Suspending Use of Contact Precautions in Patients Colonized with Methicillin-Resistant Staphylococcus aureus in a Level III Neonatal ICU and Its Effects on Rates of Transmission

Abstract

BackgroundThere is limited evidence to support whether contact precautions (CP) for MRSA-colonized patients in a Neonatal ICU (NICU) reduces rates of transmission, given current endemic MRSA. This study assesses rates of hospital-associated MRSA (HA-MRSA) in the NICU before and after discontinuation of CP for patients colonized with MRSA.MethodsActive screening for MRSA colonization occurs on admission and weekly for all NICU patients. Clinical infections were identified on routine cultures. Decolonization with Mupirocin and Chlorhexidine bathing was done for all MRSA-positive patients. Rates of HA-MRSA pre, during, and post CP suspension were assessed. MRSA isolates from before and after the contact precautions suspension period were saved and sent for pulse-field gel electrophoresis (PFGE). PFGE results from previous clusters of HA-MRSA isolates were also reviewed. Furthermore, 11 highly-ranked level III NICUs were surveyed to compare infection prevention practices for MRSA isolation. Overt hand hygiene auditing, family education, and enhanced environmental cleaning were in place during the entire study timeframe.ResultsRate of HA-MRSA during 6 month pretrial, 2 month suspension period, and 3 month post-trial was 0.94, 2.24, and 1.05 per 1000 patient-days respectively. During previous outbreaks 14 isolates were sent for PFGE testing resulting in 2 isolates matching. Six isolates from the CP suspension period resulted in 2 matching pairs. Three isolates from post-trial were different from each other and from previous isolates. Survey results revealed 100% of facilities use CP for MRSA-positive patients. Three of 11 NICUs have a decolonization protocol in place, while 10 actively screen for MRSA.ConclusionPreliminary results demonstrated an increase in HA-MRSA after suspending CP for MRSA-colonized patients. According to the survey results, the standard of care appears to be the use of CP for all MRSA-positive patients, although decolonization practices varied. Given the limited size of our study, more data is needed to determine whether CP is necessary to prevent transmission of HA-MRSA in the presence of an active screening and decolonization program, a robust hand hygiene program, and enhanced environmental cleaning in the NICU setting.Disclosures All authors: No reported disclosures.