Siblings’ Precautions and Parents’ Decolonization to Control Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit (NICU)

• Published in: Infection control and hospital epidemiology Vol. 41; no. S1; p. s87
• Main Authors: Dias, Livio, Silva, Camila de A, Richtmann, Rosana, Miglioli, Lisia, Dea, Bruna Dalla, Lima, Aurivan, Tobara, Mariana, Silva, Pollyana, Fernades, Vanessa
• Format: Journal Article
• Language: English
• Published: Cambridge Cambridge University Press 01-10-2020
• Subjects: Catheters; Colonization; Decolonization; Disease control; Disease transmission; Environmental organizations; Epidemics; Health surveillance; Hospitals; Intensive care; Medical instruments; Neonatal care; Newborn babies; Outbreaks; Personal hygiene; Public health; Siblings; Staphylococcus infections
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2020.582

Background:
Following the first reports of the emergence of methicillin-resistant
Staphylococcus aureus
(MRSA) in the 1970s, several measures to prevent its transmission were introduced in hospitals. However, controversy continues regarding the best approach to prevent and control MRSA, especially in neonatal intensive care units (NICUs).
Objective:
To report the reduction of colonization and primary central venous catheter–related bloodstream infection (CRBSI) caused by MRSA through surveillance, decolonization, and adoption of best practices in intravenous catheter care.
Methods:
Quasi-experimental, nonrandomized, before-and-after intervention study conducted in a 70-bed NICU in a private maternity hospital in Brazil. Period studied comprehended between August 2018 and May 2019 (period 1 - preintervention) and June to December 2019 (period II - postintervention). At the end of period 1, several measures were implanted to control and prevent colonization and CRBSI in the unit. The following measures were implemented: incentive to hand hygiene; best practices training on medication preparation and central catheter manipulation; systematic screening of colonized patients with nasal and umbilical swabs; contact precautions for colonized newborn (NB); contact precautions for twins of a colonized NB even when they had a negative swab; decolonization of patients with nasal mupirocin and chlorohexidine (oral preparation) for oral hygiene; concurrent linen change at the end of the patient’s decolonization; decolonization of parents of colonized siblings with chlorohexidine bath and nasal mupirocin; environmental organization; intensification of cleaning and disinfection of equipment and articles; cohort of patients and workers; isolation and precautions compliance audit; professional investigation and decolonization and universal chlorhexidine bath for newborns.
Results:
In periods I and II, the positivity rates of the collected swabs were 4.14% and 0.75% (
P
< .0001), respectively, with a peak of positivity of 11.8% in January. Also, 12 episodes of CRBSI were documented in period I (incidence, 2.9%) versus no episode in period 2, with a significant difference in incidence rate between the 2 periods (
P
= .002).
Conclusion
: The innovative measures were effective for eradicating the outbreak when instituted together with recognized good practices. In an outbreak scenario is difficult to define the isolated impact of each measure, although, parents’ decolonization to prevent the colonization of other siblings and contact precautions for twins of colonized NB seemed to improve the results.
Funding:
None
Disclosures:
None