Hand hygiene |
IA | A waterless, alcohol-based hand hygiene product should be made available and easily accessible; soap and water should be used if hands are visibly soiled. |
IA | Monitoring of hand hygiene is a key component in preventing MRSA transmission in the NICU. Direct observations of hand hygiene practices on a regular basis, or consistent enforcement of proper hand hygiene (eg, use of a unit guard, providing feedback), contribute to increased rates of compliance. |
Cohorting and isolation |
IA | MRSA-positive infants should be placed under contact precautions and cohorted (placed in a designated room or area), as should the supplies used in the care of these infants. |
IA | Gloves and gowns should be worn when caring for or visiting infants known or suspected to be MRSA positive. |
IA | Masks should be worn for aerosol-generating procedures, such as suctioning. The environment in the area of the infant should be kept clean and neat at all times. |
NR/UI | Disposal of infant supplies used in the care of the MRSA-positive cohort should be decided by the institution's infection control experts. |
IA | Whenever possible, nurses should be cohorted (designated exclusively) for care of MRSA-positive infants. Other HCWs should also be cohorted to the maximum extent allowed by the institution's resources. |
II | If cohorting of nurses is not possible, nurses should care for the noncohorted patients before working with the cohorted neonates, when feasible. |
II | The number of people (including HCWs and visitors) who enter a room or area designated for MRSA-positive infants should be limited to the minimum possible. |
II | Cohorting of infants should be maintained until the last infected or colonized infant has been discharged from the NICU. |
Neonatal surveillance cultures |
IB | Infants in the NICU should be screened periodically to detect MRSA colonization. The frequency of screening should increase (eg, to once per week) when clusters of colonization are detected; after evidence suggests a halt in transmission, it may decrease to a lower frequency (eg, to once per month) until the investigation is over. |
IA | Although cultures of swab specimens from multiple body sites, including nares, throat, rectum, and umbilicus, have been used to detect MRSA colonization, culture of nasal or nasopharyngeal specimens alone is sufficiently sensitive to detect MRSA colonization in neonates. |
Screening of HCWs |
IB | Screening of HCWs in response to a cluster of MRSA colonization or infection in the NICU should be performed only to corroborate or refute epidemiologic data that link an HCW to transmission. |
Decolonization |
IB | Mupirocin may be used for decolonization of neonates and/or HCWs if deemed necessary by the affected institution (off-label use). |
Environmental cultures |
IA | Environmental cultures should be performed in response to a cluster of MRSA colonization or infection in the NICU only to corroborate or refute epidemiologic data that link an environmental source to transmission. |
Molecular analysis |
IA | When investigating an outbreak, molecular analysis with pulsed-field gel electrophoresis or a comparable molecular epidemiologic tool should be performed to assess the relatedness of strains found in NICU patients, HCWs, and the environment. |
IB | If the hospital cannot perform genotyping in-house, then the isolates should be sent to a suitable laboratory for molecular analysis. |
Communication |
II | Open communication between regional NICUs is essential to prevent spread between NICUs at different institutions, particularly when an infant is transferred from one NICU to another. |
II | In the intake of a transferred patient, the receiving facility should be able to determine whether the infant has been screened previously for MRSA, and if so, the date, specimen source, and result of the culture. |
II | In the intake of a transferred patient, the receiving facility should be able to determine whether the transferring institution currently knows of any MRSA-positive infants in its NICU. |
IB | The receiving facility should consider isolation and screening of any infant transferred from another NICU, regardless of the transferring institution's MRSA status. |
II | Standardized instruction sheets describing methods to prevent transmission of MRSA should be developed as a resource for parents and visitors of infants in NICUs in which MRSA has been detected. |
Regulation |
IA | Overcrowding increases the likelihood of MRSA transmission in the NICU; institutions should adhere to all appropriate licensing requirements. |
IA | Agency HCWs should be oriented to and monitored periodically for compliance with the institution's infection control and hand hygiene procedures. |
II | Logs of shifts worked by agency HCWs should be updated frequently to ensure that, in the case of an epidemiologic investigation, transmission links to these staff may be evaluated. |
IC | Hospitals must comply with all local and state regulations regarding the reporting of MRSA in NICUs. |
Hospital and public health collaboration |
II | Hospital officials should collaborate with state and local public health officials to conduct surveillance for MRSA in NICUs, facilitate inter-institutional communication and coordination of prevention activities, and provide laboratory support to allow detection of shared MRSA clones among NICUs in multiple institutions. |