Nasal infection of two comatose patients with fly larvae has been linked to a Missouri hospital's widespread mouse infestation, which occurred after the hospital laid off housekeeping staff.

The disruption or loss of one vital link in hospital organization (in this case, housekeeping support) may lead to an unintended and bizarre outcome.

In the first instance, maggots were found in the mouth and nose of a 45-year-old man 10 days after he was admitted to the hospital's intensive care unit (ICU) in July 1998. The patient died from an unrelated cause 2 days after the larvae were removed.

Two months later, maggots were found around the nasotracheal tube of a 49-year-old man 8 days after he was admitted to the ICU of the same hospital. The larvae, along with adult flies found in the area, were retrieved and later identified as P. sericata, or green blowflies. More than 100 green blowfly eggs can grow and mature to adulthood in a typical mouse carcass, the report indicates.

Hospital personnel had previously complained about fly infestation of the ICU, but the problem was thought to be due to construction that required the constant opening of windows and doors. The installation of insect light traps in the medical ICU and adjacent corridors did little to abate the problem.

Upon inspection of the hospital cafeteria and canteen, mouse carcasses were found in food storage rooms, mouse nests were found on food shelves, live mice were found trapped in a wastebasket and numerous mouse droppings were observed on the canteen workroom floor.

Neither the cafeteria nor the canteen had been cleaned for at least one year due to downsizing of housekeeping personnel, the researchers note.

According to other media sources, the incident occurred at the Kansas City Veteran's Administration Medical Center.

Archives of Internal Medicine March 25, 2002;162:638-640