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Risk Factors for Neonatal Methicillin-Resistant Staphylococcus aureus Infection in a Well-Infant Nursery

Published online by Cambridge University Press:  02 January 2015

Dao M. Nguyen ,
Elizabeth Bancroft ,
Laurene Mascola ,
Ramon Guevara  and
Lori Yasuda
Dao M. Nguyen*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Elizabeth Bancroft
Affiliation:
Los Angeles County Department of Health Services, Los Angeles, California
Laurene Mascola
Affiliation:
Los Angeles County Department of Health Services, Los Angeles, California
Ramon Guevara
Affiliation:
Los Angeles County Department of Health Services, Los Angeles, California
Lori Yasuda
Affiliation:
Los Angeles County Department of Health Services, Los Angeles, California
*
276 International Circle, First Floor, Module C, San Jose, CA 95119 (dao.nguyen@kp.org)
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Abstract

Objective.

To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery.

Design.

Case-control studies.

Setting.

A well-infant nursery in a nonteaching, community hospital.

Methods.

Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis.

Results.

Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n = 6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P = .01). In outbreak 2, case infants (n = 5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114).

Conclusions.

Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 406 - 411
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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