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A number of NICUs reported MRSA outbreaks in the past decade. Multiple strategies have been implemented by hospitals to prevent nosocomial MRSA infections. However, the benefit of screening and isolation of neonates has not been conclusively demonstrated.
Objective:
To evaluate the effectiveness of MRSA screening cultures and isolation in reducing the number of nosocomial MRSA infections and to assess the financial impact of this surveillance intervention.
Methods:
Beginning August 1, 2007 neonates admitted to the NICU who were >72 hours old were placed in contact isolation and screening cultures were obtained from nares, groin, and axilla. The number of nosocomial MRSA infections that occurred from January 1, 2004 to July 31, 2007 was compared to the number of nosocomial MRSA infections that occurred from August 1, 2007 to July 31, 2009. Data regarding nosocomial MRSA infections was obtained from the infection control department. Data regarding patient charges associated with the surveillance intervention was obtained from the billing department.
Results:
From January 1, 2004 to July 31, 2007 there were 1014 admissions and 10 nosocomial MRSA infections. From August 1, 2007 to July 31, 2009 there were 579 admissions and 4 nosocomial MRSA infections (p=0.74). Of the 579 admissions after the surveillance intervention began, 282 met the criteria for screening and isolation and 164 (58%) of them had cultures done. Of the 164 patients screened and isolated, 83 (51%) had positive cultures, including 12 for MRSA, 15 for MSSA, 40 for CNS and 16 for other organisms. The charge per patient was US$450. Total patient charges associated with the surveillance intervention were US$73,800. The charge to detect one MRSA colonized patient was US$6,150.
Conclusions:
Screening of selected neonates for MRSA and isolation of colonized neonates did not result in a reduction of nosocomial MRSA infections in the NICU.