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Updated: Sep 16, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Did universal masking during the COVID-19 pandemic reduce MRSA and MSSA acquisition in the NICU?
Meaghan Neary1, Kathleen Quan2, Thomas Tjoa3
1Division of Neonatal Medicine, Department of Pediatrics, University of California Irvine Health, Orange, CA, USA.
Objectives:
To assess whether universal masking during the COVID-19 pandemic reduced neonatal acquisition of S. aureus.
Study Design:
We performed a retrospective cohort study of neonates admitted to a level three regional NICU for three years before and after implementation of universal masking for the COVID-19 pandemic. Multivariable proportional hazards regression models evaluated the effect of masking on time-to-acquisition of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA) while adjusting for fixed and time-varying neonatal characteristics.
Results:
We analyzed 2,728 neonates, 1,446 pre-pandemic and 1,282 post-pandemic; 84.9% were inborn, with mean gestational age of 34 weeks and 6 days (SD = 4.2) and mean birthweight of 2,500 grams (SD = 975). The mean number of screening cultures per neonate was 3.07 (SD = 3.31). When adjusting for covariates, universal masking was associated with decreased acquisition of MRSA (hazard ratio =0.43 (95% CI: 0.19-0.99), p = 0.04) but not MSSA (HR = 1.27 (95% CI: 00.87-1.85), p = 0.21). Among covariates, airway devices and maternal S. aureus status were associated with S. aureus acquisition.
Conclusions:
Universal masking decreased the rate of NICU MRSA acquisition by 60% while MSSA acquisition was unchanged. Masking may reduce MRSA spread via colonized healthcare personnel while MSSA may be more likely to be acquired from parental skin-to-skin contact and was thus unaffected by masking.
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