An outbreak of meticillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit: use of a case–control study to investigate and control it and lessons learnt
| Autor: | ME Török, Nicholas M. Brown, Amanda Ogilvy-Stuart, R. Thaxter, Howard Martin, Iain Roddick, Christine Moody, A D'Amore, Neville Q. Verlander, S Broster, Smokey Robinson, Jag Ahluwalia, Mark Reacher, W. Rice, Jane Greatorex, David A Enoch, Angela Kearns, Lucy Reeve |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Methicillin-Resistant Staphylococcus aureus Microbiology (medical) medicine.medical_specialty Neonatal intensive care unit media_common.quotation_subject Tertiary referral hospital Disease Outbreaks Tertiary Care Centers Hygiene Intensive Care Units Neonatal Disease Transmission Infectious Humans Medicine Colonization Risk factor media_common Infection Control business.industry Infant Newborn Case-control study Infant Outbreak Gestational age General Medicine Staphylococcal Infections Infectious Diseases Case-Control Studies Carrier State Emergency medicine Female business |
| Zdroj: | Journal of Hospital Infection. 103:35-43 |
| ISSN: | 0195-6701 |
| DOI: | 10.1016/j.jhin.2019.05.009 |
| Popis: | Summary Aim To describe the investigation and management of a meticillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal intensive care unit (NICU) and the lessons learnt. Methods This was an outbreak report and case–control study conducted in a 40-cot NICU in a tertiary referral hospital and included all infants colonized/infected with gentamicin-resistant MRSA. Intervention Standard infection-control measures including segregation of infants, barrier precautions, enhanced cleaning, assessment of staff practice including hand hygiene, and increased MRSA screening of infants were implemented. Continued MRSA acquisitions led to screening of all NICU staff. A case–control study was performed to assess staff contact with colonized babies and inform the management of the outbreak. Findings Eight infants were colonized with MRSA (spa type t2068), one of whom subsequently developed an MRSA bacteraemia. MRSA colonization was significantly associated with lower gestational age; lower birthweight and with being a twin. Three nurses were MRSA colonized but only one nurse (45) was colonized with MRSA spa type t2068. Multivariable logistic regression analysis identified being cared for by nurse 45 as an independent risk factor for MRSA colonization. Conclusions Lack of accurate recording of which nurses looked after which infants (and when) made identification of the risk posed by being cared for by particular nurses difficult. If this had been clearer, it may have enabled earlier identification of the colonized nurse, avoiding subsequent cases. This study highlights the benefit of using a case–control study, which showed that most nurses had no association with colonized infants. |
| Databáze: | OpenAIRE |
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