Skip to main content Accessibility help
×
Home

Management of Outbreaks of Methicillin-Resistant Staphylococcus aureus Infection in the Neonatal Intensive Care Unit: A Consensus Statement

  • Susan I. Gerber (a1), Roderick C. Jones (a1), Mary V. Scott (a2) (a3), Joel S. Price (a4), Mark S. Dworkin (a4), Mala B. Filippell (a5), Terri Rearick (a5), Stacy L. Pur (a6), James B. McAuley (a6), Mary Alice Lavin (a7), Sharon F. Welbel (a7), Sylvia Garcia-Houchins (a8), Judith L. Bova (a8), Stephen G. Weber (a8), Paul M. Arnow (a8), Janet A. Englund (a8) (a9), Patrick J. Gavin (a10), Adrienne G. Fisher (a10), Richard B. Thomson (a10), Thomas Vescio (a10), Teresa Chou (a11), Daniel C. Johnson (a12), Mary Beth Fry (a13), Anne H. Molloy (a13), Laura Bardowski (a14) and Gary A. Noskin (a14)...

Abstract

Objective.

In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.

Design.

Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.

Setting.

Level III NICUs at Chicago-area hospitals.

Participants.

Neonates and healthcare workers associated with the level III NICUs.

Methods.

From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.

Results.

Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.

Conclusion.

The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.

Copyright

Corresponding author

Chicago Department of Public Health, 2160 W. Ogden Ave., Chicago, IL 60612 (Gerber_Sue@cdph.org)

