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610 Control of a Methicillin Resistant Staphylococcus aureus (MRSA) Outbreak in a Neonatal Intensive Care Unit (NICU) without Treating MRSA Colonization

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Elisa M. Hill, RN, MPH , St. John's Hospital, Springfield, IL
Subhash C. Chaudhary, MD , Southern Illinois University School of Medicine, Springfield, IL
Margaret Patterson, RN, BSN , St. John's Hospital, Springfield, IL
Chris Greene, RN, BSN , St. John's Hospital, Springfield, IL
Background: Occurrence of two infants with healthcare-associated MRSA (HA-MRSA) bacteremia within 28 days in our 40-bed Level III NICU led the NICU Infection Prevention (IP) team to initiate epidemiologic investigation in August 2008.  Previous HA-MRSA infection occurred in November 2007.

Objective: Control of MRSA outbreak using basic infection prevention and control measures to interrupt MRSA transmission, and weekly active surveillance cultures (SC) of infants to assess ongoing MRSA transmission and need for additional control measures.  IP team considered SC of healthcare workers (HCW) but deferred.

Methods: Control measures included strict hand hygiene; contact precautions for all infants; cohorting [(a) known colonized or infected; (b) exposed; (c) new admissions or transfers in]; and weekly SC of all infants.  Other measures included: cohorting staff assignments when possible; review of procedures for housekeeping, equipment cleaning and disinfection, and patient care; and requesting staff report potential infection, or any skin lesion for evaluation.

Results: Exposed cohort: 24% (8/33) positive for MRSA colonization during first three weeks.  Subsequent weekly SC were all negative.  New admission or transfer in cohort: All 135 infants were culture negative on admission and weekly thereafter.  Two nurses with MRSA infection: Restricted from patient care until infection resolved and antibiotic therapy completed.  Pulsed-field gel electrophoresis (PFGE) analysis of 11 MRSA isolates: Indistinguishable from each other. This strain may have been present since November 2007.  The last colonized infant was discharged home December 2008.

Conclusions: Clonal outbreak of MRSA in NICU was controlled without treating asymptomatic colonized infants or conducting SC of HCW.  Weekly SC of infants and PFGE were useful tools in assessing ongoing transmission and enhancing infection prevention practices.