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To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Prospective observational study.
Neonatal intensive care unit (NICU).
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.
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.
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.
Free markets alone do not work effectively to solve certain kinds of human problems, such as education, old age care, or disaster relief. Nor have markets ever been the sole solution to the psychological challenges of death, suffering, or injustice. Instead, we find a major role for the non-market institutions of society - the family, the state, and social institutions. The first in-depth anthropological study of charities in contemporary Chinese societies, this book focuses on the unique ways that religious groups have helped to solve the problems of social well-being. Using comparative case studies in China, Taiwan and Malaysia during the 1980s and onwards, it identifies new forms of religious philanthropy as well as new ideas of social 'good', including different forms of political merit-making, new forms of civic selfhood, and the rise of innovative social forms, including increased leadership by women. The book finally argues that the spread of these ideas is an incomplete process, with many alternative notions of goodness continuing to be influential.