References

Hide All
1.Noel, GJ, Kreiswirth, BN, Edelson, PJ, et al. Multiple methicillin-resistant Staphylococcus aureus strains as a cause for a single outbreak of severe disease in hospitalized neonates. Pediatr Infect Dis J 1992; 11:184188.
2.Campbell, JR, Zaccaria, E, Mason, EO, Baker, CJ. Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998; 19:924928.
3.Haley, RW, Cushion, NB, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 171:614624.
4.Andersen, BM, Lindemann, R, Bergh, K, et al. Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 2002;50:1824.
5.Saiman, L, Cronquist, A, Wu, F, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003; 24:317321.
6.Nambiar, S, Herwaldt, LA, Singh, N. Outbreak of invasive disease caused by methicillin-resistant Staphylococcus aureus in neonates and prevalence in the neonatal intensive care unit. Pediatr Crit Care Med 2003; 4:220226.
7.Hitomi, S, Kubota, M, Mori, N, et al. Control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit by un-selective use of nasal mupirocin ointment. J Hosp Infect 2000; 46:123129.
8.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24:362386.
9.Centers for Disease Control and Prevention. MRSA among ICU patients, 1995 — 2004. In: Healthcare—associated methicillin resistant Staphylococcus aureus (MRSA): data and statistics. Available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_data.html. Accessed January 30, 2006.
10.Arnold, MS, Dempsey, JM, Fishman, M, McAuley, PJ, Tibert, C, Vallande, NC. The best hospital practices for controlling methicillin-resistant Staphylococcus aureus: on the cutting edge. Infect Control Hosp Epidemiol 2002; 23:6976.
11.Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593598.
12.Hussain, FM, Boyle-Vavra, S, Daum, RS. Community-acquired methicillin-resistant Staphylococcus aureus colonization in healthy children attending an outpatient pediatric clinic. Pediatr Infect Dis 2001; 20:763767.
13.Sattler, CA, Mason, EO, Kaplan, SL. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis 2002; 21:910916.
14.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004; 39:971979.
15.Baggett, HC, Hennessy, TW, Rudolph, K, et al. Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxic pantonvalentine leukocidin during a furunculosis outbreak in rural Alaska. J Infect Dis 2004; 189:15651573.
16.Centers for Disease Control and Prevention. Public health dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin lesions—Los Angeles County, California 2002-2003. MMWR Morb Mortal Wkly Rep 2003; 52:88.
17.Carleton, HA, Diep, BA, Charlebois, ED, Sensabaugh, GF, Perdreau-Remington, F. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis 2004; 190:17301738.
18.Centers for Disease Control and Prevention. Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders—Hawaii, 2001-2003. MMWR Morb Mortal Wkly Rep 2004; 53:767770.
19.Healy, MC, Hulten, KG, Palazzi, DL, Campbell, JR, Baker, CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39:14601466.
20.Eckhardt, C, Halvosa, JS, Ray, SM, Blumberg, HM. Transmission of methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit from a patient with community-acquired disease. Infect Control Hosp Epidemiol 2003; 24:460461.
21.Hartstein, AI, LeMonte, AM, Iwamoto, PKL. DNA typing and control of methicillin-resistant Staphylococcus aureus at two affiliated hospitals. Infect Control Hosp Epidemiol 1997; 18:4248.
22.Villari, P, Iacuzio, L, Torre, I, Scarcella, A. Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998; 37:274281.
23.Mitsuda, T, Arai, K, Fujita, S, Yokota, S. Epidemiological analysis of strains of methicillin-resistant Staphylococcus aureus (MRSA) infection in the nursery; prognosis of MRSA carrier infants. J Hosp Infect 1995; 31:123134.
24.Gavin, PJ, Paule, SM, Fisher, AG, et al. The role of molecular typing in the epidemiologic investigation and control of nosocomial infections. Pathol Case Rev 2003; 8:163171.
25.Loureiro, MM, de Moraes, BA, Quadra, MRR, Pinheiro, GS, Suffys, PN, Asensi, MD. Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated from newborns in a hospital in Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 2000; 95:777782.
26.Singh, K, Gavin, PJ, Vescio, T, et al. Microbiologic surveillance using nasal cultures alone is sufficient for detection of methicillin-resistant Staphylococcus aureus isolates in neonates. J Clin Microbiol 2003; 41:27552757.
27.Bures, S, Fishbain, JT, Uyehara, CFT, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000; 28:465470.
28.Vicca, AF. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect 1999; 43:109113.
29.Shiomori, T, Miyamoto, H, Makishima, K, et al. Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. J Hosp Infect 2002; 50:3035.
30.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002; 51:126132.
31.Herwaldt, LA. Control of methicillin-resistant Staphylococcus aureus in the hospital setting. Am J Med 1999; 106(5A):11S18S.
32.Boyce, JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Inject 2001; 48(Supplement A):S9S14.
33.Boyce, JM, Pittet, D, Healthcare Infection COntrol Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in healthcare settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America. MMWR Recomm Rep 2002; 51(RR-16):145.
34.Humphreys, H, Duckworth, G. Methicillin-resistant Staphylococcus aureus (MRSA)—a re-appraisal of control measures in the light of changing circumstances. J Hosp Infect 1997; 36:167170.
35.Grundmann, H, Hori, S, Winter, B, Tami, A, Austin, DJ. Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 2002; 185: 481488.
36.Watanakunakorn, C, Axelson, C, Bota, B, Stahl, C. Mupirocin ointment with and without Chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. Am J Infect Control 1995; 23:306309.
37.Fitzpatrick, F, Murphy, OM, Brady, A, Prout, S, Fenelon, LE. A purpose built MRSA cohort unit. J Hosp Infect 2000; 46:271279.
38.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998; 27:543550.
39.Hudson, IRB. The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect 1994; 27:8198.
40.Kotilainen, P, Routamaa, M, Peltonen, R, et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003; 9:169175.
41.Fujimura, S, Kato, S, Hashimoto, M, Takeda, H, Maki, F, Watanabe, A. Survey of methicillin-resistant Staphylococcus aureus from neonates and the environment in the NICU. J Infect Chemother 2004; 10:131132.
42.Behari, P, Englund, J, Alcasid, G, Garcia-Houchins, S, Weber, SG. Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk. Infect Control Hosp Epidemiol 2004; 25:778780.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed