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Hi. This is Dr. William Jarvis, President of Jason and Jarvis Associates and Medscape Infectious Diseases expert advisor. Today, I would like to talk about detection, prevention, and control of MRSA (methicillin-resistant Staphylococcus aureus) in neonatal intensive care units (NICUs).
Over the last several years, MRSA has become an increasingly larger problem in neonatal intensive care units. In the early days of MRSA, it was seldom found in the neonatal intensive care unit and, if found there, was usually easily eradicated. However, with the increasing prevalence of MRSA and perhaps the increase in community-acquired MRSA, we are seeing more and more MRSA being introduced into the NICU setting, being transmitted among those patients, and being much more difficult to eradicate.
A recent survey by Milstone and colleagues in Infection Control and Hospital Epidemiology surveyed the Society for Healthcare Epidemiology of America's Pediatric Special Interest Group about their practices for the prevention and control of MRSA. Of the 91 final respondents, 78 (86%) of them screen for MRSA; 44 (55%) of them screen on admission and do periodic point of prevalence surveys; 22 (28%) of them do culture screening on admission; and 1% do admission screening by culture, point of prevalence survey, and then discharge cultures as well.
Interestingly, of those that do screening, 43 (65%) screen all patients; 21 (32%) do target screening; and 2 (3%) screen only those infants who are admitted with mothers with a history of MRSA.
Of interest, of the 66 that do screening on admission, 23 (35%) do what I would call preemptive isolation; they isolate the patient until they get the result of the culture. Of those that do screening, 37 (47%) screen multiple sites; 72 (92%) screen the nares; 27 (35%) screen the umbilicus; 14 (18%) screen the rectum; 18% screen the axilla; 12% the groin; and 3% do the oropharynx. Of those that responded to the survey, 34 of the 91 (37%) attempt to decolonize; 19 (21%) decolonize all patients identified; 11 (12%) selectively decolonize; and 4 (4%) decolonize only those with infection. Of those doing decolonization (34 members), all of them use mupirocin, 12 (35%) of them also use a topical antiseptic, and 3 (9%) use a systemic antimicrobial.
These are interesting data to show that there is a wide variation in how MRSA is being attacked in the neonatal intensive care unit. They show that a wide variety of neonatal intensive care units are aggressively screening for MRSA colonization, cohorting or isolating those patients, and at least a third of them are also attempting decolonization.
Until next time, this is Dr. William Jarvis. Thank you very much.
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