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Eradication of Methicillin-Resistant Staphylococcus Aureus From a Neonatal Intensive Care Unit by Active Surveillance and Aggressive Infection Control Measures

Published online by Cambridge University Press:  21 June 2016

Jad Khoury ,
Marilyn Jones ,
Autumn Grim ,
Wm. Michael Dunne Jr  and
Vicky Fraser
Jad Khoury
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marilyn Jones
Affiliation:
BJC Infection Control and Healthcare Epidemiology Consortium, Washington University School of Medicine, St. Louis, Missouri
Autumn Grim
Affiliation:
BJC Infection Control and Healthcare Epidemiology Consortium, Washington University School of Medicine, St. Louis, Missouri
Wm. Michael Dunne Jr
Affiliation:
Department of Microbiology, Washington University School of Medicine, St. Louis, Missouri
Vicky Fraser*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Infectious Diseases Division, Washington University School of Medicine, Box 8051, 660 S. Euclid Ave., St. Louis, MO 63110.vfraser@im.wustl.edu
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Abstract

Objectives:

To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it.

Setting:

An 18-bed, level III-IV NICU in a community hospital.

Methods:

Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and decolonization of infants and HCWs with MRSA. A case–control study was performed to compare infants with and without MRSA.

Results:

A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9–363.1) and infection (OR, 5.36; CI95, 1.37–20.96). Gavage feeding (OR, 10.33; CI95, 1.28–83.37) and intubation (OR, 5.97; CI95, 1.22–29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA.

Conclusion:

Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2½ years following the outbreak. (Infect Control Hosp Epidemiol 2005;26:616-621)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 7 , July 2005 , pp. 616 - 621
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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