Effects of Discontinuation of Weekly Surveillance Testing on Methicillin-Resistant Staphylococcus aureus in the NICU

Abstract

Objective Methicillin-resistant Staphylococcus aureus (MRSA) infection is a major cause of serious morbidity and mortality in the neonatal intensive care unit (NICU). There is no clear consensus on infection control measures. Some approaches to MRSA colonization management may be burdensome with unclear benefits. The objective of this study was to determine if stopping weekly MRSA surveillance with active detection and contact isolation (ADI) was associated with a change in infection rate. Study Design This is a retrospective cohort study of infants admitted to two affiliated NICUs. The ADI cohort infants received weekly nasal MRSA cultures and were placed in contact isolation if MRSA colonized for the duration of their hospitalization. The No Surveillance cohort infants were only placed in isolation if there was active MRSA infection or if MRSA colonization was identified incidentally. The rates of infection were determined between the cohorts. Results There were 8,406 neonates representing 193,684 NICU days in the comparison period. In the ADI cohort, MRSA colonization occurred in 3.4% of infants and infection occurred in 29 infants (0.4%). There were no differences between cohorts in the percent of infants with a MRSA infection at any site (0.5 vs. 0.5%, p = 0.89), rate of MRSA infections per 1,000 patient-days (0.197 vs. 0.201, p = 0.92), rate of bloodstream infections (0.12 vs. 0.26%, p = 0.18), or in the overall mortality rate (3.7 vs. 3.0% p = 0.13). ADI represented an annual cost of $590,000. Conclusion The rates of MRSA infection did not change when weekly ADI was discontinued and was associated with a decrease in cost and resource utilization. Key Points

Horizontal versus vertical strategies for infection prevention: current practices and controversies

“…Similarly, another trial by Derde et al [9] yielded no additional benefit of implementing MRSA screening and contact precautions once effective hand hygiene and chlorhexidine bathing interventions had been implemented. Among studies conducted in neonatal ICUs, a retrospective cohort study and a before-and-after study failed to demonstrate the benefit of AST and contact precautions [10 ▪ ,11 ▪ ]. On the contrary, in a recent prospective cohort analysis of 123 acute care Veterans Affairs Hospitals in the USA, discontinuation of AST and contact precautions for MRSA-infected or colonized patients was associated with higher rates of MRSA HAIs in ICU (0.65 vs. 0.2 per 1000 patient-days; P < 0.001) and non-ICU settings (0.12 vs. 0.07 per 1000 patient-days; P = 0.01) when compared with facilities opting for AST with contact precautions [12 ▪ ].…”