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Impact of pre-emptive contact precautions for outborn neonates on the incidence of healthcare-associated meticillin-resistant Staphylococcus aureus transmission in a Japanese neonatal intensive care unit

Published:April 05, 2013DOI:https://doi.org/10.1016/j.jhin.2012.12.016

      Summary

      Background

      The neonatal intensive care unit (NICU) is a high-risk setting for transmission of meticillin-resistant Staphylococcus aureus (MRSA). Very few studies have investigated the impact of pre-emptive contact precautions applied to outborn neonates transferred to an NICU on the incidence of healthcare-associated (HA)-MRSA transmission.

      Aim

      To assess the efficacy of pre-emptive contact precautions for outborn neonates implemented in an NICU.

      Methods

      A before-and-after intervention study was conducted in the NICU of Kobe University Hospital. Pre-emptive contact precautions for outborn neonates were introduced in September 2008. The period before the introduction of pre-emptive contact precautions (January 2007–August 2008) was compared with the period after the introduction of pre-emptive contact precautions (September 2008–December 2010). Data for all admitted neonates, neonates who stayed in the NICU for more than three days, length of NICU stay, incidence of MRSA-positive outborn neonates on admission, hand hygiene compliance and incidence of HA-MRSA transmission were compared between the two periods.

      Findings

      There were no significant differences in the percentage of outborn patients admitted to the NICU, percentage of patients who stayed in the NICU for more than three days, length of NICU stay, and incidence of MRSA-positive outborn patients at NICU admission between the groups enrolled before and after the introduction of pre-emptive contact precautions. However, hand hygiene compliance increased, and the incidence of HA-MRSA transmission reduced significantly from 3.5/1000 to 1.3/1000 patient-days after the introduction of pre-emptive contact precautions (P < 0.0001).

      Conclusion

      Pre-emptive contact precautions for outborn neonates were effective in reducing the incidence of HA-MRSA transmission in a Japanese NICU.

      Keywords

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      References

        • Stoll B.J.
        • Hansen N.I.
        • Adams-Chapman I.
        • et al.
        Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.
        JAMA. 2004; 292: 2357-2365
        • Kusuda S.
        • Fujimura M.
        • Sakuma I.
        • et al.
        Morbidity and mortality of infants with very low birth weight in Japan: center variation.
        Pediatrics. 2006; 118: e1130-e1138
        • Morioka I.
        • Morikawa S.
        • Miwa A.
        • et al.
        Culture-proven neonatal sepsis in Japanese neonatal care units in 2006–2008.
        Neonatology. 2012; 102: 75-80
        • Mulligan M.E.
        • Murray-Leisure K.A.
        • Ribner B.S.
        • et al.
        Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management.
        Am J Med. 1993; 94: 313-328
        • Matsushima A.
        • Tasaki O.
        • Tomono K.
        • et al.
        Pre-emptive contact precautions for intubated patients reduced healthcare-associated meticillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.
        J Hosp Infect. 2011; 78: 97-101
        • Baltimore R.S.
        Neonatal nosocomial infections.
        Semin Perinatol. 1998; 22: 25-32
        • Song X.
        • Cheung S.
        • Klontz K.
        • Short B.
        • Campos J.
        • Singh N.
        A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit.
        Am J Infect Control. 2010; 38: 607-611
        • Siegel J.D.
        • Rhinehart E.
        • Jackson M.
        • Chiarello L.
        Management of multidrug-resistant organisms in health care settings, 2006.
        Am J Infect Control. 2007; 35: S165-S193
        • Safdar N.
        • Marx J.
        • Meyer N.A.
        • Maki D.G.
        Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit.
        Am J Infect Control. 2006; 34: 476-483
        • Lecornet E.
        • Robert J.
        • Jacqueminet S.
        • et al.
        Preemptive isolation to prevent methicillin-resistant Staphylococcus aureus cross-transmission in diabetic foot.
        Diabetes Care. 2007; 30: 2341-2342
        • Reusch M.
        • Ghosh P.
        • Ham C.
        • Klotchko A.
        • Singapuri S.
        • Everett G.
        Prevalence of MRSA colonization in peripartum mothers and their newborn infants.
        Scand J Infect Dis. 2008; 40: 667-671
        • Yap F.H.
        • Gomersall C.D.
        • Fung K.S.
        • et al.
        Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome.
        Clin Infect Dis. 2004; 39: 511-516