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Outbreak of Methicillin-Resistant Staphylococcus aureus Colonization and Infection in a Neonatal Intensive Care Unit Epidemiologically Linked to a Healthcare Worker With Chronic Otitis

Published online by Cambridge University Press:  21 June 2016

Mary L. Bertin ,
Joan Vinski ,
Steven Schmitt ,
Camille Sabella ,
Lara Danziger-Isakov ,
Michael McHugh ,
Gary W. Procop ,
Geraldine Hall ,
Steven M. Gordon  and
Johanna Goldfarb
Mary L. Bertin*
Affiliation:
Department of Infection Control and Epidemiology, Division of Nursing, The Cleveland Clinic, Cleveland, Ohio
Joan Vinski
Affiliation:
Department of Infection Control and Epidemiology, Division of Nursing, The Cleveland Clinic, Cleveland, Ohio
Steven Schmitt
Affiliation:
Department of Infectious Disease, Division of Medicine, The Cleveland Clinic, Cleveland, Ohio
Camille Sabella
Affiliation:
Departments of Infectious Disease, Division of Pediatrics, The Cleveland Clinic, Cleveland, Ohio
Lara Danziger-Isakov
Affiliation:
Departments of Infectious Disease, Division of Pediatrics, The Cleveland Clinic, Cleveland, Ohio
Michael McHugh
Affiliation:
Critical Care, Division of Pediatrics, The Cleveland Clinic, Cleveland, Ohio
Gary W. Procop
Affiliation:
Division of Pediatrics, and the Department of Clinical Pathology, Division of Pathology and Laboratory Medicine, The Cleveland Clinic, Cleveland, Ohio
Geraldine Hall
Affiliation:
Division of Pediatrics, and the Department of Clinical Pathology, Division of Pathology and Laboratory Medicine, The Cleveland Clinic, Cleveland, Ohio
Steven M. Gordon
Affiliation:
Department of Infectious Disease, Division of Medicine, The Cleveland Clinic, Cleveland, Ohio
Johanna Goldfarb
Affiliation:
Departments of Infectious Disease, Division of Pediatrics, The Cleveland Clinic, Cleveland, Ohio
*
The Cleveland Clinic, Desk P58 Infection Control, 9500 Euclid Avenue, Cleveland, OH, 44195 (Bertinm@ccf.org)
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Abstract

Objective.

To describe the investigation and interventions necessary to contain an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in a neonatal intensive care unit (NICU).

Design.

Retrospective case finding that involved prospective performance of surveillance cultures for detection of MRSA and molecular typing of MRSA by repetitive-sequence polymerase chain reaction (rep-PCR).

Setting.

Level III NICU in a tertiary care center.

Participants.

Three neonates in a NICU were identified with MRSA bloodstream infection on April 16, 2004. A point prevalence survey identified 6 additional colonized neonates (attack rate, 75% [9 of 12 neonates]). The outbreak strain was phenotypically unusual.

Interventions.

Cohorting and mupirocin therapy were initiated for neonates who had acquired MRSA during the outbreak. Contact precautions were introduced in the NICU, and healthcare workers (HCWs) were retrained in cleaning and disinfection procedures and hand hygiene. Noncolonized neonates and newly admitted patients had surveillance cultures performed 3 times per week.

Results.

Two new colonized neonates were identified 1 month later. HCW X, who had worked in the NICU since June 2003, was identified as having chronic otitis. MRSA was isolated from cultures of swab specimens from HCW X's ear canal and nares. HCW X was epidemiologically linked to the outbreak. Molecular typing (by rep-PCR) confirmed that the isolates from HCW X and from the neonates were more than 90% similar. Retrospective review of NICU isolates revealed that the outbreak strain was initially cultured from a neonate 2 months after HCW X began working on the unit. The epidemic strain was eradicated after removing HCW X from patient care in the NICU.

Conclusion.

An outbreak of MRSA colonization and infection in a NICU was epidemiologically linked to a HCW with chronic otitis externa and nasal colonization with MRSA. Eradication was not achieved until removal of HCW X from the NICU. Routine surveillance for MRSA may have allowed earlier recognition of the outbreak and is now standard practice in our NICU.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 6 , June 2006 , pp. 581 - 585
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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