A prolonged and large outbreak of invasive group A streptococcal disease within a nursing home: repeated intra-facility transmission of a single strain.

Inadequate infection control and improper wound care practices likely led to this 28-month long outbreak of severe infections in a skilled nursing facility. WGS and phylogenetic analysis suggested that intra-facility transmission of a single highly transmissible GAS strain was responsible for the outbreak in Facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.