Staphylococcus aureus epidemic in a neonatal nursery: a strategy of infection control

Abstract

The risk of nosocomial infection due to Staphylococcus aureus in fullterm newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection control techniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21, 2000) and the measures undertaken to bring the epidemic under control. These measures included: separating neonates already present in the nursery on August 23, 2000 from ones newly arriving by creating two different cohorts, one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus- infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns, gloves, and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions, microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can, in retrospect, be assessed to have been very effective.

Staphylococcus aureusReservoirs and Transmission Routes in a Portuguese Neonatal Intensive Care Unit: A 30-Month Surveillance Study

“…Episodes of S. aureus infection in neonates are frequently related to health care workers (HCWs), parents, and environment colonization. 5,8,9,18,23,24,44 Preventing MRSA transmission within an NICU has been shown to be achievable through implementation of optimal infection control strategies, namely hand hygiene practices; prevention of central venous catheter-related bloodstream infections; judicious use of antimicrobials; skin care, as it is the first line of defense against infection; and early enteral feeding with human milk. 10,45 Although several studies have been focused on the molecular characterization of S. aureus isolates recovered from different hospitals in Portugal over time, 2,4 none of them specifically analyzed the molecular epidemiology of S. aureus in NICUs.…”

Healthcare-associated infections in neonates

“…is frequently involved in outbreaks in neonatology, for example, as skin infections. Recently identified sources of infections included a bottle of almond oil used for massaging the babies [55] and a single, asymptomatic [56,57] or symptomatic [58] healthcare worker (HCW); as frequently observed, the source was not clearly identified in other instances [59,60].…”

Infektionsprävention bei Früh- und Neugeborenen in Thüringen: Umsetzung der Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)

“…Zum einen wird der Aspekt berücksichtigt, dass eine Übertragung von potentiell pathogenen Erregern auch von einem nicht (oder nicht mehr) intensivpflichtigen Früh-und Neugeborenen auf ein Frühgeborenes mit einem Geburtsgewicht < 1 500 g, möglich sein kann. Mit einem generellen Screening kann eine Häufung von Kolonisationen mit pathogenen Erregern, eine nosokomiale Erreger-Transmission von Patient zu Patient oder auch ein Ausbruchsgeschehen frühzeitig erkannt werden [5][6][7]43]. Somit könnte es aus infektionsepidemiologischer Sicht bedeutsam sein, den Kolonisationsstatus aller in der Neonatologie betreuten Patienten wöchentlich zu erfassen, um die nosokomiale Übertragung von Patient zu Patient idealerweise zu verhindern bzw.…”

“…Neben einer nosokomialen Transmission wird von der Möglichkeit einer vertikalen Erregerübertragung von der besiedelten Mutter auf das Kind (bei der Geburt oder beim Stillen) ausgegangen [41,43]. Umso wichtiger scheint es, die Kolonisationsbefunde von allen in die Neonatologie aufgenommenen Kindern und deren Mütter zu kennen.…”