Infectious Disease

Repeated decolonization allows persistent MRSA-carrying HCP to safely work in NICU

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Disclosures:
Quan reports no relevant financial disclosures. Huang reports conducting studies in which participating hospitals and nursing homes received contributed antiseptics from Medline, Molnlycke, Stryker and Xttrium. Sater is an employee of Day Zero Diagnostics. Please see the study for all other authors’ relevant financial disclosures.

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A repeated decolonization regimen successfully allowed health care workers who were previously colonized with MRSA to safely continue working in a neonatal intensive care unit, and it also ended an outbreak, a recent study showed.

“We wanted to share our experience with a ‘slow outbreak’ in case it helps others in a similar position,” Kathleen A. Quan, RN, MSN, and Susan S. Huang, MD, MPH, of the University of California, Irvine Health, and Mohamad RA Sater, PhD, of Harvard TH Chan School of Public Health, told Healio.

MRSA under a microscope

A MRSA outbreak affecting babies and health care personnel in a NICU ceased only after implementing chronic decolonization protocols for health care personnel who were persistent carriers. Source: Adobe Stock.

The researchers said that their institution’s neonatal intensive care unit (NICU), which they noted as having excellent hand hygiene compliance and longstanding minimal health care-associated infections, experienced a MRSA outbreak that involved 15 babies and six health care personnel (HCP). They said that in total, 12 cases occurred slowly over a 1-year period, followed by three additional cases 7 months later.

The researchers performed a prospective observational study in the NICU, where they conducted an epidemiologic investigation and implemented multiple infection prevention interventions — including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff and decolonization of carriers.

“The outbreak persisted, with both HCP and babies serving as niduses for transmission, as inferred from epidemiologic and genomic links,” the authors said. “Cessation of the outbreak occurred after implementing chronic decolonization protocols for HCP who were persistent carriers.”

They added that additional success was attributed to protocols to decolonize MRSA-positive babies and to have HCP mask for prolonged face-to-face contact with babies.

“These interventions resolved the outbreak and enabled HCP carriers of the outbreak strain to remain employed while ensuring safe care of NICU babies,” they said.

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