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Updated: Aug 14, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Reducing MRSA Infection in a New NICU During the COVID-19 Pandemic
Renee E Barrett1, Noa Fleiss1, Caitlin Hansen1
1Yale School of Medicine, New Haven, Connecticut.
Background And Objectives:
Methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in most NICUs, with a high rate of skin colonization and subsequent invasive infections among hospitalized neonates. The effectiveness of interventions designed to reduce MRSA infection in the NICU during the coronavirus disease 2019 (COVID-19) pandemic has not been characterized.
Methods:
Using the Institute for Healthcare Improvement's Model for Improvement, we implemented several process-based infection prevention strategies to reduce invasive MRSA infections at our level IV NICU over 24 months. The outcome measure of invasive MRSA infections was tracked monthly utilizing control charts. Process measures focused on environmental disinfection and hospital personnel hygiene were also tracked monthly. The COVID-19 pandemic was an unexpected variable during the implementation of our project. The pandemic led to restricted visitation and heightened staff awareness of the importance of hand hygiene and proper use of personal protective equipment, as well as supply chain shortages, which may have influenced our outcome measure.
Results:
Invasive MRSA infections were reduced from 0.131 to 0 per 1000 patient days during the initiative. This positive shift was sustained for 30 months, along with a delayed decrease in MRSA colonization rates. Several policy and practice changes regarding personnel hygiene and environmental cleaning likely contributed to this reduction.
Conclusions:
Implementation of a multidisciplinary quality improvement initiative aimed at infection prevention strategies led to a significant decrease in invasive MRSA infections in the setting of the COVID-19 pandemic.
Insights
A quality improvement initiative significantly reduced invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections in a neonatal intensive care unit (NICU). These efforts successfully eliminated new MRSA infections for over two years, even during the COVID-19 pandemic.
Area of Science:
- Neonatal Intensive Care Unit (NICU) infection control
- Public health and epidemiology
- Healthcare quality improvement
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant risk for hospitalized neonates, leading to colonization and invasive infections.
- The impact of infection control interventions on MRSA in NICUs during the COVID-19 pandemic remains understudied.
Purpose of the Study:
- To assess the effectiveness of infection prevention strategies in reducing invasive MRSA infections within a level IV NICU.
- To evaluate the influence of the COVID-19 pandemic on MRSA infection rates and intervention outcomes.
Main Methods:
- A 24-month quality improvement initiative utilizing the Institute for Healthcare Improvement's Model for Improvement.
- Monthly tracking of invasive MRSA infections and process measures (environmental disinfection, personnel hygiene) using control charts.
- Monitoring of the COVID-19 pandemic's impact, including visitation restrictions and heightened hygiene awareness.
Main Results:
- Invasive MRSA infections decreased from 0.131 to 0 per 1000 patient days, a reduction sustained for 30 months.
- A subsequent decrease in MRSA colonization rates was observed.
- Policy and practice changes in personnel hygiene and environmental cleaning were key contributing factors.
Conclusions:
- Multidisciplinary quality improvement initiatives can significantly decrease invasive MRSA infections in NICUs.
- Effective infection prevention strategies can be maintained even amidst the challenges of a global pandemic like COVID-19.
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