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.