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Impact of decolonization on methicillin-resistant Staphylococcus aureus transmission and infection in a neonatal intensive care unit

Published online by Cambridge University Press:  31 July 2019

Michael J. Bozzella ,
Lamia Soghier ,
Tracie Harris ,
Lisa Zell ,
Billie Lou Short  and
Xiaoyan Song Open the ORCID record for Xiaoyan Song [Opens in a new window]
Michael J. Bozzella
Affiliation:
Division of Infectious Disease, Children’s National Health System, Washington, DC
Lamia Soghier
Affiliation:
Division of Neonatal Intensive Care Unit, Children’s National Health System, Washington, DC George Washington University School of Medicine and Health Science, Washington, DC
Tracie Harris
Affiliation:
Office of Infection Control and Epidemiology, Children’s National Health System, Washington, DC
Lisa Zell
Affiliation:
Division of Neonatal Intensive Care Unit, Children’s National Health System, Washington, DC
Billie Lou Short
Affiliation:
Division of Neonatal Intensive Care Unit, Children’s National Health System, Washington, DC George Washington University School of Medicine and Health Science, Washington, DC
Xiaoyan Song*
Affiliation:
Division of Infectious Disease, Children’s National Health System, Washington, DC George Washington University School of Medicine and Health Science, Washington, DC Office of Infection Control and Epidemiology, Children’s National Health System, Washington, DC
*
Author for correspondence: Xiaoyan Song, PhD, Office of Infection Control/Epidemiology, Children’s National Health System, 111 Michigan Ave. N. W., Washington, DC, 20010. Email: xsong@cnmc.org
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Abstract

Background:

The value of decolonization as a strategy for preventing methicillin-resistantStaphylococcus aureus (MRSA) in the neonatal intensive care unit (NICU) remains to be determined.

Objective:

After adding decolonization to further reduce MRSA transmission in our NICU, we conducted this retrospective review to evaluate its effectiveness.

Method:

The review included patients who were admitted to our NICU between April 2015 and June 2018 and were eligible for decolonization including twice daily intranasal mupirocin and daily chlorhexidine gluconate bathing over 5 consecutive days. Patients were considered successfully decolonized if 3 subsequent MRSA screenings conducted at 1-week intervals were negative. The MRSA acquisition rate (AR) was calculated as hospital-acquired (HA) MRSA per 1,000 patient days (PD) and was used to measure the effectiveness of the decolonization.

Results:

Of the 151 MRSA patients being reviewed, 78 (51.6%) were HA-MRSA, resulting in an overall AR of 1.27 per 1,000 PD. Between April 2015 and February 2016, when only the decolonization was added, the AR was 2.38 per 1,000 PD. Between March 2016 and June 2018 after unit added a technician dedicated to the cleaning of reusable equipment, the AR decreased significantly to 0.92 per 1,000 PD (P < .05). Of the 78 patients who were started on the decolonization, 49 (62.8%) completed the protocol, 11 (14.1%) remained colonized, and 13 (16.7%) were recolonized prior to NICU discharge.

Conclusion:

In a NICU with comprehensive MRSA prevention measures in place, enhancing the cleaning of reusable equipment, not decolonization, led to significant reduction of MRSA transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1123 - 1127
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATON. The findings of this study were presented in part at the Society for Healthcare Epidemiology of America Spring Conference on April 18, 2018, in Portland, Oregon.

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