Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-30T21:32:04.776Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.

References

Song, X, Perencevich, E, Campos, J, Short, BL, Singh, N. Clinical and economic impact of methicillin-resistant Staphylococcus aureus colonization or infection on neonates in intensive care units. Infect Control Hosp Epidemiol 2010;31:177–182.CrossRefGoogle ScholarPubMed
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;51:126–132.CrossRefGoogle ScholarPubMed
Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718–723.CrossRefGoogle Scholar
Eveillard, M, Lancien, E, Barnaud, G, et al. Impact of screening for MRSA carriers at hospital admission on risk-adjusted indicators according to the imported MRSA colonization pressure. J Hosp Infect 2005;59:254–258.CrossRefGoogle ScholarPubMed
Williams, VR, Callery, S, Vearncombe, M, Simor, AE. The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus . Am J Infect Control 2009;37:106–110.CrossRefGoogle ScholarPubMed
Pierce, R, Lessler, J, Popoola, VO, Milstone, AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect 2017;95:91–97.CrossRefGoogle Scholar
Huang, SS, Septimus, E, Avery, TR, et al. Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol 2014;35 suppl 3:S23–S31.CrossRefGoogle ScholarPubMed
Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.CrossRefGoogle ScholarPubMed
Sai, N, Laurent, C, Strale, H, Denis, O, Byl, B. Efficacy of the decolonization of methicillin-resistant Staphylococcus aureus carriers in clinical practice. Antimicrob Resist Infect Control 2015;4:56.CrossRefGoogle ScholarPubMed
Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:1155–1161.CrossRefGoogle ScholarPubMed
Back, NA, Linnemann, CC Jr, Staneck, JL, Kotagal, UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996;17:227–231.Google Scholar
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;4:220–226.CrossRefGoogle ScholarPubMed
Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26:616–621.CrossRefGoogle ScholarPubMed
Nelson, MU, Bizzarro, MJ, Dembry, LM, Baltimore, RS, Gallagher, PG. One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. J Perinatol 2014;34:653–655.CrossRefGoogle Scholar
Chapman, AK, Aucott, SW, Milstone, AM. Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant. J Perinatol 2012;32:4–9.CrossRefGoogle ScholarPubMed
Chapman, AK, Aucott, SW, Gilmore, MM, Advani, S, Clarke, W, Milstone, AM. Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates. J Perinatol 2013;33:768–771.CrossRefGoogle ScholarPubMed
Kohler, P, Bregenzer-Witteck, A, Rettenmund, G, Otterbech, S, Schlegel, M. MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2013;41:33–40.CrossRefGoogle ScholarPubMed
Baratz, MD, Hallmark, R, Odum, SM, Springer, BD. Twenty percent of patients may remain colonized with methicillin-resistant Staphylococcus aureus despite a decolonization protocol in patients undergoing elective total joint arthroplasty. Clin Orthop Relat Res 2015;473:2283–2290.CrossRefGoogle ScholarPubMed
Donskey, CJ. Does improving surface cleaning and disinfection reduce healthcare-associated infections? Am J Infect Control 2013;41:S12–S19.CrossRefGoogle Scholar
Dancer, SJ, White, LF, Lamb, J, Girvan, EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009;7:28.CrossRefGoogle Scholar