Active Surveillance Cultures and Decolonization to Reduce Staphylococcus aureus Infections in the Neonatal Intensive Care Unit

• Published in: Infection control and hospital epidemiology 2016-04, Vol.37 (4), p.381-387
• Main Authors: Popoola, Victor O., Colantuoni, Elizabeth, Suwantarat, Nuntra, Pierce, Rebecca, Carroll, Karen C., Aucott, Susan W., Milstone, Aaron M.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Birth weight; Cross Infection - epidemiology; Cross Infection - prevention & control; Decolonization; Disease control; Female; Health care; Humans; Incidence; Infant, Newborn; Infection Control - methods; Intensive care; Intensive Care Units, Neonatal; Laboratories; Male; Maryland; Meningitis; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Mortality; Mupirocin - therapeutic use; Neonates; Newborn babies; Nursing; Original Articles; Patients; Phlebitis; Pneumonia; Prevention; Regression Analysis; Retrospective Studies; Staphylococcal Infections - epidemiology; Staphylococcal Infections - prevention & control; Staphylococcus infections; Surveillance; Tertiary Healthcare
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2015.316

Staphylococcus aureus is a common cause of healthcare-associated infections in neonates. To examine the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. We retrospectively identified neonates admitted to a tertiary care neonatal intensive care unit (NICU) from April 1, 2011, through September 30, 2014. We compared rates of MSSA-positive cultures and infections before and after implementation of an active surveillance culture and decolonization intervention for MSSA-colonized neonates. We used 2 measurements to identify the primary outcome, NICU-attributable MSSA: (1) any culture sent during routine clinical care that grew MSSA and (2) any culture that grew MSSA and met criteria of the National Healthcare Safety Network's healthcare-associated infection surveillance definitions. S. aureus isolates were tested for mupirocin susceptibility. We estimated incidence rate ratios using interrupted time-series models. Before and after the intervention, 1,523 neonates (29,220 patient-days) and 1,195 neonates (22,045 patient-days) were admitted to the NICU, respectively. There was an immediate reduction in the mean quarterly incidence rate of NICU-attributable MSSA-positive clinical cultures of 64% (incidence rate ratio, 0.36 [95% CI, 0.19-0.70]) after implementation of the intervention, and MSSA-positive culture rates continued to decrease by 21% per quarter (incidence rate ratio, 0.79 [95% CI, 0.74-0.84]). MSSA infections also decreased by 73% immediately following the intervention implementation (incidence rate ratio, 0.27 [95% CI, 0.10-0.79]). No mupirocin resistance was detected. Active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.