Eradication of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: which measures for...

Area of Science:

• Infectious Disease Epidemiology
• Neonatal Care
• Public Health Microbiology

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks pose significant challenges in Neonatal Intensive Care Units (NICUs).
• Previous control strategies have yielded variable success rates in mitigating MRSA transmission.
• This study details a prolonged MRSA outbreak in a university hospital NICU from 2004 to 2007.

Purpose of the Study:

• To investigate the effectiveness of various interventions for controlling a persistent MRSA outbreak in a NICU setting.
• To identify factors contributing to the control and ongoing spread of MRSA within the NICU.
• To provide evidence-based recommendations for future MRSA outbreak management in neonatal populations.

Main Methods:

• Case definition included MRSA detection via clinical or surveillance cultures from neonates.
• Systematic neonate screening for MRSA colonization was conducted for a defined period.
• Interventions evaluated included barrier precautions, mupirocin application, cohort isolation, hand hygiene audits, and staff training.

Main Results:

• During the surveillance period (48 weeks), 46 neonates tested positive for MRSA and received mupirocin treatment.
• MRSA spread was not eradicated despite mupirocin use; 9 sporadic cases occurred post-December 2005.
• The outbreak was considered controlled after December 2005, coinciding with enhanced infection control measures.

Conclusions:

• Widespread mupirocin application in neonates and healthcare workers did not effectively control the MRSA outbreak and is not recommended.
• Increased hand hygiene audits, staff training, and cohort isolation strategies were associated with outbreak control.
• Effective MRSA control in NICUs relies on a combination of stringent infection prevention practices and targeted isolation protocols.