title: Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures.
abstract: OBJECTIVE
  To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it.
  
  
  METHODS
  An 18-bed, level III-IV NICU in a community hospital.
  
  
  METHODS
  Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA.
  
  
  RESULTS
  A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA.
  
  
  CONCLUSIONS
  Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Jad
authors.initials: J
authors.lastname: Khoury
authors.forename: Marilyn
authors.initials: M
authors.lastname: Jones
authors.forename: Autumn
authors.initials: A
authors.lastname: Grim
authors.forename: Wm Michael
authors.initials: WM
authors.lastname: Dunne
authors.forename: Vicky
authors.initials: V
authors.lastname: Fraser
mesh_terms: D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D016106:Methicillin Resistance; D008923:Missouri / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects*