Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel
Name
Slow_NICU_MRSA_Outbreak_Revision_FINAL_accepted_4.22.22_submitted_6.17.22.pdf
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Accepted version
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357.64 KB
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Name
Supplementary_Slow_NICU_MRSA_Outbreak_Revised_FINAL_accepted_4.22.22_submitted_6.17.22.pdf
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1000.98 KB
Format
Adobe PDF
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Author(s)
Quan, Kathleen A
Sater, Mohamad RA
Uy, Cherry
Clifton-Koeppel, Robin
Dickey, Linda L
Wilson, William
Patton, Pat
Chang, Wayne
Samuelson, Pamela
Lagoudas, Georgia K
Date Issued
2022
Journal
Infection Control and Hospital Epidemiology
Publisher
Cambridge University Press (CUP)
Citation
Quan, Kathleen A, Sater, Mohamad RA, Uy, Cherry, Clifton-Koeppel, Robin, Dickey, Linda L et al. 2022. "Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel." Infection Control and Hospital Epidemiology.
Version
Author's final manuscript
Abstract
Abstract
Objective:
To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Design:
Prospective observational study.
Setting:
Neonatal intensive care unit (NICU).
Methods:
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
Results:
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
Conclusions:
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
MIT Department
Massachusetts Institute of Technology. Department of Biological Engineering
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Creative Commons Attribution-Noncommercial-Share Alike
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DOI of Published Version
https://doi.org/10.1017/ICE.2022.133
