Joy Cleghorn – Infection Prevention and Control Risk Manager Life Healthcare, Chairperson for the Infection Control Association of Southern Africa.
Juno Thomas – Clinical Microbiologist and Infectious Diseases Specialist, Consultant to Life Healthcare.
MRSA in a NICU
The setting is a hospital with an extremely low incidence of Methicillin Resistant Staphylococcus aureus (MRSA). Notably, there had been no MRSA cases identified in the neonatal intensive care unit (NICU) for eight months. The NICU has six open bays and two private (isolation) rooms.
During the first two weeks of July, all bays and private rooms were occupied. MRSA was identified simultaneously in two patients, from endotracheal aspirate and blood samples respectively. Both neonates had been in the NICU since birth, and were hospitalised for over a week. In both cases, the isolates were deemed to signify invasive disease and warranted antibiotic therapy.
During subsequent investigation, all other patients and nursing staff were screened for MRSA colonisation. One staff member and one patient were noted to be MRSA-positive. The staff member reported chronic intermittent eczema and had a few healing skin lesions on her forearms. The patient had no clinical evidence of infection, and was judged to be colonised. No other likely common exposure/source of MRSA transmission was identified.
Question 1: Is screening of patients and healthcare workers indicated in this scenario?
Question 2 - How should screening for MRSA colonisation be performed?
Question 3 - What is the recommended decolonisation therapy regimen for MRSA-colonised persons?
Question 4 - What infection prevention and control practices should be instituted with regards managing the NICU patients with MRSA?
Question 5 - How do you determine whether a healthcare worker is the source of MRSA transmission in an outbreak?
Question 6 - What is the management of healthcare workers colonised with MRSA?
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