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Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel

Published online by Cambridge University Press:  16 June 2022

Kathleen A. Quan*
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Mohamad R. A. Sater
Affiliation:
Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
Cherry Uy
Affiliation:
Division of Pediatrics, Neonatal Intensive Care, University of California Irvine Health, Orange, California
Robin Clifton-Koeppel
Affiliation:
University of California Irvine Health, Orange, California
Linda L. Dickey
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
William Wilson
Affiliation:
University of California Irvine Health, Orange, California
Pat Patton
Affiliation:
University of California San Francisco Health, San Francisco, California
Wayne Chang
Affiliation:
Division of Occupational and Environmental Medicine, Department of Medicine, University of California Irvine Health, Orange, California
Pamela Samuelson
Affiliation:
Department of Occupational Health, University of California Irvine Health, Orange, California
Georgia K. Lagoudas
Affiliation:
Department of Biological Engineering, MIT, Cambridge, Massachusetts Broad Institute of MIT and Harvard, Cambridge, Massachusetts
Teri Allen
Affiliation:
Respiratory Care Services, University of California Irvine Health, Orange, California
Lenny Merchant
Affiliation:
St. Luke’s University Hospital, Bethlehem, Pennsylvania
Rick Gannotta
Affiliation:
University of California Irvine Health, Orange, California
Cassiana E. Bittencourt
Affiliation:
Department of Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Orange, California
J. C. Soto
Affiliation:
Department of Microbiology, University of California Irvine Health, Orange, California
Kaye D. Evans
Affiliation:
Department of Microbiology, University of California Irvine Health, Orange, California
Paul C. Blainey
Affiliation:
Department of Biological Engineering, MIT, Cambridge, Massachusetts Broad Institute of MIT and Harvard, Cambridge, Massachusetts Koch Institute for Integrative Cancer Research at MIT, Cambridge, Massachusetts
John Murray
Affiliation:
University of California Irvine Health, Orange, California
Dawn Shelton
Affiliation:
University of California Irvine Health, Orange, California
Helen S. Lee
Affiliation:
University of California Irvine Health, Orange, California
Matthew Zahn
Affiliation:
Orange County Health Care Agency, Santa Ana, California
Julia Wolfe
Affiliation:
Orange County Public Health Laboratory, Santa Ana, California
Keith Madey
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Jennifer Yim
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California
Shruti K. Gohil
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, California
Yonatan H. Grad
Affiliation:
Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
Susan S. Huang
Affiliation:
Epidemiology and Infection Prevention, University of California Irvine Health, Orange, California Division of Infectious Diseases, University of California Irvine School of Medicine, Orange, California
*
Author for correspondence: Kathleen A. Quan, E-mail: katquan@uci.edu

Abstract

Objective:

To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.

Design:

Prospective observational study.

Setting:

Neonatal intensive care unit (NICU).

Methods:

We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.

Results:

A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.

Conclusions:

In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

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Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel
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