of Pseudomonas aeruginosa. The attack rate of this outbreak was 8.5%, with no associated mortality. Hand lotion contaminated with P. aeruginosa was implicated in the transmission of organisms; removal of this hand lotion ended the outbreak. Contaminated hand lotion applied to clean hands of health care workers may have led to direct inoculation of infants at high risk for infection.